CLINICAL VIGNETTES

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I'm just going to give you some very brief anecdotes of what you might witness in our office.  A patient whose history I have taken and whose complaints I have listened to for the first time, is put on the couch.  I say to him, "I want you to breathe this way: Take a long full breath in and just let go, and just keep breathing that way."  So he lies on the couch and starts to breathe.  He does this for maybe five minutes.  Then he suddenly starts to laugh and he tries to stop his laughter, and he starts to laugh even more, and he says, "What the hell am I laughing at?"  And as soon as he asks the question he bursts out laughing even more, and the whole rest of the hour is consumed with him laughing, trying to stop the laughter, bursting into laughter again, and then stopping it.  At the end, he says, "What the hell was that?  But I'll tell you, I feel better."

The second patient is a woman in a brief psychotic episode.  She has been referred by one of our trainees in orgonomy who is a psychiatric resident in a local hospital.  He has referred her to me because he knows that she is too much for him to handle.

Her story is that her husband was a physician who left suddenly with his secretary and all their money and left her with two children.  She quickly went into a psychotic episode for the first time in her life.  Interestingly, her twin sister has been psychotic all of her life.

She comes into my office, and she is very clearly disoriented and she keeps asking me, "Are you Dr. X?", that is, the doctor who referred her.  I say, "No, I am Dr. Herskowitz."  Every five minutes, she says, "Are you Dr. X?", and I say, "No, I am Dr. Herskowitz."  Then she says, "Are you going to hurt me, or do something bad to me?"  I reassure her, "No, I am not going to hurt you or do anything bad to you."  Then she asks, "Can I look into your mouth?", and I reply, "OK."  I open my mouth and she examines my mouth.  Then when she is reassured that I am not going to swallow her, we begin to work (she is lying supine on the couch).

I tell her to follow the flashlight and I move the flashlight in random movements in front of her eyes.  At first she has difficulty following the light, but eventually she follows it.  I tell her, "There are four objects: one object is this wall, that wall, that wall, and that wall behind you.  Without moving your head, just move your eyes and try to see each of those objects.  After she tried to do that exercise, I say, " Now just make your eyes soft and look into my eyes."  She does, and we do those three things: following the light, looking at objects in the room, and looking at me.  And at the end of the hour, she takes my hand and says that was good.