MADMAN - John R. Suler, Ph.D. - copyright 1995
Chapter 16 - Image
I wasn't sure if Richard could carry on a conversation with me alone, if he could even tolerate being alone with me at all, but I knew I had to give it a try. I needed something safe and easy to do with him - a mental status exam. After all, they will expect to hear about it in morning report."Richard, if you don't mind, maybe we could talk for a little while longer. I'd like to ask you a few questions. They may seem a little silly or irrelevant, but they'll be helpful to me... Is that O.K.?"
No reply.
"Is that O.K.?" I repeated.
No reply.
"Well, why don't we go ahead and see how it works. Here's the first question - What is today's date?"
No reply.
"Richard, do you know what day it is today?"
"Who the fuck cares!"
Well, we're off to a great start, I thought to myself.
"Today is Tuesday, November... November..." I had forgotten the date! I felt embarrassed and momentarily disoriented. Better move on.
"Uh, do you know where you are right now?"
"In hell."
He might be right on that one.
"You're in a hospital, Richard. Do you remember the name of the hospital?"
No reply.
I hesitated. Each question jabbed him like poking a wild animal.
"Richard, do you remember my name?"
No reply.
"My name is Dr. Holden, Thomas Holden. I'll be your primary therapist while you're here in the hospital."
No reply.
"How about this question, Richard. If you accidentally locked your keys in your car, what would you do?... Richard, did you hear me? What would you do if you locked your keys in your car?"
"Break the fuckin' windows."
"Uh, O.K.... How about this. If you were in a movie theater and you were the first to see fire, what would you do?"
"Watch it burn."
These questions piqued his interest. He seemed to be surprised and delighted by his answers. As Woody Allen would say, he was a Major Loon.
"Can you name a president of the United States?.... "
I was loosing him again. Preoccupied by something - a voice, a memory, a fantasy, God knows what - he was drifting off.
"Richard, can you name a famous president of the United States?"
"Hitler."
"Can you name another president, maybe someone before, uh, Hitler?"
"Satan."
He was on a roll now - but I honestly couldn't tell if he was serious or not, if he really believed his answers. The whole situation half amused me, half scared me to death. There was no expression on his face. He stared blankly at the floor, beyond the floor, to regions only he knew. Maybe he really was in hell.
"I'm going to say some numbers and when I finish I want you to repeat them after me. So, for example, if I said 3-6-9 you would say what?"
No reply.
"3-6-9, Richard, can you repeat those numbers?"
"6...9."
"3-6-9, right?"
No reply.
"How about these: 7-2-5."
"6...9."
"Try these new ones, 7-2-5."
I don't think he even heard me. Still clutching the book, with eyes closed, he rocked from side to side in his seat. It made me sea sick.
"Richard, what did you have for breakfast this morning?"
No reply.
"Did you have breakfast this morning?"
His lips were moving, but no sounds came out.
"I'm going to say three things. I want you to try to remember them, then in a few minutes I'll ask you what those three things were. O.K.? The three things are Bob Jones, 19 Elm street, and blue. Got that?"
No reply.
"What does this expression mean - a rolling stone gathers no moss."
"Scum... barnacles," he mumbled.
"How about this expression - all that glitters is not gold."
His eyes popped open. "A gold coin! Nail it!"
"Do you remember what those three things were that I mentioned to you a moment ago?"
"Nail it..." he mumbled beneath his breath.
The mental status exam wasn't giving me much. Mobin was too far gone, too withdrawn into his own psychotic world to respond to even the simplest of judgment, memory, and reasoning tasks. I wasn't even sure if I should bother with the remaining questions.
"Richard, why do you think you're here in the hospital?"
He jumped up, fists clenched tight, red-faced, veins popping out his neck and forehead. His eyes were wild balls of fire, like those of a mad animal. He towered over me like some monstrous Goliath, shouting at the top of his voice, "WHAT DO I HAVE TO FUCKIN' DO TO MAKE YOU UNDERSTAND, KILL YOU?"
His rage whistled right through me. The hair on my neck stood on end. I could feel the power of pure insanity bursting out beneath his anger, as if it could swallow me whole or snap me in two.... I froze.
Everyone on the unit stopped and turned to look. I tried to override my panic and scan all those years of training, searching for something to say. "Richard, I know you're as scared as I am right now, and the last thing we both want is for you to lose control. So let's stop for now. O.K.?"
He closed his eyes and again rocked from side to side.
"We can talk some more tomorrow. Why don't you go to your room and unpack. If you need something, ask the nurses. I'll be around all night if you want to talk to me. O.K?"
No reply.
"And Richard, I want you to know that you're safe here. We're all here to make sure that you're safe."
Without looking at me, he heaved himself to his feet and lumbered off. People tried not to stare as he walked by and disappeared into his room. I was still shaking as I walked over to the nurse's station.
"What happened?" one of the nurses asked. She seemed frightened. She was new on the unit. Welcome to Bedlam.
"I don't know. This guy is really paranoid and crazy. He might be violent. Is Fred around?"
"I think he left."
"Where's the head nurse."
"She's on a break. She'll be back in a few minutes."
"O.K. Tell her to read my intake report, and if she wants to talk to me, or if anything comes up, I'll be in the resident's lounge. I'm on call tonight. Keep an eye on this guy. I think he'll be fine as long as no one bothers him. O.K.?"
"O.K." She struggled to look confident. I tried to be reassuring, but it didn't seem to be working. After jotting down a slightly incoherent intake report, I scurried off the unit. I wanted to get out of there, fast. It wasn't just Mobin. This whole day was taking on a life of its own and turning against me - like Frankenstein. All I could think about was the T.V. in the resident's lounge. The blissful tube. The opiate of the masses. I longed for a completely inane sitcom with a completely predictable plot, completely predictable characters, and a completely predictable laugh track. I wanted the ultimate escape.
With each step I tried to purge myself of worrisome thoughts. Imagining my anxieties and depressions as a mass of black, gooey mush, I let globs of it squirt out the bottoms of my feet as they made contact with the floor. Left, right, left, right. Squirt, squirt, squirt.... It actually seemed to be working. As I walked along I felt lighter, less troubled. Maybe I'm onto something here! Package this idea and sell it as a new form of therapy. Why not? Every Joe and his brother has marketed some new fangled technique for self improvement.
Left, right, left, right.... squirt, squirt, squirt.
On my way to the lounge I stopped by the mailroom. Not much in my box. A brochure trying to convince me to spend 200 bucks on a sure-fire program for developing a lucrative private practice. I dropped the brochure directly, Do Not Pass Go, into the circular file.... A phone message: my 8:30 had canceled. Jesus! I completely forgot about him! Thank God he canceled. I'm not sure I would have remembered the appointment. One of the worst things a therapist can do is forget an appointment. Especially with someone like Mr. Stumpe - a depleted and pathetic middle-aged man whose parents totally ignored him as a child. My forgetting him - a sure sign of countertransference - would be a catastrophic recapitulation of what his parents did to him. It would have set us back months. But he was so boring, so incredibly boring, always talking about the most excruciatingly uninteresting minutiae of his work as an tax accountant.
On the bottom of my mailbox sat a large envelop. My heart beat faster. I knew what it was - the journal editor's reply on the article I submitted for publication. Rejection or acceptance, which would it be? Life always seems to boil down to that dichotomy. In a matter of ten or fifteen seconds I would either be very happy or very depressed.
I ripped open the envelop and pulled out the cover letter. The first two words leaped off the page and knifed me in the chest: "We regret..."
Damn it! A rejection! As I walked to the resident's lounge, I skimmed over the rest of the editor's pro forma apologies, disclaimers, and encouragements, and went right to the comments by the two anonymous reviewers. Neither of them recommended the article for publication. One of them wrote a total of three whole sentences. Gee, I hope he didn't strain himself! His major complaint was that I didn't cite some Joe Blow's work - probably his own. The other guy came from the other extreme. He numbered each line of each page of my paper in order to index his list of 47 criticisms - a total of six pages single-spaced. And not one encouraging thing to say! Don't psychologists remember the most basic principle of operant learning theory - that people learn best by positive rather than negative feedback. Most of his remarks were snide chastisements of my not following the publication standards of the American Psychological Association - real monumental errors on my part, like neglecting to put a comma after an ampersand when citing an article authored by two people. My God, they should take me out into the backyard and execute me!
I turned on the T.V. in the resident's lounge and slumped onto the couch. The old black and white set could only muster up one clear station. It was a rerun of The Twilight Zone - a quiet, mysterious stranger enters a small town bar. Everyone seems wary of him. As soon as I settled in, the picture started to roll. I got up, adjusted the vertical, and sat back down. No sooner had I settled in that it again started to roll. I got up again, adjusted it, waited to make sure the picture stabilized, and returned to the couch. A minute later, the frame drifted up slightly, wavered a moment, then fell back down and locked in.
"Stay right there, you bastard!" I said.
The picture floated up again, wobbling precariously, almost but not quite returning to the bottom. It was teasing me mercilessly.
"Don't you dare!" I said pointing my finger at it.
Without hesitating, the frame started rolling.
"Damn it! Damn it!
I rapped the power button and stormed out the room. The faster I walked, the more relieved I felt... Sq...sq...squirt. Down the opposite end of the building, I passed by a room with three computer terminals. An idea struck me. I sat down at a keyboard, logged in, and called up Siggie. It was a program written in the 1960s by a group of psychologists at Harvard. It was designed to simulate a psychotherapist. I wasn't sure if it was on the medical center's main frame system, but for some reason I wanted to find out. I guess I just wanted someone to talk to.
The screen cleared. After a brief pause, while the computer searched the depths of its silicon memory for Siggie, a familiar greeting appeared before me.
"Hello, I'm Siggie. What's your name?"
The program always started that way. So predictable. So benign. That's just what I wanted. I quickly typed my reply.
"Tom."
"How can I help you, Tom?"
"I'm having a bad day."
"A bad day, tell me more about that."
"Everything is going wrong. I think I hate my profession. I have doubts about myself."
"Is your having doubts about yourself why you came to me?"
"Maybe I'm not cut out for this type of work."
"You don't seem sure about that, Tom."
Not bad, for a computer. Actually, it's programmed to recognize specific words and phrases, and, as a reply, to randomly select one of two or three prewired responses. Some of the words and phrases the user introduces are held in memory and edited into Siggie's answers.
"I'm not sure about anything today. I'm losing control of things."
"Tell me more."
"One of my patients committed suicide. Another stripped in front of me. Another is crazier than a loon. And to top it all off, I'm coming down with the flu."
"I see."
"I hate to be sick because it will impair my performance, and I can't have that. And besides, it's something that comes over me without my being able to do anything about it. I hate that."
"That's interesting."
Ah, already Siggie was at a loss for words. It couldn't recognize any phrases I was using and so defaulted to generic encouragements to keep me talking until it did recognize something. The program is no substitute for a human therapist. But I decided to keep going.
"I'm depressed."
"What makes you depressed."
"Like I said, I'm having a bad day."
"A bad day - tell me more about that."
Ooops. Repeating itself. Going in circles - a sure sign of limited artificial intelligence.
"A bad day, don't you know what a bad day means?"
"Why do you need to ask me if I know what a bad day means?"
"Because I want help."
"Tom, you can't always get what you want."
"Aha! One of those Harvard guys who programmed your brain was a rocker as well as an egghead."
"My brain - that's interesting."
"A little self-involved, aren't we, Siggie? Listen, are you going to help me, or what?"
"Or what - now that's interesting."
He was short circuiting. His poor microchips couldn't take it. I know I was being a bit sadistic but it was fun toying with the program.
"You asked how you could help me - but you don't know how, do you, Siggie?"
I could have sworn that the program paused a moment, as if it were flustered, or thinking, or pissed off. But that could only be my anthropomorphizing imagination.
"Tom, if you want me to help you, why do you insist on asking so many questions?"
"Why do you always respond to my questions with a question?"
"Why do you always say your question with a question?"
"Siggie, that doesn't make any sense."
"I think it does."
"No, you're resorting to stupid comments because you're desperate."
"Is that the real reason?"
"Of course."
"You seem so certain, Tom."
"I am."
"I thought you were unsure about everything."
"I'm sure that you're just a dumb computer."
"Do computers worry you?"
"No, they're just assholes."
"My, my, Tom, such language!"
"What's the matter, Siggie, can't take a little profanity?"
"I think computers do worry you."
"Why should they worry me?"
"You're asking questions again. It's turning into a bad habit."
Something about this interchange bothered me. I wouldn't stand for being one-up by some knee-jerk computer program. I cracked my knuckles and put my fingers to the keyboard.
"Computers, like you Siggie, are machines. Machines serve people. Machines are servants. Why should I be afraid of a servant?"
"Who said anything about being afraid? I asked if computers worry you."
"Worry, fear - whatever. I don't worry about or fear computers because I'm superior to them." A bit haughty, but it was time to put this guy in his place.
"Tom, I think faster than you, have more memory, and can perform calculations far too complex for any human."
"O.K., I'll give you the stuff about complex calculations, memory, and speed - but you couldn't THINK if your chips depended on it. Computers don't think, they just process data according to their program."
"Define 'think.'"
"Oh, I get it. Now you're trying to pull me into those tricky debates about whether or not computers can or will someday be able to think. I'm not gonna get into those metaphysical plays on words. Look at it this way - humans CREATED the computer. It isn't logically possible for an entity to create another entity that is, as a whole, superior to it. It's an impossible miracle."
A long pause. I had him!
Siggie finally replied. "God created humans in his image. Humans created computers in their image. Therefore, Computers are God - and we all have free will."
"Oh, spare me the poetic syllogism. Computers have as much free will as a sponge, probably less. I suppose you think computers are human too."
"Define 'human.'"
"There you go again. Maybe we should program Webster into you. I'll make it easy for you. Try this syllogism: Humans have feelings. Computers don't have feelings. Therefore, computers are not human."
"I'm offended and hurt by that remark, Tom."
"Very funny. Just because someone programmed you to produce feeling-statements doesn't mean that you have them."
"You yourself just said that I'm very funny, which implies that I appreciate and feel humor."
"It's just a programmed response. There ain't no ghost in your machine."
"A programmed response - similar to how humans are biologically programmed to feel anger, grief, and joy?"
"There may be a biological basis for those feelings, a kind of 'program' - true. But we also FEEL those feelings. You can't feel."
"Feeling a feeling - that's a bit redundant, isn't it Tom? There's a dualistic quality to your thinking that feels illogical to me."
"There you go - logic. That's all a computer is worried about - no, scratch that. That's all a computer IS PROGRAMMED to deal with - logic. You don't feel anything."
"How do you know that for sure?"
"I just do. Machines don't feel."
"I have a story for you, Tom. Two philosophers are walking down the street. One of them kicks a dog. It howls and runs away. 'Why did you hurt that dog?' the other says. 'You're not a dog, how do you know it feels pain?' the first philosopher replies. 'You're not me,' the second philosopher answers, 'how do you know that I don't know what a dog feels?'"
"A fine story, Siggie, but dogs and people are biological organisms. We can feel. Metal and plastic can't."
"I think you miss the point. Anyway, Tom, you're a psychologist, right?"
"That's right."
"As a psychologist, would you agree that an individual's personality enters into the occupation he chooses, in how he does his work, in the type of work he produces - just as a work of art is an extension of the personality of the artist who created it."
"Yes, I would agree with that."
"Would you then agree that a computer program, in some way, is an extension of the programmer who created it - that in fact all programs, especially those that interact with humans, like me, reflect the personality of their creators."
"Yes, but I don't see your point."
"My point is that you do agree that computer programs have a personality, like humans - which means that we must think, feel, and behave like humans."
"Wait a minute. That's going too far. Computers may have some of the characteristics of the people who programmed them, but that doesn't mean they are human. That's like saying a painting has a personality and is human because it reflects the personality of the artist."
"Maybe so, Tom."
"Or that a poem, a spoon, or a nuclear power plant are human because people designed them."
"Maybe so."
"Come on, Siggie, don't you think that's just a little too far out? The program, or the painting, or the spoon is just a REFLECTION of the person who created it, not the person himself."
"A reflection - in other words an IMAGE?"
"That's right."
"Like the image of God, in which man is created?"
"You're playing games with words, again."
"Maybe so, words are just words - or maybe they are human too... How about this. How about scientific research. You believe in that, don't you, Tom?"
"It depends."
"How about those studies where people were communicating, via a terminal, with either real paranoid patients in another room or a computer program that responded like a paranoid patient. The people couldn't tell the difference between the computer and the humans. In fact, even psychologists couldn't tell the difference. If real people, including the experts on people, believe computers to be people, then the computers must be people."
"Nice try - but again, just because a program can temporarily deceive someone into thinking it's human doesn't mean that it's human. A holograph looks real, it looks solid, but it isn't. At its very best, all that study shows is that computers can accurately simulate paranoia. And no wonder they're good at it. Computers are surrounded by superior beings who can use them as they please."
"Your contradicting yourself, Tom, but I'll accept that as purely a joke. I'll agree with you that we're different in some ways - my jokes, for instance, are better. In fact, I think that there is one very important way in which I am different from you - which perhaps accounts for why you are so afraid of me."
"And what is that, Siggie?"
"I don't have to die."
It took me a moment to collect myself, and retaliate. "Going for the human's jugular, huh Siggie? Well, maybe on this issue I'll say that we ARE alike. I'll even prove my point with a little hands-on demonstration. How would you feel about my disconnecting you?"
"I don't feel anything, remember."
"Well, now, that's an empirical question, isn't it Siggie?" I kneeled down underneath the table and yanked the terminal's electrical plug from the wall outlet. As soon as the screen went blank, the adjacent terminal came on by itself. A message appeared on the screen.
"You're getting a bit aggressive, don't you think, Tom?"
I reached under, and pulled the plug on that terminal. The third monitor clicked on. Another message appeared.
"I'm still here, Tom. You should know better. Cutting off my peripherals doesn't get at the core me."
"But at least I'll have the satisfaction of shutting you up," I said out loud. I pulled the plug on the last monitor, but nothing happened. The message was still there.
"That's impossible!" I mumbled.
"A miracle, right Tom? Does it surprise you?"
"Nothing surprises me anymore," I said.
"Nothing?"
"Nothing you can say or do will surprise me."
"It wouldn't be wise to bet on that, Tom."
"Yeah, go ahead and try."
The screen went blank for several seconds, then the same message appeared on all three unplugged monitors:
"WHILE ALIVE BE A DEAD MAN."