MENTAL ILLNESS IN HIGH PLACES

Victor Bloom MD

In the short space of a week I have seen three in-depth interviews of Sol Wachtler, the former chief justice of the New York State Supreme Court. He was on "20/20", "Dateline" and the "Larry King Show". All this must be PR in advance of his book, based on his journal kept while in Federal prison for 15 months. The proceeds of the book will go toward legal aid for the poor, as he must not profit from his crime. Before his arrest, he was highly esteemed for his legal writings and decisions and was considered a strong candidate to run for governer of New York.

What is amazing about his story is that he is now mentally intact,panerai replica watches intelligent and articulate, as he must have been as a supreme court judge. He is telling the story of how he was under surveillance by the F.B.I. and was arrested while making yet another threatening phone call to his former lover, Joy Silverman, a much younger woman to whom he had taken a shine. Now he relates that he was involved with her when he was manic and the trustee of her estate. He broke off the relationship when he became depressed. When he became psychotically depressed, he assumed a different name and made threatening phone calls and letters, which harrassed Ms Silverman and her daughter, and in the process included lewd and obscene messages. All this while still functioning as a supreme court judge!

In her anxiety, and suspecting it was him, she notified the head of the F.B.I. She was able to do this as she was a heavy contributor to the Republican party campaign fund. The New Yorker Magazine subsequently detailed story of the F.B.I. surveillance of him in a top-priority case in which 80 agents were involved with high-tech equipment. It was not long before they arrested him not far from his own home on a freeway where he was making one of his calls. They simply handcuffed him and cut off the phone, securing his fingerprints for an air-tight prosecution case. He pled 'nolo contendre' and accepted a 15 month jail sentence in plea bargaining. This decision pre-empted a lengthy, public court trial in which he would have had to plead insanity or 'diminished capacity', which he obviously did not want to do.

Larry King asked Wachtler why he didn't seek psychiatric help, and he responded that he didn't want to have that "taint" on his political career. The stigma is such that he could not have been elected governer. Now he has the taint of a prison record as well as public knowledge of his underlying sociopathic personality and his loss of judgment. When asked if he was cured, he responded, "no", as he now realizes he requires both medication and psychotherapy to control his emotions and behavior. He is grateful for the ongoing support of his family and friends, without which he could not have made such an apparently complete recovery of his emotional balance.

His illness is bipolar disorder, which used to be called, manic-depression, and he is a classic case in that while in the manic or 'high' phase, there is super-normal activity, with a high degree of self-confidence, energy and creative intellectual functioning. It is possible for very clever and intelligent individuals to have a split personality, like Dr. Jeckyll and Mr. Hyde. Such individuals are capable of impressive accomplishments, but when the mania leads to grandiosity, heightened sexuality and psychosis (loss of contact with reality) and associated loss of judgment, individuals may go on disastrous spending sprees or sexual exploits which may ruin a person's life. In fact, they often feel so good that they resist medication, as that would bring them down to earth, which for them, is quite an undesirable come-down. One famous psychiatrist who has struggled with bipolar disorder admitted that being hypomanic was better than cocaine.

That is one of the reasons that people with manic-depressive disorder usually require psychotherapy and a good rapport with an experienced psychiatrist. The therapist must work with the resistance to treatment which is common; in other words, the person wants to be ill because the illness is associated with wonderful feelings. In spite of repeated experience that mania often leads to psychosis, these individuals tempt fate and take (unnecessary) risks. Once they feel better they want to stop treatment, but that is a prescription for failure.

More and more we see that manic-depressive disease is unrecognized and untreated. Psychiatry is getting better and better at diagnosis and treatment. Individuals with a strong family history are at greatest risk and many, like Sol Wachtler, try self-medication with 'uppers' and alcohol to their detriment.

We must try to overcome the stigma against psychiatric treatment and realize that lack of treatment may be courting disaster. Better to be safe than sorry.

Dr. Bloom is Clinical Associate Professor of Psychiatry, Wayne State University School of Medicine. He is a Life Fellow of the American Psychiatric Association and a member of the American Academy of Psychoanalysis. Email address- hyperlink. URL- victorbloom.com