Imprinting

“Dr. Waldt this is Connie Bassett calling from Compassion ED. I don’t know if you remember me; we met at last year’s Summit Psychiatric Convention. I’m the psych house-doc at Compassion.”

     “Yes, Connie, I do remember you. Please call me Thomas. What can I do for you so bright and early this Sunday morning?”

     “We’re admitting one of your patients to the hospital. Anne Sandberg. She signed a two-way release. I’d like to talk to you about her,” Bassett says.

     “Anne? Oh yes, I remember Anne. But I would’t consider her a patient. I consulted with her only once, and that was several months ago.”

     “She’s asking for you. That’s why I figured you were treating her.”

     “What’s happened?” Waldt asks.

     “It’s not exactly clear. Doesn’t appear to be a suicide attempt though.” 

     “Thank God for that, at least.”

     “Yes, but we don’t know yet what’s all going on with her. She’s disoriented and seems to be suffering some sort of memory lapse for the last day or two. Plus she has a mild concussion. So she’s not much help. What she does tell us makes no sense.”

     “Certainly, I will tell you what I know about Anne. Is she stable? Will she be alright?” Waldt asks.

     “Actually, yes, she is physically stable.” Here Bassett changed her collegial tone to one of a dispassionate report. “Anne took a fall which caused a mild concussion and thirty stitches running up the back of her head. Despite substantial blood loss, she has stabilized. But her confusion and amnesia do not appear to be caused by her head trauma. It seems more likely the cause is a cocktail of unknown, mostly illicit, drugs,” Bassett says.

     “As far as I know Anne is not a drug user. But if any of the drugs in her system are psychedelics, I think I might have an idea of what happened. When I saw her, she expressed an interest in experimenting with psychedelics as a way to treat, what may have been dysthymia.”

     “You hit the nail on the head with psychedelics,” Bassett says. “So far her lab work points to MDMA, ketamine and metabolites of PMA.”

      “No Fentanyl?” Dr. Waldt asks. 

     “We can’t say for sure. But I don’t think so. She’d be in even worse shape if she’s also taken Fentanyl. According to forensics this is a different combination than has been showing up in the ED these last few weeks. She’s being admitted to the psych unit. Hopefully, she will clear up and be able to tell us more about what happened.”

     “Apparently there is a therapist in town who is administering psychedelics. Anna was considering working with her.”

      “That fits with what we know so far. Apparently Anna’s sister contacted MPD and asked them to make a safety check on Anna. The police found her injured and unconscious. She’d left a note saying that she participated in—and here you can’t see me, so I’ll just tell you, that I have both hands in the air, and am making finger air-quotes . . . . ’a Guided Therapeutic Journey.’”

     “Oh my. I’m so sorry to hear this, Waldt says. “I advised her not to take psychedelics. You see Anna is adopted. When I met with her she had not yet looked into her family history. There was no way to know if she might have schizophrenia, bipolar or some other sort of psychosis in her family tree. Plus having only met with her the one time I did not have a sense if her personal history included any psychotic episodes or tendencies. She did strike me as creative. Her associations, although not loose, certainly were, at times, outside the box. She struck me as a creative person who was not living a creative life. Under the circumstances I reasoned she might be at risk if she took psychedelics.” 

     “It might have turned out alright if she’d been given a micro dose of just one psychedelic, but this looks like a cluster-fuck dose, if you don’t mind me saying,” Bassett says. 

    “I hope when these drugs clear out of her system, her brain will rebound. She seems to be a lovely person,” Waldt says. 

     “She’s not just a lovely person, Thomas. For a decade she has been a high functioning physician in our community. She has a very good reputation in this hospital.”

     “Yes, as I recall she is an OBGYN,” Waldt says. “You mentioned Anna asked to see me?”

     “Yes, she’s loquacious—sometimes talking a mile a minute. Only most of what she says is not making sense. But in-between sunflowers and painters, she keeps saying, ‘I have to tell Dr. Waldt. I have to tell Dr. Waldt.’”

     “Certainly I will come to see her.”

     “Give us a couple of hours to get her transferred and settled in. Meanwhile MPD is trying to locate the sister and therapist. Both were apparently present when Anna was given the drugs.” 

     “Connie, thank you so much for contacting me. I look forward to our collaboration in Anna’s behalf.”

     “Dr. Waldt, I have one more question,” Bassestt says. “If I could take a moment more of your time. I’d like to tap into your insight. The therapist who did this is a legitimate, licensed therapist. She works in an established clinic. What would make someone like that go moonlighting, break the rules, break the law and endanger her patient? Money. I suppose. No insurance would cover this, so it must be straight up money, right?”

     Waldt is quiet for a moment and then responds, “No there might be more to it than money. The effects of these drugs includes spikes in oxytocin and other attachment hormones. I assume the therapist in question has taken the drug herself and experienced the expansive high of both giving and receiving unconditional love. Being on the receiving end of infantile attachment is undoubtedly gratifying.”

     “So the therapist is getting off on having patients who adore her.”

     “Well yes. . . . but this is likely on an unconscious level. So although the therapist is not herself taking the drug, she is on the receiving end of the patient’s unconditional attachment,” Waldt says.

     “Yes, I had not thought of that. Just by the function of being present while Anne’s brain is being flooded with oxytocin, the therapist becomes the object of attachment.”

     “In psychiatry we naturally focus more often on the imprinted—those poor souls who are destined to have their dependency needs met by following. It might be another person, they follow—like a spouse, parent or cult leader. Or they might become attached to an identity. For example some people are bonded with the victim stance, or sick person role. They become their sickness. At any rate we know much more about the dynamics of the person who is following. We can understand and empathize with how the act of following creates feelings of being loved and cared for. We know much less about the dynamics of the person being followed,” Waldt says.

     “I think I should not ask this next question, because I do not think I will like the answer.”

     “Now I’m curious to hear your question,” Waldt says    

     “How does it come to be that we know so much about the dependent follower and so little about the one who is followed?”

     Waldt is quiet for a moment before answering. “That’s a good question and I think you already know the answer.” 

     “Yes, it’s because we are the ones being followed,” she says.

     “Exactly, and we are not always so good at knowing ourselves.”