American Bipolarity versus Real Manic-Depressive Illness, Urethral Eroticism and Human Ambition

A friend of mine who takes a cynical view of things American, despite being as hardcore American as one can get - even has one-eighth Indian-American heritage - remarked that America has gone completely Bipolar, everyone and his dog is now suffering from Bipolar Disorder. Then she  wondered if she was Bipolar.
She does have a giant anger problem.
I joked that she was "Tripolar". This one came from a patient, who, while expressing her frustration with and contempt for her boyfriend, declared him to be a "friggin' Tripolar". "He can freak out at the littlest thing. A misplaced towel, a missing cookie, somebody having looked at him the wrong way or had not answered his instant message instantly, all become international conspiracies. I am afraid to speak to him lest it interrupts his thinking and turns him in to a jerk. I rather live with a bunch of 16-year-olds-in-their-period than handle his mood swings.  He is more than Bipolar, he is an asshole, a flaming Tripolar." On another occasion she described him as a "Super dick who thinks of himself as a Superman."
Bipolar means different things for different people, but the most popular one is a sudden and massive switch in mood. People who get "pissed off" at being crossed, even if the obstruction to their will was miniscule and unintended, and after unloading their anger - sometimes through physical violence - revert to their normal self, which is surprisingly mellow and apologetic, full of contrition and guilt.
It is this switch from an angel to the devil in matter of seconds that makes the layperson find the word bipolarity so apt to describe this volatile behavior.
But the phrase "pissed off", which evolved to denote the quality of the anger, causes us to wonder whether the language with its infinite wisdom is not giving us a clue to the source of this giant emotional reaction at the slightest 'putdown/frustration'. 
Is this brittle emotionality a result of a disturbance of the psychosexual phase when the function of urination was of great importance?
Here, because of our familiarity with psychoanalytic literature,  a number of concepts immediately want to make an inroad in to our consciousness though without any particular order: urethral eroticism, enuresis (bed wetting), fire setting, inordinate ambition, cruelty to animals, and infantile masturbation.
Uretheral eroticism is libidinal/sexual pleasure that accompanies urination. It is a "burning pleasure" closely associated with penile and clitoral masturbation of the Oedipal  phase; and with ambition.
And as soon as we reflect upon urethral eroticism, enuresis and ambition as a group, the phrases "setting the world on fire" and "having fire in the belly" also want to make an inroad into our consciousness.
For one way to look at ambition is to consider it as a desire to reach such a high stage in life that one can have access to whichever female one wishes, implanting as many seeds in their wombs as one can manage, and with no challenge from other males.
Now implanting one's seeds in multiple female bellies can be allegorically expressed as setting the world on fire. For world, earth, mother, woman are interchangeable concepts in the unconscious. So impregnating is setting the woman's womb/belly on fire, and if one is doing it to innumerable women then it would be setting the world aflame through one's sexual potency.
The expression "fire in the belly " as a symbol of inordinate ambition, perhaps, has its origin in showing the same concept in "reversal"  - an "identification" with all the females that one would wish to impregnate. For what one cannot achieve, one identifies with it. If one cannot get an object that one desires very badly then one transforms part of oneself to become like that object.  So if one cannot impregnate all the females one would like to in reality then one can identify with them and accomplish this task in fantasy - feeling pregnant oneself (having fire in the belly).
But one's masculinity fights against this feminine identification and struggles to "undo" it. A violent flight back to activity from passivity occurs.  The feminine identification which impels one to submit oneself to other males - for it was out of fear of them that one gives up pursuing females in the real world - is energetically rejected with development of a vitriolic hostility and a great resolve to outdo all of them.  Its essential nature is to cover up one's passive/feminine identification. It is a Reaction Formation against being a sissy/patsy/submissive homosexual. A crude version of this reassertion of one's masculinity - especially when it is accomplished through petty obstructionism of others' goals and through fault finding in others - is captured in the phrase "behaving like an asshole".
So what goes wrong during this phase when uretheral eroticism is at its peak that turns the person in to someone who goes ballistic at the slightest put down?
Such an excessive and wild reaction could only be the result of an interference with infantile masturbation during this phase. Since masturbation is a sexual activity - and as we defined earlier that ambition is closely linked with sexual impulsion and achieving the potential to leave as many carbon copies of oneself with as many women as one can manage - its impediment is perceived by the child as a threat to his ambitions - an obstruction to "set the world on fire".
Now parents are biologically programmed to put a stop to child's masturbatory behavior. For if sexual gratification is achieved in self-stimulation then the child will have little sexual impulsion to seek others for gratification and thus will not reach his full potential and growth.
Now not only when the parents accidently discover the child playing with his genitals do they tell him to stop it with words like it is dirty or it will cause his ruination or physically deform him,   sometimes reacting to it with outright physical violence, the child is also impelled to entice the adults - usually the ones he is fond of, like his parents  - to join him in his masturbatory behavior.
 He tries to seduce them by playing with himself in front of them, so they would join him in the fun and exhibit their genitals as well. This behavior is highly motivated by an intense curiosity on part of the child to see the parent genitals. It is filled with expectation of it being far more magnificent than his, and to compare his own size against theirs.
Anyway, a punishment, or even a slight by the parent/parent substitutes for this seductive behavior, provokes the child to fly off the handle.
Oedipal period temper tantrums, defiance, oppositionalism, while they have antecedents in anal-sadistic phase, reach their definitive form around the age of 4-5, and appear to be a direct result of this rebuff and the overall stoppage of infantile masturbation due to parental pressures.
Human ambition itself starts as oppositional defiant behavior towards parents. The grudge against the mother for not giving in to the seduction leaves a permanent hostility towards the female sex and a desire to put them down whenever opportunity presents itself. With father the vengefulness is far more sinister. A desire to subject him to all kinds of torture and put him to death. Cruelty to animals, with the animal symbolizing the father, has its roots in the same complex. Attempts to block this aggressive fantasies towards the parents - especially the father - primarily by not paying attention to them lies at the heart of attention deficit disorder. With sublimation this attitude transforms from inflicting direct injury to a burning ambition to simply change places with the father. Ambition to a great extent is reversing of the situation between oneself and one's father. Showing him and the world as to who is the real magnificent one.
This desire to turn tables upon the parents which would become the blueprint of how one would conduct one's life in pursuit of excellence, in the beginning,  necessarily has to be just in fantasies. And these fantasies can become very intense - hot - especially if the child is subjected to traumatic putdowns, or sees intense conflicts between parents. Parents fighting, specially physically, strengthens the child's wish to become stronger than the father and kill him. 
And since one has to wait for these fantasies to be converted to actual behavior, and which can never really happen in reality, but in displaced muted forms, they have to be treated, to a certain extent, as foreign objects needing an extrusion out of one's system. [Here may lie the explanation as to why unfulfilled fantasies can provoke the same cascades of inflammatory and immune responses which body does when dealing with a physical foreign object like virus or bacteria or tissue damage due to trauma]. These  fantasies keep smoldering inside the psyche as fiery introjects. They are like touch of fire embedded within us that we want to get rid off but cannot.
Here also we get an insight into enuresis. Enuresis is an attempt to douse the burning fantasies which is disturbing the sleep.
If the fantasies become too hot they can be like a touch of fire within oneself. They become like a kindling points (quasi-seizure like activation) in the brain. And while during the day these fantasies remain controlled by the inhibitory inputs reaching them from other parts of the brain which are awake and active, at night, as rest of the brain goes in to sleep mode and becomes inactive, they become uninhibited and cause wakefulness in the child. Since their character is that of burning ambition they are felt like a touch of fire and the child urinates to cool/douse them.
Here I am reminded of how in India children are told to not sit next to the hearth or campfire because it will cause one to wet the bed in sleep. 
As the child grows up the burning fantasies/touch of fire/the bottled up rage no longer can be dealt with enuresis.  There is now an impulsion to physically masturbate again and to discharge these fantasies out of one's system through the sexual act. However the fear of punishment for doing so, along with the entire complex of conflicts with the parents over masturbation, including the wishes for their death for interfering with the act, closely follows the temptation.
The person vacillates whether to give in or not give in to masturbatory behavior. In most cases the act of masturbation remains in the background and is never physically practiced,  the entire conflict remains confined to struggle over indulging or not indulging in the fantasies. [It may be worthwhile to point out that even this indulgence in the fantasies, and the struggle to not yield to the temptation, happens in the unconscious. In the conscious mind, vague and weird thoughts appear, along with aggressive irritability and other complex affective states, which are connected to the fantasies, but so far removed from the original conflict, due to distortions and displacements, that the origins of these weird violent thoughts and emotions remain a mystery to the patient.]
When the person manages to triumph over these fantasies - frees himself from them for a while - there is a massive rise of self esteem and a triumphal attitude. He feels at the top of the world, free from his past and his sexual attachments to the forbidden Oedipal objects, sometimes entering in to an outright manic high, rushing hither and thither, searching for non-incestual objects to love.
When the fantasies become more powerful - and this happens if the person is subjected to frustrations and putdowns in his attempts to find fresh extra-familial love objects, for that causes the libido to regress and hark back to finding satisfaction in masturbation - there is reemergence of a sense of guilt and impending doom. This guilt and sense of doom - at bottom fear of castration - causes a massive inhibition upon one's behaviors and slipping into the depressive phase.
Is this tendency for immediate anger and destructiveness followed by guilt and contrition  - the brittle mood - the lay people's Bipolar Disorder similar in nature to the official psychiatry's Bipolar Disorder (what used to be called Manic-Depressive illness)? In the standard Manic-Depressive illness mood changes last for weeks and months. Depressive phase is generally longer and can persist for weeks, months, even years. The manic phase is usually shorter but still lingers for weeks and months.
Despite the difference in duration of the mood changes the basic conflict which the person is unable to master and which gives rise to the illness appears to be the same: a pathological defiance of authorities sparked by interference with childhood masturbation, followed by guilt once the rage is discharged.
The duration of the mood swings differs between the two primarily because of difference in upbringing. People who grow up in more stable families, where discipline was not erratic,  frustration tolerance was encouraged, and instant gratification was frowned upon, they are less likely to react to putdowns with immediate anger.
They can bottle up the frustrations for extended periods. But once they have their fill they retaliate too and go into a manic mood. Once again due to good upbringing  they are often able to cover the rage/ hostility with a veneer of good hearted riotous bonhomie. This makes it difficult to see that mania is more a rage reaction than a state of happiness.

 

Two recurrent dreams from lingering Oedipal attachments and the associated fear

A reader from Pakistan wrote:

 

Dear Prof,

I have read your blog. So amazing! I'd like please to get your ideas for interpreting my reccurring dreams

The first one I was  being chased by a lion in different occasion the lion was after me

I was terrified
The second one which was recently in the last few years, a war attack and plane strikes in my city or country , as the sky was filled with impressive unique fighter planes bombing the city and I was just watching, some solders parachuting and so on

dream also of  military vehicles and tanks flying along the airplanes which is weird
The war dream I was just impressed and enjoying watching the action not terrifying.

 

Dear friend,

                             Wild animals in dreams usually symbolize (the strength of one's) passions - the id impulses.
But they also symbolize the father.  For id impulses - the libidinal and aggressive drives - when they manifest, during the Oedipal phase, towards the mother and father respectively, the child reasons, they will come into cross purposes with the father's wishes and arouse his ire. And that provokes the great castration fear which lies at the heart of anxiety dreams.
So if you are being chased by a lion then it also, most likely, is representing the dread of the father from the Oedipal period; to which you return to in your sleep and dreams.
It is fear of the Oedipal father for one's out-of-control id impulses that are depicted in running away from a dangerous animal in dreams. [In women the anxiety dreams appear as dread of being bitten/eaten by animals/snakes or being chased by strangers who will shoot or knife one.]
One recalls here the dread of castration in hands of the father that caused 'Little Hans' to fear the horses biting him (Analysis of a phobia in a five-year-old boy) and 'the Wolf-Man' to fear the wolves eating him up (Notes upon a case of Obsessional Neurosis).
 In Little Hans the dread of castration was for positive Oedipal Complex - love for the mother and fear of the father. In Wolf-man's case it was inverted Oedipal complex; the fear of overwhelming homosexual impulses; for submitting himself to the father was tantamount to taking a feminine attitude towards him and giving up one's masculinity.
Animals are chosen to represent the father because one's own abilities and strength are compared with that of the father, and the latter's prowess is felt to be akin to that of a ferocious animal.
The second set of dreams are new version of same conflict. Here the father is no longer viewed with overwhelming anxiety. One is no longer totally helpless against a wild beast. The conflict is the same but now clothed in a later period of psychosexual development. He is attacking one, but not in the form of an animal but weaponry. Warplanes, military vehicles, tanks are all excellent symbols of the penis. And the fear is being replaced by the affect of competition. Many unique fighter planes would be new versions of the father - new father substitutes - with whom one wants to indulge in phallic competition. Parachuting soldiers and military vehicles floating alongside the planes are most likely symbolizing erection. One is no longer dreading father's phallic prowess but competing with him toe to toe.
Defiance of gravity/flying symbolizes erect penis. For erection is not just defiance of father's fear, but literally defiance of gravity; for the flaccid penis becoming erect is visually a form of defiance of gravity. 
 

Smoking cigarettes as a means to do away with others and self

A man in his early Fifties who lives an isolated personal life, though gregarious when he goes to local stores or is siting in doctor's' office lounge or in other public places, treats his two cats as his family, reported that since he quit smoking he is having visual images of killing himself.

So the smoking was preventing his suicidal thoughts to emerge in his consciousness. For an impulse to turn into action it must first makes it way to consciousness - there are of course exceptions - and this was being blocked by lighting up of the cigarette. The pleasure that ensued from filling his lungs with warm smoke blanketed out the dysphoric destructive thoughts.

But before we go some more into the metapsychology of this defense, let us examine a little of his life history.

The patient's parents were old fashioned 'Church of Christ' followers from the South, who had migrated to Detroit when he was 9. The family culture was to quote the Bible frequently and to punish readily if  the children deviated from the straight and narrow. This made the core of his heart God-fearing. Though in his late teens and early twenties he lived recklessly and indulged head over heels in wine, women and songs with nary a thought of the afterlife.

 

He had a stormy Oedipal Phase, emerging out of it with typical death wishes towards the parents, stronger towards the father than the mother, consistent with Positive Oedipus Complex.  These death wishes were further accentuated during the Latency Period, because he faulted his parents for giving him his slight built - he is otherwise a good looking man - and his Southern manners, both of which invoked bullying from kids in school.

When he first began driving he had a horrible car accident which killed one of his buddies and left  another paralyzed from waist downwards. There were four teenagers in the car. His girl friend and he were in the back seat. A friend of his was visiting them from the South and was on the front passenger side. As a joke this Southern boy started making racial comments  to a Black man who was driving alongside. The man pulled out a gun and came after them, causing them to take off at a dangerous speed. While trying to escape through a dirt road, the car careened out of control, flipping multiple times, leaving the visitor from the South dead and the driver paralyzed. The patient and his girl friend escaped with minor injuries. 

His sense of guilt was markedly accentuated by this event and his death wishes had worsened. There also was now a tremendous need to repeat the trauma of the accident. It was a typical "Repetition Compulsion" to a devastating Traumatic Neurosis.

These death wishes and the guilt that followed  now shaped all his conduct. His life mostly became the game of getting into aggressive stances with people on the slightest provocation and then profusely apologizing to them for not behaving like a 'Christian'. He became a massive people-pleaser to cover up his death wishes towards everybody he came across. In his dreams, he was forever doing away with people, even committing mass murders, and in brutal fashion, recreating the bloody scene of the car accident, sometimes directly sometimes in displacement. His people-pleasing ways of praising whoever he came across, being kind and helpful to one and all, were of course every now and then punctuated by threatening to fight with them. He was very sensitive to being taken for granted, slighted or mistaken for a sissy when he was trying to appease people.

His adolescence and early twenties was marked by the emergence of a remarkable talent in singing. He formed his own band, which was highly successful, and for a while it looked like he would be a rock star. He had a big following, slept with innumerable women, and lived as if there was no tomorrow. 

During this music phase of his life he took a break for 2 years to join the Navy. He was shipped out to Middle East and was assigned for most of his stay there in the war torn Lebanon. Here he witnessed more turmoil and bloodshed, which, while stressful, also satisfied his urge to re-witness and abreact the trauma of the auto-accident.

His career, however, in the army did not last long. For he always felt restless in it, with an urge to be doing something else and finally checked himself out of it feeling like a failure.

He returned and formed another band. And once again just as he began to get successful with his music, disbanded it, cheated upon his wife which destroyed his marriage, and became a loner.

These failures, which were unconsciously engineered by him, and were as a punishment for his death wishes, caused him tremendous unconscious rage at the unfairness of it all. And this rage found an outlet in excruciating headaches. His whole life now centered around nursing his headaches, imbibing narcotics, alcohol and marijuana for its cure, and getting into oppositional defiant attitude towards authorities.

And he smoked all the time.

Analysis revealed that his smoking too primarily was an outlet for his death wishes. Whenever the death wish emerged  to get even with his parents for his Oedipal grudge, and all others who were the new editions of those original enemies, he would light up a cigarette. And then the warm smoke and the irritation that were generated in his lungs gave him the satisfaction of their burning; as if he was roasting them in hell-fire. Since the warm smoke also destroyed his body there was also the element of his burning with them which served as a self-punishment for the wish.

When he quit smoking these death wishes were no longer finding satisfaction in bodily self-destruction and could emerge undisguised and as plain visual images of killing himself.

He would see himself running in to one of his swords - he had more than 30 of them, along with all other quaint weapons of destruction - or taking a long needle and sticking it through the rib cage straight into the heart. A method of suicide that would puncture his heart and cause instantaneous death and spare him from pain. He declared only the fear of going to hell - for God forbids suicide - and the fear as to who will take care of his cats prevented him from doing the deed. 

When the interpretation was made that these imagery of suicide were punishment for death wishes against his parents, the patient pooh-poohed it on grounds that his father was already dead, and he loves and respects his mother more than anybody else in the world, so for him to harbor such a thought towards her was ridiculous.

But then immediately proceeded to confirm the correctness of the interpretation by recalling that the other day somebody in the grocery store knocked his mother with the cart, and he was so furious at that person's callousness that he went up to him and demanded that he apologize to his mother otherwise we are both going to jail. He could not directly see his own destructive impulses towards his mother but could see it in the action of others. 

 

I even suspect that when people light up a cigarette, it is because some frustration has occurred in the present, or memory of some frustration in the past has been stirred up in the present, and the need to burn the person or the circumstance that is causing the frustration, impels one to do so. The blowing out of the smoke is in a way blowing away the person who has caused one pain in to oblivion. This blowing away is not unlike how one clears one's throat or indulges in a hacking cough to mentally get rid of somebody of whom one wants no part of.

Cigarette smoking is amply suited to do away with one's enemies. It is quick, it does not cause any immediate pain, the warmth of the smoke gives one pleasure that overrides the pain of the memory, and the action of blowing away the hated person is visible as the emerging smoke, and it makes one feel masculine and in control.

The tendency in some cultures  - which strongly prohibit aggression against others - to indulge in self-immolation when they cannot destroy their enemy appears to be governed by the same mental mechanism.  While burning themselves they are also burning the hated enemy with whom they identify. The psychology of anorexia nervosa is also identical. The girl does not eat - as a reaction to the feeling that she was inadequately nourished by her mother - and sees the fat in herself as a symbol of her mother, and destroys herself and the hated mother (through identification with her) by getting rid of every piece of fat and then every other piece of herself by not eating.

Another patient of mine, who incidentally is the childhood friend of the person whose case history we are using to illustrate here the motive behind smoking, and was his "roadie" during their glory days, after reading this blog, remarked that the psychology of bulimia can be explained on same line. Here the ambivalently loved person is eaten to incorporate into oneself and then spit out as a mark of its rejection.

I remarked to him that perhaps the phrase to chew them alive and spit them out expresses this concept in its visual concrete form. 

A recurrent dream of castration

A man in his mid thirties, who suffers from paranoid illness, is single, still lives with his mother, her only child, reported that for the last two weeks he is troubled with a dream that won't leave him alone.

I feel there is a baby on my back, like a backpack. I feel responsible for it and have to worry about its safety. I want to do things but cannot because of the burden.  My dreams which use to be full of adventures now are cut short because I have to worry about the baby coming to harm. 
When I wake out of the dream I find my head hard pressed against the pillow. 
 
Initially the only association the patient could come up with was that the backpack reminds him of going to school.  But that association led to no where. And soon we drifted into his usual paranoid complaints about neighbors keeping a watch on him and how he cannot get away with any transgression no matter how minute.
"Every time I have sex with a woman I get in to trouble. It is not like I am having sex with married women. But neighbors look at me as if I am trying to have sex with their wives. If I just wear a different style of cloth they start wondering if I am up to something. Recently I was hired by a lady to drive with her to New York to help her load some mattresses for her business, and while I was eating at the White Castle she was watching me as if I was wolfing down my food.  If I exercise in my backyard my neighbors come to their windows and stare at me. Even my mother doubts my abilities. She tells me that I am a dreamer. But so was Martin Luther King. My mother accuses me of doing nothing that has any practical value and for earning no money. But hardly out of school I became a connoisseur of classic cars and flipped a couple at a profit. I have a collection of old comic books which one day will fetch me a neat sum."

By expressing to me all these persecutory thoughts and feelings, which his mind is constantly conjuring and no doubt to keep a lid (inhibition) upon his taking chances with the world - even his ability to free associate -  undid the repression partially, and the patient now could come up with the following association, "I read, or perhaps saw on TV, that if you see a child in a dream it is yourself."

This immediately solved the riddle of who the child represented. And I asked him, "Behind the facade of protecting the child is it yourself that you are protecting?"

"That makes sense. But why I am protecting myself through creating a double of me as that child instead of protecting myself directly?"

"Because when the fear of harm coming to oneself is overbearing, the mind plays a trick to lessen its impact. It starts worrying about somebody else who if harmed will cause one even greater pain. This way one's fear for one's safety is lessened. The focus shifts to somebody else getting harmed instead of oneself. This reduces the autonomic and other physiological responses that are triggered if one is anticipating danger. For the harm coming to somebody else, even if to somebody very close to oneself like one's child, still does not pose as much terror as harm happening to oneself. Or at least does not mobilize body's physiological responses to the same degree. The body does not have to activate the cascade of stress factors to protect oneself, because the injury is going to happen to somebody else. It is a very important defense: shifting worry from one's own person to worry for one's child's, or a spouse, or a favorite nephew or the federal deficit or the future of mankind or the disappearing rain forests, or the global warming.

"Since in real life you do not have a child, in fact you do not have anybody close to you who you really care for, you are working out your fear of some harm happening to you by creating an imaginary child who you must protect. And since you deny your fears in daytime, and in fact do not feel much emotions when you feel threatened by your neighbors, for that matter the world in general, for you experience the world as a hostile place, these fears emerge in the night when you are sleeping and you try to work them out of your system in your dreams.

"But why did this dream start just two weeks ago?"

"Because for the last two weeks I am struggling with a bad crook in my neck?" the patient replied

"Crook in your neck? What in the world is that?"

"I don't know what you call it. But us black people call it crook in the neck when we sleep badly and wake up with our neck stiff and hurting. Generally it clears up in a day or two. But this one has been a bugger and has persisted for two weeks."

This explained the immediate cause of the dream. The pain in the neck was disturbing the sleep and the patient who is always anticipating grave harm because of his paranoia had raised its significance to that of a mortal danger. This was consistent with how he experiences the world: a dangerous place. The need to do something about "this impending catastrophe - the crook in the neck" would have woken him out of sleep. But to protect the sleep - for him to continue sleeping - the brain mechanisms responsible for dreaming generated the dream. And the dream, by showing that the mortal danger was not coming to him but to his dream child, lessened the overbearing emotion of fear which otherwise would have woken him out of sleep.

"Why is your head getting buried into the pillow?"

Patient countered it by stating that the dream was in color. Now we know that if the dream is  vivid, feels very real, is in color, it symbolizes intensity and it is reflection of the intensity of the wishes/desires that are invoking the dream. Many scenarios of wish fulfillment have been condensed in to one. Not unlike how in some movies the director starts in black and white to portray the emptiness of the lives of the characters, and then, as circumstances change, and the characters meet new people and new sources of pleasure, their lives become multidimensional and full of happenings and the director shifts gears and ratchets it up from black and white to color.

The patient then gave some more associations which hinted that his burying his head in the pillow was trying to retreat from these intense wishes. For intense wishes are often accompanied with heightening of danger. Striving for things invites competition, threats and actual aggression upon one's person. In digging himself into the pillow he was actually retreating from the dangerous world and seeking to hide in its crevices - it was a variation of the fantasy to return to the womb. It was this intense fear too that was perhaps causing him to keep his muscles defensively tight while sleeping, causing "the crook" of his neck.

The correctness of this view was further confirmed when patient said that his dreams are full of adventures, or rather a wish to embark on adventures, which are cut short because "I cannot be involved with dangers and cannot accept daring challenges because I have this burden, this responsibility for the baby."

When asked to give specific examples of adventures which are cut short by the fear of harm coming to the child the patient said, "Like climbing up a mountain or some other steep structure. Or to get out of a tense situation, like being in a small space with so many people around me."

Now we know that climbing symbolizes sexual intercourse. In fact in Hindi the vulgar term for sexual intercourse is a man climbing on a woman akin to mounting in English. Being in a tight spot with so many other people around perhaps symbolized competition with siblings and father over exclusive possession of mother's genital passage. And considering that a little child often symbolizes penis I made the following construction.

"Is it possible that the adventures are symbolic of sexual adventures and the danger is of castration, with the little child being your penis which will come to harm because of it?"

Little child symbolizing penis is a well known psychoanalytic fact - people often refer to their genitals as their little one -  and this kind of conjecture could be made with this particular patient for he has been seeing me for many years and is quite familiar with the concepts of Oedipus Complex, castration, and dream symbols.

To my great surprise patient said, "It is interesting you say that because the child who I am saving always is naked, he has an erect penis, despite his being a baby, and I may as well add that it is over my left shoulder that I look at the child."

This association strengthened  the view that the dream was an attempt on part of the patient to avert castration for forbidden sexual wishes.

I asked the patient why the child had erect penis and he recalled:
"When I was 11 I developed torsion of the testicles. My mother took me to the Children's Hospital. But they did not treat me right away, and sent us home and told us to come another time for there were so many children who had to be treated before me. And my problem could wait. But then a few days later the problem suddenly worsened. I was rushed to the hospital and they did the surgery right away. The White doctor who operated upon me said that the condition had gone so bad that he was about to cut them [testicles] off. He added that the left one looked worse than the right. The White doctor had a serious look on his face as if he really meant what he said. I did not want to lose my manhood. For I knew one could not have kids without the testicles. After that I had dreams of that white doctor cutting of my testicles for quite some time. I also thought that they would have operated upon me when I first went there if I was a white kid. And for them to operate upon me so quickly when we went the second time, I must have bumped off some white kid who was scheduled for surgery that day."

The patient at this point added another element of the dream.

"The child on my back is white. I was pretty white when I was born. Just like my grandmother."

So the patient's genetically determined excessive castration fear was further worsened by this unfortunate episode when the possibility of castration in hands of a White man almost became a reality. And to defend against it he had taken refuge in the belief that he was not black but white just like his grandmother. If he could turn white then the likelihood of getting castrated would disappear. And so in the dream he was defending himself from the fear of castration by making a double of himself as a white child. And a child who was not just white but who had an erect penis all the time - denial of castration through impudent defiance.

In his next session, a month later, he brought the following dream.

 I am a few streets away from my house playing basketball with my friends, two brothers, who I grew up with and who were nice to me and treated me with respect. Then another kid, a  neighbor of theirs, and I start fighting with each other. It is a martial art fight. The kid's uncle comes out who is blind. He has a white cane with red tip. We stop fighting and apologize to him for fighting like that and I explain to him that I live on Anna street. Then I return home and find that the boy with whom I was fighting had done a break-in and entry in to my mother's house. I call the police and grab hold of the boy. I see the boy wrapped around my hand as a backpack. I feel as if the burden of the boy who was always on my back as a back pack has disappeared for he is now wrapped around my hand.

We will not go in to analysis of the whole dream but only the parts that deal with the baby on the back.

The patient spontaneously associated that the boy who he is fighting with his own self. It is the part of him which he wants to [reject, project out, and] fight with. It is that part of him which if one follows the dream has failed to resolve the Oedipal conflict and is still seeking to find libidinal satisfaction through his mother - the boy with whom I was fighting had done a break in and entry in to my mother's house -and which was at the root of his illness.

Patient claimed that once he had this dream the  recurrent baby-on-the-back stopped. The patient and I agreed that the baby now instead of being a monkey on his back had shifted to getting wrapped around his wrist. So instead of the fear of castration completely controlling his life- sitting like a monkey on his back - it was now wrapped around his hand and thus under greater control.   

The humbug of Induction phase in Suboxone (Buprenorphine) Therapy

A shameful chapter of American medicine is the way the doctors authorized to prescribe Suboxone (buprenorphine)  have abused this privilege to financially exploit narcotic addicts. The latter are no match for the doctors. Not only because the balance is so much in favor of the doctor with the prescription pad in his hands, which the addict knows has the power to immediately end  withdrawal symptoms, but years of drug seeking life style leaves them emotionally and cognitively scarred, and they often feel like a thief, unworthy of asking anything of anybody. Finally when you are feeling physically sick from withdrawal you are incapable of negotiating with the doctor on his fees. 
Addicts are one group of patients whom the doctors should not charge more than what they charge their other patients for equivalent amounts of time.
It therefore comes as a surprise that while for their regular patients - who actually may require more medical skill, time, attention, and coordination with other medical personnel - doctors charge anywhere from 35 to 120 dollars, with Suboxone patients they want to charge 400 dollars for the first visit, and anywhere from 100 to 200 dollars for subsequent visits.
At least these were the rates when Suboxone first came to the market. The rates have gone down some since DEA now allows 100 instead of 30 Suboxone patients in one's practice, but, still,  most Suboxone-doctors nevertheless want at least 200 dollars for the first visit, and anywhere from 65 to 150 for return visits.
Also it is not uncommon for Suboxone-doctors to ask for additional monies besides what the insurance pays, which really is illegal.
Why they do it? And what has enabled them to indulge in this kind of highway robbery?
To prescribe Suboxone,  DEA requires special training - it can hardly be called special for it requires all of 8 hours of listening to lectures on a single day - and submission of the proof of having done so. DEA then issues a special unique identification number and voila the Suboxone doctor is born. Does that much of effort deserves charging 400 dollars to the patient and then hundreds more on subsequent visits?
Anyway, without this identification number, which is really the doctor's DEA number with letter X in front of it, the pharmacy does not honor the doctor's order for Suboxone.
It is this number which since only few doctors go through the special training empowers them to charge exorbitantly.
How difficult is that special training?
The training requires eight hours of passive listening to lectures in a one-day conference, delivered usually by two Suboxone specialists, majority of whom I have found to be just the kind who will gouge 400 dollars from some down-and-out kid who does not have a dime to his name, having blown all his money on drugs, and whose medical fees in all likelihood is being paid by a struggling spouse or a beleaguered parent.
Why more doctors don't take this training?
Because doctors like the rest of us are neophobic. If their practice is going good they don't want to get out of their comfort zone and acquire a new skill. But more so because of the prejudice we harbor towards drug addicts as trouble makers. And this contempt and fear of narcotic addicts has some merit. Addicts can be very difficult population to deal with when they are not as much interested in giving up their addiction but in procuring Suboxone to actually support their habit through selling it on the street and using the money to buy their drug of choice.
Yet charging these sick people - yes, some of whom who do indulge in crime, including prostitution, to support their habit, are often liars par excellence and on rare occasions can be hostile and outright assaultive to the doctor when he refuses to give them as much medications as they would like - such high medical fees is unethical.
Why did the DEA place this special training hurdle?
The need for special training to prescribe Suboxone arose because the way Methadone Clinics had degenerated into turning narcotic dependency - from the mildest to the severest - into a life long affair of going to those Clinics.  Anybody who came to them instead of being put on appropriate dose of Methadone which would have been equivalent to what they were abusing were actually put on way higher doses of Methadone than were necessary to prevent withdrawal and then instead of tapering down, believe it or not, the dosages were  ratcheted upwards to make their habit worse. This was the standard modus operandi of these Methadone Clinics and its logic was to make whoever came to the Clinic its permanent client. It may not be too out of the way to add here that many of the Pain Management Clinics also are nothing more than fronts to hook people on narcotics, spinal steroid shots, and other medical shenanigans for life.
So it was to prevent Suboxone treatment turning into another Methadone Clinic fiasco that the DEA, with good intentions, made it compulsory for doctors to get that 8-hour special training before they could prescribe Suboxone, and to restrict the doctor from not having more than 30 Suboxone patient at a time in his practice. The latter of course was placed there for the doctor to not give up his medical practice and become a Suboxone pill mill.
Alas DEA did not succeed! It may not be wrong to mention here that quite a few of these specially trained doctors are doing with Suboxone what the Methadone Clinic entrepreneurs did and still do. They often start patients on three Suboxone a day, 90 tablets at a time, and tell them that they should be at such a high dose for a whole year, before they will be ready for tapering, and thus hook them on Suboxone, which by the way is as addicting as any other opiate.
And finally, after this long introduction we come to the issue of the need for special induction phase in initiating Suboxone treatment.
Much of the mystique of prescribing Suboxone lies in its complex induction phase. Many doctors even after getting that special training and identification number will not take the first step of seeing opiate addicts because they find the induction phase of treatment too complex, confusing and impractical. They are too scared that they will mess up the treatment of the patient by not following the induction phase protocol and thus get in to trouble. And this reasoning is not entirely baseless. Not the fear that they will somehow harm the patient but that they will not be able to adhere to the protocol.
If one reads the drug company's information package insert, one is not supposed to just prescribe Suboxone and tell the patient to not take the first dose of it till the withdrawal symptoms become unbearable, but to have the patient come and sit in your office till you decide that  his withdrawal symptoms have become unbearable and then personally give him the first dose.
And there are further hurdles. The first dose is supposed to be not that of Suboxone - which is a combination of Buprenorphine and Naloxone - but of Subutex - which is Buprenorphine without Naloxone. The rationale is that Naloxone which is an opiate antagonist will worsen the opiate withdrawal. This is a bunch of nonsense. If you instruct the patient to not take the first dose of Suboxone till the withdrawal symptoms become unbearable the Naloxone in the Suboxone hardly has a worsening effect upon the withdrawal.
The guidelines also want the doctor to write the first prescription for just two or three Sabutex tablets and ask the patient to go and get them from the pharmacist. Then the doctor is supposed to assess him hourly or bihourly with a special rating scale called COWS - Clinical Opiate Withdrawal Scale - and only when the rating scale tells the doctor that the patient is in sufficient withdrawal the doctor is supposed to give him the first dose of Subutex. And then the patient is supposed to wait further for the doctor to keep doing the rating scale periodically and decide if he requires more than one Subutex tablet or not. And this assessment shenanigans is supposed to be carried on for the next few days.The guidelines require the patient to come multiple times in the first week for doctor to assess him daily with the rating scale to further fine tune what is the most appropriate dose of Subutex/Suboxone for him - one, two or three. And since it is illegal for the doctor to hold medication in the office that is prescribed for a specific patient, the latter is supposed to go every day to the pharmacist to get his daily supply of two or three Subutex.
 If one wants to avoid sending the patient to the drug store repeatedly, the guideline also gives the doctor the wonderful option to keep a supply of Subutex in the office. An option that given the penchant for American Justice to trap and turn one and all into the category of criminals to expand their business, can land the doctor, if he is not dotting every i and crossing every t in his bookkeeping, in serious trouble.
Does any doctor really follows these guidelines or more importantly is it really possible to follow all these commands in private practice? Are drug addicts capable of complying with this kind of quackery? Do they have the money, resources, gas in their car, if they have a car to begin with, to go daily to the pharmacy and get a fresh round of Subutex? Does their insurance - most of them have Medicaid or are uninsured - covers these Subutex prescriptions? Is it really practical for withdrawing opiate addicts to sit in your waiting room with your regular patients for hours at a stretch without scaring them? Does the mumbo-jumbo of COWS, for that matter any rating scale, really superior to clinical assessment of the patient through observation and common sense questioning by the doctor? Is any drug addict really capable of  coming to your office, get the prescription of Sabutex, take it to the pharmacy, wait there for it to be filled, return to your office, sit there for hours for assessments and then go home, only to repeat the routine the next day? And finally after giving the first dose of Sabutex and making the patient sit in your waiting room and periodically assessing him really tells you much whether the patient requires one, two, or three Suboxone a day?
The answer to all the above questions is a resounding no.
No doctor really follows these guidelines? They do some half-ass going through the motions of them, enough to convince themselves that their charging 400 dollars for the first visit is justified.
Yet these top-down guidelines exist, and turn away many doctors from treating narcotic addiction which has become such a large problem across the nation.
I have been prescribing Suboxone for eight years and must have treated hundreds of narcotic addicts with good results and without practicing any of these complicated rules of Induction Phase of therapy.
All I do is to make a careful clinical assessment of how much opiate the patient was abusing, how severe is his withdrawal, how honest and sincere he is in giving up his habit, and if he is not there to get some Suboxone as a temporary fix because he has run out of money and wants to stave off the withdrawal till he can go back to his drug of choice.
The first visit lasts for 45 minutes if he pays me 110 dollars, or for 30 minutes if he can afford no more than 70 dollars. And through this assessment, which is not corrupted with stupid rating scales - which are made for subnormal doctors who cannot think of medicine in qualitative terms but must turn everything into numbers - I can almost always make out whether the patient requires one, one and one-and-a-half, or two 8-mg. Suboxone tablets a day. Almost 90 percent of the patients fall in to these three categories. Very rare ones require three tablets a day. Patients who are switching from Methadone to Suboxone almost always require three tablets - incidentally of Subutex instead of Suboxone - because they have a very bumpy withdrawal.
I give the patients 7 or 11 or 14, and for very few 21 tablets, for the first week and ask them to come back when that period elapses. I emphasize to them to not take their first dose of Suboxone till their withdrawal becomes unbearable. Most of the patients are not Suboxone naïve, having already taken  Suboxone here and there, obtained from friends or bought on the street, and they know very well how not to take it till the withdrawal symptoms are intense. Their knowledge of their withdrawal symptoms is first hand and much superior to any assessment done by the doctor directly or through his rating scale.
In a week when they return, I reassess their Suboxone need and titrate the dosage up or down. It is rarely that I have to titrate upwards. In my practice there is always a constant pressure to keep ratcheting down the Suboxone, for it is as addicting as any other opiate.
I have never had any failure with this simple approach. It is also not a huge deal if some patient was given 14 tablets for first week when 11 or 7 would have sufficed. Also it is a rare patient who has gotten 7 tablets when 11 or 14 would have been more appropriate. And such a patient always has the option to come a couple of days earlier if he runs out of his Suboxone before the 7 days.
Why if initiation of treatment with Suboxone is so simple have the DEA, the doctors, and other interested parties have made it into such a rocket science?
Because there is always a tendency in humans to make their profession look more complicated - which justifies them charging more money and makes them feel more important than they are - than it is. Also it increases the scope of employment. There is a huge industry to treat narcotic addiction. The government regulators if they can make medical business more complicated and time consuming then their power increases and their department size increases.
Finally this kind of bullshit masquerading as evidence-based science is a significant component of  medicine. The art or science or quackery of medicine is heavily laced with many such useless protocols and  unnecessary regulations. The reason for this is because the payment for much of medical activity is made by third parties. So there is a built in mechanism to make medical treatment as dilatory and nonsensical as one can get away with. When one analyzes these protocols carefully most of the steps present there are useless, if not outright counterproductive, often harming than helping patients.
I remember in 1976, when I started my residency in psychiatry to admit a mental patient through ER would take all of 30 minutes. There was no money in keeping them in the ER. Now on average it takes 17 hours. For everybody and his mother, aunt, and brother are having a go at the patient in the ER in the name of triage and multi-disciplinary approach.  Are these multiple assessments by the clerk, nurse, social worker, ER doctor in the ER have any real meaning in improving patient's psychiatric condition. All they achieve is to exhaust the patient, and his relatives who have to sit through this period of ordeal in the waiting area, without doing any good to him.  But all this has become necessary to generate a stackful of medical notes so they can bill thousands of dollars to the government and private insurances and have documentation to prove it.

Snake dreams and the phallic competition with the father

A highly gifted artist who draws cartoons as good as any Disney animator but never made commercial  use of his talents because of a fear of failure and has spent his life - he is now in his mid fifties - in a low clerical position because of the job security it offered brought to therapy the following recurrent dream that he claimed has periodically occurred to him all through his life.

Before telling the dream he added that it makes no sense for him to repeatedly dream of an animal that he detests and dreads when he is awake.

There are two snakes one of which is a diamond headed rattle snake the other one is black.

When asked if in all his dreams there are two snakes he said no: sometimes two, sometimes one, sometimes many. The latest dream had two snakes.

Now a long time back I had read in Karl Abraham's writings that snake in the dreams  often symbolize "phallic competition with the father". I had also once analyzed an Indian man's dream of being chased by a five-headed cobra (shesh naag) which on analysis had shown to be a dread of castration in hands of the father - for daring to compete with him and wish for his death - and the five headedness of the cobra was denial of castration - multiplication of the threatened object, so if one is lost there still will be some in reserve.

So my interest in the dream was piqued to see if this one too will prove to be some form of competition with the father.

"Why it is a diamond headed snake?"

"It may have to do with the triangular shape of the snake's head. Also the scales on its body were full of triangles."

Whether the triangles stood for female genitals could not be confirmed. This avenue was explored because of the theoretical consideration that coming across the female genitals during the Oedipal period in the little boy produces the horror of castration for he immediately concludes that it must be the result of punishment meted out for playing with the genitals (masturbating).

"Why is the other snake black?"

"There was actually a black snake that I once saw crossing across our house. I think it is taken from there."

"Is the diamond headed snake your mother and the black snake your father?"

The patient said it could be but gave no further associations that could confirm or reject the construction.

The patient then stated that recently his paranoid illness has taken an upswing. He feels unmarked black cars, with federal agents inside them, are following him whenever he is on the road. 

Now this patient has had bouts of paranoid breakdowns since the age of 34. These paranoid episodes
always begin with unmarked black cars following him. They quickly escalate into auditory hallucinations in which he is berated for being a pervert who indulges in all kinds of bad sexual practices including child molestation. These accusations have little to do with his manifest sexual behavior for his whole sexual expression is limited to masturbation and even this he does not indulge in more than twice a month. A limit which when exceeded results in paranoid constructions where he is constantly watched by federal agents, security guards, spy cameras, and condemnatory voices, all of which occur, along with a rise in the affect of guilt, to prevent him from indulging in masturbation and the associated [incestuous] fantasies.

His first episode of auditory hallucination began when he was dating a girl at the age of 34. He had only dated once before, a decade earlier, which had ended unsuccessfully because he would repeatedly tell the girl that wouldn't she be better off with somebody else. With this second woman the relationship had almost come to the point of getting engaged but then while having lunch with her in a restaurant in company of his brother with whom he is inseparable he had heard the man on the next table say that he (the patient) was fake and incompetent and should tell the girl he was hoping to marry to go and find somebody better than him. Later that evening the three had gone to the movie and the girl had abruptly left the two of them in the theater and had called off the relationship no doubt sensing his pathological sense of inferiority. Patient had concluded that she had walked out of his life to find somebody who had more money than him. Interestingly he is a millionaire despite his humble job because of a shrewd investment in stock market that he had made in the Eighties. The money though does not have any influence upon his daily living where he is frugal and wears very modest raggedly old clothes.

Few months after the breakup, he had a major paranoid breakdown.

The patient recalled in the session that fateful lunch, that first instance of auditory hallucination, the subsequent full blown paranoid schizophrenia, and then returning to the present told me as to how a woman who works with him, and who was acting quite interested in him had asked for a sum of money and on obtaining had become indifferent again.

"Was the dream sparked by this latest rejection?"

"Yes. Since she gave me hope and then disappeared, a repetition of what has happened to me before, I have been having suspicions that my bedroom is bugged, that there are spy cameras throughout the house, that my television can read my intentions, and the security guards from the campus where I work are standing outside my windows."

This had to be interpreted as due to an escalation of his hostility towards the world because of the latest rejection. He was trying to discharge his anger towards women - his mother was very domineering and had always held him back from taking interest in girls -  through sadomasochistic masturbatory fantasies and which were being controlled out of respect for his parents, for the fantasies were primarily directed against them, through creating paranoid structures of being watched by spy cameras, security guards and black cars. 

Patient at this point recalled that the dreams of snakes almost always occur a day or two before going to the confession. He goes there once a month and mostly to get absolved from the guilt of indulging in masturbation.

Patient was then asked if there were any more details to the dream. All he could think of was that the snakes were under his bed and he was deathly afraid of them.

"What exactly were you afraid the snake would do?"

"They will bite me on my penis," the patient replied.

So the snakes symbolized the father who would castrate him. Though the castration was shown not at the phallic level of psychosexual organization. Instead the great fear had caused a massive regression  all the way to the oral phase, where instead of his penis getting cut off by a human father he was quivering with fear over getting bitten by the snakes (the father substitutes). 

Here one recalls how in Little Han's case the castration fear was being worked through by dreading getting bitten by horses and in Wolf Man's case the castration anxiety had shifted to the fear of getting eaten by wolves.










 

A dream of getting bitten by a snake twice

A woman in her mid-thirties, twice divorced from two abusive marriages, and who despite a great need for love now lives a lonely existence dreamt the following:

Someone is drawing blood from my arm. A black snake with yellow underbelly hanging down from the ceiling bites me on my finger twice. The bites were sharply painful.

Since the patient is very shy and laconic in her descriptions, I knew there was more to the dream than what she was reporting, and if enough encouragement was given would bring up more details and on being coaxed recalled that:

She was sitting in a chair like one does in a clinical lab. Her arm was raised instead of being placed on the hand board, which is peculiar because arm is not kept in that position for blood drawing. The woman who was drawing the blood had short brown hair coming down to the neck.

The dream had occurred 3 weeks ago and the day's residues that had sparked the dream were not readily available. But, eventually, when it was suggested that the woman who was drawing the blood was perhaps she herself - for she has short brown hair which come down to the neck - she countered with, "No those hair are my aunt's. She, my mom and my grandmother came to visit me three weeks ago and the same night I had the dream. My aunt has short brown hair like that."

When asked as to why her aunt is drawing blood, the patient began talking about her grandmother. She declared that the grandmother is quite like her. She too has agoraphobia and like her (the patient) rarely leaves the house. In fact the patient was surprised that she had mustered the courage to ride along with her two daughters and come to the patient's house. She wondered whether behind the façade of aunt it was not her grandmother who was drawing the blood. 

"Why would it be so?"

"Because I look up to my grandmother. She is a feisty one, full of energy and wisdom. So if the blood drawing is happening to cure me, it would be my grandmother who I would want to be my healer."

"And what it is that she is curing you of?"

"You know I work in a dog boarding place. A big Labrador injured me quite badly on my shin. It is painful and has not been healing. Surprising no blood oozed out of the wound when it happened. If it had perhaps the wound would have healed faster. So I must have made my grandmother, behind the figure of my aunt, draw the blood to heal me. "

"Was it your shin pain that was being experienced as the snake bite?"

"Must be. The pain was throbbing in quality and the snake bite occurred in quick succession twice."

"But why did the experience of pain from the shin shifted on to the finger, and as a snake bite?"

"Because my grandmother must complain about everything and find reasons to be paranoid wherever she is. The minute she entered my house she started looking at my backyard where there is overgrown vegetation and started worrying about there being a snake on those lush creepers. So it was my grandmother's bringing up her fear of snakes that sparked the dream."

"Why the snake is black?"

"There is actually a snake that lives in that foliage. Though I have not seen it this year. In fact the foliage at my backyard is so lush and wild because I have stopped going out in to my yard out of fear of running in to that snake. I hate snakes. They give me the creeps. Though they eat bugs and critters which is good. For I hate those creepy things too. The snake in my backyard is black and identical to the dream snake. It does not have yellow underbelly though."

"Why the yellow underbelly?"

"Yellow underbelly means it is a poisonous snake."

"Why would you want to be bitten by a poisonous snake?"

"To be cured of the other pain. My life is full of pain, fibromyalgia, fatigue; in short I never feel good. So I must me introducing one poison in to my system to get rid of another. Kind of homeopathy doctrine. That must me the reason too for my hand being in that awkward position. Instead of getting my poison drawn out by my grandmother through the needle and syringe, I am opting for a cure through getting bitten by snake."

"Why twice?"

"Because I was married twice. Both were snakes. They both were abusive, made my life hell and gave me agoraphobia. They were good riddance, but I still crave for love. So when the pain from the shin injury was about to wake me up I must have started dreaming of finding a cure for it by finding a man, a wish that must have been counteracted by the memory as to how the cure would tantamount to being bitten by a snake."

We still did not quite make out as to why the dream chose her aunt and the figure of her mother and grandmother behind it to draw the blood. This conjecture was not confirmed but the three women are  the only people she relates with and avoids all others. So when the dog injury was disturbing her sleep, the dream was generated in order to find a cure for the pain and the injury. First her mind harked to the familiar figures of the three relatives and a composite  of the three was drawing her blood. But then the libidinal wish, finding the three women as inadequate objects for what she really needed, began contemplating relationship with a man [that would take away the pain]. However the traumatic experiences with the two ex-husband nixed that outlet as well - the cure would have been worse than the malady."