A Collection of Poems that Refutes the Binary in Favor of Imaginative Plurality

Fall 2023 • Volume 4, Issue 4
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Photo on cover by Joseph Silvio, M.D.
Dr. Joseph R. Silvio took this photo
of a Collared-Redstart in Costa Rica.
Restricted to highland forests above
1500 meters in Costa Rica and Panama,
the species typically forages by fanning
its high-contrast tail and flushing
insects from vegetation and leaf litter.
Photo on back inside cover by Arsinée
Donoyan.
Arsinée describes the photo:
The Monastery of the Holy Trinity -
Built in 1458-1476, monks used ropes
and baskets for transportation until
1925. Since, a rocky path of 140 steps
has been carved. (Tessaly, Greece).
Management
Next Wave Group, LLC
Newsletter Design
Betsy Earley / Director of Publications
Email: Betsy@baymed.com
• Letter from the Editor P6
Gerald P. Perman, M.D.
• Gaming the Elite College Application P7
Cartoon by David V. Forrest, M.D.
• New Insight Into Understanding Human Nature P8
Joseph S. Silverman, M.D.
• Emerging New Treatments for PTSD and Treatment Resistant
Depression P9
Veronica Slootsky, M.D.
• Breathtaking Scenes of Meteora, Greece P12
Photos by Arsinee Donoyan
ARTICLES
• Moral Treatment and Our Modern World P16
Austin Lam, M.D.
• Nazis and Germans: Psychological Interpretations in English-Language
Journals 1933-1945 P19
Reimer Hinrichs, M.D.
• Law – Science = Injustice: The Crime of Punishment P25
Joseph S. Silverman, M.D.
• The Healing Impact of the Schizophrenic Patient Using His Body
to do Some Work P30
Wilfred Ver Eecke, Ph.D.
ESSAYS
• My Life and All That Jazz P33
H. Stephen Moffic, M.D.
• Drowning in a Sea of Knowledge P38
Aditi Agrawal, M.D.
• Three Years in Brussels P40
• Advance Book Notice: Dare to be Extraordinary: Maslow’s Secret to
a Meaningful and Joyful Life P43
L. Ari Kopolow, M.D.
BOOK REVIEW
• TWO KINDS OF PEOPLE: Poems from Miles End by
Vincenzo Di Nicola, M.D. P44
Reviewed by Dennis Palombo, MA, MFT
POETRY
• It Just Is P47
Elton Viseli, GWU MS-III
• On the Suicide of a Stranger P48
Aman Chishti, MS-II University of Missouri
• The Dialogical Cure: Fault unto Gestalt P49
Joshua Goeltz, MS-II Medical College of Georgia
• Todd, Aerialized P50
Michael Diamond, M.D.

4 CAPITAL PSYCHIATRY, THE E-MAGAZINE OF THE WASHINGTON PSYCHIATRIC SOCIETY
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© Copyright 2023 by the Washington Psychiatric Society.

5
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By Gerald P. Perman, M.D., DLFAPA
L E T T E R F R O M T H E E D I T O R
Welcome to the fall 2023 issue of Capital Psychiatry: the
e-magazine of the Washington Psychiatric Society and
the proud recipient of the 2023 American Psychiatric
Association Best Practices Award presented at the APA
Annual Meeting in San Francisco this past May. You
will find this issue of Capital Psychiatry to be robustly
informative, research heavy, musically whimsical,
visually stunning, and psychiatrically poetic.
This issue opens with a cartoon by my good friend from
the American Academy of Psychodynamic Psychiatry
and Psychoanalysis, David V. Forrest, titled “Gaming the
Elite College Application.”
Joseph S. Silverman then provides a brief notice
describing “New Insights Into the Understanding of
Human Nature.” Dr. Silverman recently brought to my
attention the No Free Will movement that I believe has
important untapped implications in psychiatry, the
criminal justice system, and how we function as human
beings. Kudos to you, Dr. Silverman, for bringing your
work to our readers.
Veronica Slootsky brings us up to date on cutting-
edge treatments for PTSD and Treatment Resistant
Depression in anticipation of the Israeli Psychedelic
Medicine Conference, December 10-13, 2023, that our
Capital Psychiatry readers are invited to attend.
In another stunning photo spread, Canadian
photographer Arsinée Donoyan treats us to majestic
mountainside scenes in Meteora, Greece.
Our regular section of articles begins with a brilliant
treatise by frequent contributor, Austin Lam, on Moral
Treatment and Our Modern World. Then Reimer
Hinrichs (author of a biography in German of Johnny
Cash: “A Boy Called Cash”) provides with a remarkable
piece of research of English language citing Nazis and
Germans in psychoanalytic journals during the second
world war. Joseph S. Silverman, noted above, makes the
case that Law minus Science equals Injustice: the Crime
of Punishment. My Lacanian colleague, Wilfred Ver
Eecke, in his disarmingly beautiful writing style, helps
our readers work psychotherapeutically with patients
diagnosed with schizophrenia.
In our essay section, H. Stephen Moffic describes his
lifelong love affair with jazz, a musical form also dear to
my heart. You will revel in Dr. Moffic’s ability to immerse
you in varied aspects of jazz — healing, universality, and
his own personal legacy. Aditi Agrawal addresses a little
talked about but universally experienced topic in our field:
how we are all drowning in a sea of knowledge! Gerald P.
Perman – your editor – describes his three years studying
medicine in Brussels, Belgium, having twice failed to
gain entrance into a U.S. medical school. It was a glorious
time — studying medicine in French, eating wonderful
chocolates, and drinking Belgian beer. I hope that you
enjoy reading about my unanticipated foreign excursion.
L. Ari Kopolow whets our appetites with an advance
notice of his soon-to-be-published book: “Dare to Be
Extraordinary: Maslow’s Secret to a Meaningful and Joyful
Life,” followed by an elegant book review of Vincenzo Di
Nicola’s “TWO KINDS OF PEOPLE: Poems from Miles End”
written by Dennis Palombo.
The first three of our extraordinary poetry contributions
are by medical students. This issue’s poets include Elton
Viseli, Aman Chishti, Joshua Goeltz, and Michael
Diamond.
Capital Psychiatry thanks Joseph Silvio for his lovely cover
photo, Arsinée Donoyan for her Meteora photo spread
and inside-back-cover photo, Betsy Earley for selection of
graphics and putting Capital Psychiatry together, Patricia
Troy for her continued wise counsel, and John Clark,
John Fatollahi, William Lawson, and H. Steven Moffic,
our outstanding Editorial Staff.
We hope that you enjoy this fall 2023 issue of Capital
Psychiatry.
Capital Psychiatry welcomes your articles, essays, and
poetry. Our APA Award-winning e-magazine depends on
you!!!
Cordially yours,
Editor, Capital Psychiatry

7
GAMING THE ELITE COLLEGE APPLICATION
Cartoon by David V. Forrest, M.D.

B
rilliant minds from Baruch Spinoza and Charles
Darwin to Cornell’s William Provine and
Stanford’s David Eagleman have concluded that
people are not autonomous, with Free Will,
as they have generally believed. However, it has been
difficult even for most scholars to shed the Illusion of
Free Will. As a result, humans are strongly inclined to
blame others for behaviors they find annoying, disdainful,
and reprehensible, creating an unnecessary burden of
guilt, shame, and remorse, as well as unjustified hatred,
cruelty, and aggression toward others.
Robert M. Sapolsky, PhD, Stanford University faculty,
author of the highly acclaimed 2017 Behave: The Biology
of Humans at Our Best and Worst, is releasing Determined:
The Science of Living Without Free Will in October 2023,
targeted for a popular audience. Both books describe why
human beings think and act as they do. Sapolsky plans to
engage the general media with the publication of his new
book in the hope of stimulating the public interest that
his discoveries deserve.
California is also the home of Beverly Hills psychiatrist
Gerald P. Perman, MD, Editor of Capital Psychiatry: the
e-Magazine of the Washington Psychiatric Society who
immediately grasped and advocated the No Free Will
neuroscientific understanding of how the brain works.
Dr. Sapolsky “heartily endorsed” and commented on
my article, “Free Will Illusion Perverts Law & Human
Relations,” published in the fall 2022 issue of Capital
Psychiatry (www.dcpsych.org).
Later this year Capital Psychiatry will publish two more
of my articles that apply No Free Will neuroscience to
American politics and criminal justice. The public and the
medical community have so far remained ignorant of this
intellectual goldmine.
I would be glad to furnish additional information and
expand on my proposal at the request of the editors of
the Los Angeles Times. Dr. Sapolsky (sapolsky@stanford.
edu) would probably be happy to assist as well.
By Joseph Silverman, M.D.
New Insight into Understanding Human Nature

9
Emerging New Treatments for PTSD and
Treatment Resistant Depression
By Veronica Slootsky, M.D.

A
bout one-third of patients with depression do
not respond well to traditional pharmacological
combined with psychotherapeutic treatment1,2
and treatments for PTSD often yield inadequate
responses3
. I decided to investigate recent research
about psychedelic medicine after I learned about life-
changing experiences shared by some of my patients with
treatment resistant depression and PTSD, as well as the
interest and enthusiasm expressed to me by the veteran
community.
Promising studies on psychedelic medicine have recently
been published in well-respected journals such as the
New England Journal of Medicine2,4
and Nature3
. Two
examples follow.
The first FDA Phase 3 trial using MDMA with
psychotherapy to treat severe, chronic PTSD found
that after three MDMA assisted therapy sessions, 67%
of participants no longer met the criteria for a PTSD
diagnosis, and 88% experienced a clinically significant
reduction in symptoms3
.
A phase 2b study of psilocybin with psychotherapy
for treatment-resistant depression showed that about
30 percent of adequately dosed patients achieved
remission — better than equivalent lines of treatment
in the STAR*D study1,2
. It is hypothesized that one of
the ways psychedelics exert their beneficial effects is by
potentiating neuroplasticity, leading to rapidly formed
new connections in the brain that can improve these
conditions5
. Thus, integration and concomitant therapy
to guide the brain into new ways of thinking are very
important in psychedelic medicine2,3,4
.
Although larger trials are needed, these response
and remission rates hold promise for outperforming
the standards of care in treating treatment-resistant
depression and PTSD. Based on such results, Australia
has recently authorized psychiatrists to prescribe
psilocybin and MDMA for depression and PTSD.
Psychedelic medicine may be a promising option for
some patients but requires a great deal of further clinical
investigation. It is not appropriate for all patients,
especially not for those with a family history of psychotic
disorders. However, while reviewing the current research
and through conversations with my patients, I became
convinced that the medications do hold healing potential
for many individuals. I also learned that there are many
barriers to further research due to DEA Schedule I
classification of these medications as solely drugs of
abuse with no medical utility.
My interest led me to join the Veteran Mental Health
Leadership Coalition (VMHLC). This coalition brings
together veteran advocates, scientists, physicians, policy
experts, and attorneys, all of whom work together to
affect policy change. We lose over 40 veterans a day to
suicide. When traditional treatments fail, some veterans
seek out psychedelic medicine to heal.
However, due to barriers in our country, many veterans
are leaving the country to access the treatments legally
while we are unable to provide treatment to Americans
in America. Those on active duty or who hold security
clearances are not able to obtain the treatments abroad
— even in countries where they are legal. Some of those
who benefited from the treatments started this coalition
to advocate not only for access to these treatments for
veterans, but for the greater American public.
Over the last few months, we have been advocating for
the Breakthrough Therapies Act (BTA). The FDA classified
MDMA and Psilocybin as “breakthrough therapies”
indicating the possibility of substantial improvement
over current treatments. Yet they remain Schedule I drugs
Psychedelic medicine
may be a promising
option for some patients
but requires a great
deal of further clinical
investigation. It is not
appropriate for all
patients, especially not
for those with a family
history of psychotic
disorders.

11
according to the DEA, making research cumbersome. The
BTA supports the re-scheduling of MDMA and Psilocybin
from Schedule I to Schedule II to allow for more ease of
research and possible compassionate use.
In June, we met with members of Congress on both sides
of the aisle about this issue. One special forces veteran
congressman, Morgan Luttrell, previously traveled
abroad for treatment with Ibogaine at “The Mission
Within” in Mexico and he spoke about his own healing
journey, encouraging his fellow members of Congress to
get involved.
As research and advocacy continues, it is imperative that
psychiatrists become aware and knowledgeable of these
emerging treatments. Some patients are not waiting for
legislation to pass and are pursuing them on their own.
Thus, it is important, at the very least, to learn about
them: their potential benefits as well as their risks.
For those who would like to learn more about this
subject, I will be presenting a poster about our advocacy
at the Israel Psychedelic Medicine Conference on
December 10-13, 2023, in Tel Aviv. Israel has important
ongoing research about how to best utilize these
medications and the conference will be a great learning
experience for all who attend. We plan to offer CMEs
through the conference.
If you are interested in more details about this conference
or the emerging therapies discussed above, please
contact me at veronica_slootsky@yahoo.com.
References
1
Rush AJ et. al. Sequenced treatment alternatives to relieve
depression (STAR*D): rationale and design. Control Clin Trials
Feb 2004; 25(1):119-42.
2
Goodwin GM et. al. Single-Dose Psilocybin for a Treatment-
Resistant Episode of Major Depression. N Engl J Med Nov 2022;
387:1637-1648.
3
Mitchell JM et.al. MDMA-assisted therapy for severe PTSD: a
randomized, double-blind, placebo-controlled phase 3 study.
Nature May 2021; 27:1025–1033.
4
Carhart-Harris R et. al. Trial of Psilocybin versus Escitalopram
for Depression. N Engl J Med April 2021; 384:1402-1411.
5
Ly C et al. Psychedelics promote structural and functional
neuralplasticity. Cell Rep Jun 2018; 23:3170-3182.

Breathtaking Scenes of Meteora, Greece
Photo Spread of Arsinée Donoyan
Meteora - Overlooking the town of Kalabaka and the Mountains of Pindus. There were
initially 24 monasteries, perched as high as 1,300 feet, built to escape persecution from the
Ottomans. Only six remain functional.

13
The Monastery of Roussanou - Built in the 16th Century, it is now home to communities of
nuns. (Tessaly, Greece).

The Monastery of Roussanou - Originally, it was reached by a ladder, but since 1930, two
strong bridges have replaced it. (Tessaly, Greece).

15
The Monastery of Great Meteoron - The largest and highest, it was built in the 14th Century
(left).
The Monastery of Varlaam - The second largest, it was built in the 16th Century (right).
The Monastery of Roussanou (below, middle). (Tessaly, Greece).

By Austin Lam, PGY-2 Psychiatry-Research Track, University of British Columbia
Thomas Insel and colleagues (2023) opined in The
Washington Post that rehabilitation services are
important and needed in psychiatry. These rehabilitation
services span “peer support, family education and
supportive housing. They can be as effective as dialysis is
for renal failure or physical therapy is after a stroke. And
none is new” (paragraph 8; emphasis added). Insel and
colleagues rightly identified the paramount necessity of
rehabilitation. Related to the need to treat mental illness,
including through rehabilitation, we again face questions
and debates that have been argued before regarding
involuntary detention and treatment of people living with
serious mental illness who struggle with homelessness
and other psychosocial adversities (Hogan, 2023; Kerman
et al., 2023).
The need for comprehensive rehabilitation is not new,
as pointed out in Insel’s opinion article. Here, the
history of psychiatry is instructive. An understanding of
A R T I C L E S
MORAL TREATMENT AND OUR MODERN WORLD
history provides the necessary bedrock for the present
and the future. In their viewpoint on reimagining
institutionalization and a continuum of care for people
experiencing mental illness and homelessness, Koh
and Gorman (2023) underscored the pitfalls of the
past in terms of overcrowded conditions in what were
intended to be therapeutic institutions. They described
the principles of “new care models”. How new is “new”,
though? They rightly pointed out that “compassionate
inpatient facilities and community-based solutions are
both key components, not mutual replacements, in an
effective continuum of care” (Koh & Gorman, 2023,
p. 1450). Again, how new is “new”? History has not
only instructions regarding pitfalls but also points of
inspiration. Let us find this inspiration.
A useful example of rehabilitation in the history of
psychiatry lies in moral treatment. The pioneers of moral
treatment include Philippe Pinel, Jean-Étienne Dominique

17
Esquirol, William Tuke, and Vincenzo Chiarugi (Charland,
2007). What united these figures of psychiatric history
were their common concern for patients’ welfare, with an
emphasis on the environment’s role in shaping abnormal
and normal behavior, the conviction that mental
disorders could be effectively cured, and a strong faith in
the institution’s treatment methods (Sprafkin, 1977). The
term “moral” here more closely parallels “morale” rather
than our conventional meaning of “moral” (Borthwick
et al., 2001). Moral treatment was aimed to instill self-
control by way of building the capacity for self-esteem
(Tuke, 1813/1996). Broadly defined, moral treatment
entailed a range of therapies focused on the rational and
emotional etiologies of “insanity” that actively involved
the patient in their recovery (Digby, 2004).
Bockhoven (1972) remarked that: “One might say that
moral treatment was essentially a teaching program
in how to make friends and enjoy outside interests.
A hospital managed according to its principles was a
going concern as productive as a university in providing
individuals with greater capacity to enjoy life and take
part in society” (p. 76).
The rebirth of moral treatment through more recent
twentieth-century history has been described by Sprafkin
(1977) in the conceptual descendants of the milieu
therapy / therapeutic community (cf. Hollander, 1981)
and the social learning therapy approach. The circularity
of history is not new. At the same time — we have
been through a “way of experience” (Erfahrungsweg;
Tugendhat, 1979), from which we cannot return to the
original starting point. While two views were previously
possible, now only one remains possible. It’s time to
revisit moral treatment in the twenty-first century.
Moral treatment encompassed two laws: the law of love
and the law of engaging the mental and bodily faculties
(Hollander, 1981). The law of love can be summarized
as the “single idea — humanity — the law of love — that
sympathy which appropriates another’s consciousness
of pain and makes it a personal relief from suffering
whenever another’s sufferings are relieved” (Bockoven,
1972). The second law pertained to the “modes of
engaging the mental and bodily faculties” (Eastern
State Asylum, 1843). This entailed organization of daily
activities and a regimen that targeted every facet of work,
love, and play (to borrow the phrasing from Freud). While
we must be careful not to equate the nineteen-century
notion of humanity with that of today’s, we can recognize
the importance of (1) compassion and kindness and (2)
structure and order.
Even amidst the heated philosophical debates in
nineteenth-century French psychiatric circles between
“physiology” and “psychology”, the basic principles of
moral treatment were accepted across philosophical
lines. As described by historian Jan Goldstein (1989):
“Not only was the moral treatment for insanity
impervious to philosophical preferences, but the
standard treatment for insanity across philosophical lines
contained both moral and physical elements. Esquirol,
working within the framework supplied by Cabanis, had
laid down the dictum for this ‘mixed’ treatment at the
very beginning of the nineteenth century, and aliénistes
of all stripes echoed it” (p. 265).
From a relatively more contemporaneous view, the
relevance of moral treatment to psychiatric treatment in
the twenty-first century has been described (Borthwick
et al., 2001). Focusing on moral treatment that was
practiced by William Tuke and members of his family at
The Retreat, Borthwick and colleagues (2001) identified
seven basic principles of moral treatment that apply
equally well in the contemporary world: (i) concern for
the human rights of people with severe mental health
problems, (ii) personal respect for people with severe
mental health problems, (iii) emphasis on the healing
power of everyday relationships, (iv) the importance of
useful occupation, (v) emphasis on the social and physical
environment, (vi) common sense approach as opposed
to reliance on technology or ideology, and (vii) a spiritual
perspective.
Several of these basic principles directly address modern
psychiatry’s bio-psycho-social model (emphasis added)
and I would add an additional existential layer as well. In
particular, occupation provides the basis of a new daily
routine, creating healthy alternative activities that can
supply meaning and purpose in the patient’s life. Over
three decades ago, in 1989, Peloquin articulated with
great prescience that: “Moral treatment’s decline relates
closely to a lack of inspired and committed leadership
willing to articulate and redefine the efficacy of
occupation in the face of medical and societal challenges”
(p. 544).
From a philosophically-informed perspective,
meaningful labour is so much more than mere “work”. As
nineteenth-century philosopher G. W. F. Hegel described
(1820/2002), the alienation between ourselves and the
social world is overcome, in part, through the specificity
of our labor and our work forms an integral part of our
freedom rather than something that limits our freedom.
Patients can find their true selves through meaningful
occupation, relating to the etymology of “recovery”
— stemming from c. 1300, recoveren, “to regain
consciousness” (Online Etymology Dictionary, n.d.). I
have written previously in the fall 2021 issue of Capital
Psychiatry on recovery through reflection on Thomas
Hardy’s poem, “In Tenebris II” (Lam, 2021).

Furthermore, the emphasis on the social and physical
environment addresses the need for alternative socio-
material conditions that promote healthy individual
habits and new meaningful social networks. Borthwick
and colleagues (2001) noted that The Retreat
“endeavored to create … a quiet haven in which the
shattered bark might find the means of reparation
or of safety” (p. 431). The healing power of everyday
relationships applies well to the need to intervene in
the intersubjective domain affected by serious mental
illness: “Kindness, acceptance, encouragement, affection,
friendship … are all seen as powerful forces in helping an
individual to recovery” (Borthwick et al., 2001, p. 431).
Further, while referring to distinct facets, a spiritual
perspective relates to the existential domain. One way to
address existential self-understanding in mental illness
can be by way of a “deeper or transcendent meaning
to our lives” (Borthwick et al., 2001, p. 431). Overall,
contemporary application of moral treatment principles
holds promise to support the patient’s capacity for
meaning-making through comprehensive rehabilitation
where this meaning-making is disturbed in the throes of
their illness (de Haan, 2020).
The ambitions of Pinel, Esquirol, Tuke, and Chiarugi to
improve the lives of those severely afflicted by mental
illness reverberate through history and continue to act
as a lodestar for our current societal challenges. We can,
must, and will treat serious mental illness as a profession
duty-bound to alleviate the suffering of people afflicted
by severe and seemingly unremitting psychopathologies.
Although moral treatment declined partly due to waning
optimism about the curability of mental illness (Sprafkin,
1977), the conditions of recovery are always possible, but
we must seize the opportunities to create them. Hope is
ours to co-create, share, and co-nurture with our patients.
The hubris of “curability” of old is over; the optimism of
treatability is and must remain a staying force.
References
Bockoven, J. S. (1972). Moral treatment in community mental health.
Springer Publishing.
Borthwick, A., Holman, C., Kennard, D., Mcfetridge, M., Messruther, K.,
& Wilkes, J. (2001). The relevance of moral treatment to contempo-
rary mental health care. Journal of Mental Health, 10(4), 427-439.
Charland, L. C. (2007). Benevolent theory: Moral treatment at the
York Retreat. History of Psychiatry, 18(1), 61-80.
de Haan, S. (2020). Enactive psychiatry. Cambridge University Press.
Digby, A. (2004). Moral treatment at the Retreat, 1796–1846. In W. F.
Byum, M. Shepherd, & R. Porter (Eds.), The anatomy of madness (pp.
52-72). Routledge.
Eastern State Asylum. (1843). Annual Report.
Goldstein, J. E. (1989). Console and classify: The French psychiatric
profession in the nineteenth century. University of Chicago Press.
Hegel, G.W.F. (2002). The philosophy of right. (A. White, Trans.). Focus
Philosophical Library. (Original work published ca. 1820)
Hogan, M. F. (2023). Another effort to get people with mental illness
experiencing homelessness off the streets—A sound idea? JAMA
Psychiatry, 80(6), 529-530.
Hollander, R. (1981). Moral treatment and the therapeutic commu-
nity. Psychiatric Quarterly, 53(2), 132-138.
Insel, T., Sooknanan, A., & Zimmerman, K. (2023, May 23). America
should fund rehab for schizophrenia — not jail and ER. The Washing-
ton Post. https://www.washingtonpost.com/opinions/2023/05/23/
mental-health-treatment-fountain-house/
Kerman, N., Kidd, S. A., & Stergiopoulos, V. (2023). Involuntary
hospitalization and coercive treatment of people with mental illness
experiencing homelessness—Going backward with foreseeable
harms. JAMA Psychiatry, 80(6), 531-532.
Koh, K. A., & Gorman, B. L. (2023). Reimagining institutionalization
and a continuum of care for people experiencing homelessness and
mental illness. JAMA, 329(17), 1449-1450.
Lam, A. (2021, October 14). Thomas Hardy’s “In Darkness:” Recov-
ery through the lens of poetry. Capital Psychiatry, Fall 2021 issue.
https://bluetoad.com/publication/?m=65729&i=724931&p=13&v
er=html5
Online Etymology Dictionary. (n.d.). Recovery (v.). In Online etymol-
ogy dictionary. https://www.etymonline.com/word/recovery
Peloquin, S. M. (1989). Moral treatment: Contexts considered.
The American Journal of Occupational Therapy, 43(8), 537-544.
Sprafkin, R. P. (1977). The rebirth of moral treatment. Professional
Psychology, 8(2), 161-169.
Tugendhat, E. (1979). Selbstbewusstsein und selbstbestimmung.
Suhrkamp Verlag.
Tuke, S. (1996). Description of the retreat. Process Press. (Original
work published ca. 1813)

19
Nazis and Germans:
Psychological Interpretations in English-Language Journals 1933-1945
By Reimer Hinrichs, M.D.
Summary: The article summarizes interpretations of the German people and National Socialism
published in English-language psychological journals between 1933 and 1945. This approach
expands on the retrospective historical commentaries on the dynamics of the Third Reich by adding a
psychodiagnostic dimension that is special in its temporal proximity to the events.
“We can only hold fast to the fact that it is rather the rule than
the exception for the past to be preserved in mental life.” (Freud, 1961, p. 19)

Method
I wanted to take a closer look at the question as to how
non-German authors trained in psychology experienced
and interpreted the German mentality at the time of
the Nazi dictatorship. To this end, I did a search of non-
German journals of psychology published between
1933 and 1945. This allowed me to leave aside the vast
number of papers published on the subject after 1945,
both as monographs and in periodicals, which increased
exponentially as time passed after the end of the Second
World War. I also ensured that, in addition to the authors’
being trained psychologists, they also had no political
connections to National Socialism and were distanced
from the events geographically, but close to them in terms
of time.
I found and searched eight journals for which all
issues for the years 1933-1945 were available. A ninth
periodical, “Psychiatry,” was also complete, but not
founded until 1938. In this case Volumes 1-8 (1938-
1945) were included.
From these volumes I selected only original papers that
explicitly focused on psychological interpretations of
Germany during the Third Reich.
I searched the following journals thoroughly:
Psychiatry; The American Journal of Orthopsychiatry; The
American Journal of Psychiatry; The American Journal of
Psychology; The British Journal of Psychology; The British
Journal of Medical Psychology; The International Journal
of Psycho-Analysis; The Journal of Abnormal and Social
Psychology; The Psychoanalytical Review.
Results and discussion
I was surprised by the small number of papers I found
that were relevant for my subject (12) and also by the
fact that all of these papers were only published in the
nineteen forties (Bode, 1943; Brickner, 1942; Brown,
1943-44; Bruner, 1941; Bühler, 1943; Erikson, 1942;
Money-Kyrle, 1941-43; Schreier, 1943; Silberpfennig,
1945; Thorner, 1945; Van Clute, 1942; Warren, 1943).
Language
In his (1945) paper, Thorner used linguistic analysis to
elucidate German characteristics from a psychological
perspective. He compared developments in the English
and German languages. He stresses the significance of
the dominance versus submission polarity in German,
pointing out that, up to the end of the 16th century,
the words master and Meister had roughly the same
meaning; they were similar both in terms of sound and
understanding, that is, they were similarly spoken and
heard.
The second example that Thorner discussed is that of
“Schadenfreude” (malicious glee). While the affect of
“Schadenfreude” is known in all cultures, there is only
a word for it in German. English requires 13 words to
translate “Schadenfreude” (p. 409). Brown (1943-44, p.
48) pointed out that “Schadenfreude” has an affinity to
sadism.
Another characteristic to which Thorner drew attention
is punctiliousness, which the German language uses as
a defense against responsibility. While other peoples
recognize values that transcend the state, in Germany the
state is an end in itself (see also the discussion of Bühler’s
(1943) paper on this subject, below). Thorner (1945, p.
413, footnote) gave an interesting example that shows
that these elements of unconditional obedience to the
state are also evident in the use of language.
In the process of the Americanization of Germans in
the USA at the end of the 19th century the question
arose as to whether German or English should become
the national language. In this discussion the Germans
expressed the fear that German children who spoke
English would be less obedient than if they continued to
speak German (emphasis R.H.). Thorner finally concluded
that in English-speaking countries attention is focused on
the individual, while in German-speaking countries the
attention is on obedience.
Warren (1943) compared the lyrics of National Socialist
party songs with those of American Christian chorales.
In his view the resemblance between the lyrics of the
two groups was substantial (Warren, 1943, p. 98). The
following themes are frequently found in the party songs
of the Nazis: loyalty, eternity, dead heroes, self-sacrifice,
the Fuehrer principle, freedom, fatherland, imminent
victory, togetherness, enemies, youth, and the prohibition
of calling their own symbols into question.
Van Clute (1942) also identified the key contents of
fascist statements. He saw the suppression of life instincts
and diffuse destruction as the main elements of fascism.
For Van Clute, the nature of fascism is cruelty, harshness,
and oppression (Van Clute, 1942, p. 337).
Propaganda is a special form of language which is
discussed in two of the other papers (Bruner, 1941;
Money-Kyrle, 1941-43). Bruner explained and
interpreted the mechanisms and strategies of National
Socialist agitation mainly from the point of view of
the methods employed. He identified nine strategic
dimensions in programs broadcast on German short-
wave radio during the period between February and
August 1940, which were intended as systematic
disinformation targeting US citizens. The aim of all these
dimensions was to undermine US citizens’ trust in their
country and/or the Entente. Dissonances between the
enemy nations were to be created systematically.

21
Bruner saw the main methods of this disinformation
as exaggeration, displacement, and repetition. The aim
was not only to sow uncertainty among the enemy (the
Allies), but to convince them of Germany’s lack of blame
for the war and of the peaceful intentions of the National
Socialists. These interpretations were in fact not new, but
I am mentioning them because Bruner highlighted this
form of propagandist activity as a specifically German
form of aggression.
Money-Kyrle (1941-43, p. 82) equated propaganda as
a principle with mass suggestion. The extent to which
individuals are suggestible is proportionate to their
mental and psychological dependency or immaturity.
Based on psychoanalytic theory in the strict sense,
Money-Kyrle described the situation of suggestible
people as follows: they have typically internalized a
cruel father imago at an early age, and this has become
unconscious. This cruel father imago is a source
of anxiety against which defense mechanisms, e.g.
projection, have to be mobilized. If a good (suggesting)
father appears whose suggestions also correspond to
the recipient’s unconscious phantasies, for example, the
wish to be saved from suffering and anxiety, then we
have all the prerequisites that the dependent person
needs to merge psychologically with the contents and
representations of the propagandist suggestion and
agitation. This is true of the nature of all propaganda and
is — according to Money-Kyrle — linked to a counter-
suggestive blockage of the perception of contradictory
information.
In this connection Money-Kyrle (1941-43, p. 86ff.)
analyzed two typical speeches by Goebbels and Hitler.
The two speeches have a similar structure. The stages are
the suggestive induction of
- self-pity (i.e., feeling sorry for Germany)
- hatred (for the USA, Jews. and Social Democrats) and
- grandiosity (of their own group, the NSDAP).
The psychological structure was simple. First an appeal
was made to the audience’s latent weakness, anxiety and
helplessness, a message that must elicit a psychological
echo in any listener because it has to do with their
unconscious phantasies. Finally, an appeal to unity was
added, targeting the atavistic longing for a paradisiacal
and “complete” family.
In terms of psychopathology here we have an inductive
sequence of melancholy, paranoia, and megalomania.
The function of such speeches is to trigger a series of
temporary psychoses.
This is also true of other forms of National Socialist
agitation. Two phases are always inducted in sequence.
In the depressive-paranoid phase (p. 89) anxiety and
helplessness are established by suggestion. Once
this anxiety has been established the image of an
external enemy is set up, to which hostility is directed,
transforming anxiety into hate (for more about anxiety
and hate, see also Reik, 1925, also Hinrichs, 1990a for a
review of the literature).
The hate was rendered effective by simultaneously
offering a way to save the life of the collective. This leads
on to Phase 2, the manic-enthusiastic phase (Money-Kyrle,
1941-43, p. 90ff.). Now hope (of salvation by the leader,
the Fuehrer) is induced, dissolving the paral¬ysis of the
helplessness that went before. Unconsciously the savior
is seen as a mixture of representations of the (good)
father, mother and/or elder brother who takes the lead in
the fight against the (bad) father.
This transformed the paranoid German psychosis into
a collective mania which made Hitler into a quasi-
religious savior. Money-Kyrle interpreted this process as
a psychopathological attempt to cope with the trauma of
the First World War.
Collective German psychopathology
We find an illuminating illustration of this thesis in
Brickner’s (1942, p. 543) paper. He likewise assumed
that the Germans were suffering from a collective
paranoid psychosis and listed its symptoms and defense
mechanisms: habitual mistrust, feelings of persecution,
delusions of grandeur, prejudice, rationalization,
projection, and retrospective falsification, i.e., denial of
history.
In her paper Judith Silberpfennig (1945) examined some
“paradoxes” that she considered to be due to fascism
and that she had identified in the Japanese and German
peoples. Silberpfennig (1945, p. 76) described the
resulting behavior as paranoid, criminal and pseudo-
grandiose, colored by the following typical symptoms:
boundless greed, subservience to the father imago,
inability to keep promises, distortion of facts, releasing
one’s aggression on the weaker, glorification of one’s own
self, limited reality testing, a need for and dependence on
mysticism.
According to Silberpfennig, the Nazis’ racist theories of
the Uebermensch (superhuman) reveal especially clearly
the secret fear that something may be wrong with one’s
own body and thus also with the collective body of the
people. In her view, the Nazis’ desire for elevation was
ultimately a direct derivative of vague infantile fantasies
(ibidem, p. 82) which were essentially to be understood
as reactions to collective castration anxieties. In turn,
she believed that death wishes directed at one’s own
feared father were behind these anxieties, but that these
wishes remained unconscious and led, at this level, to
the development of equally unconscious guilt feelings,

which were then once more projected. She added that it
is even clearer for the masses than for individuals that
the disturbed and weak have such an intense longing for
a good and powerful father that the re-sulting pull leads
them to find a matrix that is receptive to fascist ideologies
and personalities.
Schreier (1943) also supported the above-mentioned
diagnosis of collective paranoid psychosis and applied it
to the German bourgeoisie.
For Schreier, a complete explanation of German
aggressiveness had to be pluralistic, and he therefore
distinguished between different types of aggressors in
Germany:
• directly aggressive individuals who love violence
without its being possible to trace the origins of this more
specifically.
• sadistically aggressive individuals who have remained
at the pregenital level of the voyeur; they lack the courage
to act, and merely watch.
• inhibited aggressive individuals who need state
authority so that they can act out aggression
disinhibitedly with its blessing.
• cynics who are consciously as little interested in actual
aggression as in everything else; their dangerousness lies
in their indifference: they do not accept any values.
• defensively aggressive individuals who always believe
that they are threatened.
• insecure individuals who are especially dependent on
leadership and once they have recognized a leader follow
him everywhere, even to their own doom.
• fanaticists who are convinced that the idea justifies
everything (for more on the psychopathology of the
fanaticist see also Bolterauer, 1975).
• antiprogressive individuals who have a fixed
understanding of tradition and anxiously avoid getting to
grips with novelty.
• individuals who believe in success may not be in
agreement with all stages on their paths as they run
amok but believe that success is inevitable and for them
this justifies all attendant details.
Bode (1943) also assumed that the Germans were
suffering from a collective aggressive disease but was
somewhat more conciliatory since he also discerned
healthy aggressive tendencies in Germany. He estimated
that the number of people who passively resisted the
Nazis could have been as high as 5 million and described
Hitler as the most un-German German who ever ruled
(over the German people) (Bode, 1943, p. 198).
William Brown (1943-44) stated that he had originally
been sympathetic towards the Germans. However, citing
Fichte, Heine, Herder, Hölderlin and Nietzsche, he then
hastened to draw attention to what he called an original
and collective bellicosity of the Germans, a claim he both
substantiated and provided examples of. For him it was
clear that Germany was a sick nation (p. 50).
Brown (1943-44, p. 50) also backed up his diagnosis
of a collective mental illness of the Germans with the
thesis that the Germans had a dread of individuality
that the Nazis recognized and skillfully exploited, i.e.,
by emphasizing the “block” mentality (party, army, and
people: mentality of the block warden).
According to Charlotte Bühler (1943), the Nazis
manifested a particularly distorted form of what were
general German characteristics (p. 153). She thought
that the tolerance that English-speaking people showed
in accepting the independence of other people was
experienced by Germans as sloppiness and carelessness,
and expressed the opinion that it was typical of Germans
that they were unable to follow a path without help from
outside.
She went on to suggest that since the Germans took
the absence of criticism for constructiveness and the
ability to criticize for destruction they lacked a sense of
what tolerance and humor can mean. What was behind
that was an incapacity to believe in the good in people
without associating it with an objective ideal.
Hitler
Psychopathology
Most of the authors describe Hitler as clearly mentally
disturbed: William Brown (1943-44) first discusses the
classical patterns:
• The Freudian view is that Hitler showed a fixation on
his young mother and hated his older father.
• Jungians saw Hitler as a medicine man with
mediumistic inclinations who was hypnotically
suggestive.
• In Adler’s individual psychology, Hitler was classified as
a typical case of an inferiority complex.
• Brown (1943/444) did not subscribe to any of these
clichés and, in particular, rejected Adler’s thesis. He
(and some of the other authors, see below) cautiously
supported the idea of Hitler’s having been fixated on his
mother. What Brown (1943-44, p. 51) considered to be
central and to have had a marked influence on Hitler’s
personality dynamics was his loneliness in Vienna fol-
lowing his mother’s death.
In his psychological classification, Brown addressed the
issue from different angles, seeing Hitler as a paranoid
personality (p. 52), but also as an opportunistic cynic (p.
53), and then again as clearly hysterical (p. 51, Brown,
1943-44, p. 52; see also Erikson, 1942, p. 489).

23
Brown ultimately decided to focus on Hitler’s oedipal
trauma, which he considered to be ac¬counted for by the
large age difference between his parents (23 years) and
the resulting tempt¬ation for the son.
Brown concluded that Hitler was traumatized by his
mother’s death (on December 21, 1907), when he was 19
years old. (His father had died four years earlier.) Thus,
Hitler was alone with his mother in his adolescent years.
In his attempt to grasp the inconceivable, Erikson (1942)
also placed the emphasis on Hitler’s life history. Born
in the border region between Germany and Austria,
Hitler also belonged in the borderline category clinically
(Erikson, 1942, p. 477). Erikson saw the first chapter of
“Mein Kampf” as an “involuntary confession of Hitler’s
Oedipus complex,” i.e., of his hate of his old father (the
issue of the emperor of the Austrian dynasty) and his love
for his young mother (Bavaria or Germania).
In the Linz junior high school that Hitler attended,
the German national anthem was sung instead of the
Emperor’s Hymn of the Habsburgs that had the same
tune (Fest, 1973, 8.6.1). Quoting from Hitler’s ‘Mein
Kampf’, Erikson noted that as a child Hitler was among
those who “...long for the hour that will allow them to
return to the arms of the beloved mother...” (Germany)
(Erikson, 1999, p. 73). He added (p. 73):”Little Adolf’s
personal experience thus blends with that of the
German minority which refuses to sing “God Save
Emperor Francis,” when the Austrian anthem is sung and
substitutes for it “Germany over All.”
According to Erikson, Hitler projected the situation of his
family of origin onto the nation: no old man was to stand
in the way of his love for his mother.
Erikson traced this pattern down to the level of the
individual German family. He found that German fathers
typically lacked a true inner authority and compensated
for it by establishing an external, formalistic, and
bureaucratic tyranny that demanded unquestioning
allegiance, but with a simultaneous defense against
responsibility, a concept whose existence was denied, and
which was displaced onto the next level of authority (see
also the discussion of Thorner’s [1945] article, above).
Thus, for Erikson what was typical of the German father
was a mixture of extreme outward harshness and a lack
of inner authority (Erikson, 1963, p. 332).
Since the Germans always felt that their own
(psychological and geographic) boundaries were
threatened (for reasons whose dynamics have been
explained by Judith Silberpfennig [1945], see the
discussion above), but the “Limes Germanicus” (a wall
that the Romans built through western and southern
Germany) was no longer there, there was a need to
References
Bode, K. (1943): Acceptance of defeat in Germany. J. Abn. Soc.
Psychol. 38, 193-198.
Bolterauer, L. (1975): Der Fanatismus. Psyche 29, 287-315.
Brickner, R. (1942): The German cultural paranoid trend. Amer. J.
Orthopsych. 12, 544-545.
Brown, W. (1943-44): The psychology of modern Germany. Brit. J.
Psychol. 34, S. 43-59.
Bruner, J.S. (1941): The dimension of propaganda: German short
wave broadcasts to America. J. Abn. Soc. Psychol. 36, 311-337.
Bühler. Ch. (1943): Why do Germans so easily forfeit their freedom?
J. Abn. Soc. Psychol. 38, 149-157.
Erikson, E.H. (1942): Hitler’s imagery and German youth. Psychiatry
5, S. 475-493.
Erikson, E.H. (1993). Childhood and Society. New York: Norton.
Erikson, E.H. (1999). The Legend of Hitler’s Childhood. In: A. Green
and K. Troup, The Houses of History. A critical reader in twentieth
century history and theory. New York: New York University Press.
Fest, J.C. (1973): Hitler. Der Aufstieg. Ullstein, Frankfurt/Main,
Berlin,Wien.
Freud, S. (1961). Civilization and its Discontents. Transl. James
Strachey. New York: Norton
Hinrichs, R. (1990a): Was ist Haß? In: Herdieckerhoff, E., von
Ekesparre, D., Elgeti, R., Mahrahrens-Schürg. C. (eds.): Hassen und
Versöhnen. Psychoanalytische Erkundungen. Vandenhoeck &
Ruprecht, Göttingen, pp. 35-49.
Hinrichs, R. (1990b): Patient DDR. Kursbuch 101. Rowohlt, Berlin,
57-65.
Landauer, K. (1929): Zur psychosexuellen Genese der Dummheit.
Psyche 24 (1970), 463-484.
Money-Kyrle, R. (1941-43): The psychology of propaganda. Brit. J.
Med. Psychol. 19, 82-94.
overcome this “Limes complex” (Erikson, 1963, p. 347f)
by creating a human wall, the Watch on the Rhine. This
phenomenon corresponds to the German contempt for
the individual as described by Charlotte Bühler.
Erikson (1942, p. 488) saw this mixture of the sense
of being threatened from outside and having a fragile
identity as the main root of German anti-Semitism in the
Third Reich, remarking that Jews remained themselves
despite being scattered across the world, whereas
Germans had difficulty in developing an image of
themselves in their own country.
Future Prospects
We know that the Federal Republic of Germany missed
the opportunity to use the zero hour to make a new start.
Why this opportunity was also missed in the GDR on
March 18, 1990. remains an open question. The issue of
the role played by fascism in the former GDR is a sensitive
topic and without doubt a chapter that still remains to be
written.

Reik, Th. (1925): Über den Zusammenhang von Hass und Angst.
In: Reik, Th.: Der unbekannte Mörder. Hoffmann und Campe, Ham-
burg (1978), 306-315.
Rosenberg, A. (1930/2016). The Myth of the 20th Century. Create
Space Independent Publishing Platform.
Schreier, F. (1943): German aggressiveness - its reasons and types.
I. Abn. Soc. Psychol. 38, 211-224.
Silberpfennig, J. (1945): Psychological aspects of current Japanese
and German paradoxa. Psychoanal. Rev. 32, 73-85.
Thorner, I. (1945): German words, German personality and
protestantism. Psychiatry 8, 403-417.
Van Clute, W. (1942): How fascism thwarts the life instinct. Am. J.
Orthopsychiat. 12, 335-337.
Warren, R.L. (1943): German Parteilieder and Christian hymns as
instruments of social control. J. Abn. Soc. Psychol. 38, 96-100.
reimer@bln.de • ww.reimer-hinrichs.de
Editor’s note: I asked Dr. Hinrichs to clarify zero hour
and what opportunity was missed on March 18, 1990.
This was his reply:
The zero hour was May 8, 1945, the unconditional
surrender of Germany.
From 1945 to 1949, it was all struggle and an
incomplete de-Nazification, performed by the Allies.
They just needed the German Ex-Nazis in re-building
the country. The exception was the Nuremberg trial.
There was no working through in the population.
West Germany (FRG) and East Germany (GDR) both
were established in 1949; our first West German
chancellor Konrad Adenauer placed Ex-Nazis like Hans
Gobke in his federal cabinet of secretaries.
I believe that in the following decades, until the
student’s revolution in 1968, there was a lot of denial
about the peoples support of the NAZI regime in West
Germany. After that, we started working through the
Nazi matter.
All were busy with “Wirtschaftswunder”, and it was
easy to forget that the whole German people were
involved with the NAZIS, at least as bystanders, passive
supporters, and in latent collaboration — with only few
exceptions.
In East Germany, a lot of Nazis were part of the
Communistic regime, and their NAZI past was an
untouchable taboo. The elections on March 18, 1990,
were led by the East purpose of starting a new EAST
German political system, far left still. Helmut Kohl
stopped and changed all that.
No Nazi judge was ever banned or punished
for breaking the law in the Third Reich; it was a
continuation of the political elite from Nazi regime
into many East + West German political and legal
organizations. I know that from my father who served
on the Eastern front in Russia as a military doctor
during WW II.
MAGAZINE OF THE WASHINGTON PSYCHIATRIC SOCIETY
Dear WPS Members:
The editorial team for Capital Psychiatry: the
e-magazine of the Washington Psychiatric
Society is currently seeking articles for
publication in the upcoming Winter 2024 issue.
Articles should be 1500-2000 words in length
that are of psychiatric topical and scientific
interest to our readership. We also welcome
relevant literary essays in the style of The New
Yorker to allow you to give free rein to your
creative muse. We encourage members to
submit brief abstracts of articles for the Winter
2024 issue and beyond. Please email your
abstracts to gpperman@gmail.com.
Thank you and let us know if you have any
questions. Feel free to contact me for a copy of
the Capital Psychiatry Editorial Policy.
Cordially yours,
Gerald P. Perman, MD / Editor
Capital Psychiatry
Spring 2023 • Volume 4, Issue 2
Summer 2023 • Volume 4, Issue 3

25
Law - Science = Injustice: The Crime of Punishment
By Joseph S. Silverman, M.D.
Human beings, through the ages, have generally imagined
that they are making up their own minds and acting
under their own direction. Their sense of self-regulation
has rarely been questioned. This concept, termed “free
will,” is defined briefly in Table 1.
This notion, originally philosophical, reframed here as
psychological, has real-world implications, especially
in the arena of criminal justice. Western jurisprudence
has not questioned the concept of free will. Only once,
in a United States Supreme Court decision involving
the criminalization of drug addiction, has free will been
challenged in any way. But the minuscule advance of
Robinson v. California (1962) was wiped out within six
years by a contradictory judgment.
The legal profession overall lacks curiosity about such
matters. Like the rest of the population, lawyers do not
suspect that critical unconscious influences operate
continuously, powerfully, in everyone’s daily life.
The premise of free will has not been accepted
unanimously. Over the centuries, such notables as Baruch
Spinoza (17th century), Charles Darwin (19th century),
and Albert Einstein (20th century) have rejected it.
Individuals able to sense the mechanism of evolution
perceived that original, spontaneous ideation — free will
— is impossible. Predecessors are obligatory.
Over the past 40 years, neuroscience has raised doubts
about human autonomy. To be sure, the medical literature
on No Free Will has been sparse. Journal editors have
not welcomed its proponents, not even such authorities
as Will Provine and Robert Sapolsky. It is likely that the
body of work produced by No Free Will determinists was
unfamiliar to this magazine’s readership until its Fall
2022 issue (pp. 20-22).

Libet’s Brainstorm
Research supporting free-will-as-illusion, not essential
though helpful, is admittedly thin, primarily Benjamin
Libet’s studies of 35 years ago. Libet demonstrated that
the conscious intention to flex a finger follows unconscious
brain activity, its true origin. Libet interpreted conscious
intent as an epiphenomenon, an afterthought — not a
trigger.
Over time, Libet’s conclusions have been confirmed
multiple times but have been contested. At the least,
the Libet phenomenon has served as a model for
understanding conscious experiences as creations of
prior brain activity. Libet’s work likely provided the
impetus for many who followed.
Psychologists Daniel Wegner, Susan Blackmore, and
Jerry Coyne have doubted free will. Wegner memorably
cited a comment by Marvin Minsky, a leader in artificial
intelligence, explaining why No Free Will is such an
uncomfortable concept: “None of us enjoys the thought
that what we do depends on processes we do not know;
we prefer to attribute our choices to volition, will, or self-
control.”
Later, neuroscientists (Sam Harris, David Eagleman)
and psychiatrists (Alan Felthous, Eric Kandel) made
important contributions. Special merit should be
accorded to two law students. Matthew Jones, in 2003,
and Matthew Moyer, in 2017, had recognized the
implications of No Free Will well before their seniors in
the legal profession.
Over the past two decades, scientists have concluded
that people are never fully aware of why they think as
they think and do as they do. The origins of our thoughts
and actions, tangled in the brain’s myriad crisscrossing
pathways, are in the main neither conscious nor
knowable. “The engines of causation operate without
revealing themselves to us,” Eagleman stated. “As far as
we can tell, all activity in the brain is driven by other
activity in the brain…[T]his seems to leave no room for
anything other than neural activity — that is, no room
for a ghost in the machine.” The “ghost” specified is “free
will” or “conscious will.” The brain can do what it has
been primed to do — and nothing more. Free will is an
illusion.
Neuroscientists have not kept their conclusions secret.
Publications, mainly outside the medical literature, have
been numerous. Yet, beyond their respective disciplines,
this growing consensus has gone unnoticed. (Exception:
Capital Psychiatry.) The knowledge deficit is most
unfortunate where it is needed most — in the courts.
In particular, all by itself, rejecting the assumption of
conscious will could plausibly deliver a coup de grace to
the current system of criminal justice.
The Neural Unconscious.
Neuroscientists find no evidence that conscious will
exists. Some have understood that animals, including
Homo sapiens, are not autonomous; their nervous
systems, not their conscious minds, control their
behaviors. Although the conscious mind has limited
control of an individual’s behavior, it can activate learned
behaviors. The unconscious mind has far more influence
than is suspected.
Genetic priming of the brain profoundly shapes the
unconscious mind, as does the social environment. Our
brains, not our conscious reflections and intentions,
produce our thoughts and actions. In contrast to the
psychoanalytic unconscious, the neural unconscious,
as used here, encompasses brain activities that are
physiological rather than ideational, highly influential
though invisible.
What the brain, including the neural unconscious, cannot
do is create something out of nothing. A substrate is
required. De novo initiatives are impossible. In any
decision-making process, what is stored in our central
nervous system, the genetic potential that was there
at birth plus what was absorbed throughout a lifetime,
provide the raw material.
People badly overestimate the power of conscious
choices. Consciousness, representing only a relatively
small amount of brain activity, is vastly overvalued as a
generator of behavior. A person’s conscious sense of self-
initiation of any act, though persuasive to the individual,
is nevertheless unjustified. We are more like robots than
we imagine.
Implications of the neural unconscious, if taken seriously,
could revolutionize forensic psychiatry, the study of
psychopathology, and the practice of psychotherapy.
Further out, the revolution could modify moral standards,
interpersonal relations, politics, governance, and
international negotiations.
Unfortunately, the findings and conclusions of No Free
Will determinism are wildly counterintuitive. They
challenge many traditional beliefs. In most lay people
they induce cognitive dissonance, which easily leads to
resistance and rejection. But those who overcome their
free-will bias find exhilaration in applying determinism,
the governing principle of nature, to human psychology.
Much of the opposition to free-will-as-illusion arises from
this mistake: attributing learned behavior to free will.
Once someone has discovered how to do something, that
something endures in the person’s repertoire of actions.
You never have to relearn how to ride a bicycle.
Although belief in free will is unfounded and individuals
cannot justifiably be morally condemned for their
unacceptable behavior, nothing should exempt actions

27
from moral judgment. Indeed, based on the effects upon
victims — without assigning blame to particular actors
— individual and group ethical standards can and should
be established for the good of society.
Table 2 summarizes the negative implications of
“conscious or free will.”
Psychology of Blame and Punishment.
On learning about a heinous crime, many persons
experience shock and anger. For them, the urge for
retribution may be almost automatic. The prosecutorial
approach to criminal justice incorporates this urge to
retaliate against a perpetrator.
Yet the actual basis for any criminal act is complex. It lies
within the perpetrator’s neural unconscious, reflecting
his genetic and experiential history; he had control of
neither.
Drexel law professor Adam Benforado has observed: “We
often seem to punish first and seek justification second.
We want to hold someone morally responsible when he
commits a harm…Our desire to punish may drive our
belief in free will.” (Unfair: The New Science of Criminal
Injustice, pp. 194-95)
We profess not to blame children in the same way that
we blame adults, or to punish those whose mental
illness kept them from understanding the nature of their
criminal actions, but, in fact, we do exactly that.” (p. 194)
By imagining most criminals as autonomous, rational
actors deciding to pursue greedy, lustful, or hateful ends,
we underestimate the significance of forces in the world
around us and dynamics in our brains over which we
have little control.” (p. 48)
Like some other proponents of criminal justice reform,
Benforado recommends elimination of “blame as an
organizing principle.” His suggestion: “Why not instead
treat crime like a public-health issue — an epidemic that
we are all fighting together? We need to quit wasting
our time trying to sort out who really deserves blame.”
Psychiatrists who have performed forensic work for
criminal defendants may sympathize with this sentiment.
If blaming is bad, punishing someone you blame is worse.
Even a critic of the use of neuroscience in the courtroom,
Vanderbilt law professor Christopher Slobogin, can
foresee a drastic revision of criminal law, one that focuses
on understanding why lawbreakers offend, rather than,
as at present, assigning blame and calculating the extent
of “deserved” punishment.
Overcoming the Free Will Fallacy
“Criminal justice reform” is often touted, but the fallacy
of free will is rarely addressed. Neuroscientists have
stated their case for the impossibility of free will but have
not maintained advocacy. In court, forensic psychiatric
testimony, while often invited, is less often honored.
Criminal justice activists have not challenged the courts
on the fundamental misconception: free will. Finally,
the legal profession would surely find No Free Will
conclusions unfamiliar, uninspiring, incomprehensible, or
unrealistic.
Formidable are the obstacles to reforming the criminal
justice system along deterministic lines. One factor is that
plague of humankind, Us vs. Them-ism (Sapolsky), which
itself is related to individuals’ empathy levels, genetics,
and hormones (Melchers). Promising ideas published
over the past 20 years have not reached the needed
audience, inducing advocates to invest their energies
elsewhere. There is hope that Sapolsky’s late-2023
publication and media campaign will be able to turn the
tide toward determinism.
Historically, a slow, erratic dawning of social conscience
has materialized across the globe. In the U.S, some
groups, to varying degrees, have regained their dignity:
slaves, native Americans, the foreign-born, African
Americans, women, and religious and sexual minorities.
Yet to be recognized as fully human are the millions
swallowed up by the criminal justice system.
The Quaker Contribution
Harvard psychologist-philosopher Lawrence Kohlberg
assigned “the law” to the “conventional” level of morality.
But the American Friends Service Committee has higher
aspirations for the nation’s legal system.
In Beyond Prisons (2006), Laura Magnani and Harmon
L. Wray presented a challenge to all Americans. During
the intervening years, their publication has attracted
attention but not the influence that it deserves. The
authors rejected the usual no-questions-asked cultural
condemnation of prohibited behaviors. They lamented
the law’s narrow focus on stamping out illegal acts.
This focus, they argued, emphasizes the troublesome
behavior of individual perpetrators while overlooking
the social basis of many if not most crimes. The authors
described crime as an indirect offshoot of appropriate
dissatisfaction with long-tolerated social injustices, the
latter reflecting a bias favoring the upper class at the
expense of lower classes — “people of color, the poor, and
other exploited people.”
From Beyond Prisons: We reject the concept of criminality
that supports the myth of a criminal type, a concept that
grows in part out of ignorance and fears rooted in biases
and prejudices. This concept of criminology provides a
simplistic explanation of highly complex social problems.
It tends to project distinctive images of good people as
opposed to bad people, and victims as opposed to villains.
The new morality we seek demands a reordering of
priorities in a way that enhances life and is just for

everyone. Economic justice — a redistribution of wealth
such that basic needs are met — must be at the heart of
this new morality. Without economic justice, individuals
will resort to violence, and all efforts to curb violence will
focus on individuals instead of economic imbalance. Our
comfort with punishment should alarm us and make us
ask ourselves profound questions about who we are as a
people.
The Friends’ view of the origins of crime, focusing on
underlying societal causes, lines up neatly with the
neural unconscious/no one’s to blame/deterministic
understanding of human nature detailed in this article.
Either schema, the sociological or the deterministic,
would initially ignite skeptics’ fear of “anarchy” and
“radical liberalism.”
But eventually even some seeming opposites, like
enlightened evangelicals and humanists, might find
something different and highly promising in the union
of sociology and religious optimism about human
nature. Biblical literalists might detect in this approach
the essence of Christian kindness. Rationalists, gaining
more tolerance of religion, would rejoice in the broader
appreciation of science.
One way or another, this initially off-putting,
counterintuitive idea of No Free Will determinism, so
intellectually impressive, will eventually be met with
enlightened embrace instead of scorn — if humanity can
grasp and apply it.
Beyond Prisons deserves the thoughtful attention of every
advocate of criminal justice. The present writer, co-author
of an article on this subject, regrets that he had not
discovered Beyond Prisons prior to our 2014 publication.
Our conclusions may have seemed radical at the time. It is
now clear that they were not radical enough.
Summary.
An unfamiliar conception of the unconscious mind,
what could be termed the neural unconscious, is an
undetectable but powerful influence on human behavior.
Shaped by genetics and life experience, it operates 24
hours a day, affecting the possessor’s thoughts, actions,
and entire body.
The brain can generate thought and deed only insofar
as it is primed by genetics and life experience, including
learning. Yet humans, feeling autonomous, believe
that they live within the confines of their conscious
minds. They are unaware of where their personal traits,
decisions, and reveries come from. The complicated root
causes of misconduct are not intuited, let alone explored.
Therefore, to blame someone for a misdeed is short-
sighted, and to punish a lawbreaker is to miss the point
while committing an intentional but unknowing wrong.
If the insights of neuroscience were widely adopted,
crime would be interpreted as a social problem to be
solved rather than as individual instances of evil intent.
Science is ignored at humanity’s peril. The Society
of Friends’ longstanding campaign for a sociological
understanding of the causes of crime dovetails with the
neuroscientific concepts advanced here. Every aspect of
the criminal justice system needs to be reimagined.
Table 1. What is “Free Will”?
1. In philosophy and science, the supposed power or
capacity of humans to make decisions or perform
actions independent of any prior event or state of the
universe. Encyclopaedia Britannica, Feb11, 2023
2. Philosophers, for millennia, have debated whether
humans possess the ability to think and act
independent of other persons or forces. Independence
from anything beyond one’s conscious thoughts and
memories characterizes what is classically considered
free will.
3. Almost all humans assume that they have free will
because they are unaware of influences that operate
unconsciously in their brains.
Table 2. Negative Implications of “Conscious Will”
1. Because it empowers judgmentalism, the free will
myth is malicious.
2. All of us are at the mercy of our brain’s predispositions.
3. The brain, with circuitry designed by genes and life
experience, cannot outperform its endowment.
4. One cannot realistically claim authorship of one’s own
thoughts and deeds.
5. In a moral sense, people cannot rightly be blamed for
the unpleasant things they say or do.
6. Likewise, no one can validly take personal credit for
the positive things one says or does.
7. Individuals are already doing as well as they can.
8. Making a stronger conscious effort will likely produce
only a limited effect.
9. Those who cannot perform up to standards deserve
assistance, not criticism.
10. Rational thinking and behavior are rarer than
commonly imagined.
Table 3. Toward a New Justice Paradigm (adapted)
1. Needs of survivors of crime must be taken seriously.
They need help moving beyond the tragedy that they
have experienced. The assumption that their relief
will come through retribution must be reconsidered.
Meeting with the offender may be therapeutic.
Working in violence prevention may promote their
personal health.

29
References
1. Felthous AR: The Will: From metaphysical freedom to normative
functionalism. J Am Acad Psychiatry Law 36: 16-24, 2008
2. Spinoza B: The Chief Works of Benedict de Spinoza, 2:
DeIntellectus Emendatione – Ethi- ca, rev. ed. London, UK: George
Bell and Sons, 1901
3. Cobb M: The Idea of the Brain. The Past and Future of
Neuroscience. New York, NY: Ba- sic Books 2020, pp 110-115
4. Einstein A: Albert Einstein Quotes About Free Will. Available at
http//www.azquotes.com/author/4399-Albert_Einstein/tag/
free-will. Accessed December 8, 2020
5. Provine W: No free will. Isis. 90, S117-132, 1999
6. Kandel E. The Age of Insight: The Quest to Understand the
Unconscious in Art, Mind, and Brain, from Vienna 1900 to the
Present. New York, NY: Random House, 2012
7. Eagleman D: Incognito. The Secret Lives of the Brain. New York,
NY: Pantheon Books, 2011
8. Wegner D. The Illusion of Conscious Will. Cambridge, MA: MIT
Press, 2002
9. Harris S: Free Will. New York, NY: Free Press, 2012
10. Kahneman D: Experiments in Conversation. Audiotape May 9,
2019
11. Coyne JA: Why Evolution Is True. Dawkins and Krauss on free
will. Available at http:// whyevolutionistrue.com/2017/20/18/
dawkins-and-krauss-on free will. Accessed December 9, 2020
12. Sapolsky RN: Behave. The Biology of Humans at Our Best and
Worst. New York, NY: Penguin Books, 2017, pp 583-613
13. Benforado A: Unfair: The New Science of Criminal Injustice.
New York, NY: Crown Pub- lishers, 2015.
14. Blackmore S: Conversations on Consciousness. What the Best
Minds Think About Free Will and What It Means to Be Human.
New York, NY: Oxford University Press, 2006, pp 8-9
15. Eisler RL, Silverman JS: Criminal injustice. Psychiatric Annals 44:
pp 156-160, 2014
16. Silverman JS: Letter. J Am Acad of Psychiatry Law 46: 405, 2018
17. Alces PA: The Moral Conflict of Law and Neuroscience. Chicago,
IL: University of Chicago Press, 2018, pp 65-101
18. Libet B, Gleason CA, Wrist EW et al: Time of conscious initiation
of a freely voluntary act. Brain 106: 623-642, 1983
19. Jones M: Overcoming the myth of free will in criminal law: the
true impact of the genetic revolution. 52 Law Journal, 2003.
Available at https//scholarship.law.duke.edu/dlj/vol52/ iss5/4/
20. Moyer MD: Free will’s enormous cost: why retribution, grounded
in free will, is an invalid and impractical penal goal. NDLR, vol
92, 2017. Available at https://scholarship.law.nd.edu/ ndlr/
vol92/iss5/15/
21. Minsky M: The Society of Mind. New York, NY: Simon & Schuster.
1985, p 306
22. Slobogin C: Neuroscience nuance: dissection the relevance of
neuroscience in adjudicating criminal culpability. Vanderbilt
University Law School. Legal Studies Research Paper
Series. Working Paper Number 17-44, http://ssm.com/
abstract=3046213 SSRN-id3046213, p 22
23. Worth JM: The moral arc of the universe. Harvard Unitarian
Universalist Church (https:// uuharvard.org) November 13,
2016. Accessed December 9, 2020
24. Rest J, Narvaez D, Bebeau MJ, Thomas SJ: Postconventional Moral
Thinking. A Neo- Kohlbergian Approach. Mahwah, NJ: Lawrence
Erlbaum Associates, 1999, p2
25. Wray HL & Magnani L. Beyond Prisons: A New Interfaith
Paradigm for Our Failed Prison System. Minneapolis, MN:
Fortress Press, 2006
26. Tutu DM: No Future Without Forgiveness. New York, NY:
Doubleday. 1994.
27. Melchers M: How heritable is empathy? Motivation and Emotion
40(5) October 2016
28. Tyson NDG: Starry Messenger: Cosmic Perspectives on
Civilization. New York, NY: Henry Holt Company, 2022
29. Silverman JS: Free will illusion perverts law and human relations.
Capital Psychiatry, fall 2022
30. Sapolsky RM: Determined: The Science of Living Without Free
Will. New York, NY: MIT Press, 2023
2. The offender should have the opportunity for
repentance, reparation, and reintegration.
Acknowledgement, apology, and atonement are
the components of repentance. (Cf. The Truth and
Reconciliation Commission of Archbishop Desmond
Tutu)
3. Only by rehumanizing the perpetrator in the mind
of the survivor is forgiveness possible.
4. Offenders should be viewed as people out of balance
in need of rebalancing, not punishment. Confinement
in an atmosphere of negative expectations contravenes
positive change.
5. Offenses due to mental illness, drug addiction,
homelessness. and consensual sex should be
decriminalized.
6. Gang membership should be understood as attempts
at compensation for social deprivations and not as
inherently malign
7. A rehabilitation orientation should supplant the
penitential. Penal abolition should be considered.
Table 4. Antiscientific Policies
1. Although evidence indicates that the human frontal
cortex cannot fully control emotional impulsivity until
about age 25, most states allow 18-year-olds to
purchase military-style weapons.
2. Medical experts regard access to abortion as
imperative. But many states strive to reduce or
eliminate that access.
3. Misepristone has been safely provided for
twenty years, yet one federal judge, falsely claiming
dangerousness, sought to prohibit its availability.
4. Climate change denial has yet to be fully rejected.
5. The right of psychiatrists to commit patients
involuntarily for their own benefit still requires legal
approval in some states.
6. Public health officials’ guidance of the COVID-19
pandemic was challenged by many.

Jacques Lacan stresses the fact that schizophrenic
patients have a defective relationship to language
(Evans 1996, pp. 154-7). These patients have difficulties
with metaphors and metonymies (Lacan 2005, Ch 12,
20). Lacan finds ample evidence for his thesis in the
autobiography of Daniel Paul Schreber (Schreber 1903).
One of my patients explained to me why he as a mentally
ill person had difficulty with language. He said: “When I
look at the world with my senses, the world is infinitely
rich. When I describe the world in words, I lose the
richness of the sensual world. What am I supposed to do?”
This patient explained one reason why a schizophrenic
person feels it challenging to use language.
The use of language requires that one can deal with loss.
Lacan has told us that the schizophrenic person has not
been able to deal with the loss of his imaginary idea that
(s)he (the patient) is everything his(her) mother could
want.
For a schizophrenic patient, loss is difficult to deal with.
Hence, a therapist needs to help a schizophrenic patient
by presenting the patient with the language needed to
clarify her(his) world. Thus, if I like to know how the
patient came to my office, I do not ask the question:
“How did you come to my office?” I say something
like: “Some patients come by foot, some patients come
by bicycle, some come by bus.” The patient might then
answer: “I came by bus.”
By Wilfried Ver Eecke, Ph.D. Georgetown University
THE HEALING IMPACT OF THE SCHIZOPHRENIC
PATIENT USING HIS BODY TO DO SOME WORK

31
The first phase of my treatment of
a schizophrenic patient, therefore,
consists in trying to augment the usage
of realistic language, not the language
describing delusions. I will start by
describing in detail the objects in the
consulting room. With one patient from
a top U.S. university, I described for
45- minutes the figures and the colors
of the rug in my office. I never saw a
patient who more fascinated. I did for
the patient what he feared doing.
Furthermore, by listening to my
detailed description of an object in the
room, the patient must have had the
experience that he and I belonged to a
same world. Consequently, the patient
felt less lonely.
The next step of my treatment
consists in describing the objects
in the patient’s room in his or her
apartment or house. I say something
like “all rooms have windows.”
Your room could have one or two
windows. The patient might say: “One
window.” As I try to describe objects
in the patient’s environment, slowly a
positive transference develops. At this
point I start the working phase of the
treatment.
I also delegate the task of ending the
session to the patient. Consequently,
the patient has the last word in the
session. This strategy invites the
patient to become a little bit more of
an agent. I then invite the patient to
describe more in detail the objects in
his current and his past life. When the
opportunity presents itself, I invite the
patients to describe their experience
of their body. An easy opportunity is
offered when the patient reports pain.
When a patient complains about pain, I do not just
empathize, saying: “Sorry to hear that you have pain.”
Instead, I help the patient describe in detail where
the patient has pain. I wonder in what body part (s)he
has pain. I also encourage the patient to describe the
magnitude of the pain and its variation over time. After
several such sessions, one patient reported: “Before
coming to therapy, I was not aware of where I had pain.
Now I know exactly where the pain is.” The patient
became capable of experiencing her body.
Another opportunity to concentrate on the experience
of the body is to explore any kind of work the patient
is doing. Often, in the beginning of the treatment
schizophrenic patients have no job. But they are living
human beings and need to eat. One schizophrenic patient
is mostly mute. Hence, I must do the talking for and about
him.
This patient talks, nevertheless, about one topic: eating.
To use Freudian language, this patient can talk about the
oral dimension of his experience of the world. He became
able and willing to say what he has eaten for breakfast,
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lunch, and dinner. I then invited the patient to describe
where he eats and who makes the meals. The patient
reported that he helps his mother in preparing meals or
that he made the meal himself.
Later in the treatment he reported that sometimes he
went to buy his meal at McDonalds. I encouraged the
mother to let the patient help her in preparing the meals.
Currently, this patient helps with preparing the meals,
among others, by cutting onions. I pointed out that
cutting onions is dangerous. One can cut one’s finger. The
patient responded by saying that he first cuts the onion in
half and then in small pieces. This is as of now the most
sophisticated discussion we have had.
With another schizophrenic patient, the method of
inviting and helping the patient describe his cooking
has helped the patient increase his agency such that he
decided to get a job in a wine store. One strategy we use
is to try to link the current achievement and habits to
the historical past of the patient. In this case the patient
reported his interest and skills in cooking to the fact
that in his own family his father, a professor at a top
US university, regularly cooked. As a young child from
seven years on, he helped his father with cooking. We
invited the patient to describe what he contributed to the
cooking. On his own initiative, the patient reported that
as a teenager, he discussed cooking with his father and
the difference in cooking in Indian, Chinese, and French
cooking. This kind of discussion allowed the patient to
connect a current skill with his own history and allows
the patient to see who and how he has become who he is.
We made use of the part time job of the patient in the
wine store to invite the patient to describe the different
wines that he is asked to sell and to report on the
different customers. The patient, early on, reported that
there were regular customers. Some come every day. I
asked the patient if he has had conversations with some
of these patients. He reported that he does not start a
conversation with his customers. But then the patient
continued and said: “I should.”
Notice that I did not tell the patient that it is good to
talk to people, even customers. I brought up the topic
of conversation with the customers after the patient
reported that there were regular customers. We used the
patient’s work as an opportunity to increase his use of
language and thus his communication with people.
This patient also brought up the idea that in the evening
he is tired. His wife works until 5:00PM at home now. The
patient reported that he and his wife often walk at night
and on weekends. This allowed me to ask if walking is
not tiresome to his body, particularly his legs. The patient
responded that he likes small walks but on Sundays, he
Bibliography
Evans, D. 1996. An Introductory Dictionay of Lacanian Psychoanalysis.
London: Routledge.
Lacan, Jacques. 2006. Ecrits. Trans. B. Fink. New York: W.W. Norton
and Company.
Schreber, Daniel Paul. 1903. Memoirs of my Nervous Illness. Trans-
lated and edited by Ida Macalpine and Richard A. Hunter with a
new introduction by Samuel M. Weber. Cambridge, Mass.: Harvard
University Press.
Ver Eecke, Wilfried. 2019. Breaking through Schizophrenia. Lacan
and Hegel for Talk Therapy. Lanham: Rowman & Littlefield.
Villemoes, Palle. 2002. Ego-structuring Psychotherapy. In Journal of
the American Academy of LacaPsychoanalysis, 30, No 4, p. 645-56.
and his wife go for long walks, and he stated that then his
legs get tired.
After we had a positive transference, I brought up more
intimate topics. It is well known that schizophrenic
persons have an aversion to bodily expressions of love.
I started by asking if the patient and his wife sometimes
kiss. He answered: “We do that regularly.” He even
confirmed that he and his wife regularly have sex, but
lately less. This led to the question if the patient had any
idea why recently less.
The patient reported that his wife was worried about
her job. I told the patient that he might use their joint
dinner to ask his wife to talk about her worries in her job.
I pointed out that she might feel relieved in being able
to articulate her worries. The patient responded that he
found that a good idea. We were hereby able to help the
patient improve his empathy with his wife, a challenge
for schizophrenic patients.
Conclusion
From the above examples it looks like patients
suffering from schizophrenia have difficulty using their
imagination as to what they can do in their lives. I avoid
telling them what they should do. But it seems helpful to
present the schizophrenic patient with ideas of what one
could do. The patient then states what they intend to do.
In later sessions I then bring up what they said they were
going to do.
Sometimes they report that they did for a while what
they said they would do and they add: “I need to
continue to do it.” The active improvement of the life of
schizophrenic patients is a slow process. But, as the case
I have described show, active improvement in the life of
schizophrenic patients is possible. Getting them to do
some work is a big step forward.

33
BY H. STEVEN MOFFIC, M.D.
E S S A Y S

Recently, the editorial team of Capital Psychiatry
decided to encourage articles about what psy-
chiatrists like to do outside of work. Although
there are many other aspects of life that I enjoy,
especially any time with my wife, listening to jazz
music is way up there.
It started in high school, in Chicago. Somehow
I got to buying and listing to Stan Getz’s record
“The Girl from Ipanema.” Maybe it was the sexy
girl walking on the beach in Brazil or the sensual
bossa nova jazz fusion music of the recording
itself.
The next year, my first at the University of
Michigan, there was an older classmate across
the hall who loved jazz and played it often. He
exposed me to much of it, probably the standout
at the time being Dave Brubeck’s rhythmic inno-
vative song “Take Five.”
My interest spread and a collection of jazz albums
began, though it had to be restarted after the
first batch was stolen from my dorm room. I
guess there was another jazz freak out there,
or someone who wanted to get back at me for
something!
The Healing Aspects of Jazz
My interest led me to review some records for
jazz publications under the moniker of Dr. Jazz,
but that stopped after a few months of medical
school because time got short.
But I never stopped listening. The music seemed
therapeutic then and still does. Take the famous
Miles Davis cut titled “Kind of Blue.” Talk about
emotional empathy being conveyed in times of
sadness! How about John Coltrane’s “A Love
Supreme,” a spiritual source for whoever and
whatever you love? Charlie Parker’s “Now’s the
Time” can rally sagging energy. Anti-anxiety?
Chick Corea’s set of children’s songs.
There is a field called Music Therapy in psychia-
try. Some of the music used comes out of jazz,
especially for the rhythmic aspects. However, the
whole field of Music Therapy has been hit with
the for-profit managed care business control of
medicine and mental healthcare that wants to
spend as little money as possible.
Jazz in America
After I began my psychiatric career in commu-
nity and cultural psychiatry at Baylor College of
Medicine in 1977, jazz complemented what I did.
By then, though my introduction was to popular
white jazz musicians, it was clear to me that jazz
was a Black cultural innovation. I also had a posi-
tive Black identification in sports, given that my
favorite baseball player was Minnie Minoso of the
Chicago White Sox.
Both experiences must have thankfully overcome
any natural tendency to fear and scapegoat the
other, at least the other in terms of skin color. In
a parallel process, I was also beginning to under-
stand that my being Jewish was being the “other”
in a different religions and cultural sense, though
Jews were overrepresented in psychiatry at that
time.
Like jazz, the community mental health center
where I was Medical Director was overrepre-
sented by Black patients who historically were
often underserved and misserved in psychiatry.
Our multicultural staff paralleled the beginnings
of jazz in the early 20th century, where the jazz
audiences and groups were about the first places
where integration occurred in the United States.
Benny Goodman and his groups were an early
and popular example.
The record business paralleled the white control
of other businesses in the United States, includ-
ing psychiatry. And the improvisational interac-
tion of the jazz musicians seemed to parallel
how life was led, with planned structure, but the
inevitable improvisation along the way and in
everyday conversation.
My late best friend — who was the focus of my
article on friendship in the previous issue of
Capital Psychiatry — and I had one experience

35
where segregation went the other way. I was in
my internship in Los Angeles and my friend vis-
ited. We decided to go to a daytime concert in
Watts where an interesting Black band was to
play. We got there, but were told: “This is only
for the brothers.” My plea and providing infor-
mation on my record reviewing went nowhere,
and we left. All other occasions when we went to
jazz concerts in Black areas, and where we were
sometimes the only Whites there, we were wel-
comed with open arms.
The Universality of Jazz
Personally, the vignette of what jazz has meant
to me is illustrated by a presentation that I was
asked to do soon after I retired from clinical
and administrative work in 2010. I was asked to
speak on the role of jazz in ending apartheid for
a Creativity & Madness conference being held in
Cape Town, Africa.
The musician I featured was Dollar Brand, whose
name was later changed to Abdullah Ibrahim
when he converted to Muslim. One of his songs
was used as the musical theme for the opposi-
tion. As an aside, we used his “Wedding Song” to
accompany our daughter when she walked down
the aisle to get married. During my presentation,
my wife also sang America’s Lous Armstrong’s
“What Did I Do to be So Black and Blue?” Indeed!
When we opened the door to our meeting room,
the hall was lined with the Black staff who were
listening and dancing. What better confirmation
could we have received?
Dollar Brand had been noticed and publicized by
America’s Duke Ellington. That illustrated how
jazz became America’s unique musical gift to the
world. Wherever jazz has been introduced in the
world, it has become popular, that is, unless it is
a restrictive dictatorship. There was a time before
the Soviet Union split up when jazz was a forbid-
den music, although it did thrive in the under-
ground. The same with China.
During the “Cold War,” the Voice of America was
used to try to spread jazz music to listeners in
the Communist countries. I suppose some similar
case could be made for rock and roll, but rock and
roll started as much in England as in the United
States, with the Beatles and the Rolling Stones as
the prime examples.
Classical music spread from Europe to elsewhere,
but in a much more limited fashion. As a form of
music, jazz is also able to incorporate musical ele-
ments from other music and cultures, adding to
its universal appeal.
Even so, jazz has rarely been popular music for the
masses. It is often too sophisticated and unpre-
dictable in its musical structures. Although there
have been great jazz singers that use powerful
words, like Billie Holiday in her still racially riveting
“Strange Fruit” about lynching, for the most part it
is a nonverbal form of communication.
The kind of jazz called “smooth jazz” is easiest to
listen to and overall, more popular. But like all
forms of communication — reading, visual art,
and theatre, among them — there is more depth
and meaning if one wants more from music. If
so, learn more about the music and gradually
explore the more complex forms. You will likely
be rewarded from doing so, though we all have
our own musical preferences.
My Legacy
I’m a listener, not a player: I only played the
accordion briefly for my Bar Mitzvah. Though I
occasionally think of picking it up again, it’s not
much of a jazz instrument.
By now, my record and compact disc collection
has grown to the thousands. So, when I think of
the legacy I may hope to leave the world, some
of it, of course, is with the patients I helped and
students that I taught and mentored. In my per-
sonal life, it is in the positive, intimate, and heal-
ing relationships that I have had with loved ones,
acquaintances, and strangers. All these relation-
ships have potential rippling effects.
Then there are my more academic psychiatric
contributions that are left in print and videos.

These include multiple edited and written books,
hundreds of articles, and online videos. Some
of these were on jazz, including a chapter about
blind African American musicians that I did for
the innovative new book “Lenses on Blindness:
Essays on Vision Loss in Media, Culture, Religion
and Experience,” edited by the psychiatrist
Sharon Packer. I now do a daily weekday column
for Psychiatric Times on the Psychiatric Views on
the Daily News and a weekly video for the online
psychiatric newspaper on Psychiatry & Society. All
that is out there be as it may for people to find
and use.
The challenge now for me is where to find a
home that will value my jazz collection as much
as I have. I’ve become more optimistic of that
potential as the popularity of records has been
escalating once again. If you know of any poten-
tial homes, let me know!
Now and then, during medical school and psychiat-
ric residency, I wondered what I would do if I didn’t
make it in medicine and psychiatry? Well, no surprise.
It had to be something in jazz. A disc jockey (DJ), per-
haps, on the radio was one option, though at that
time I didn’t like to speak in public. Either that and/or
being a writer on jazz. Record reviews was one idea,
writing articles and books was another.
By now, books on jazz have become quite volumi-
nous. But here is an annotated list of some of my per-
sonal favorites that cover some of the topics I’ve just
discussed.
1. Geoffrey Ward and Ken Burns: Jazz: A History
of America’s Music. Knopf, 2000. Here it is. Ken
Burns, America’s videographer, also says that jazz
is America’s music. This is the companion volume
to the Burns’ 19-hour series that aired on PBS
in January 2001. There is also an accompanying
compact disc series to hear much of the music that
is discussed Although it is an extensive and artistic
history all forms, it tends to be on the conservative
side of jazz history.
2. Gioia: The History of Jazz, 3rd Edition. Oxford
University Press, 2021. This is a more updated and
socially minded view of jazz history. That it is in its
3rd edition indicates how well received it has been.
The new edition adds the overlooked women who
have shaped jazz and who are now much more well-
represented in all aspects of the music, including all
women bands.
3. Jones Leroi (Amiri Baraka): Black Music. Akashic
Books; Reissue edition, 2010. In the early decades of
jazz, despite most of the musicians being Black, the
writers were mainly white. Leroi Jones, now known
as the late Amiri Baraka, was a notable exception.
Focusing mainly on the more “free jazz” of the sixties,
the music is put in the social context of civil rights.
4. Eugene Marlow: Jazz in China: From Dance
Hall Music to Individual Freedom of Expression.
University Press of Mississippi, 2018. This is a
fascinating volume in a time of China’s rise to power
as a Communist state. Jazz reflected the changes of
China’s leadership over the last hundred years. It
was introduced successfully in the 1920s; when we
visited China about a decade ago, it was striking to

A Collection of Poems that Refutes the Binary in Favor of Imaginative Plurality

A Collection of Poems that Refutes the Binary in Favor of Imaginative Plurality

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