Contemporary Rorschach Interpretation

By J. Reid Meloy; Marvin W. Acklin et al. | Go to book overview

disruptive aspects of Dr. W.'s emotional state contributed to a disorganization of his ability to attend, concentrate, and process information accurately. Depression could account for some, but not all of his performance variability.

Tasks requiring verbal skills were generally better than tasks with a motor component. Memory, as assessed by the WMQ and TPT Memory, was in the intact and/or superior range despite the reported complaints by the patient. This may have been due to the purposeful effort put forth by Dr. W. for his "performance" that overrode the "hypothetical limited capacity attentional system" ( Kaszniak & Christenson, 1994). He does well when compared to most adults, but as a surgeon, his findings are unexpected. His generalized mild deficits in information processing are exhibited in both neuropsychological testing and on the RIM, especially the Cognitive Triad. He will likely continue to have problems in grasping spatial aspects of relationships with implications for his surgery skills. Compensatory verbal mediation will help but only partially. He can "talk the talk" but has trouble "walking the walk" (W. Lynch, personal communication, March 15, 1995).

Based on these findings, I referred Dr. W. for psychiatric evaluation and treatment and consideration for medication. I specifically requested assistance from the Department Head of Psychiatry who was a senior officer for two reasons: enhanced prestige in case "mano à mano" conflict occurred, and to add credibility to the consultation in view of Dr. W.'s general lack of motivation and psychological curiosity. Due to the "macho" environment in which we existed, and as a junior female officer, I felt he needed the enhanced "horse power" of a senior male. Perhaps there was some devaluation in our interaction of which I was only minimally aware. He agreed to this, was evaluated, and was placed on an antidepressant and continued in psychotherapy for a brief period of time.

As a result of the neurological and neuropsychological consultations, the Medical Board was dropped. Dr. W. was allowed to complete his residency and was transferred to another U.S. Naval hospital, where he performed competently throughout his 3-year assignment. Unfortunately, he was passed over for promotion due to the negative fitness reports he had compiled while in his residency, and he then left the U.S. Navy to begin competing in the civilian sector.


EPILOGUE

Not surprisingly, Dr. W. had continuing interpersonal difficulties and "misunderstandings" in civilian medicine. In one situation, he and the hospital he worked at "squared off" and entered the legal arena regarding issues related to Dr. W.'s educational time. He then went to a practice in the "Heartland" and left there after interpersonal difficulties. A few years ago, he was hired by a Veteran Affairs Medical Center and has since performed well. As readers are aware, some systems work better than others for certain personality types.

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