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About Dr. Allison

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TO BE OR NOT TO BE
THAT IS THE QUESTION
by 
Ralph B. Allison, M.D.
(With thanks to W. Shakespeare)

Submitted for Publication 
October 10, 1993
to
Bulletin of Anomalous Experience
David Gotlib, M.D., Editor
1365 Yonge Street, Suite 200
Toronto, Ontario, Canada M4& 2P7	

Much of the debate about the stories told therapists of
abduction by UFO's or Satanic Ritual Abuse in families may be
the result of difficulties the therapists are having rather than
the problems of the patient.  Patients approach advertised
professional therapists, expecting treatment for what ails them,
and the therapists may have difficulty deciding what role to
play.  Their common choices are Shaman, forensic reporter, or
detective.  I suggest that it is impossible for one person to
play all of these roles with one patient/client/suspect. 
Attempts to do so may have been responsible for much of the
debate about whether the patient/client/suspect is telling "the
truth."   I should know, since I have tried to play all these
roles myself, at one time or another, and I now realize the
futility of such an unrealistic attempt to be so "flexible" in
one's professional life.  This is especially true when dealing
with certain types of patients.

	Most individuals who come for therapy have a degree of inner
anxiety that has risen to a level that they can no longer stand.
They come for "diagnosis and treatment" to one who has publicly
offered to play a helper role to the general public.  What the
patient needs is a Shaman, someone whom they invite to join them
on their shamanic journey.   Together, they can explore the
world of ideas, emotions, fantasies, and physical discomfort in
which the patient resides.  Patients are very particular about
whom they invite along on such journeys.  They need someone who
can share their experiences, who can accept what they experience
as valid (in contrast to bad, evil, or worthless), and one who
has taken sufficient previous similar journeys so that he/she
can help the patient make sense out of the trip.

	I use the word Shaman as the ancient term to describe the
healer the tribe recognized, but today that person may be called
doctor, physician, psychotherapist, therapist, psychologist,
healer, counselor, guide, support person, etc.  When I attended
medical school, no professor even mentioned the word "Shaman,"
and I did not become acquainted with the extensive history of
this professional role until I met anthropologists who studied
healing methods around the world.  Some of them had learned to
be Shamans, and they described the shamanic journeys they went
on in the "other world" where animal spirits were seen as
protectors of them and their patients.  Only then did I realize
that, during my years of psychotherapy practice with
dissociating patients, I had "invented" a number of shamanic
techniques.  In discussions with these "anthropologists of
consciousness," I learned that my "innovative" techniques had
been in use for centuries in many cultures around the world. 
Since no one had never taught me any of these procedures in
medical school or psychiatric residency, I thought I was being
creative when I "invented" them and used them with dissociating
patients.

	After my formal psychiatric training, I attended hypnosis
classes and Mind Dynamics courses, and I watched rituals
performed by a priest who had trained with a Native American
medicine man.  I also realized I needed to have "symbolic"
techniques that transformed mental concepts of my patients into
three dimensional reality.   I "invented" techniques to assist
my patients' progress through their torturous mental journeys. 
My overriding goal was to bring the patients to a state of
improved mental health, so they could lead productive lives in
our 20th century environment.  That goal had been drilled into
me during my medical and psychiatric training.

	While going through shamanic journeys, patients told me strange
stories about their histories, past lives, family members and
significant others.  Once, a dissociating patient reported, in
hypnosis, that she had killed her stepfather and his two friends
after they had attempted to kill her.  When she was awake,  I
informed her what she had told me while in trance.  She picked
up my phone to call the police and turn herself in.

	I asked what evidence she would give the police to demonstrate
her guilt for three "murders," as she had described hiding the
bodies in distant states and in Canada.  After she decided she
had nothing physical to prove her "memory" was accurate, she put
down the phone.  As her mother was her only financial and moral
supporter at the time, I resisted the urge to play detective. 
If I asked the mother what had happened to her second husband,
she would want to know why.  If she thought her daughter had
killed him, that could destroy my patient's support system.  On
the other hand, she might have met him for lunch the previous
week, for all I knew.  If that were true, what was I to tell the
patient?  Satisfaction of my curiosity was not worth the risk of
either outcome.

	Other patients have ended up in the hands of police and courts,
who looked to me, as the therapist, to explain what was going
on.  Then I was forced into the role of the forensic reporter,
where my goal was different, but the patient/suspect was the
same.  What was I to do?

	In an ideal world, I could have stayed out of the legal arena
and insisted that the legal authorities bring in an outside
expert to advise them. Once, I was the Program Chief of the
local mental health service and one of only two psychiatrists in
the county.  My office partner was the other one, and he had
enough work to do without taking on my cases.  Also the legal
authorities often considered me the only one knowledgeable about
the patient/client/suspect, and they expected me to tell them
enough to solve the legal problem without harming the patient. 
They had no desire to convict a mentally ill patient of mine if
I could give them valid reasons not to do so.

	A forensic reporter plays a completely different role with the
client and is assigned to the case by a court or defense
attorney.  The reporter must quiz and examine the client to
determine evidence of mental illness, as he would any patient,
but his/her database is much larger than that used in a therapy
situation.  The reporter must review whatever documents are
available that might enlighten him/her about the client's past
behavior. Some of these documents have primary information, such
as school or hospital records, but some have only secondary, and
possibly unreliable, information, such as police interviews of
witnesses and accomplices.  Sometimes attorneys will hide
important documents from him/her when they are trying to bias
his/her report in a direction favorable to their clients.

	The forensic reporter is beholden to the legal authorities for
payment, and those officials must understand his report.  The
authorities ask questions that are in the involved legal
statute, and the report must address those questions or the case
will be referred on to other experts for further evaluations.
The reporter is not in the position of providing treatment to
the client, who may now be under the care of a jail physician.

	When I was the only psychiatrist in a slum area mental health
clinic, I treated many psychotic patients.  One of my delusional
patients invaded an elderly couple's home and accused them of
stealing the house from his cousin. The police arrested him and
took  him in the county jail, where I conducted psychiatric sick
call every Tuesday afternoon.  I told the public defender this
man was mentally ill, without giving details.  He asked the
court for a psychiatric examination regarding competency to
stand trial.  The judge appointed  me to be the forensic
reporter on the case.  I responded that he was incompetent to
stand trial.  The law required a representative of the Director
of Mental Health to recommend the proper place for treatment,
and the director asked me to write that report, advising
admission to the state hospital.  When the hospital's staff
recommended his return to court as competent, the judge asked me
to write the report about his ability to stand trial.  When the
defendant pled insanity, I wrote the report on that issue also,
with a recommendation that he had recovered his sanity and could
return home.  After release, he resumed treatment as my clinic
patient.

	That is not the way these matters are supposed to be handled,
as the chances for a conflict of interest on my part were
rampant.  But in that small county, where I had a number of
assignments while working for the mental health service, the
officials trusted me to be ethical and professional in telling
them what I wanted to about my patient. After his arrest, I
switched roles every time I saw him.  Fortunately he was a
chronic schizophrenic and not a dissociator.  He did not appear
to suffer from the changes in our relationship, as he was
usually in his delusional world.  That would not be true when
the patient/client is someone who has a severe character
disorder, especially someone who used dissociative defenses
extensively.  With those patients, severe transference and
countertransference problems will inevitably arise.

	The third role we therapists are tempted to play is detective. 
That is the one I see as causing the trouble leading to the
rhetoric surrounding the debate over true or false memories, be
they Satanic Ritual Abuse or UFO survivor stories.  To some
degree, I blame TV for fostering the idea that anyone can be a
good detective, that none of us need training or experience to
solve crimes.  Certainly, none of us therapists need be aware of
the rules of evidence adopted by our criminal courts!  

	Two of my favorite shows are "Murder She Wrote" and "Father
Dowling Mysteries."  Every week, I see examples of a writer,
Jessica Fletcher, outwitting the local sheriff and identifying
the killer each time.  Where does she get the time and energy to
track down the clues needed to find so many criminals in her
small town, when she should be doing research and writing every
day?  Why doesn't the sheriff ever find the criminal with his
own staff?

	In "Father Dowling Mysteries," I see a priest and nun, Sister
Stephanie, totally neglecting the daily duties of the parish and
traipsing all over town chasing down crooks before the police
even know someone has committed a crime.  Where do they find
time to do all that investigative leg work, while they are
locked in freezers and dressed up as bug exterminators, when the
parish has a long list of activities they should attend to? 
What bishop would put up with such negligence for long?

	Shows like these, plus many others, give the impression that
detective work is suitable for the amateur, and it is not!  I
have had numerous patients tell me stories of incidents that I
wish I could check out.   For example, one dissociating patient
went into a spontaneous trance and told me that her first born
daughter, who had been taken from her by her grandmother and
adopted out at birth, had just died in a car crash at a
designated rural intersection in Fresno county.  For the first
time, I had a story I could check out, but I had no idea how to
persuade the Highway Patrol let me see records of accidents in
Fresno county on the day reported.  Three days later, I learned
from her Inner Self Helper that the imagery had been concocted
by her inner therapists to give her a chance to grieve over the
loss of that child.  There was no accident!  Fortunately, I had
not contacted the Highway Patrol, so I avoided looking like a
fool, had they had been cooperative enough to investigate my
story and learn no such accident had occurred that day at that
intersection.

	During my first year of providing psychiatric services in
prison, an inmate with multiple personality disorder told me
that, before his arrest for car theft, he had shot 11 motorists
on the highways of our state.  As an employee of the Department
of Corrections with a responsibility to report crimes inmates
admitted committing, I sent a report to the prison Security
Squad. They forwarded the report to a department in the Central
Office that investigates such stories.  They checked every
county this man had lived in, according to his police records,
and found no reports of shot motorists on any highways anywhere
in those counties.  The Security Squad officer relayed this
information back to me, but I never told the patient.  Later, I
discovered that the alter-personality that reported these
"killings" was one that was there "to get the attention of the
doctor."  He only came out when he felt that I was not taking
the patient seriously.  Then he would say and do something that
no one could ignore.  He performed his mission very well!

	The other factor that therapists seem to be unaware of is the
change in the Shaman-patient relationship that must occur when
the Shaman tries to be a detective.  The Shaman is privileged to
be invited along on the mental journey with the patient, and, to
stay invited, the Shaman must appreciate and accept the reality
of the journey.  This does not mean that the Shaman has to agree
with or like everything the patient says or does, but he has to
identify with the patient enough to be able to understand what
the patient is experiencing.  When one dons the uniform of the
detective, one must consider all persons involved as  possible
suspects, and one must doubt the veracity of any suspect.  A
professional investigator also keeps secret what previous
suspects and witnesses have told him, so that a subsequent
suspect will not know what to confirm or deny to keep a
fabricated story straight.

	During my involvement in a malpractice case, an investigator
from the California Medical Board interrogated me regarding the
actions of a misbehaving psychologist. The investigator was a
former police officer who tried hard not to brag about how much
he had learned from other witnesses.  I tried my best to get him
to tell me what he already knew so I could emphasize the points
needed to counter what the psychologist had said that cast me in
a bad light.  We played cat and mouse with each other, since I
wanted to make myself look as good as possible. Only by being
the subject of an investigation did I come to appreciate the
relationship that develops between the interrogator and the
witness or suspect.  The investigator must be suspicious of your
every word, and he will not believe you unless you agree with
other reliable sources.  In my case, I used his personal pride
to get him to tell me what the other witnesses had already told
him, so I could be sure to include facts favorable to my
position.

	When a therapist has had an accepting relationship with a
patient and then turns into a detective, the patient will
perceive the therapist as "not trusting me."   This change can
forever cause the patient/client/suspect to refuse to divulge
any more secrets to that person.  Therapy will cease
immediately, and any new therapist who tries to gain the
confidence of the patient will face doubt and mistrust in return.

	All therapists are curious people by nature, or we could not
listen to so many tales of woe.  But, if our goal is the
improved health of the patient who came to us with pain and
bewilderment, then we must stay in the role of Shaman.  The
patient has graciously invited us to share the journey so that
we, as Shamans, can add our own experience, judgment and insight
to that of the patient, so that together we can find meaning to
and resolution of the patient's plight.  When our patients are
in legal trouble, someone else should be the forensic reporter,
while we continue to support them through this part of their
journey.  We must let the professional detectives do the job
they trained to do, to ferret out the "consensual truth" and
determine who are the liars.  Detectives cannot be therapists,
and therapists cannot be detectives.




  Copyright© 2017 - Ralph B. Allison