another rubric puzzler

[Rosemary Hyde]

Yesterday, I did an intake interview with a patient who will undergo mastectomy next week as the initial treatment for an aggressive form of breast cancer.

One of the unusual features of this person's presentation is that she feels absolutely omnipotent -- totally convinced, for instance, that she can "visualize" away the cancer in the next week (she's demanding a follow-up mammogram before the surgery to see how well her visualizations have succeeded). During our interview, her cell phone rang several times, and rather than turning it off, she answered each call and proceeded to order about the people calling her -- she apparently has a virtual army of folks running around doing errands for her. It included a strange conversation where she was giving orders to the surgeon about the liposuction of her hips and buttocks she wanted along with the mastectomy (he was gently refusing, but it didn't deter her).

Her past history has included several dire injuries and illnesses that she apparently glided through almost magically, so I'm sure that set of experiences buttresses her feeling of omnipotence. (One of these was losing a huge piece of her skull and frontal lobe after a teenage accident as a daredevil horse rider, an injury which I'm sure is responsible for her living in a total fantasy world, believing that everyone in her present life played a role in her previous lives, which she claims to know in great detail -- the novels in which she lives assure that she'll never need to read one for diversion. She manages to compartmentalize this psychotic part of her life very well, since she's also a highly successful trial lawyer -- talk about polarities in one person!! But this is not part of what needs to be cured in her perception -- it works for her. It's important only in that we can't know how it relates to her delusion of omnipotence, which does cause problems in her personal and family life, which she described thus: "it sucks.")

In any case, assuming that her extreme state of denial is part of the case, I'm looking for a rubric that characterizes delusions of personal omnipotence -- no supernatural aspects to it. Obviously, "haughty." But is there a rubric that gets the wildly unrealistic aspect of this individual's haughtiness?

I thought this might produce some interesting discussion, for others as well as myself. I'm discovering that others' puzzling rubric searches resonate surprisingly often with my own.

Rosemary Hyde
[Non-text portions of this message have been removed]

[Joy Lucas]

Dear Rosemary, many of the Delusions around superiority and everything
seeming smaller, (PLATINA) also contempt for others, cannot bear
contradiction (ASTER - prominent breast cancer remedy), + courageous and
fearless re: her past activities + Opium (doesn't see or feel the fear or
the real situation) - just for starters

Best wishes, Joy
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[Rosemary Hyde]

Aster, a remedy with which I'm not very familiar, on cursory reading seems
really possible for this patient. Of course I'd thought of Platina... Both
sides of her polarities seem to be on the manic side, so I don't see Op in
her. Thanks, Joy. Rosemary

[Jon van Hoffen]

Dear Rosemary,

Would Delusion is superhuman (cann-i) cover this? Or Delusion of immortality
(anh.)? Delusion is a great person has a few more remedies.

Jon van Hoffen

[Dale Moss]

How about MIND, audacity? There seems also to be an obstinate quality to her overwhelming self-confidence, so MIND, obstinate. Also, MIND, delusion, she is all-powerful.

Do you have any feeling that without that delusion of omnipotence, she'd suddenly crumble? It appears, as you say, as if this delusion has served her well in many ways. What's going to happen to her when her visualizations don't magically reverse the cancer? Is she likely to go into deep depression?

I used to be married to a lawyer and did a fair amount of writing for trade magazines on lawyers and their problems. For one piece on lawyers and job stress, I approached it thinking depression would probably be the #1 problem for members of the bar -- only to discover that what psychiatrists were really seeing was obsessive-compulsive disorder. The reason? I'd speculate that a lot of people go into the law thinking it's going to give them absolute control over their lives; then they find out it's just the opposite, which can exacerbate likely latent obsessive-compulsive characteristics.

Peace,
Cinnabar