At the Menninger Clinic in Topeka Kansas where I trained, trauma was becoming a hot topic, and more and more patients diagnosed with PTSD or dissociative disorders were admitted to the units. I had a plenty of opportunities to see these patients and attend lectures on the topic. Some dissociative patients reminded me of several patients that I saw while I was practicing in Japan. They displayed occasionally some uncharacteristic behaviors and became amnestic about it. I classed them as difficult-to-diagnose patients, without making further attempt to understand what they were really suffering from. Human being has a habit of denying and neglecting those who we don’t understand, and it was a good example.
I reminisced especially about a case A , a young female university student and one of my initial cases on the unit. She was a shy and passive woman who however displayed many characteristic behaviors that dismayed me as a neophyte psychiatrist. A occasionally became dazed or suddenly behaved in a very uncharacteristic way that was oblivious of later on. A was dating a young man, who reported that she sometimes talked like a small child. When he was about to leave A for someone else, she got really agitated and violent, that necessitated a psychiatric hospitalization to our unit.
A was a sort of diagnostic puzzle for us. Some senior psychiatrist suggested that she be best understood as a borderline case, which sounded reasonable to me. In a sense, A showed the idealization/devaluation pattern typical of borderline personality disorder. She seemed frightened at the idea of being left alone, which also matched the profile of borderline. However, it really puzzled me that A sometimes appeared a different person and did not remember most of that time.
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