A new patient, "Ben H.," says he is deeply troubled by the recent shootings in Colorado and needs to talk. He is a tall, handsome, familiar-looking man who is often seen with a rifle slung over his shoulder. He complains of insomnia and his friends complain that he keeps them up at night speaking in somewhat Seussian cadence about "a handgun, a long gun, a small gun, a large gun, a black gun, a purple gun, an ugly gun ... Saturday night specials, plastic guns" and so on.
Chief Complaint: Ben H., as president of the National Rifle Association, laments the lack of armed teachers and janitors in the schools (he refuses to use the PC term "buildings and grounds people"). "If there had been even one armed guard in the school," Ben H. says, "he could have saved a lot of lives and perhaps ended the whole thing instantly.'' I wonder if he knows that there was an armed guard at Columbine. Where is my guard stationed, the patient wants to know. Is he under my couch?
History of present illness: The acute phase of Ben H.'s illness began after the Colorado incident on April 20. He now finds himself excited, unable to sleep. As terrible as this is -- does he mean his insomnia or the shootings? -- at least it shows the nation how important it is to have free and easy access to firearms, he says. It proves to him once and for all that guns don't kill people. When the Bureau of Alcohol, Tobacco and Firearms announced that it took them four days to trace the sale of the murder weapons, Ben H. was appalled. "How dare they act so quickly," he remarks. Infuriated, the patient says we need to take the privacy of freedom-loving gun purchasers more seriously, as the bumper sticker on his car proclaims, "Guns Don't Kill People: Loss of Blood and Damaged Internal Organs Kill People!"
Clearly in a state of emotional pain, Ben H. fears that this tragedy will wrongly mobilize anti-gun forces against him. It reminds him of the ancient tale about a group of wandering Jews who defied moral leadership (is it Ben H.'s moral leadership?) by worshipping a golden calf instead of a Remington. As head of the NRA, Ben H. fears that people will no longer honor their fathers. Until the shootings, Ben H.'s obsessions had been relatively quiescent with occasional eruptions during various speeches he'd given since becoming the organization's president in 1998. A year earlier he had said, "AK-47s are entirely inappropriate for private ownership." He then followed with, "Hear and obey! Let my people go!" That last statement gives me an insight about his isolated delusional system.
Medical and psychiatric history: Ben H. has no significant medical problems and continues to look extremely strong and well-oiled.
Referral source: Ben H. had a longtime friend named Dr. LJW who was a psychiatrist and man of great courage. In fact Ben H. is also a man of courage whom I realize I admire -- once it occurs to me who he is. But because he constantly rambles on about guns and cross-hairs aimed at the Second Commandment (I think he means "Amendment"), he's hard to recognize. I know that in 1960 he bravely stood his ground against restaurant owners in Oklahoma who were refusing to integrate their lunch counters. He chose me in particular because he thought that my uncle was Frederick M. Frank -- the man who wrote "El Cid," "The Ten Commandments" and "The Greatest Show on Earth." In fact, my uncle Freddy is a hair dresser.
Past history: As a child growing up in the Michigan woods in the 1920s Ben H. spent a great deal of time alone. He was the oldest of three children by the time his mother left his father and took the family south. What was striking was his determination as a young boy -- he hunted to put food on the table, he held many jobs to earn spending money, he was a loner. His parents divorced and he took his mother's family name and his stepfather's last name as his own. He was never himself even in childhood, having been born John Carter.
Acting was a perfect profession for the young John, soon to become the young Ben H. As he wrote in his autobiography, "I retreated even further into the pretend games I'd entertained myself with all my life, finding better guys to be than I was." What frightens him now is finding out that he no longer knows whether he is pretending or just being himself. Maybe he is Moses. Who can say for sure?
Mental status: Ben H. is an extremely handsome, seemingly self-contained man who in actuality doesnt know where or who he is. He isnt even clear about the time he lives in: At one moment he thinks he is on a ship landing in Boston in 1633, a few moments later he believes he's wandering in a desert carrying some tablets. Then suddenly hes a fur trapper in the Rockies saying, "Ain't never been lost. Been fearsome confused once or twice, mebbe." He stays confused -- not just about time and place -- about person, about who he is. At one point he offers to paint the ceiling; then he wants to chop up the wood frame of my couch for extra kindling.
Because of his personal disorientation, completing a mental status exam is next to impossible. Insight is good unless one thinks about that bumper sticker. Same with judgment. He can do routine addition and subtraction and his memory is satisfactory, though cluttered with chariot races and apes.
Interview: He keeps talking about the First Ten Commandments and the Bill of Rights. "Thou shalt not kill" and the Second Amendment get blurred together. In his mind, Honor thy father changes to Become thy father. He speaks of a recurring nightmare in which he climbs a circular staircase to rescue a princess, only to find a witch jumping out at him and sending him hurtling out into the dark. Does this mean that whenever he chases after a damsel or an automatic weapon, he expects to be confronted by a hag-witch or a protester?
He believes he is a "moving target in the cross-hairs of the anti-gun movement" which aims -- as it were to take away our most precious freedom. He remembers that his stepfather, Chet, had his right index finger cut off in a printing accident when Ben H. was in high school and deciding to become an actor. He also keeps mumbling that he is not a "rustic, reckless radical." I think he is more restless than reckless.
Formulation: This is a tough case to crack, as Ben H. clearly has a long history of acting, and occasional heroic behavior. Yet he is never himself, saying just this year that he "pretends to be other people." I believe he yearns to be inside another man, in any way possible. If he could not have a father he could be one, first to his own family and later to the whole of the world, having played God, Moses and John the Baptist. He turned the tables on his real father completely, rejecting even his name. But his stepfather's accident is for him a symbolic castration, throwing him once again back on having to become someone else in order to remain a strong man. Finally Ben H. got a father who could never disappoint -- God Himself. And the more matzos he eats, the more powerful he feels. Then, once Ben H. arms himself with a long rifle, he becomes invincible. He says he can "resist with deadly force any assault on our homes." And he can continue saying, "I am who I am" with impunity, as well as with immunity -- from anti-NRA lawsuits.
Diagnosis: Isolated messianic fixation to compensate for castration anxiety. Ben H. uses both guns and identification with God to achieve a sense of security and safety.
Treatment plan: Mourning the loss of his own father should help with Ben H.'s messianic delusional system. He then can put the pop back into the old popgun. However, only Viagra -- since dead children in Colorado don't seem to do the trick -- will help him to totally relinquish his long rifle.