“The diagnosis of Depression,” our psychiatry lecturer said in a thick Caribbean accent, “is made with the gut. You make the diagnosis by studying your own reaction to the patient. The depressed patient looks depressed. The depressed patient expresses depressing thoughts. And, after you have interviewed the patient for a bit, you yourself feel depressed. Listen to your gut,” he admonished us.
It was an oversimplification, of course, but the underlying message was that, if we are paying attention to our patient, their affect, their thoughts and their mood, all affect us. Sometimes, the patient’s mood in incongruous with the content of their thoughts.
Imagine that you are talking with an individual who has just caused the death of someone else. The person is expressing profound remorse for what is supposed to be an accident while wearing a broad smile and describing the event in a cheerful demeanor. “WTF?” you say. Their affect is incongruent with their thoughts.
I thought of this while watching segments of Emily Kohrs, the Georgia special Grand jury foreperson, being interviewed about the testimony she had heard. Her affect was ebullient and at times fawning as she described meeting witnesses like Rudy Giuliani and Lindsey Graham.
Think about it. We’re talking about the testimony of people who were witnesses, if not participants, in an insurrection against the government of the United States – an event that was the proximate cause of multiple deaths. And she is smiling and laughing? Something doesn’t add up here.
I’m not a psychiatrist, but over a 30-year career, I have interviewed thousands of patients. I have learned to listen to my gut, and can tell when something isn’t right. Ms. Kohrs’ responses and affect are about herself – not about the Grand jury witnesses. It’s all about her, her need for recognition, about her 15-minutes of fame, as it were. Does she have some other deep-seated psychopathology? Almost certainly.
How hollow and unrewarding does your life have to be to get you in front of the camera to tell what you know about a legal proceeding like this? And if you think this behavior is normal, where are all the other Grand jury jurors?