25

It’s a gratitude day. 25 years clean and sober.  I take my cake this coming week at my home group Burnaby Men’s with George insisting he’ll bring the cake.  I joke and say we celebrate the sacraments of cake and coffee of Bill and Bob.  It’s a long fast.  Thankfully the hang over goes in weeks to months though we clean up the ‘wreckage of the past’ for sometimes years’, making amends and just living sober.  

I was a binge drinker . Much of my life was intensely dedicated but I was attracted to the ‘chaos’.  I married women who shared my pleasures.  My family was orderly by comparison.  So much alcohol and mental illness with those I was attracted to or what I attracted.  I wasn’t called ‘Wild Bill’ because I was tame.  Always the first to dance on tables and do anything on a dare.  

I remember at Homewood Treatment Centre, Graeme Cunningham saying to me ‘some people run with the cheetah’s and some people run with the turkeys, you’ve been running with the turkeys’.  My dad called them ‘fair weather friends’.  He was what men called a ‘straight shooter’.  I regret that I didn’t listen more to him.  He transformed from the stupidest man I knew as a genius to the greatest man I knew as an adult.

When I stopped drinking, smoking tobacco and cannabis, so much of that life paled. We joke and say an alcoholic 10 is a  4 with a 6 pack.  Just so much of what people do when they’re drinking has no appeal sober. Like staying up late. I love the dawn now.  I love waking refreshed and alert. I can’t imagine why I would suffer a hangover and then go back and do it again.  

I can’t imagine today ‘not living life on life’s terms’.  I don’t want to be ‘dope dumb’ on marijuana joking about how stupid we talk even if it is like taking valium and relaxing. I don’t want to knee jerk emotions of alcohol and I never want the lack of peace of mind or the ability to appreciate a natural high.  Jesus said we must be like children again to enter heaven.  I remember thinking pot was coming out of my fat cells when I regained the natural love of life and joy de vivre. 

 Do you now remember the joyful times of childhood? a celebrity friend in recovery said to me.  

Suddenly I remembered myself playing baseball in a radiant green park with happy people and a glorious sun.  When we are depressed we remember depression because we are in the valley of our minds. Only on the peaks can we see all the joy of the truly high places as well as the lows and valleys of life.  Drugs and alcohol are depressing.

Asked to remember all the things in life I was proud of and would like to be remembered for I realized that the vast majority of them occurred sober, family and church and childhood, hunting and fishing, the great romances, provincial gymnastic and volleyball competitions,  dance training and competitions, theatre performances,  cycling across Europe, study of history and literature, studying  chemistry and anatomy, medical school training, working as a country gp, delivering babies, flying doctor through the sub arctic, residency training in community medicine and psychiatry. Then psychiatry and another divorce and alcohol abuse. Then work continued but my recreation increasingly was associated cigarettes, reefers and wine.  I’d gone camping to tent and fish but now looked forward to drinking a bottle of wine and smoking a joint around the fire. There was a shift.

At first it’s fun , then it’s fun and trouble, then it’s trouble..  I remember it being trouble sailing down to Mexico and then in Mexico, Instead of sailing around the world my partner and I stayed in margaritaville.  There were good times.  Sailing was spectacular.  Playing blues in the band was fun. Spear fishing and snorkelling and sun was great but it was going nowhere . When we came home she wouldn’t get help.  I didn’t want to be around her friends or my friends that drank and drugged. I’d liked her because she had her own group of dealers and prayers . Her’s tended to have university degrees but were no less ‘friends in high places and low places’ while I had friends who were interesting the sober ones in high place and the ones who crank and did dope professionals and bikers and rural.  

She would get so impaired she couldn’t work. I’d party on the weekend but I’d go to work and I was seeking help seeing professionals and told that my problems wasn’t the joint or wine I drank but the impaired wife doing cocaine. The lying and destruction increased . My unforgettable line was , “I can go to work and help. a hundred people or stay home and help one person. I can’t do both.”  I’d been years of covering for her.  I was so tired of being told a man would handle his wife. She was not a pretty site drunk and stoned though we’d both been younger. We were passed the magic forty year old place where you’re expect to be able to get your act together.  She lied and lied and lied.  It was impossible.  I never liked cocaine but she sure did.  I didn’t like the people around cocaine either. I’d liked the hippy wine and reefer world but this cocaine crowd was mean. My former friends who had fallen to cocaine were the same.  We joke that an alcoholic will steal your wallet but an addict will not only steal your wallet they’re help you look for it.

I just couldn’t carry on. I was working harder than I’d ever trying to cover for her when she suddenly refused to get out of bed forever or see a doctor. I knew this couldn’t go on.  She’d had a grow operation and with friends of her. She’d moved all the money I made into her accounts except for what required my signature.  In the end it was apparent that she’d been financially scheming for a year.  I remember thinking I’m trying to make this work and she’s been stabbing me in the back.  Separation and divorce.  The times she almost killed me and the times drunk when she almost killed us both. I saved our lives so many times, the worst being when I went off the bow wave of a tanker coming out of San Francisco harbour in the fog having again messed up the radar and lied when I asked if she’d touched it.  

I don’t want to ever be back in a relationship with someone drunk and stoned. I don’t want to ever be drunk and stoned again. I can see her behaviour clearly but only know that I was a mirror. I loved in AA the ‘restore us to saniety’ clause. I never realized how insane I was but I certainly saw how insane she was, yet I was with her and our friends were too. It was a bad sit com, something out of a Kardasian bizarro world.

I remember thinking that my life had gone wrong when I was sexually abused by my professor, when I was a psychiatry resident, when I committed adultery when I saw so much learning to understand the insane.  I thought when was my life right and remembered church and prayer and meditation. I was going to return to Winnipeg to talk to the people there I knew and trusted.  I was going to leave psychiatry and maybe go back to being a country doctor or just get out of medicine all together.  The psychiatrists I knew were drunks and addicts and as I learned the depths of my wife’s deceit and even the deceit of my therapist and authorities in general I became paranoid.  My fair weather friends stole from me as did my ex wife. Manly I’d taken nothing of hers and we’d lived on my income as most of our times she’d been a student and took her own income.  I remember thinking that as a man I was powerless and that maybe I could become a woman because I was really tired of having all the responsibility and accountability, all the blame and none of the praise.  I was utterly confused too. I’d spent 20 years with women to have a family but after marriage I learned they didn’t want children.  They wanted a daddy.  Their fathers were alcoholic or absent.  But God were they beautiful, brilliant and fun. I forfeited joy and peace for fun and drama. Not a bad trade when young but time marches on.  

I had been in church as a boy with my brother and mother and father and that was the oasis I aimed for. A Christian friend asked if he could help and offered to rent me his trailer . He didn’t smoke dope and rarely drank.  I returned to church.  She’d refused to go. In psyhiatriy the psychoanalytic professors hearing I meditated as a disciple of Paramahansa Yogananda and a follower of Christian Dr. Carl Ridd I was summarily told that meditation was harmful and must stop and that if I wished to continue my training with these two psychiatrists I had to leave community medicine and stop taking Christian studies courses while in residency.  I had left surgery and family medicine and now was told if I wanted to be a psychiatrist I needed to be a devotee of the megalomaniac analyst I who I frankly admired.  Psychiatrists then were a weird mix, mensch’s and devils.  All were charming and highly skilled. We learned from the psychopaths , narcissists and borderlines. We walk miles in their moccasins and they get under our skin. We are as much artists of the mind as scientists. I was naive and vulnerble.  I was also obedient.  Thise who rise high in systems much have this trait of obedience as the rebels get pruned.  Systems are like military organizations.  They’re like religious organizations.  The abuse of power is ubiquitous.  

I was willing to stay a doctor sober and clean. I was encouraged to go to AA and asked my friend, Kirk, who I trusted if he trusted AA. Kirk and I and been spiritual disciples our whole live, he a follower of Prem and me a Christian doctor who’d taken a detour in better living with chemistry, the tantra yoga,Daost path.  

“I think AA is a good group. I know people who belong and they’ve done well.  I think it’s good that you’ve stopped drugs and alcohol.  I didn’t think that was making you happy. I’m sorry that you and your wife have separated but I never thought she and you were that compatible.  But yes I think AA is a good thing.”  

I’d stopped drinking and left the drug crowd and was detoxing on a hillside with my Bible and my shotgun. The bikers I’d been staying with who stole my money, possessions and vehicle were threatening to come by one night and kill me for the registration.  They never came by but I saw they’d sold my vehicle without registration. I learned that I obeyed laws but so many didn’t .I was so naive. I’d also have all these ‘god’ moments. Events were constantly synchronistic.  Good came to me. I was free of the baggage and suddenly out of the dark I was in the light and it was uncanny how my relationship with God restored. I’d actually thought I was beyond God’s love.  

Bernie showed up in his new truck, the ex wife had destroyed my truck, I was riding a bicycle American Express wanted to claim, my ex wife having with her lawyer and her millions used up all my money on lawyers who said ‘she and her lawyer are refusing to meet so they’re using seige techniques to destroy you and ruin you financially.’  I’d given the last of my money to the lawyer to free my accounts to pay the rent. I was getting charity and food from the church and Christian friends. I went to welfare and the woman screamed at me saying that a ‘doctor can’t get welfare…welfare is for the poor people…you rich men can’t expect poor people to pay you….get out of my office…you’ll get nothing here.”  Every day was humiliation. I’m still hoarding food as again I was hungry like when I left my father’s home.

So i went to church and I went to AA and I trusted Christians .  I trusted godly people. I was lied to by the College of Physicians and Surgeons. I was lied to by psychiatrists but I’d been a family physician , a member of the family physician of canada before becoming a specialist in medicine and psychiatry. I found myself trusting family physicians and Godly psychiatrists. I’d extend my trust to Sam Sussman , an Orthodox Jew. I had named the psychiatrist who raped me drunk and stoned out of the blue and left field this powerful connected man ‘made me his woman’ and ‘bred me’ as my engineer friend liked to put it.  He was a misogynist.  I am still confused.  I was the wife in my marriages to female doctors doing the cooking and cleaning as well as working each day. My colleagues most had wive ‘s and mothers of their children and they went home to the traditional division of labour but I was married to female doctors and never had any support. They did school , I did the wifely duties, and worked two jobs for their ‘desires’ and maintained us while they brought in stipends.  I realized that the guy who said marriage was institutionalize prostitution was talking to me. I was destitute after divorce and they were wealthy yet I’d spent the marriage helping them academically literally dragging them to the library to study and sitting beside them as a study coach, I was ahead of them. But women repeatedly put me down projecting their anger at their husbands and boyfriends who somehow got ‘served’. I never got served’.  I cooked and cleaned and worked.  As a psychiatrist I was most interested in the escorts and their pimps. I was fascinated having pimps as patients and learning how they trained ‘their bitches’.  Exact opposite to all I did.

I read Gottman of Love Lab fame and learned that I was a master at verbally winning battles but lost the war because my wives held onto resentments.  They had horrendous relationships with their alcoholic families and their horendously abusive mothers and I’d had this straight arrow ex military engineer who supervised hundreds of men and a religious Baptist loving mother who had wanted a daughter but had me and couldn’t have more children. I failed her because while I was apparently the prefect child I left home. I preferred running with the pack and had this spiritual path that took me away from the safety and love of home. I truly was the prodigal son.  I came home after I left and then left again. My parents were always there for me. I feel sorry for so many who haven’t had that. The trouble was always my pride.  

Pride is the original sin.  Alcohol and addiction create the mental state of ‘egomania wth inferiority comp;lexes’.

I’m thankful to day because of all the people who helped me to surrender to God and let go of self. The Swami song say ‘mother father have I none I am he, I am he, blessed spirit I am he’.  In my training in theology I learned that there is God and me and if I wanted to know God more fully I must let go of ‘me’.  I had to learn to trust God. The last 25 years have been good. Better and better.

Sober I went to AA with the former head of UBC psychiatry. I continued to see Christian Psyvhiatrists who helped me deal with the addicts and alcoholics in government who abused their power rather frequently. I was blessed to know the lawyer Jonathan Meadows and lived in this great psychodrama of my life.  I was often not the centre state. The play was called William Hay but there were all these bad actors trying to make it all about them. Meanwhile I was listening to the big black Milton who in AA said he pasted a message on his mirror ‘you’re looking at the problems’ to remind him it’s his perception that is the problem.  AA taught me that alcoholism was first a ‘thinking disease’. I had thought I had thought I was spiritual but I’d worshiped the demon drink and demon pot and demon tobacco.  Now I thank God for the early deep breaths I take in the morning. Now I’m writing gratitude lists each morning thanking the Lord for my dog Madigan, my long term friend and lover Laura and all the precious people in my life. I also thank God for the ‘enemies’. The College of Physicians and Surgeons resident pervert was a trial as is the PM today. I was so thankful for the fourth step in AA and Bernie, Hank and Father John who helped me work thought my resentments and fears. I was so hurt and angry and frightened and betrayed. I really wasn’t a good man or a good husband. I probably was a pretty good doctor. I joke and say I fear a class action suit from the 100 babies I delivered who get together and find they share a thumb printed on their forehead because I held too tight guiding them into life. I also think that any day the thousands of people I convinced not to suicide will sue me for false promise.  Yet I did my best and thanks to the amazing teachers and those who went before me and the College of Physiccians and Surgeons, and the Royal College of Physiians and Surgeons and the Canadian Medical Protective Associations and the Society of Addiction Medicien and Christianity and AA and frankly and friends and dogs and cats I’ve done okay.

I’m alive and 25 years ago I so suffered indescribable and utter ‘incomprehensible demoralization.  I had such anxiety and was told by an old internist in a late night meeting of International Doctors in AA, “anxiety is a measure of your distance from God and a measure of your humanity.’  I know God is an experience and not an idea. I used to say I knew Christ and Christ consciousness but today I know Jesus as a friend. God is good all of the time.  

I continued to hunt big game with my friend Bill Mewhort shooting moose and deer and bear with him. I continued to sail and sailed solo on the SV GIRI San Francisco to Hawaii in winter through a hurricane. Thanks to Dr. Willie Gutowski I worked a couple of years in Saipan in sobriety so enjoying meetings on the beach with Frank beneath palm trees watching the sunset.  I loved learning from Phillip another sailor doctor and wise man.  I still struggled with the inclusivity of Christian churches caught between the LGBT include church of Peter and the exclusive church of my evangelical friends. I loved studying theology with the purest deepest Catholic psychiatrist John whose paraplegia he may as well have called his ‘glad gethseame’ like the catholic priest friend of Bill Wilson.  All the Christians I knew and admired were living inspirations as they were persecuted in Canada like the disciples of Jesus were.  I was blessed to go to Israel and make so many trips to conferences all over the US and be with the finest of men like Nady and Art and Carroll and Dick and men and women who are now dying or dead. I loved my friend George in recovery , another physician who would go for dinner with me before an AA meeting as we’d talk about baseball and life and love.  I’ve been truly blessed despite being a kafetch and having the worst tendency to slip into rabbit holes and whine with self pity. My military friend who told me ‘you’ve got one foot in the future and one foot in the past and you’re pissing on your day, get your head in the same room as your ass’ also said ‘get down off the cross we can use the wood’.  

Recovery is ancient healing journey. Just for today was a profound awakening for me as I felt that God , omniscient, omnipotent, omnipresent was here and now and for me to be with god I had to be present. The journey I ‘d begun as a child and later continued in church and school and temple and love came to this point of intersection in the cloud of unknowing at the point of Stellate reality and Interdimensional experience with each day a beginning. I pray to know God more and to know God’s will more. I have quiet time.  I meditate. I do right livelihood . I listen to the spiritual teaching of the Bible and the Big Book of AA and Kurtz book, Spirituality of Imperfection, the great teachings of the world. Paramahansa Yolanda taught “I bow to the saints of all religions’.  I never thought of a hell and didn’t believe in the tribalism religions that said ‘our little group wins and your group loses’ but I liked Pascal’s wager and Eben Alexander the neurosurgeons ‘proof of heaven’.  I’ve known sacred and supernatural.

I would love more. I would learn to be more loving not in that sentimental way but in the way of the God of Gods.  God is all. God made the devil and free will and fate are central We like to choose free will when we do something good and blame the other guy but refuse to accept fate when ‘shit happens’.  It’s all ego.  God is good all of the time. The people like the man who abused me or the ex wife who lied and stole or the college administrator whose perversion obscured her vision , all of these people were bicycle lessons like the soldier who held me hostage threatening to kill me, or the native who shot at me and all those antagonists in my play of life with me as the protagonist.  

I’m so thankful to be sober so that I have been able to live this good life with knowing people like I do,  I struggle now with gender, sexuality and aging. At the point when I’m Shakespearean with desire greater than performance no longer a consequence of alcohol but rather a product of physically hurting and slowing. I struggle to stay fit when I was always active and climbing mountains to experience the joy above the clouds with a sober friends revelling in the beauty of existence.  I loved seeing the great works of arts and museums in Edinburg Oxford and London and Paris this spring taking Laura as a companion but missing Madigan yet knowing Karen and Belinda people I could trust with my puppy while I was away.  I can trust today and people don’t lie and betray me. I know that expectations are preformed resentments and I don’t have the unrealistic expectations I had younger.  I’m more mature. Who would have guessed. But I do miss the theatre and dance world and find so many older people still pretentious and tedious.  

I’m becoming ornery with age.  I’m happy alone.  I’m less afraid.  I worry I might drink or smoke dope again and fall into the psychosis of believing the false is true.  

It’s 25 years. A quarter century, much longer than the entire time I smoked or drank. I still don’t know what I will do when I grow up.  Right now I have to go have my hair done and the biggest challenge is whether to wear a skirt or slacks.  I’m having a lot of first world problems and very few third world problems .  I’m full of gratitude and know grace.  I really am blessed but often don’t know what next. I miss the Sturges expedition.  I knew I wanted to ride my Harley there and back like I knew I wanted to visit the church’s of Ethiopian and see the black Jesus.  I knew I wanted to go to Athens and the Vatican and Mexico City pyramids ,  I’ve known what it is I have to do but now I’m able to plan the day but don’t have any real idea for much into the future. I felt last winter I was kedging my life off the sand bars of Covid and the WHO . I’m aware that Trudeau is the devil incarnate and that I’m at best a hobbit in the spiritual warfare of today but it’s hard to see.  I’m in the cloud of unknowing and just keep walking forward with Jesus.  

I need to be sober because the world is so crazy I need all my wits about me. I don’t want to be an ostrich that puts it’s head in the sand and doesn’t know who kicked it. The Donovan song, season of the witch and beatniks are out to make it rich makes me ware of my vulnerability.  I am learning to trust God more in old age. 

I’m thankful for sobriety and don’t believe I’d have achieved the long term sobriety that Vaillant of Harvard fame wrote so eloquently about without AA.  

I’ve a doctors in AA meeting tomorrow. So I know I’m looking forward to that. I’m continuing to work. I’m here. I’’m muddling along. I have a principle responsibility to Madigan who is dependent on me.  He’s a messy room mate.  

Thank you.  25 years. Thank you, Thank you God and as I learned in AA God works through people. Thank you.

I remember being tormented after I stopped drinking and smoking. I think the tobacco was as bad as the pot. I was in withdrawal for weeks to months, hiking all day and visiting a Christian psychiatrist, going to church, praying, meditating, writing, doing odd jobs to pay 

IDAA 2017 Snowbird UTAH - CME - Crucial Conversations with your patient: pain and cannabis - Dr. Mark Weiner

I really enjoyed Dr. Mark Weiner’s  presentation because it clearly delineated “cannabinoid research and treatment’ from the whole area of “medical marijuana”.  Marijuana is a 100 compounds in one with a wide diversity of response and much marketing these days of the ‘anecdotal evidence’ without consideration of the overall  science.   I’ve been prescribing for some years ‘medical marijuana’ and pharmaceutical “nabilone”  and the excellent ‘SATIVEX ”(Bayer)  buccal spray with considerable discrimination and concern.  It’s never a first line choice.  I have seen a lot more negative results than positives. Admittedly the occasional positive result is, like any success, a joy.
There is however a religious devotion especially among  the heavily addicted devotees to the ‘herbal’ treatments with a whole lot of religious claims of “panacea”.  There is  little consideration of cannabinoids as just another ‘medication’ to doctors like myself.
I’ve seen people respond to marijuana like I have to other treatments but it’s not a panacea.  There are also serious side effects.   It certainly was widely available and passed over in favour of the most successful modern treatments that have been associated with cures of epidemics, increased longevity and amazing cures of once deadly diseases.
I was commonly recommending marijuana for my patients with HIV and Aids when they developed anorexia. It was an excellent ‘adjunctive treatment’ but it wasn’t curative. Today being diagnosed with HIV is similar to being diagnosed with Diabetes. The life expectancy is shortened by perhaps 10 years.  When I first worked with HIV it was a deadly disease with few survivals and large death toll despite the ubiquity of marijuana.  Today the pharmaceutical companies and medical researchers have produced retrovirus medications in combinations that have caused the extraordinary successes in treatment of new cases. The latest of these treatments, Truvada, is truly a god send but I know some of the nutbars in the ‘medical marijuana cult’ would tell people not to take it because it is produced by their ‘devil god’ "Big Pharma”.  I can honestly say as a simple clinician it’s increasingly difficult to do my job with all the argumentative stoners with their overnight Google MD’s.  Now that Big Tobacco is backing Big Marijuana with Big Smoke Money at the public health level we know whatever tax benefits we see for politicians will be off loaded in increased suffering for patients and health care costs.
I have a head injury patient whose response to marijuana was truly remarkable. I had tried a wide variety of medications for his various symptoms before the trial of marijuana which had a profoundly beneficial response. Unfortunately clinically the majority of my head injured patients have been made worse by marijuana as it disrupts mood stability and motivation and interferes with memory and learning in these other cases.  I read the heavily funded marketing literature on marijuana and it reminds me of when Cocaine was said to be a ‘cure-all’ without addiction. Then Belushi died.
As a clinician, typical of my colleagues. I don’t care what works. I just want to see my patients get better and we welcome treatments. The paranoia associated with the ‘us and them’ crowds of ‘health food’ ‘pusher’s’ is difficult to tolerate.  Today’s marijauania is 30% THC compared to the 3 % THC of the highest grade marijuana of my college days. The dangers to developing brains of this high dosage compound and the longevity issue of using a potentially toxic substance over long periods is worth consideration.
I enjoyed Dr. Mark Weiner’s discussion  of  the effects of cannabinoids on the heart especially in elderly patients causing me to be better equipped to discuss the pros and cons of medical marijuana in the increasing numbers of retired patients who ask me about it’s use in various chronic diseases.
Some patients commonly in clinical practice try to pidgeon hole the doctor into an “either you are for or against marijuana’ categorizatio.  As a psychiatrist I’m well aware of this   ‘black and white thinking” and profiling  so common in paranoid disorders and drug abuse.”  I enjoyed how Dr. Mark Weiner side stepped this issue simply by presenting the clinical evidence. This is what we know. This is what we can say about the cost/benefit of this treatment for individuals.. It’s really no different than what we say when a person wants cosmetic surgery or some other medical treatment which isn’t ‘first line’ and might even be classified as ‘experimental’.  He was clear in presenting the ‘evidence’ and maintaining his comments in this realm. It was refreshing. I learned from his example.
(I reflected that a patient had told me that my dog who had his eye removed recently for glaucoma could have been saved with the cannabinoid oil this patient promotes.  Its been shown to be of some benefit in human glaucoma.  So feeling guilty that my dog had lost his sight in one eye I was willing to consider anything to help him keep his sight in the other eye.  His veterinarian ophthalmologist, Dr. King, hadn’t recommended cannabinoid but another medication which has been working very well in keeping the pressure down in his remaining eye.  I reviewed the veterinary research literature that evening and found that in fact marijuana had been researched and was contraindicated in dogs. Veterinary medicine is fascinating because a drug that can save a cat’s life can kill a dog.  They’ve been researching cannabinoids just as we have.  My patient is a religious nut about marijuana.   I definitely have prayed for my dog’s eyesight.  I have trusted  Dr. King whose treatment is working just fine.  I had a delightful dinner with Dr. Larry Cooper a San Diego Opthalmologist who was kind enough to share some stories of his successful surgical and medical cures of eye disease, being especially thankful for the gifts of modern medicine which have resulted in him being able to save a person’s sight or life.  I really don’t think he as a compassionate clinician would withhold any treatment but I expect that if I smoked a joint I could even imagine this wonderful mensch of a doctor could indeed be an evil operative of Big Pharma and Big Surgery. )
I enjoyed the lecture because it dealt with the science of today. Dr. Mark Weiner is simply one of the leading authorities and yet also broad minded. He does emphasize what the research says about cannabinoids and questions what is in a marijuana plant in general.  He’s a scientist and not a snake oil proponent. It was an interesting lecture from this perspective.  What we know. What we don’t know. What research says. What research doesn’t say.  I enjoyed that.  Great ideas.  I will make a point to follow him in future and consider adjusting my practice to take account of the insights that he provided.
 This is not a reflection of the overall lecture which was much more extensive. I’ve just selected certain slides and some ideas that were of interest to me. I wouldn’t want anyone to see this writing in any other light than this. I certainly will be attending more of his lectures if I can and would strongly recommend him as a presenter, communicator and scholar.

Drug Induced Paranoia

He had just walked into the room. Big guy.  Lots of chains and tattoos. Unwashed hair.  Poor eye contact.  Slouched down in the chair across from me.

Lifted his head.  Stared at me.  Real hard.

I waited.

"I don't want you writing anything down." he said.  Low voice, Controlled. Ordering.

"I take notes. It's what a doctor does.  It's the law." I replied, softly.

When you have worked here long enough, you've heard it all.   You feel the insaniety  though.  Maybe it's in the tone.   It feels  palpable.

"I don't want you to write anything down. I know you doctors give your records to them.  That's how they know everything. I don't want you writing anything down."

"What do you want from me, then?"  I didn't ask about them.  Them is them.  If you have to ask you probably don't know.  He walks out and you don't see him again.  So much for caring.  That kind of stupidity is 'selecting'.

"I want my drugs."

"Your methadone?"

"Yea."

"Are you doing any street drugs."

"I'm not going to answer any of your questions.  You're just going to tell them."

"Who are you worried I'm going to tell?" Now it's right to ask about them.  Things are moving along now.

"Everybody.  The only way people know I do drugs is someone tells them. I don't want you telling anyone else.  I know it's in my record but that's because doctors won't shut up and just give me the drugs I need."

I'm old. I'm afraid.  I didn't want to tip him over the edge. I was just seeing him in passing.  I've never seen him before, might not see him again.  I'm just covering for a colleague.  I peruse the chart, peripheral vision keeping track of his torso.  The chart shows  hes been doing crack and crystal meth. He'd actually been doing well.   Not using heroin like before. My colleagues a good doctor.  Maybe the guy was just pissed to see me.

I wasn't well.  Feeling fairly irritable myself.  The air was bad here.  Smoke and pollution blowing up from the forest fires in the south.  The lighting was already bad in this building.  Hazy. Eerie.  Besides a garbage truck had spilled out back.  The bad air now stank.  Couldn't get worse.

He was probably having a bad day.  Something must have happened before he came in.  He wouldn't leave a urine.

"It's going to be positive for crack".  he said.

I thought that was progress.  I didn't want to push him.   I could have followed the rules strictly, goose stepped, clicked my heals, shouted Heil Hitler.  There's real advancement in that approach. On the other hand, people who do that,  usually have 'burn out' and 'compassion fatigue".  Sometimes they're just new and afraid.   The system doesn't want anyone to know about the Jews and Auschwitz. You're supposed to crayon inside the lines.   I took an Oath "Do no harm".  Days like this I think it's a curse.      It wouldn't  help him, my being hard.  I wanted to keep an open mind.  But not so open the marbles fell out.   Only people far from the front survive being pollyanna.  They're the critics.

I gave him the medication.  He'll be back in a few days to see his own doctor.  After he left I wrote a brief note. No harm done. Gave my colleague a heads up.  Somedays, we bend a bit. Sometimes we don't.  Maybe it's was just the air. Maybe it was them.

Personality Disorder and Personality Traits

First and foremost a diagnosis of a disorder means illness, and dysfunction. Mental health has best been described first by Freud and later adapted by the WHO as roughly, the ability love, work and play.
We consider a person's ability to love by the quantity and quality of relationships.  A person might have many 'superficial' 'short term' relationships best described as acquaintances without any long term deeper relationships, better described as friends. It is unlikely that at any time a person has so many deep and personal relationships as they do acquaintances.
This friendship pattern and the years of relationships and how a person's voice changes in the mentioning of friends is indicative of the nature and depth of relationships.  Psychopaths may describe relationships without a tonal differentiation which can deeply reflect the depth of the relationships.  A patient with Aspergers may similarly lack the ability to indicate emotionally the difference between their mother's name and the person who they just met today.
Dr. C. Jung did research on significance of delays in response but similarly one of the cues emotionally to the 'meaningfulness' of relationships is in the non verbal communication which simply tells a sensitive examiner that a person's reference to a friend is a 'felt' friendship and not merely an 'acquaintance' relationship.
The love life of an individual starts with family and how a person speaks of family is inherent in the nature of the communication given when one asks about family and family history.  Some people maintain long term positive relationships with family members indicating healthy maintenance of relationship compared to those who have not seen or communicated with a parent in decades. The latter indicates all manner of potential area of conflict and/or deficit.
After family relationships, friendships begin in school era, and hometowns then progress to workplace and associated institutions such as church and club and recreational associations.
Finally the length and depth of primary relationships is an indication of presence or absence of disorder.
People who have maintained relationships with family, have friends and acquaintances, can name them and speak about them, and those who have maintained intimate relationships for 5 years or longer have clearly a highly developed personality regarding the 'capacity' to form and maintain relationships. I say '5' years for the latter because our 'western society' has been described as 'serial monogamy' with a 50% divorce rate and average length of relationship at 5 years.
Clearly in a previous generation the role of the marriage was a more significant indicator of personality development but considering an arranged marriage with limited choice for alternatives this might well reflect societal development over individual development.  The greater the 'free choice' the greater the development of a trait since, as with morality, lack of opportunity for vice, doesn't necessarily reflect "virtue'.  Virtue requires the potential for 'test'.  Similarly an isolated individual might well not have the opportunity to make friends whereas a person in a healthy community's isolation might well reflect intrinsic deficits.
A disorder of relationships is not only seen with personality disorder but is at it's worst with thought disorder (e.g. schizophrenia) and mood disorders (e.g. bipolar, depression).
The ability to work and maintain work reflects a person of strong personality because the character traits of survival and success are related intimately to work. This is reflected first in schooling, the higher the education, the greater the learning, the greater the diversity and buffering and the greater the successful network.  A university education is like a 'white collar' or 'officer class' development whereas a trade school or skills specific learning may be likened to a 'blue collar' or sergeant class development relative to society or military hierarchies. The success of an individual may reflect to a large degree his family of origins wealth and privilege, the area of community they are from and their associations.  The advantages and disadvantages sociologically and geographically are well documented.
Cultural factors are intrinsically an important aspect of diagnosing and understanding a personality disorder.  One example I recall from practice was an obsessive compulsive upper class asian psychiatrist describing a Jamaican reggae star as having a 'personality disorder'. The Jamaican millionaire's later highly accentuated description of my colleague left me in doubt as to who most like had the personality disorder but clearly understanding that the cultural values of each individual differed by work and place of origen.
As for play one considers diversity of activities. Does one merely 'watch' an event or are they a higher developed 'participant' in sports,arts, or social and recreational communities.  Fat academics don't notice the higher development of a person who coaches and participates in community hockey for instance but will think a 'wine connoisseur' is somehow 'refined' and 'tasteful'.
One is considered to have a 'disorder' when ones' educations, work, and social life and relational world are below an arbitrary standard set roughly for a similar person of similar background and age and culture.  A ghetto child who achieves the first Phd in their family is more 'successful' than a Bachelor of Social Work from a family of PhD's in classics and mathematics.  Though both have achieved an educational development it must be considered in 'context' of the individual family and community.
Naturally everyone wants to 'dumb' down 'classifications and the KISS , "keep it simple, stupid" competes with the KISS, "keep it stupid, simpleton" proponents.
Obviously classical music is beyond the ken of the average country and western musician or rapper just as quantum physics is beyond the ken of the average or even above average arts student.
The traits of personality are in all of us.  All of us have antisocial traits, grandiose traits, narcissistic traits, dependent traits, paranoid traits, obsessive compulsive traits and histrionic traits etc.  The absence of the traits at particular developmental stages is the indication of a more serious disorder than the presence. Traits are also seen to be in balance.  A trait is further 'contextual'.
To understand this is to reflect on the person who 'talks shop' at a part, clearly 'overly dependent on rationality' and 'lacking in capacity for emotionality and relaxation and 'fun', as opposed to the opposite 'workplace 'jokester' who can't 'settle down' and 'pay attention' in the workplace and disrupts the serious flow of work. One's a party pooper and old before their years while the other is immature and disruptive.
The presence of personality traits in excess however is indicative of a disorder. Hence a person who is narcissistic in their workplace ( a leader apparently in war does best if they don't share their inner doubt and fear and resists waffling) but may be very loving in the home.  The American Generals I've met had good friends and  were considered good friends. Hitler, obviously a severely disturbed personality in the area of eugenics, had a powerful friendship network, and  was admirable as a leader before the war and at times quite brilliant in other areas as well as maintaining a love relationship with Eva Brawn for much longer than most North Americans can sustain sexual relationships today.  Prime Minister Mackenzie King, long thought an excellent Canadian leader, frequented prostitutes, held seances to speak with his dead mother and had most peculiar relationship with his dog, Spot.  I don't think it would be right, by mental health standards, to describe him as 'disordered' but I have colleagues who wish to walk on the snow shoes of their betters, so claim that Jesus was Manic Depressive and a masochist and that PresidentGeorge Bush was a narcissistic personality disorder or that President Clinton was a histrionic personality disorder.  To this I respond, some of colleagues are 'nut bars'.
Most great individuals, despite the criticisms found in excellent texts like Paul Johnson's "Intellectuals', would not be called 'personality disorders' even though Marx for one had  distinctly narcissistic traits and St. Paul could well be described as having greater than normal obsessive compulsive traits.
The personality disorders of the DSM - the classification of the American Psychiatric Association - are derived from Carl Jung's classification of personality as Cluster A - Odd , Cluster B - extrovert and Cluster C - introvert.
Personality is developed in late teen years, though Thomas and Chess saw that the temperament of children as calm, or irritable or in between could be seen in infancies.  Over the years the 'context' of the environment in which a personality exists will cause their personality be 'compensated' so that an introvert who gets a job as a television host might well appear an extrovert in later years though actually prefer solitude and quiet time outside of work situations and vice versa for an extrovert who works in an introverted area of endeavour.  Odd individuals left alone will accentuate their differences but when involved in a community the association will polish these diamonds in the rough.
We might call a judge 'narcissistic ' or a psychiatrist 'paranoid' but neither would necessarily have a 'disorder' as these statements may reflect a situational context.  As stated earlier the burden of abnormality must itself be 'abnormal' and their outcome cause significant clinical difficulties for the individual or society and be a long standing 'pattern' of behaviour.  Freud indeed said 'maybe the paranoids were right' when he was escaping Germany because of the Nazi's. Obviously a judge whose interested in 'pleasing everyone' as the histrionic would be, couldn't possibly maintain a 'moral compass' apparently important in such a position where 'objectivity' is demanded by 'justice'.
If a person's personality is 'successful' in that it progresses the individual through life in the main stream of their community then something 'changes' dramatically so that a person's behaviour is 'out of the norm' for that individual, one considers that possibly situational events have impacted on the individual, such as a change in personality from drugs and alcohol or medical disease, such as a brain tumor, or social events, such as war or poverty which might require a wholly different 'adaptive' stately.  Adaptive diversity is what' personality' is also about, its a collection of 'coping strategies' which have 'worked' to date and began to work in adolescence.
 The antisocial personality disorder might have been a bully physically in high school who continued on as a bully through excessive litigation and abuse of women and co workers so that they might overtly succeed' in work, play and relationships overall, for a time. But if they are a 'disorder' versus having 'trait's then these early coping strategies won't carry them well in more complex situations which come with maturity.
A person without  a full blown 'disorder' per se' may nonetheless be described as 'narcissistic' and 'manipulative'.  They might even be 'pathological liars' but not be considered a 'personality disorder' because clearly some work and relationships succeed with lies versus 'text book truth'.  I might not think well of a tobacco executive for instance, the lowest of scum in my opinion frankly, worse than rapists, whores, pedophiles and thieves, but I can't say that a tobacco company executive has a 'personality disorder, he's obviously 'successful' in work, love and play - assuming his golf handicap is adequate - but in my mind, his characterological deficits are strongly 'anti social'.  In contrast a petty thief in and out of jail is clearly an 'anti social personality disorder'.

Now there are those who consider anyone 'different' from them and 'not politically correct' by their standards as being 'ill' or disordered.  In an earlier era these defilers would have called someone a 'goat fucker' but today due to political correctness and deceit,they attempt to use less 'delicious' terminology by 'pseudoscienfically pigeonholing people they don't approve of. To say a person is a personality disorder in this day and era is to perhaps imply that they are a goat fucker but in a 'nice way'.  The poet ee cummings made much fun of those people who described these people thus.  Inclusivity and exclusivity is a central facet of a society where the leadership is 'generous' or 'not generous' as a reflection of whether you're 'useful' or 'not'.  It's a bit of a 'paranoid' analysis. You are either 'with us' or agin us, a 'team player or not'.  To be 'acceptable in England you had to have an Eton accent, in French society, a Parisian accent.
In India there were the 'untouchables' and the jobs associated with them. The gypsies of Europe carried a stigma, as once the gays and blacks and their activities carried a stigma.  A white 'cotton picker' was unlikely to be invited to the local southern country club for instance especially in the 19th century.  Today even as Mandella is being buried the Africans are insisting that the blacker one's skin colour the more African (inside, top of the heap) one is.  Clearly a white man is 'personality disordered' by the new leadership standards, i.e. he's the new goat fucker.
The attempt at the development of a diagnosis of personality disorder and 'traits' was to be as objective scientifically as possible. There is a variety of 'personality' assessment tools.  These are developed from a variety of ways of looking at personality.  There is a complex sophisticated qualitative and quantitatively multi dimensional personality inventory favoured by Europeans and researchers and likely superior in many ways to the DSM working system.  It's a bit like the 'miles' versus 'km' debate.  Despite a lot of lobbying this complicated system wasn't accepted for the latest DSMV which continued to use the 'traditional' Axis II approach. As an older clinician whose studied personality disorder extensively I was frankly thankful because I know the present system backwards and am glad to let the next DSM come of age in the understanding of personality and change and disorder as modern research  is changing.
Character and personality are multidimensional and change over time with core features usually constant.  Yet even a group of 'psychopaths' ,  (psychopaths being thought to absolutely lack a capacity for empathy unteachable and incapable of learning) appeared in their late 50's or early 60's to change in the relationship with a strong maternal loving constant in their lives.  Various theories about 're parenting' and 'holding environments' were developed for these 'exceptions'. New theories are even being required to incorporate understanding of 'spontaneous remissions' which are being discussed in terms of 'quantum change' research.
In contrast' countless studies going back to Kohut and Kernberg and Masterson have shown that Borderline Personality Disorders can be 'cured' in a combination of group and individual therapy. Cameron et al have studied extensively the cost effective and scientific evidence based outcomes of various psychotherapies relative to diagnosis. While few psychologists were trained in the 'curative' treatment of Borderline Personality Disorder, psychiatric psychoanalytic therapy  maintained 'public payment' for this 'evidence based therapy'.  A noted psychologist recommends treatment for borderline personality disorder that have long been established by solid evidence based research as wholly ineffective but are interestingly exorbitantly and exclusively expensive.
Alternatively 'group therapies' have been found by psychologists and psychiatrists alike to 'cure'  borderline personality disorder when combined with standardized individual therapies.  12 step support groups have had high success with borderline personality disorders because of the group holding environment and tolerance for deviation. Indeed many previously diagnosed with a personality disorder who abstain from chemical addiction have a 'spontaneous' cure' of their 'concurrent diagnosis' of personality disorder. As addiction psychiatry has long demonstrated, remove the on going chemical brain damage, and the true personality, not the 'disorder' shines forth.
Similiarly the Elizabeth Fry society has provided 'community' based treatments that have succeeded with antisocial individuals where many psychologists would be 'ignorant' of the success of these modalities while known to sociologists and psychiatric psychotherapists.
A presentation of the successes of the 'community based treatment' modalities developed first in New York for the worst of the marginal,  homeless and drug addicted personality disordered was a major topic at the International Society of Addiction Medicine.  In face of the high cost of individual psychological therapy modalities for this poorly responsive often non compliant group, the community models were being adopted internationally not only because of their clinical success but mostly these days, their cost effectiveness coupled with their high outcome success.
Unfortunately, 'give a little boy a hammer and everything is a nail' couples with everything that isn't a nail, isn't interesting to a little boy with a hammer.  Personality disorders don't respond to 'medication treatment' so are by nature the 'bane' of the reductionist psychopharmacologist psychiatrist.  Indeed the 'cluster b' personality disorders are commonly excluded or actively discriminated against by 'individual psychologists' or by psychopharmacologists psychiatrists' because they don't respond to "their' treatments".  That they respond extremely well to personality disorder specific treatments is widely ignored.
A colleague who was captured by the Pol Pot made an interesting observation of the schizophrenics during his ordeal.  "They didn't get shot.  The Communists withheld food and the schizophrenics were happy to work for food so they didn't get shot like the doctors, lawyers and professors. I followed their lead or I'd have been shot….I think this is a key to understanding why the cluster a 'trait' survive in our society".  What this brilliant cultural psychiatrist, today, was referring to ,was the genetic research work which shows a trait apparently counterproductive is maintained in society because of it's benefit in aberrant situations.  The sickle cell anemia genetic trait is thought to be maintained in a community because it 'protects' against falciparum malaria'.
Similiarly 'antisocial personality disorder' traits are often what make successful soldiers and the 'protectiveness' of borderline personality disorder 'mothers' is what is commonly described in stories of 'mothers' who defend their children against wild animals and  terrorists. In quieter days in better times these same people are often called 'rebells without a cause'.
To understand personality disorder fully one must appreciate that most of those who are 'successful by today's society's standards' would not have been successful a hundred years ago and may not be successful in a hundred years.  Histrionic traits might well be successful in media dominated America but to date hasn't been a particularly successful survival trait in obsessive compulsive paranoid communist China, if one speaks generally.
Whereas schizophrenia appears present in 1% of individuals regardless of culture, country, or political regimen, personality disorders are defined as 'coping' and coping is affected by sociological, psychological and biological and even spiritual factors  which fluctuate by country and culture.  Cluster C individuals are more likely to succeed in traditional Japanese society whereas Cluster B individuals succeed more freely in Los Angeles or New York.  There are even divisions to be made by gender with 75% of antisocial personality disorders being male whereas 75% of borderline personality disorders are female.  Further rural and urban communities differ in regards to areas where a person might more likely be diagnosed a 'personality disorder' as opposed to an eccentric if they were 'cluster a'.  Cluster A personalities generally do more poorly in the city , despite their creativity and uniqueness, but often thrive as 'eccentrics' in the country and especially Britain. Older cultures, as opposed to new cultures like the Canadian frontier, appreciate more wisely the contribution of the eccentrics like Turing.
Of course, stupidity trumps personality every day and very stupid people have been saying all manner of offensive and inconsiderate and downright stupid things about personality and character, reflecting by their statements their own lack of character. The more a person is a 'media personality' the less 'character' they might indeed have as superficial consumer societies dominated by power and money tend to be the least diverse and lack all depth.
They tend to view 'difference' which is what 'personality and character traits' is all about as abnormal and wrong. The more primitive a society the more demand for conformity.  Indeed in the most primitive society decisions are made according to power and all discussion is simply to support the a priori decision.
The arrogance of the ignorant is never to be underestimated because they commonly solve arguments about quantum physics, theology and psychiatry with guns.  Might is right in their realm.  That said, they are frequently wrong, even when they do their best to rewrite history and populate the world with people just like them.  Yes, men , to their negativity.
When a society is anthropological limited to development by the 'strong man' , pre democracy state, then every on is by nature their' bitch'.  Anyone who has true 'character' is a 'threat'.  In Shakespeare, only the 'fool' or 'jester 'is allowed to tell the truth in court which might explain the rise of Comedy today.  King Lear ends with him saying, 'we'll talk of courtly things, whose in, whose out."    Only the 'fool' can tell the truth, which is why the cluster b 'histrionics' and the cluster a  'odd' may well have have have survived considering the above genetic hypothesis. .
Personality is about character and character is about successful 'coping'.  That said, tools to assess personality however have not been able to separate high class call girls , from successful business women and lawyers.  An artist like Joni Mitchell, one of the greatest genius of music and words, would not be considered as successful financially as a stripper singer marketing millions in music as oral pornography. In this case 'all art is sales' is only offensive to those who question the financial system and consumer context of society which equates the death of a baby as a 'fixed' dollar value.  These aspects of 'success' are probably not the realm of 'personality' and 'character analysis' in the context of a 'materialistic' society who argue that success is solely defined by "those with the most toys when they die 'wins'.  What really is the different between love and lust?
Given the limitations of traditional psychology in face of modern research the American Society for education of psychiatrists requires residents be trained in 'spirituality' and the British Society of Psychiatry has a speciality 'division' for ''Psychiatry and Spirituality'.  Apparently when the reductionists threw out the bath water they lost the baby and everyone is now scampering to find this lost infant.
Perhaps that's why reflecting on Personality and Personality Disorder on Christmas Eve isn't so difficulty.

Spousal Abuse-Domestic Violence - Against Men

One of the principle problems of any discussion of domestic violence or spousal abuse is the persisting belief that 'women' as a 'gender' are 'collectively' victims.  One may as well enter into a discussion about Middle East Peace with a Zionist Jew or Radical Palestinian.  This collective 'denial' of violence as 'species' violence perpetuates gender violence as much as any number of other factors.
Radical feminism began with social communism.  In communism there is a paranoid vision of the world derived from Marx.  He saw the world in terms of 'victims', the 'proletariat' and 'victimizers' the beourgeosie and his solution was a one class society.  However Lenin felt that this 'one class' society required 'dictatorship' of the proletariat hence the latter day Russian communist regime with the dachaus and special stores for the 'leadership'.  China is no different and all communist countries despite their successful revolutionary beginnings have turned into the feudal equivalents theywere against.  There is a middle in society and Scottish socialism showed clearly that there was a place for diversity and a middle class and that 'war', the only solution of communism, was unnecessary.
In gender politics the new beourgeosie were the Women's Studies Professors and the the writers of radical feminism all the way down to the lipstick feminists who sound very much like people without a banner.  Hence the movement in universities to expand from the revolutionary 'paranoid' position of 'us against them' to (finally) some work on the value of 'egalitarianism".  The irony is this latest group calls themselves 'egalitarian feminists"  which sounds like capitalist communists to those who pay attention to language.  But we do have our 'red tories' today and and our blue liberals as everyone fights for centre stage and the teen agers claim they don't wear a uniform.
While 'crime studies' show that men are more likely than women to use violence, other studies usually family and domestic violence studies  show that men are more likely to inflict injury but that when all acts of physical aggression or violence are considered women are either as aggressive as men or more violent than men.
These violence studies further do not take into account that while men may be sexually aggressive women are freer to and are more likely to act out their aggression against men by having sex with their partners friends, family members or bosses.  Further agression between females is often expressed sexually through sex with a a girl's  boyfriend.
Further female parents acting alone were the most common perpetrators of child abuse.
Added to this,1/3 of sexual abuse victims are likely to sexually abuse themselves.  Then too a significant portion of physically abused will go on to physically abuse.
In addition to this there is a major variable of the person who has had one aggressive relationship compared to the person who has recurrent aggressive relationships. In the latter there are predators and volunteers more than predators and victims.
When I have been willing to enter into a discussion of solutions to the problem of spousal abuse or domestic violence from this position of 'fact' and 'scientific information' I have been threatened , ostracized and attacked directly and indirectly.  I have never hit a woman but I have repeatedly physically violated by women publicly and privately.  I have further treated countless men probably an equal number to the women I have treated who have been violently attacked by women.
The researchers I have known who were men have been castigated for bringing forward this information yet until we move out of this backwater we will not be able to get on with addressing the inherrent species violence and the bullying of those in power whether female or male. Further the tendency of any revolution is to exchange one bully and their spouse for another bully and their spouse. Matriarchy has long be associated by anthrolopologists with war, slavery and torture.  That suggests that violence is not gender specific but rather 'species' specific.
Lesbians have the highest incidence of violence over homosexuals and both have greater violence than heterosexuals.
Note that alcohol and drugs are directly associated with violence as are poverty and most importantly men fight men and women fight women so focusing on 'blame' rather than 'solutions' is going nowhere.
2007 1/4 of relationships reported violence.

Projection and Projective Identification

Projection is a psychological defence or coping strategy. We all use it to varying degrees. The truly mentally ill use it more often than not.  In the case of projection I attribute my inner world to the external world or interpersonally, you.  In the classic example a paranoid is afraid of nazis so attributes anti semetic intent to everyone.  A woman afraid of rape accuses you of wanting to rape her.  A republican afraid of democrats accuses you of being a democrat when you question his or her authority.  An overly sexualized pervert accuses you of sexually wanting them when you're really not at all interested.
In all these cases there is 'false accusation'.  It's also commonly coupled with a generalization that is made specific.  Philosophically illogically, "all men are rapists, You are a man. Therefore you are a rapist."
As for projective identification, there was a meeting of psychoanalysts once, asked to give a meaning and the multitude of meanings was so diverse that rarely thereafter was the term formally used.  My own take on it was that if you acted afraid of me I might act differently in a way to increase your fear, identifying with the projection.  The idea is that you somehow get caught up in the the stronger projections. This is especially seen in 'folie et dieu'.  In folie a diew, the more insane person convinces the weaker person of their projections and the two live in a shared paranoid reality.  In one home visit I made to the proverbial old ladies with cats, they were eating the cat food with the cat food because human food was poisoned. They were also spying on their neighbours because they were anti semetics, perverts and communists. They'd never met any of their neighbours but the severely disturbed one had intuited this from the way they carried their groceries in and out of the house.  As a result they had to keep their blinds drawn and couldn't go out in the day because the neighbours were spying on them.
Hospitalized together on the psych ward they remained certifiably insane. However once we separated them the lesser disturbed one came to her senses and told the story of the increasing insaniety and her getting caught up in it.  Despite medications the other lady never did return to normal. She remained high suspicious and quick to incorporate some innocent activity you might do into her 'scheme' of things.  She never acknowledged her neighbours were innocent. It's very hard for many people  to admit they were wrong, something ironically is true of both the most ignorant and the most insane.  Admittedly I never did poll the neighbours to see if they were individually anti semetic, perverts or communists.  Perhaps they were all spies and personally out to get this one little old lady whose life without her delusions was rather barren and deeply sad.The other lady returned to normal life in the community and remembered these years much as a bad dream.
Projection is part of the 'group hysteria' that results in places like the Jones town massacres.  On a smaller scale it's seen in petty jealousies, body insecurities, and issues of self esteem.  "They don't like me because I'm not loud like they are," incorporates projection in a particularly twisted and sublte way.
As infants our mothers are part of us and we don't know where we begin and leave off.  Slowly but surely over time we appreciate how we are individual and interconnected.  Drugs cause a break down and regression to infancy with loss of separation of self and others.  Smoking pot or crack one or heroin one can believe all those smoking together are like a 'family' or 'friends' when in fact the group together only has in common the addiction.  As the brain is altered by the substance it is open to all manner of insaniety with projection and projective identification being common.
Patients who have had traumatic pasts often project under stress.  A woman sexually abused as a child might suddenly hit a man on a date claiming he tried to rape her when he was just helping her on with her coat. An ex military man may believe for a second a waiter is the enemy when he comes up behind him and startles him bringing the menu.
When the Nazi wanted to kill Freud and friends helped him escape to England he said, "Maybe the paranoids were right".  It's only paranoia if they aren't out to get you.  The joke also goes, 'what's the opposite of paranoia? Thinking you're following someone."  Projection is part of our mental make up and certainly a significant part of our community and a major part of regressive politics.  It's a useful term and worthwhile to be aware of.  Good friends are often helpful to tell a person when their past is being played out in their present and they're making their future a replay of their past just to prove they were right.  It's been said that the mind is a dangerous place and not somewhere to go alone. Certainly it can be such some nights.