Dropped on:February 1, 2014
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In Act I, Scene 4, of Christopher Marlowe’s Edward II (1593), the Earls of Mortimer and Lancaster debate whether Edward’s detested low-born lover, Gaveston, should be brought back from exile. The move has been proposed to reconcile the besotted king with his angry peers. Lancaster bitterly opposes it; wily Mortimer counters that upon Gaveston’s return he can be quickly dispatched by an anonymous assassin to the general rejoicing of court and country, without blame being cast upon the nobility.

Ay, but how chance this was not done before.

Because, my lord, it was not thought upon.

There’s something ineffably curious about this exchange. It comprises a totally unexpected “duh” moment in the midst of Marlowe’s sumptuous poetry. It also expresses a potent, if mundane truth.
History is strewn with calamities stemming from disregard for dire consequences lying in plain sight, but perversely “not thought upon”. One example amongst the multitude: France’s defense against the German invasion of its borders in 1944 hinged upon a “Maginot Line” of powerful fixed fortifications. The German army simply swept around it into Belgium and the Low Countries to conquer France in six weeks. “Duh” indeed.

Flash forward sixty years: at Nelson Mandela’s memorial service in Johannesberg on December 12, one Thamsanqa Jantjie stood a scary heartbeat away from world leaders (Barack Obama included), high South African government officials, other notables and the Mandela family. Jantjie was tasked to describe the event by signing to hearing impaired people in attendance and watching throughout the world.
During the long ceremony, as different languages were spoken (including African dialects), Jantjie’s gesticulations were curiously stilted, varying little from one speaker to the next. His face, often raised to the heavens, remained impassive; lacking the expressive play that fleshes out the play of hands in every deaf signing system.

Complaints from the local and worldwide deaf community flooded the internet. It quickly was obvious that Jantjie was performing a pantomine of outlandish gibberish. Nevertheless he was allowed to plough on, with not a finger raised to give him the hook. Jantjie blames his aberrant behavior on an attack of schizophrenia, in which he saw angels hovering about the stage. Apparently he has been treated for past episodes of the disorder; had himself hospitalized a few days after the memorial.

The disorder has also been invoked on several occasions since the mid-1990s, resulting in his being declared unfit to be prosecuted for criminal charges, including an attempted murder. In one television interview he appeared quite lucid, showed no psychotic stigmata. In fairness this does not prove conclusively that he was not delusional at the memorial.
Jantjie claims his signing credentials are impeccable; state that he has signed before without incident. However his bona fides have yet to be ascertained. The interpreting firm which hired him out possibly has intimate ties to the ruling ANC party, and so far has not responded to ‘phone calls. At the TV interview he was asked to prove his signing ability, and testily refused on dubious grounds.

So far, government officials have yet to offer a satisfactory explanation as to how Jantjie got to crash the party. The predictable investigation is being undertaken. Its conclusions are not likely to be known soon. At this writing, the only certainty amidst the swirl of uncertainty is that some agency or individual did not properly vet Jantje. Apparently “it was not thought upon” that he might so flagrantly sully this solemn occasion, and also pose a spectacular security threat.

The Jantjie affair comprises yet another example of humanity’s timeless obliviousness to what should be a glaringly obvious potential for crisis, leading to dire or merely risible consequences. One wonders if this chuckleheaded disregard is hardwired into our genome. Down through the ages, it continues to afflict geniuses as well as those of little wit; politicians, generals, and the average Jane or Joe.

Our profession is hardly immune. During my Bellevue residency, a patient in a trichotillomania study was a successful, apparently well put together borderline woman. In those green and salad days I was blissfully unaware that a high-functioning facade could mask serious borderline pathology, and overzealous about breaking new research ground. I did not recognize that my patient was gradually becoming unglued as I probed relentlessly into her history. Fortunately, an astute supervisor showed that I was undermining her fragile defenses, and she returned to her previous tranquil state, once I gentled up my approach.

Today as never before, we labor under formidable pressures to spend ever less time listening to our clients. The problem stems from – inter alia – the incursions of ill-Managed Care, the shift from a ‘talk’ paradigm to biological and cognitive interventions; the prevailing yen of the age for therapeutic quick fixes.

If anything is to be taken by clinicians from the Johannesberg debacle, it’s that we must be even more mindful of distress and despair which can easily elude a quickstep march through DSM-V criteria. Like Poe’s purloined letter, a profound sorrow may lie in plain sight under one’s clinical gaze – but not yet thought upon.

An earlier version of this piece appeared in PSYCHIATRIC TIMES.


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