June 1998

The following is out of the book 'ANGER, MADNESS' and the DAIMONIC The Psychological Genesis of Violence, Evil and Creativity Published in 1996 by State University of New York Press, Albany www.Amazon.com carries the book including a full table of contents for your information.

 The Author, Stephen A. Diamond has granted me permission to publish this segment out of his book, as follows:

 'Jack Rosberg's Direct Confrontation Therapy'
I would like next to present a verbatim transcript from another case of intensive psychotherapy performed by an altogether different clinician: Psychologist Jack Rosberg. The year is 1974: The place is Los Angeles, California; the setting is a psychiatric hospital. The transcript that follows was contributed by Jack Rosberg for specific use in this chapter.

 Rosberg specializes in the psychotherapeutic treatment of schizophrenia: probably the most intransigent, crippling and bizarre type of psychotic disorder. For reasons that will soon become clear, Rosberg refers to his highly unconventional form of treatment as 'Direct Confrontation.' In essence it resembles exorcism, during which Rosberg relates to the patient in a distinctive psychodramatic style. As readers will learn from the following vivid account, Rosberg carefully controls an directs the action during each session, utilizing trained staff members as well as other patients to create the proper milieu. Kelly, the 17 -year old, Caucasian, male recipient of Rosberg's unorthodox ministrations in this extraordinary session, had been recently diagnosed as 'schizophrenic'. As is so commonly the case, Kelly's malady evolves slowly, stealthily, until eventually, he becomes severely withdrawn, behaved bizarrely, could not longer function at home or at school, and was morbidly preoccupied with the devil; indeed, he flagrantly insisted that there were 'two devils' living within him. Strangely enough, such symptoms are commonplace in schizophrenia and certain other psychotic disorders. In the days of demonology, Kelly would surely have been said to be possessed by demons, if not the devil himself.

 The dimly lit room in which this therapeutic encounter - the second of five - takes place, contains a-half-a-dozen patients and several staff members in addition to Kelly and Rosberg. Rosberg, sporting sleek, impenetrable sunglasses, chain-smoking slowly engages Kelly in a primarily mysterious, movingly symbolic ceremony - one which could best be compared to an exorcistic ritual. Even after having viewed this event on video tape several times, it is still truly difficult to describe the daimonic quality of this deeply disturbing - yet humane - procedure. One is unmistakably aware of an irrational - yet expertly orchestrated and regulated - primitive power permeating the participants; the hypnotic, pounding rhythms of distant drums in the primordial darkness are all but palpable, in parting the uncanny impression that this sacred ceremony has been performed, in some form or another, by shamans, witch doctors, medicine men, priests, priestesses, and assorted healers of the human spirit, soul, and body since time began.

 We pick up the action - heavily edited for brevity's sake - as Kelly is confronted by Rosberg and his assistant, Chess Brodnick, about what they have inferred from the case history to be Kelly's suppressed rage toward his parents. Chess plays the provocative role of Kelly's father; Helen, herself another patient at the hospital, plays the part of Kelly's mother: 'DAD': I need to hear . . . the feelings that go with that hatred. . . .Tell me so that I can hear it.

 ROSBERG: Let him have it, Kelly!

 [Kelly is crying, but unwilling or unable to express any anger. His 'father,' Chess, continues to encourage Kelly to communicate his hatred directly toward him. Gradually, after a great deal of reluctance, Kelly haltingly expresses his secret feelings to his 'father']

 KELLY: I just don't think that you are a good father, because you take things to technically. [Still sobbing.] You didn't tell me about sex.

 Suddenly, Rosberg, having remained silent during most of the session until now, rises from his chair, and begins speaking loudly in his booming, bass voice.

 ROSBERG: No. I think the devil --you [Chess} will move out of the chair, because the devil is still inside of him, and I have to get the devil out of him again. . . . I want you to feel the devil growing inside of you. Do you feel the devil growing inside of you? Taking over your mind? Taking over your soul? Taking over your body? Do you feel it now? Do you feel the devil inside of you? Do you?

 Now Kelly is angry, but simultaneously continues to sob deeply.

 Kelly: Go to hell father! Go to hell!

 The emotional atmosphere turns electric.

 ROSBERG: Get the devil out of you! Get the devil out, out, out, out, out!!! It's coming up [He stands right next to Kelly, gesturing with his hands.] Now, I'm pushing the devil up, up, up your thighs. I am pushing it up.

 KELLY: Get out of here! [Attempts to push Rosberg away from him.]

 ROSBERG: No! I'm going to get the devil out! The devil is going to get out of you! Now. . .now. . .now. .. .Up. . .up. . .up. . . .Out of your face. . . .Open your mouth. . .Get rid of the devil. . . .The devil is in there. Open your mouth. Open your eyes. . . .

 KELLY: You fucking stupid devil! Get out of here! God damn it.

 ROSBERG: Kill the devil! Kill the devil! Here. Here. There he is. Get him! Kill him! Destroy him! Get rid of him!

 Rosberg hands Kelly a piece of plain blank paper. Kelly is by now in a barely controlled rage, screaming violently at the imaginary paper 'devil' tearing at it, twisting it as if strangling someone, and angrily stomping it with his feet. At one point, he even tries tearing it to pieces with his teeth. Rosberg continues to exhort this expression of rage until Kelly tires and starts to sob even more deeply than before. Rosberg's demeanor softens dramatically.

 ROSBERG: Now look at me, Kelly. . . . Is the devil still inside of you?. . . The 'she devil' and the 'he devil,' are they inside of you? [Kelly shakes his head indicating no.] I want you to talk [now] to your mother, and tell her what you feel about her.

 At first, Kelly refuses to speak to his 'mother' as played by a fellow patient. Finally, after some manipulative pleading from 'mother' to speak to her, Kelly bitterly reacts.

 KELLY: Go back to where you belong!

 'MOM': Where do I belong?

 KELLY: In hell.

 'MOM': Why?

 KELLY: Because you are evil!

 'MOM' But I can change!

 KELLY: No you cannot; you cannot change!

 'MOM': Why?

 KELLY: Because God damned you!

 'MOM': Please forgive me, Kelly. I'll try to be good. I've been exorcised by Father John! [She continues to cajole Kelly to trust her, sometimes seductively.]

 ROSBERG: Don?t trust her Kelly. . . . She's trying to trick you again. . . .Tell her to get out of your life, to get out of your body.

 KELLY: [Begins to breathe laboriously. Then, he fiercely explodes] Leave me alone! Get out of here! Go back to hell! Go back to hell!

 Having expressed some rage toward his mother, Kelly- - still inflamed- - is a few minutes later redirected toward his troubled relationship with his father.

 ROSBERG: Okay. . . .Now we'll talk to the father devil.

 KELLY: [Gasping for air.] You weren't a good father to me. You weren?t a good father to me!. . . I hate you. I don't even want to talk to you! Get out of here! hate you!. . . Stay out of my life!. . . I hate you as much as my mom. . . .I hate you more!

 Dissatisfied with the quality of Kelly's response, Rosberg again actively intervenes.

 ROSBERG: No, he still has it inside of him. Move aside. . . . He still has the devil in him. . . . I've got to get the devil out of you some more. Now let the devil grow inside of you again!

 KELLY: Noooooooooo!

 ROSBERG: Yes, let the devil grow inside of you again. Let it grow stronger and take over your mind. Let the devil take over your mind and your soul and your body. Do you feel him growing inside of you? Do you feel him now?. . . Do you feel the devil?

 KELLY: Yessss! Now get out of here!

 ROSBERG: Well, I'm going to take him out of you. Again. . . .It?s going to come up here and it's coming up to your stomach, and it's coming up to your throat, and let him out!

 KELLY: Get back! God damn you! Oh shit!

 At this point Kelly seems to momentarily disintegrate, speaking in schizophrenic gibberish and convulsively rage crying. But again, Rosberg urges him to 'kill' the paper 'devil.'

 ROSBERG: Kill the devil. Kill him again! There's the devil on the floor [pointing to the paper]. Destroy the devil! Harder!. . .Choke it!. . . Tear it to pieces! [Kelly cooperating, totally destroys the paper 'devil'] Get rid of it! The devil die! Die devil, devil die.

 By now, Kelly is spent. Having vented his rage, it appears - for the moment - to have dissipated. However, he still sobs furiously as Rosberg, once more in a much kinder, gentler, supportively paternal tone, speaks to him softly.

 ROSBERG: All right, look at me, Kelly. . . . I want you to look at me. You can throw the devil on the floor. . . .See, the devil's gone. The devil's gone? [Kelly nods affirmatively.] Okay. You killed the devil. Congratulations. . . .Now let me talk to you. . . . I'm going to explain what the devil is. . . .Do you understand what I'm saying to you? . . . .Is your head clear? [Kelly nods affirmatively again.] Do you feel crazy? [Kelly nods in the negative.] I know you're pretty tired. That was hard work! Do you know what the devil is? You had a 'he' and a 'she devil' inside of you, right?. . .When you grow up and up and up you take the mother and the father inside of your system, inside, and they become a part of you. They have good parts and they have bad parts. . . . And when you gown up and you mature, then you get rid of the bad parts and you keep the good parts.

 Next, and for the remainder of the session, Rosberg continues to talk with Kelly- as a good therapist might with any adolescent patient- about his parents, the fact that they, like all of us, have both bad (evil) and good aspects; and about Kelly's will to be well, which Kelly convincingly confirms.

 According to Rosberg - founder and former director of treatment at the Anne Sippi Clinic in Los Angeles, California, a freestanding residential treatment center for schizophrenia - after five equally confrontive sessions, Kelly recovered sufficiently to be released from the hospital, and was referred for ongoing outpatient psychiatric treatment. As of 1977, three years after his brief but stirring treatment, Kelly was still receiving outpatient psychiatric care, attending college, and functioning comparatively well, reports Rosberg. Kelly was one of the few fortunate victims of schizophrenia who found effective treatment early enough in the 'disease' process to stave off disaster. Most are not as lucky.

 Jack Rosberg did his clinical training in 'Direct Analytic Psychotherapy: with schizophrenics during the mid-1950's, under the supervision of psychiatrist John Rosen. He sees schizophrenia as a series of intricate, deeply-rooted defenses or resistances designed to fend off painful reality, and prevent others from gaining entry to the patient's subjective world. Rosberg believes- as do the majority of mental health professionals - that schizophrenia is virtually untreatable by traditional methods of psychotherapy. Yet, in contradistinction to most mainstream clinicians, he claims that constructive contact can be established by unwaveringly challenging and verbally piercing what he conceives of as the psychotic patient's expertly executed psychopathological defenses. The challenge in working with chronic schizophrenic patients, contends Rosberg, is to directly confront their bizarre behavior unequivocally, without being driven away by it - which is precisely what typically occurs in most cases: ' Schizophrenics are often labeled treatment - resistant because the psychological treatment they receive is seldom appropriate for their needs. . . . [Mental health] professionals must learn that changes occur because the therapist is stronger than the psychotic defenses of the patient, i.e., the patient's resistance to treatment.? (44) Penetrating this formidable - and almost always effective - fortress of psychotic 'symptoms' protecting and precluding the schizophrenic person from intimate, meaningful human relatedness, entails an intense, intrusive, close encounter with these autistic and narcissistic defense mechanisms, and the daimonic emotions underlying them. Enormous stores of hatred, anger, and rage, as well as the ever - present possibility of violence, are regularly aroused, and are typically utilized by the patient as a form of resistance. If the psychotherapist - like the exorcist - is physically, spiritually, or emotionally unprepared for what can quickly become a venomous verbal (or even physical) defensive onslaught, he or she will withdraw, and the psychosis or 'demonic possession' will have won. (Readers might remember the 1973 film version of William Peter Blatty's best-selling book The Exorcist, dramatically depicting the life and death battle between exorcists and the 'demonic' forces against which they intervene on behalf of the 'possessed' person.)

 In this sense, the daimonic passions of anger and rage play a key role in Rosberg?s direct confrontation therapy, for both patient and therapist. In effect, Rosberg, rather than retreating from the daimonic, actively exploits the vitriolic anger and rage of his patients - as well as at times his own anger - to aggressively attack and combat the psychological demons bedeviling them. Rosberg, in the words of one well - informed reported, recognizes that the therapist, to work effectively, has to be able to understand [and constructively utilize] his own angers and rages, . . . [and] that his patients seem to benefit from open anger which is directed toward their illness, not them. We [the reporter] were reminded of the dramatic physical and oral struggle between Annie Sullivan and the young Helen Keller. The beneficial effects of that anger resulted in the breakdown of Helen's defenses. (The defenses of the therapist, unless understood, may also be obstacles to successful treatment.) (45)

 The initial phase of treatment consists of establishing the fact - in no uncertain terms - that the therapist (and not the patient) is in complete control of the therapeutic situation:

 This is achieved by making a strong initial impression, orally, and by countering any aggression with a show of power. For example, if the patient is exhibiting aggressive behavior, the therapist . . . [may at times 'give permission' to] the patient . . . to continue with his aggression! Or he may merely engage in an 'outshouting contest,' until the patient is exhausted and yields to the power of the therapist. Physical proximity is emphasized, especially in this phase. (46)

 Following the securing of control within the physical environment, which is reinforced and supported by the clinic's many well-trained staff members, Rosberg's preliminary path to connecting with the schizophrenic requires boldly entering into the patient's strange subjective world of delusions and hallucinations, rather than trying - at least at first - to force the patient to conform to the therapist's own more conventional view of consensual reality. Hence, Rosberg could be said to concur with Rollo May's existential conviction that, in psychotherapy, 'our initial task is to make available an interpersonal world - consisting chiefly of the therapist-patient relationship - in which they are able to confront . . . the daimonic, as fully and directly as possible? (47)

 Once 'inside'the schizophrenic's fragmented, hellish universe, Rosberg aggressively allies himself with the patient against the 'demons': the morbid emotional components of the psychotic process of daimonic possession.? This critical third phase of the treatment process has been call 'catharsis,' during which the therapist draws a crucial distinction between the patient. . . as a worthwhile, likeable, valuable person versus. . .[the] illness, which the therapist describes to the patient as awful and hateful, but separate, and something which can and must be cast out from him.? Here we have the very quintessence of exorcism: the furious 'casting out' of the offending devils or demons. But while this potently abreactive aspect of treatment is indeed cathartic and healing, the expulsion or release of these daimonic emotions, while supremely important, is not in and of itself curative:

 Next comes the 'rebuilding' phase. Generally during this period the patient doesn't understand all of what has happened and is happening to him, and he is very angry with the therapist. . . . It is during this aspect of treatment that the patient must be kept from regressing and must be increasingly motivated to get out into the world. . . . Thus, slowly, gradually and painfully, healthy defenses are substituted for unhealthy [ones], and strengthened. The patient comes to realize that there are greater rewards for him in life as a well, rather than as a sick person. He does not need to remain ill if he really chooses not to be and is willing to work hard on becoming and remaining well. (49)

 Note that the patient's anger is not eradicated, but rather plays as important part in providing the much-needed impetus to return to the world during this essential 'rebuilding' phase. In effect, the daimonic rage is first freed from its fetid and negativistic state of psychotic repression; transitionally directed toward the therapist; and, finally, channelled into constructive activity: namely, the creation of a new life. In my opinion, Rosberg's insistence on the patient's having to consciously choose or decide whether to remain ill or to fight for a healthier, more satisfying lifestyle reflects a fundamentally existential attitude toward psychotherapy. By breaking through the schizophrenic's brilliant but moribund psychotic defense system, Rosberg renders such 'hopeless' patients amenable to more conventional methods of psychotherapy. His ongoing work with schizophrenia at the Anne Sippi Clinic - as well as in Scandinavia and Russia - is some of the most innovative and pragmatic treatment currently available for the psychotherapy of acute or chronic psychosis.

 I thank Dr. Diamond for his generosity in permitting me to put the above on our website. This is the end of the excerpt from the book 'ANGER, MADNESS, and the DAIMONIC' by Stephen A. Diamond, Ph.D.

 This book, is, in my opinion an important contribution to some of the causes of violence in our society. I believe that every responsible clinician and other interested professionals and responsible individuals should make this interesting investigation a must for reading. In view of the increasing violence amongst the young and the older generations in our society, there must be some way of understanding the basis for this complex problem. This book does indeed offer us a greater understanding of this problem.

 Till we meet again,
Jack Rosberg