Dear Nikola,

Thank you for your letter. I hope that as the days go on, your thinking and feeling become more tranquil and productive, and that you will continue to write down (and send to me) what is on your mind. I have five comments:

a) I am persuaded by what I was taught in 1952 and 1953 in medical school, that sanity is defined by behavior which is socially acceptable. Accordingly, I consider myself ostensibly sane because I have consistently (and since no one reads what I write, successfully) limited my expression of my "true" thoughts and feelings to my writing. In ordinary discourse, I cannot and I do not reveal what I think and what I feel. Admittedly, this systematic untruthfulness creates an ethical dilemma, inasmuch as it reflects the necessity, in order to survive in society, to live an untruthful life, i.e. to lie. Arguably, the ethics of Immanuel Kant, which posit a categorical imperative to tell the truth, constitute the ultimate obscene falsehood. If you conclude from my comments that I consider myself surreptitiously insane, you are correct.  

b) My experience accords with the teaching of Heraclitus that existence is flux, and as such unpredictable. It is conventional wisdom, that illnesses often get worse, seemingly to a point of no return. But I am convinced from observation and experience, and have consistently advised my patients, that illnesses also often spontaneously get better. The prescription and use of medication requires assessing the balance between benefit and harm, a balance which is inherently unpredictable and unstable, and requires thoughtful titration by the physician and the patient. 

c) Although I must not presume to serve as your psychiatrist, I am prepared to help you evaluate and implement your psychiatrist's instructions, and if you wished to deposit with me a small amount of each prescribed medication, I could supply it to you when you needed and were unable to find it.

d) My experience with mind is entirely subjective. I only investigate and reflect on my own thinking and feeling. I have no comparable access to, or understanding of the fundamental mind that pertains, as you say, to the remaining tribes of the earth.

e) I fervently wish you well.

EJM