Reading the presentations and discussions by Jim Pretzer (8/1/97; 8/21/97) and by Jessica Broitman (8/6/97; 9/2/97) I would like to comment briefly. Jim presents in Gary an interesting person with rather frequently found problems. In spite of much evidence to the contrary Gary apparently doubts his competency in meeting the demands of daily life (e.g., he labels as stressful his job as well as graduate school and also living with his parents) and his emotional stability (e.g., becoming angry for no apparent reason, he says). It is interesting and, perhaps, significant, that the emotional support he gets from his sister or from his girl friend can restore his self-confidence to some degree. Gary contrasts that with the attitude of his parents: mother tore down what he did and father was distant and did not believe in him. It seems that Gary implies, consciously or not, that he needs certain positively responsive relationships for functioning with a feeling of self-confidence.
In the absence of such supportive relationships he feels insecure and worries that he does not function well and that the anxiety will aggravate his Irritable Bowel Syndrome into uncontrollable diarrhea. I suspect that there is much truth in these observations of himself. It is interesting to note that he is making an uncomfortable educational effort to get into an administrative position. Does that mean he is trying to get away from his clinical job, that is, from having to deal more with patients than if he is in an administrative post? Jim Pretzer's next sentence is about Gary having always been uncomfortable with dating. That makes me wonder whether there is a connection (an association in psychoanalytic language) between the thought of getting an MBA and the thought of being uncomfortable with some people. Be that as it may, there is also the history of the onset of his symptoms around the time of puberty which is usually the time that youngsters feel some pressure to relate more closely to others and especially to the opposite sex.
I would expect that Gary will respond quite well to Jim's benevolent interest and attempts to help him cope with the anxiety. Gary may well experience Jim's concern as a sought for mirroring relationship analogous to what he gets from girlfriend and sister. When Jim states that Gary experienced needles anxiety he is judging Gary from the outside and not >from how it feels to Gary. From the outside it looks as if Gary's concerns are irrational since they appear to focus on his skills when trying to function as radiologist or socially or as a student. I believe Gary knows he has those skills. What he does not know is that his whole sense of self is shaky because he lacks the needed emotional support. He does not know that he is undergoing an experience of some disorganization of his self and that such an experience of fragility and vulnerability is quite anxiety producing. It is analogous to being placed into an environment that lacks sufficient oxygen: one will experience a shortness of breath without necessarily knowing the cause. Does the anxiety or the shortness of breath have a function? I think they are unavoidable consequences of the conditions of shortage (of relationship in one, of oxygen in the other) that can, perhaps, eventually serve the function of warning one about the conditions of shortage.
Etiologically I see the source of Gary's vulnerability much like Jessica Broitman does. The attitudes of his parents were such as to deny him the opportunity to feel appreciated and develop self confidence. Perhaps, he also has learned that complying with their deprecating view of him has some advantages.