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Utoponil: A Breakthrough in the Treatment of Xenophobia

by J. Martin Labuschagne


There was a fluttering of papers and white coats as the new psychiatry students walked behind Professor Doctor Franz T. Smalberger through the Xenophobia wing of the Manto Tshabalala-Msimang Hospital. He only stopped when he reached the reception area of the ward and he waited as the students formed a semi-circle before him. The students were ready with the pens to capture every word of the learned doctor. Everybody except Marius Troskie, who didn’t look particularly impressed with the lecture. He was the most senior amongst the students with grey patches appearing around his hairline. After a career as a doctor in the army medics he decided at his age to specialise in a field he has always been very interested in, namely psychiatry, but he was having second thoughts whether it was really worth it.

The learned doctor professor Franz T. Smalberger spoke.

“Now, after we have been through the section for the criminally insane and you thought you have seen the worst of mentally ill, we now come to the Xenophobic.”

All wrote down what he said.

“These patients are our most dangerous…”

“Well, Professor, do you seriously believe that they are dangerous?” interrupted Marius and provoked sharp glances from the other students.

“They might not be violent now, but they carry with them the propensity for the most horrendous sort of violence, comparable only to sexual violence, namely racial violence.” Professor Smalberger looked directly at Marius when he said the words ‘racial violence’ to bring the point home.

Marius quickly added another question: “But Professor, is institutionalisation really a neccessity?”

“Well, Dr Troskie, it is not only imperative for medical reasons it is also demanded by the authorities. As you can recall that after the proclamation of the ‘Prevention of Racial Violence and Related Social Deviance Act’ of 2035 it is a statutory obligation of all psychiatrists and other health workers to report any signs of xenophobic behaviour to the local police station so that the necessary court order can be obtained to remove such an individual to a safe surrounding for treatment. I want everybody to remember that it is not just good, sound medicine, but law to report xenophobes.”

After his lengthy reply the professor and Marius tried to stare each other down for a moment or two. All the other students industriously took notes of the professor’s comments. When it looked like everybody had written down what they wanted to the doctor continued: “Let’s proceed now to view the different treatment methods we employ at our facility.”

The professor led everyone down the corridor where there were numerous windows in the walls. He stopped at the first window and it was clearly a two-way mirror to look into the room. Inside two people were busy with some sort of session. The one was a white man clothed in the standard light blue garb of the hospital and was obviously a patient. The other was a meagre Indian lady in a short skirt sitting crosslegged. She appeared to talk to the patient. He in turn sat with his arms folded looking at the floor.

“Our first line of treatment is extensive psychotherapy to bring the patient to acknowledge the problem and to develop insight into the harmful consequences of the disorder. We have found that cognitive behavioural therapy is the most effective therapy in treating this disorder. The patient is shown the irrationality of his fear and assisted in forming positive experiences of people of other races.”

While the students were scribbling away, Marius just shook his head. Professor Smalberger glared at him. When it appeared that everybody has finished writing, the doctor said: “Follow me”. He walked to the next window and everybody formed a semi-circle around him. In this room was a circle of white men listening as one of them spoke

“As a second line of treatment, we also encourage our patients to regularly attend group-therapy to help them integrate their psychotherapy into their daily lives. You see, we find that although the CBT is initially successful, when the patients are released in civil society they tend to relapse back into old  behavioural patterns. So there we have created XA – Xenophobe Anonymous – to act as self-maintaining, self-perpetuating support group for people suffering from this disorder.”

A Chinese lady put up her hand. “What if the second line is also ineffective? What would the next step of treatment be?”

The professor raised his eyebrows. “Well, there is a rather controversial procedure applied currently with many human rights organisation up in arms about it, but it has proven to be the breakthrough that we have long hoped for. Will you please follow me so that I can demonstrate?”

The professor and his flock containing a reluctant doctor Marius Troskie trodded down the corridor to its far end. Here the professor paused before a set of swinging theatre doors and announced: “We are in luck. There is a procedure in process at this very moment.”

They entered another room where there was again a two-way mirror, but the other side contained a surgical theatre of some sort. There was a bed in the middle of the room with a television mounted to the wall. On the bed lay a white man dressed in a green frock. His hands and feet were tied with leather straps to the frame of the bed while his head was held in place with a set of  straps around his crown, chin and neck. It appeared that his face was directed at the television monitor. At this stage the screen was blank. A set of wires were attached to his body at various points; his ankles, his abdomen, his hands and face; which again all lead back to a sophisticated machine with numerous lights apparently indicating whether a certain wire was active or not. Next to the machine was a console with a computer screen. A man in a white jacket, presumably a doctor, was typing away on the machine entering commands into it, while other staff with surgical masks and attire were attending to the patient ensuring everything was in working order. A nurse entered the theatre with a trolley on which was displayed a set of different metal syringes. One of the staff took a syringe, tapped imaginary bubbles out and unceromoniously injected the patient who was awake but looked despondent. His eyelids started fluttering and soon settled into a stare.

“Now that the preparations have been finalised the main procedure can follow,”  commentated professor Smalberger as everybody watched curiously the drama unfolding before them.  All the theatre staff suddenly looked at the screen of the television.  A few pictures appeared – at first out of focus and then slowly being adjusted so that the screen read ‘Phase 1”

“The patient has been sufficiently drugged to assure that he would feel the minimum pain and that he would be able to withstand the whole process.”

The staff left the theatre room. Only a nurse and the doctor operating the console stayed behind. The nurse kept busy with the machine monitoring the vital signs of the patient.

The doctor sighed and pressed a button. A set of pictures started flashing on the screen and simultaneously with every picture a shock is inflicted on the patient. His body gave a light jolt with every shock. Marius could make out some of the pictures: swastikas, Prussian crosses, white raised fists. As if professor Smalberger could read his mind, he suddenly said: “The patient is shown a whole complex of images associated with racial hatred accompanied with a shock to cause a natural aversion to them.”

A hand goes up among the group. An Indian lady asked: “But, professor, the patient is sedated? How can he form a aversion response to the images?”

“Oh, that is the beauty of the treatment. The response of aversion is inserted subliminally. The patient would have no memory whatsoever of the painful shocks, but would have a different attitude after phase two has been completed…”

“Phase two?” asked another student.

“Yes, the follow-up phase where we reprogram the subconscious mind to have a positive appraisal of the specific race of whom the patient has a phobia.” Everybody scribbled down notes.

“And how is that achieved, professor?” asked a third student, this time a person of African-descent.

The professor looked genuinely delighted to be given an opportunity to explain. “Well, the reverse of what is done here is, is applied. The patient is shown a set of pictures depicting the race he fears and is fed a set of pleasant stimulations via electrical current.”

Everybody looked impressed as they were scribbling away their notes.

Then Marius suddenly asked: “But what if the fear is based on reality?”

“What do you mean?”

“Simply: what if the fear is due to a traumatic experience with people of other races, say black persons and his phobic reaction is a normal defensive strategy towards any future danger?”

Everybody seemed shocked by his peculiar suggestion.

“I still don’t get your point,” the professor insisted.

“It could be that the patient’s so called fears are in fact natural and rational responses to threatening situations. These sensations might actually be necessary for the organism, in this case our human patient, to cope with potentionally dangerous situations. Has anyone actually checked into the grounds for his fear? Maybe shock-reflex treatment is not knocking sense into the  patient, but knocking sense out of him.”

“I see where this is going, doctor Troskie and I am not going to allow it during my lectures. Please come and see me afterwards in my office,” professor Smalberger said sharply and lifted his finger as a warning gesture. His good delight in explaining to the students the process has suddenly disappeared and a surge of irritation has bolted through his whole demeanour.

Marius nodded in agreement.

The balance of the lecture is in a very-toned down manner as the professor imparted the wisdom of the psychiatric sages to the young minds of his students. When everybody dispersed, Marius was waiting for the doctor. There was an uncomfortable air between the two men.

“Please follow me to my office,” the professor simply commanded and started leading the way. They walked through the maze of corridors and finally arrived at the professor’s office behind a grey door.

“After you,” said the professor and let Marius to enter. Marius wasn’t surprised by the office of the professor as it looked much like his own. There is a bookshelf with a sorty of  books and articles, mostly the paraphernalia of  the psychiatric establishment.

What was interesting though was the copy of the painting depicting the Tower of Babel. Marius frowned at this – trying to place its meaning with the rest of the office’s.

The professor sat down behind his writing desk upon which a human skull was standing. He gestured to Marius to take a seat.  After Marius was seated and a few seconds passed, the doctor spoke: “So, doctor Troskie, how can you possibly deny that Xenophobia is a delusion?”

Marius cleared his throat and began: “Well, doctor. I started having a few doubts a while back. Say about three months ago. I was working late one evening at the hospital when I drove home at about 4:30 the morning when I was hijacked by three black men at stop street…”

“Yes….?” professor Smalberger was frowning.

“Thereafter, I was fearful and hateful towards black people in general to such an extent that it influenced my relationship with my black colleagues. I was rude to them and generally irritated by their behaviour. I started analysing my change in conduct and concluded that I was forming a defence mechanism against black people in order to protect myself physically in future against another assault. In other words,  I realised that my fear was based on a real experience and therefore a valid response…”

“Surely, doctor Troskie, you can’t be serious.”

“Why not? All the behavioural literature acknowledges that a fear response has some basis in reality and therefore a natural reaction .”

“It is not the same thing,” the professor insisted.

“How can it not be?”

“Doctor, I can’t believe you are thinking this, nevermind saying it. Remember the Nazi’s? Remember the massacre of 6 million…?” (he  emphasised the words ‘6 million’) “…And all this due to the xenophobia that you want to defend. Imagine, doctor, how many lives could have been saved had the disorder been identified earlier. The Holocaust would simply never have happened.”

“But that is not what I was intending, I simply wanted question the validity…”

The professor summarily interupted: “Well, that would be the outcome of this fear if it goes undetected and untreated.” The doctor jabbed his finger at the desk. “…And this could lead to another horrific situation like the  Holocaust, Apartheid, not even to mention the surge of attacks in Great Britain on Pakistani youths in the summer of 2023. Remember that?”

Marius shrugged now feeling embaressed by his suggestions.

Professor Smalberger sat back in his chair, almost triumphantly, while Marius looked down sheepishly .

“Are you aware that the xenophobic disorder manifests itself also as a denial regarding the classification of Xenophobia? As if your mind is denying the delusion of racist violence?” professor Smalberger added.

Marius sighed deeply. “I don’t know professor, it’s just that lately I doubt the validity of the disorder…”

“You are suspicious of the definition of the disorder?”

Marius was reluctant to answer, but the words slipped through his lips. “Yes.”

With the self-assuredness that only an academic can have, professor Smalberger nodded his head. “It sounds like a text book case of xenophobic denial coupled with a recent traumatic experience causing deeper suspicion. Are you aware of that?”

Marius looked down at his hands. “Yes, I am aware of that.”

“Are you currently being treated for this?”

“No, I am not.” He kept looking at his hands.

Again the professor nodded and pulled a writing pad closer. He started writing something and when he was finished he presented it to Marius, who took it reluctantly.

“This is a prescription for Utoponil,” said the professor.

“Utoponil…?” Marius was perplexed.

“Yes, it is a new selective serotonin re-uptake inhibitor. It would help you ease your fears for…you know, for blacks and other races. I am taking them myself.”

“Do they work?”

“Like a dream.”

“Thank you, professor,” said Marius.