Name: Achashverosh

Date of Birth: Unknown

Date of Evaluation: March16, 2014 / 14 Adar 5774

Identifying Information and Presenting Problem and Social History:

Achashverosh was presented for a psychological evaluation by Frum Therapists to assess his psychological and cognitive functioning. He is a 2000 year-old man of Persian descent who lived in Shushan, and was employed in a government job as the King of the Persian Empire for most of his adult life. He is obviously no longer alive, and the evaluation and report are for educational/research purposes only. Sources for the evaluation include the text of Megillas Esther, Rashi’s commentary, and various Talmudic and Midrashic teachings.   For a more thorough account of his known social history please refer to the Megilla we just read cover to cover publicly twice this past weekend. Ok?

Achashverosh presents with a wide array of symptoms of emotional, intellectual and behavioral impairment, making differential diagnosis a complex and challenging endeavor. Since the days of the Talmud, scholars debated whether his pathology was more developmental and cognitive or characterological and sociopathic in nature.   Yes, I am talking about the old Machlokes in the Gemorah about Achashverosh Melech Teepesh or Melech Rasha. While there is certainly evidence for both formulations, and the two do not contraindicate each other diagnostically, this report will examine from a phenomenological and theoretical perspective all the data and possible interpretations.

Cognitive Functioning:

Achashverosh’s cognitive impairments are severe and impede his functioning in several areas including many Activities of Daily Living.   Considering his socioeconomic status, it would be expected that know how, for example, to respond to a minor domestic squabble such as his when his wife Queen Vashti did not want to go out one night to one of his parties. Achashverosh felt the need to involve all of his governmental advisors and make it into a whole federal case. Furthermore, when Haman took advantage of the opportunity to easily manipulate and weaken the king by inflaming and exacerbating the problem, Achashverosh was unable to consider the consequences of an action such as having his wife executed; namely that she would then be dead and he would be a widower.  

As the king of an empire that spanned the entire civilized world at that time (127 States, please don’t ask me to name them), his basic functioning necessitated at least the most rudimentary ability to think strategically about legislation, administration and public relations. His poor executive functioning, memory, planning and organization skills, however, time and again caused Achashverosh to issue impulsive and nonsensical edicts that made him the laughing stock of his own subjects.

His melodramatic judgment of guilt and death sentence on Vashti, his own Queen, was viewed as even more ridiculous when he presented it in the context of the need for all men to show their wives “who is boss,” and “decrees” that every man should rule his own castle.   At that time (back in the days before the political correctness police) this was what would now be aptly called a “no-brainer.” He lost a lot of face, and his approval ratings sunk lower than Obama’s on a day of government layoffs. People were like “Seriously? He’s the king. He has to make a point about this? Dude, get a clue.” Some commentaries point out that the second part of his legislation was even more imbecilic: In every marriage of mixed ethnicities and cultures, the women, who were already basically living like slaves whose work in the house was crucial for any kind of familial, economic or civic functioning, would be required to go back to school to learn a second language just for the formality of respecting their husbands. Come on, man?

Perhaps the single most idiotic and self-defeating law made by Achashverosh was that when the king passed any pronouncement of law, as soon as it had been publicized, it could never be repealed, and even he himself could not change his mind. (Thank G-d Obamacare doesn’t have that provision, right?) So although he didn’t have a “.gov” internet site, making the “roll out” of his acts even slower, if by any chance, he had time to reflect on or research the value of a law before people even knew about it, he could not just say, “oops, my bad,” and needed to find ever more creative ways to back pedal. Say for example one day you, as king, decide to commit genocide of the Jewish people (not so uncommon in history), but say you find out that your wife, whom you have allowed to keep her national identity a secret, discloses that she is a Jew.   (Couldn’t see that one coming, huh?) What to do?   He couldn’t save Ester’s life any more than he could prevent Vashti’s demise. Only this time, he put the problem in more trustworthy and intelligent hands, and Ester and Mordechai came up with a lomdush solution.

At this point, there is only one consideration mitigating Mild Mental Retardation aside from lack of formal IQ screening. (Can you see how much fun it would be to hear his answers on “Comprehension” and “Similarities”?) This is the unknown variable of the long term effects alcohol abuse had on his neuropsychological functioning.  Which leads us to the next area of interest regarding Achashverosh.

Maladaptive Behaviors:

The text of Megillas Ester reads like a veritable AA Big Book with accounts of the many degrading and life destroying effects that the addiction to alcohol can have on an individual. Not one important decision or event in his life actually happened with Achashverosh really “present”.   Whether it was getting rid of his old queen, finding a new queen, deciding to kill the Jews, deciding NOT to kill the Jews, every important occurrence was a reason for celebration or drowning of sorrows.  And he, ruling over the whole ancient world, should have known more than most that “Denial” is not just a river in Egypt. Rumor has it, that under his Royal robes, he liked wearing a T-shirt he had found at a tourist shop in the Arab Shuk that said “I’m not an alcoholic, I’m a drunk……Alcoholics go to meetings.”  

It is not clear at what point in his life he started “using,” and we cannot know whether Achashverosh’s addiction developed from a need to self-medicate emotional pain, or just came from his college days at the frat house, but the sheer volume of wine he poured down just that we know about is more than enough to consider as an etiological factor in his impoverished cognitive abilities.

Emotional Functioning:

From a psychological perspective, Achashverosh presents as exhibiting mood swings, bouts of depression, and general emotional lability. He has had more than one episode of manic partying, including early on in his reign when he threw a party for the government officials of the entire civilized world for 180 days non-stop. This was immediately followed by an “intimate affair for his closest friends” comprising the entire population of the capital city.   He also had severe angry outbursts that often lead to very poor judgment, such as when he became enraged at Haman’s trick to kill the Jews, but ran out of the room, leaving Haman alone with his wife Queen Ester.

These manic states were both triggered by and contributed to delusions of grandeur, in which he literally considered himself the most powerful man alive…ok, maybe he was, but still.   The Medrashim says he dressed himself up in the Bigdei Kehunah, convinced that he would be the one to outlive the prophecy of the rebuilding of the Beis Hamikdash that was to happen within 70 years of its destruction. It is possible that mathematics learning disorder played a role in his mistake here, but you would think this would be something where you would want to check your answers, no? There appears to have been grandiose thinking involved when at first Achashverosh thought that young virginal women would all line up to want to be his queen after what he did to Vashti. In general he tended to overestimate him masculinity and to compensate in immature ways. Freud would certainly have made much of his babyish phallic “touch my scepter” game he invented to intimidate people.

Even more than most monarchs, Achashverosh tended towards suspicious fears for his safety, a suspicion of others that at times bordered on paranoia. Behind his anger at Vashti was an unconscious fear that because she was the one in the couple who came from “real Yichus”, one day she would use that against him to deprive him of power.   When he became frightened one time that he had not adequately repaid Mordechai for saving his life, it was not real gratitude that sprung him to action, but a fear that others would hold grudges or be less likely to intervene to stop his assassination. The story of his close call at the hands of Bigson and Seresh just goes to show the old aphorism that, “Just because you’re paranoid, doesn’t mean that they aren’t REALLY out to get you!”

As with most cases of bipolar mood disorders, after he crashed, Achashverosh was likely to fall into a deep depression. The grieving over his loss of his beloved Vashti was so severe, the Midrash says that his servants feared he would become suicidal, and were therefore emboldened to make “shidduch” suggestions to him. He ruminated over her and what had happened to her, and could not forgive himself or be consoled…..at least until he found somebody better.

Personality Functioning:

For Achashverosh, his understanding of and adherence to social norms and regulations is impoverished, as he tends to “live by his own rules,” and make up edicts on society as he goes along, to satisfy his own personal wishes, with little heed to the feelings of others. In general, Achashverosh shows very little ability to empathize with or care for others’ needs. Agreeing to allow Haman to wipe out the Jewish people (without even accepting a huge bribe for it) shows a particularly hostile and sadistic side to his character that lends weight to the Talmudic opinion of “Melech Rasha.”   His ego-centricity, grandiosity and lack of empathy reveal a narcissistic sociopathy usually found in dictatorial tyrants.

While Achashverosh expresses a desire for intimate connection and love, his attachment style is generally of the ambivalent type, and he tends to see others mainly from the perspective of his own needs.   This interfered with his ability to sustain his first marriage and made it difficult for him to find a second wife by more socially appropriate means. His pattern of unstable and intense, hot and cold relationships such as with Vashti, with Haman, and with the Jewish people as a whole, show poorly developed ego functioning and what Otto Kernberg would call unintegrated part-object introjects that could only be resolved in psychoanalysis. Of course, a bissel DBT skills training wouldn’t have hurt either…. Even in his most long lasting “healthy” relationship with Queen Ester, we find a frantic effort to avoid abandonment, where he begs her repeatedly promising to give her “up to half of my kingdom” if she were to reassure him of her love. (Pretty good pre-nup, no?)

Diagnostic Impressions:

Much of Achashverosh’s presentation can be explained with the “Cluster B” Axis II personality disorders and sociopathy he suffered from. His alcoholism that certainly exacerbated cognitive limitations also caused great distress to himself and others in his environment.

However, in looking at the bigger picture of the man and his story, there appears to be more here than meets the eye.   As someone with experience and expertise in treating survivors of sexual abuse, you can guess where I am going. I know you are going to say that “when you have a hammer everything looks like a nail”, but I will remind you that sometimes a cigar is just a cigar. So…..

Many of the behavior problems and psychological symptoms of Achashverosh are often seen in individuals who have suffered traumatic sexual abuse in childhood.   While there is no recorded history of such a trauma in his case, the fact that he never spoke of it could certainly be due to avoidance of the triggering of overwhelming emotions.   Furthermore, current research suggests a prevalence of about one in five children being sexually abused in some way by the age of 18.   That 20% statistic is among the general population, and studies show that in the “clinical” population, those who present for treatment (or in Achashverosh’s case SHOULD be presenting for treatment) the incidence is significantly higher. A further exploration through structured trauma interview would be advised if it were possible.

In any case, there is also a very strong correlation between traumatic sexual abuse and alcoholism. The prevailing theory is that substance abuse can serve to create dissociation that is a common and at least temporarily adaptive defense mechanism employed by victims at the time of the abuse.   Unless given adequate support and treatment, (there were no child advocates back then), many victims will use a variety of dissociative psychological defenses or behaviors to drown out thoughts, memories and feelings about the trauma, alcohol being a common vehicle.

Acting out sexual aggression in an abusive way is one way that some traumatized victims try to cope with the trauma, the memory of which is often dissociated and split off from the conscious aspects of personality. Achashverosh’s serial raping young women on the pretext of looking for a wife shows very poor boundaries regarding sexual relationships. Compelling Vashti into exhibitionistic behavior to humiliate her for his voyeuristic pleasure could also have been an attempt to gain mastery over the trauma by inflicting abuse on another. In this case, since it lead to his placing his own beloved wife’s life in danger, it may also have served as a kind of vicarious self-punishment seen in many survivors of child sexual abuse (like self-mutilation, cutting, para-suicide and suicide).  

Once the trauma was re-enacted unconsciously, Achashverosh was re-traumatized leading to symptoms of recurrent ruminative and intrusive recollections of the event of his abusing Vashti. He displayed symptoms of increased arousal, such as difficulty falling or staying asleep, irritability and outbursts of anger, hypervigilance, and exaggerated startled response (“Vayomer Hamelech, Mee BaChatzer?!”)   While he craved the security of love and intimacy, he clearly was unable to create or sustain this kind of romantic relationship, as in both of his marriages he either killed or almost killed his wife.  

DSM-IV Diagnosis: (Sorry, they didn’t have -V yet. Plus, I forgot to buy one at the NEFESH Conference)

Axis I:

296                         Bipolar I Disorder, Most Recent Episode Mixed

309.30                   Alcohol Dependence

309.81                   R/O Post Traumatic Stress Disorder

291.2                     R/O Alcohol Induced Persisting Dementia

V61.1                     Sexual Abuse of Adult

Axis II:

301.81                   Narcissistic Personality Disorder

301.7                     Antisocial Personality Disorder

301.83                   Borderline Personality Disorder

301.50                   Histrionic Personality Disorder

317                         R/O Mild Mental Retardation

Asher Lipner, Ph.D.

Evaluator