COLUMN ONE : Window on Psyche of L.A. : Therapists get vivid, daily portraits of anger and boredom, depression and fear. The city seems to be held together by thin and frayed emotional threads.

Even after 35 years as a psychiatrist, there are nights when Dr. Michael Singer lies awake, fretting over the people of Los Angeles. More and more, it seems to him, their lives are consumed with fears, anxieties, the pressures of a rapidly growing metropolis.

Many of Singer’s patients are phobia sufferers. Some never go outdoors, living as hermits in tiny tract homes. Others are intensely afraid of increasingly crowded supermarkets, concert halls, banks, freeways.

“Some people get on the freeway, it’s rush hour, bumper to bumper, and they’re terrified,” Singer said. “Their hearts are pounding, they’re sweating, they’re hyperventilating. They’ll get off at the next ramp and take surface streets even though it may take them two extra hours. Or they’ll call (work) and say they’re sick, and go home.”

Perhaps more than any other professionals, psychiatrists and psychologists are daily observers of the difficulties of Los Angeles life. Like voyeurs at the window, peering in at the city’s soul, they see the populace in all of its Angst, struggling with frailties and demons, both real and conjured. Los Angeles, in this skewed perspective, emerges as a fascinating yet frightening landscape: a city of tics and violent moods, ravaged by urban crowding, greed, crime, divorce.

There are wealthy Westside matrons who love their diamonds but not their husbands; victims of inner-city violence; bored and aching housewives in the San Fernando Valley. There are homeless psychotics living in downtown alleys; frustrated yuppies in designer ties, yearning for that first yacht; AIDS patients and the sick elderly, unable to come to grips with dying.

“I’ve found a tremendous demand for psychiatry (here),” Singer said, echoing what many other therapists express even more emphatically.

Today, Greater Los Angeles ranks second only to New York City as the emotional-therapy capital of America.

The sprawling metropolis from Santa Barbara to Orange County is home to about 2,000 psychiatrists--more than in all of Pennsylvania, or Texas or 46 other states. The psychiatrists share the load with an even larger number of state-licensed psychologists and counselors, all grappling with a monumental array of disorders.

A place of great expectations, the metropolis attracts tens of thousands of newcomers each year. Some come filled with visions of an almost quixotic land of palm trees, beaches and poolside parties, and these dreamers often are disappointed to discover a harsh, competitive city much like any other. Others come as refugees from the ravages of war or Third World poverty, and in their new city, with all its contrasts of rich and poor, that baggage can grow heavier, more likely to rip at the seams.

Problems that tend to trigger emotional strife often vary widely from one community to the next, or among subpopulations. No part of the city is invulnerable; anxiety and mental illness cross all geographic and cultural boundaries.

Dr. Michael Gitlin, who practices in affluent West Los Angeles and at UCLA, says that a typical patient at his office is a 30-year-old male who grew up in a pampered world of maids and servants. But now, a few years out of school, he is frustrated that he has not yet made his first $1 million. He is acutely aware that his father is rich, that his friends from high school are rich; they all own Mercedes-Benzes and beach homes.

“(His) sense of what’s good enough is very warped,” Gitlin said.

Dr. Milton Horowitz, a Beverly Hills psychotherapist, has noticed a similar pattern, seeing upper-class patients with “a very self-centered, inflated view” of themselves. One woman in her 50s had been in therapy, without success, for 14 years. She boasted of buying gowns for $1,500 apiece and, despite several face lifts, permitted Horowitz to view her only from certain flattering angles.

Her complaint involved relationships: After two failed marriages, she had spent 10 years looking for a new partner. She seemed sure her time was running short.

“She was desperate,” Horowitz recalled. “She’d say, in a plaintive, almost demanding way: ‘You’ve got to help me find a man.’ ”

No man she had ever met, however, was good enough for her; to her mind, she was the most important creature in the universe. Inevitably, the men in her life failed her, including Horowitz.

Across town, in the inner city, poverty, drug abuse, rampant divorce and gang violence create a world in which anxiety and depression touch thousands of patients each year.

Dr. Quinton James works at a pair of counseling clinics in South-Central Los Angeles and in Inglewood, evaluating troubled schoolchildren. In a random sample of his patients a few years ago, James found that 10 out of 130 children had lost a family member or close friend to violence. One 14-year-old told the psychiatrist that he was playing on the street when his mother was shot and killed in broad daylight--by the boy’s father.

On a recent afternoon, James kept a log of his conversations with inner-city students referred to him by school counselors. One was an 11-year-old who had been starting fights, acting up in class and performing poorly on tests.

“I asked him . . . ‘Is there anything you worry about?’ ” James said.

“Yeah.”

“What is it?”

“I worry about dying. I think I’m going to die. . . . I’m going to get shot by gang-bangers.”

“Are you involved in a gang or anything like that?”

“No . . . but I’m afraid.”

A second student, a 9-year-old, was being raised by only a grandmother; he feared for her declining health. If she died, where would he go?

One of the economic ironies of psychiatry in Los Angeles is that most professionals practice in upscale neighborhoods where the patients can afford to pay. In the inner city, where therapy is most desperately needed, the burden falls on a public mental health system that has been all but dismantled through state and county budget cuts.

Beverly Hills divorcees and South Los Angeles children unnerved by violence are the extremes, but like the city itself, the psychiatric caseload contains a vast middle ground, found in the suburbs.

Dr. David Gorton, who practices in the San Fernando Valley, handles a caseload filled with middle-class housewives, accountants and government bureaucrats. He estimates that 75% suffer a kind of malaise. They think they should be happy, but they are not. They have gone for so long doing what is expected of them, following the script that others have written for their lives, that they cannot really figure out how they feel.

“Often, they don’t know what they want in life,” Gorton said. “They’re drifting and floundering and can’t understand it.”

Gorton tries to lift the doldrums. “I say, ‘Happy, angry, sad and afraid are the basic emotions.’ I have the patients stop themselves during the week and ask themselves which emotion they’re closest to.

“Some people are very excited to realize they have feelings. . . .”

A few respond in surprising ways, leaving dull marriages, quitting dull jobs. One housewife went to graduate school and became a psychotherapist. A lawyer gave up his lofty salary to become a horse rancher.

“He’s happier,” the psychiatrist said.

Entertainers make up their own sizable subculture in Los Angeles, and they are especially prone to insecurities and job stresses, said Dr. Judd Marmor, who treats a large celebrity clientele. Like professional athletes, actors and actresses are ever-conscious of growing old, ever-fearful of losing their place in the limelight.

“The entertainment industry is characterized by a unique quality: You never know whether you are going to succeed or fail in your next project,” Marmor said.

In Hollywood, a county mental health clinic once provided emotional help to many of the young men and women who flock to Tinseltown each year with dreams of stardom. One actor in his 20s came West several years ago from New York, recalled the clinic’s psychiatrist, Dr. Emmanuel Prepetit. When he could not find work-- any kind of work--he became homeless and suicidal.

The clinic found him a part-time job; later, he landed a bit role in a TV miniseries. He was the kind of success story that simply does not occur at the clinic any more.

“Nowadays, no successes--just frustration,” Prepetit said.

Because of budget constraints, county hospitals provide psychiatric care only to the most severely disturbed psychotics, schizophrenics, drug addicts, deranged children and the suicidally depressed. No longer is there room for people who are merely angry, despondent or afraid.

At Martin Luther King Jr./Drew Medical Center in Watts, 1,000 patients a month enter for psychiatric emergency care, and all but about 150 of those are back on the streets within a few hours, said Dr. Claudewell S. Thomas, chairman of the hospital’s psychiatry department. A typical case is a cocaine addict who becomes violently psychotic after ingesting street drugs. If his symptoms ease in the first few hours after he is brought in, Thomas said, the patient is released, sometimes with an outpatient appointment scheduled for three or four months later.

Hundreds of sicker patients simply demand precedence.

“We’re turning people loose into the community who, five or six years ago, we would have admitted to treatment as inpatients,” Thomas said.

The youth of the inner city, he added, are a particular concern; they appear to represent an entire generation of angry, disaffected citizens. “We have a ringside view of psychopathology in the making,” Thomas said, “. . . but we’re powerless to do anything about it.

“We are creating a bomb.”

At places like King, or the Los Angeles County-USC Medical Center, it seems as if overworked psychiatrists and psychologists are holding the city together by very thin and frayed emotional threads.

The adult outpatient clinic at County-USC handles 1,200 seriously deranged patients a month. A 96-bed inpatient ward, where patients once could come and go freely, is now kept under lock and key--a concession to the increasingly unstable nature of the guests.

People who cannot obtain needed psychiatric treatment at county facilities often must fend for themselves. Many wind up in jail, on the streets or in crowded housing projects.

“You find people stacked in board-and-care homes, almost like zombies, who are really just being fed and medicated,” said Dr. Louis Jolyon (Jolly) West, the dean of psychiatrists in Los Angeles and the former director of UCLA’s renowned Neuropsychiatric Institute. “We have medications that keep them docile. These patients just sit and stare at the television set, whether it’s on or off.

“In spite of our (medical) advances . . . L.A. County has become a disaster area with respect to the mentally ill.”

Psychiatrists fear that among the region’s new immigrants, many from war zones, there exists an unseen but teeming population of the mentally troubled. Living in scattered urban pockets, untold thousands of refugees struggle to adapt to a strange, intimidating region. Nearly 400,000 are from El Salvador alone. By some estimates, 10% to 50% of them carry bitter memories of political repression, even torture. Fears rooted in their homeland experiences keep many from seeking professional help.

Dr. Harvey Weintraub, who donates much of his time to treating torture victims, finds them through nonprofit charitable groups. They talk of their troubles only after long hours of delicate questioning, often through an interpreter.

“We find sleep disturbances, stomach problems . . . things like flashbacks and nightmares,” Weintraub said. “They’ll hear a car backfire and think they’re back in the torture chamber.”

One young Salvadoran, who was involved in a student demonstration, told of being blindfolded, beaten and thrown for several days in an isolation cell. The youth was interrogated about the protest organizers while enduring brutal electrical shocks and suffocation torture.

Before it was over, the captors had forced him to watch while they executed a friend with a shot to the head. Then they staged a mock execution in which the gun was lifted to his own head, a final stroke to destroy the spirit.

He was allowed to go free, physically scarred and trembling, as a warning to other students, Weintraub said. He managed to flee the country alone and eventually turned up at a Los Angeles refugee center. Weintraub suspects there are a lot more refugees struggling to cope with the same sort of demons.

“They all sort of disappear into little ghettos that the average Los Angeles resident never sees,” Weintraub said. “People drive by on the freeways and don’t know what’s going on at 9th and Alvarado (streets), or wherever. It’s a hidden world.”

Dr. Liane Colsky, a Woodland Hills psychiatrist, attends to the elderly of Los Angeles, an especially large population because so many elderly flock to the warm California climate. Frequently, however, their golden years become tarnished; they find themselves alone in nursing homes--men crippled with arthritis and emphysema, delusional with Alzheimer’s disease; women whose worlds collapsed 10 or 20 years ago, when their husbands died, now lying bedridden and forgotten.

A few of the old women see Colsky and react with confusion, saying, “Get out . . . you’re trying to steal my husband!” The more rational patients demand to know how she can possibly help them. “They say, ‘You’re not going to give me my health back.’ ”

Colsky does what she can, holding their hands, talking with them. “Loneliness is a very big problem for a lot of these people,” she said. “They want to give you a hug. They want to feel that you like them.”

Therapy can wear on the therapists. Some therapists estimate that more than half their colleagues seek counseling, no doubt many because they believe in its virtues. Many tell stories of extreme professional frustration.

Dr. Paul Barkopoulos treats victims of unexplained chronic pain, a baffling psychosomatic disorder.

One patient, an elderly woman with severe asthma problems, keeps intentionally taking too much medicine. It gives her the shakes and softens her bones. After several fractures, “she’s always depressed--everything hurts, everything’s terrible,” the Westwood psychiatrist said.

“She starts screaming she’s going to kill herself. . . . She’s screaming at me to give her something to stop the shakes. I try to explain to her that she’s going to have to cope with a chronic condition. She can’t hear that. She’s quite angry about the fact that she’s not able to get relief.”

By the time he gets home, Barkopoulos said, “I don’t even want to talk to my wife. I don’t want to do anything--just ‘veg out’. . . .”

Dr. Geoffrey Newstadt’s practice in West Hollywood and West Los Angeles is geared toward the ever-growing AIDS epidemic, a caseload with built-in frustrations. The people who enter his office are often crying, or angry, screaming about their medical care, about medications that they think they should be getting. Although a number take the disease in stride, others doggedly dispute the diagnosis.

Often, all Newstadt can do is attempt to persuade them to enjoy the time they have left. Meanwhile, he also helps to tie up the loose threads of their lives, putting them in touch with clergymen, support groups, hospices; counseling their distraught families.

The going rate for psychiatrists in Los Angeles is $130 to $180 an hour, about the same as in the nation’s other top market, Manhattan. The national median is $101 an hour, according to the American Psychiatric Assn., and in some rural states the rates may be $80 an hour or lower.

While some psychiatrists offer reduced payments to the poor, fees in general are a touchy subject. Many psychiatrists simply won’t discuss them, confessing to that familiar hang-up, guilt.

“For some reason we can talk more about sex than we can about how much we charge,” said Dr. Diane Weiss, a psychiatrist who practices in Beverly Hills’ “Couch Canyon,” a short stretch of Bedford Drive that is home to nearly 200 therapists. “I think it’s a taboo.”

For decades, psychiatrists were considered the outcasts of the medical profession, the fringe students and oddballs who couldn’t hack it as surgeons or heart specialists. Though the image is changing, the field gropes toward maturity like a flighty teen-ager. Schools of psychiatric thought abound, and even many therapists warn about the crackpots who manage to run pricey practices.

Los Angeles therapists vary widely in style and background. Dr. Richard Rosenthal attended Cornell and the Albert Einstein College of Medicine and later allowed his fascination with the great Russian writer, Feodor Dostoevsky, to influence his practice.

Because Dostoevsky was a compulsive gambler, Rosenthal began treating the disorder, taking on patients from Beverly Hills and West Los Angeles whose wagering has cost them homes, cars, even their families. “Some,” Rosenthal said, “will gamble on anything, including which raindrop goes down the windowpane faster.”

Dr. Saul Faerstein, who nurtured an interest in the law, makes psychiatric judgments on the sanity of accused criminals; in face-to-face interviews, he has probed the twisted psyches of “Hillside Strangler” Kenneth Bianchi and Nazi war criminal Andrija Artukovic, among others.

Then there is Dr. Len Bergantino, a Couch Canyon psychologist who treats an affluent clientele suffering a cornucopia of complaints. A few severely afflicted patients would simply lie on the couch, “slavering at a pre-verbal level, crying for 50 minutes at a time,” Bergantino said, “not knowing what they were crying about.”

Bergantino treats them with a combination of Gestalt therapy, high-brow philosophy and extrasensory powers.

“A woman comes into my office. She’s got broken toes,” he said, recounting a case from many years ago. As the therapist talks, he raises his arm; his eyebrows go up behind red-framed glasses. “A laser beam of energy goes through my arm, shoots down to her toes. . . . I had no idea what the hell was happening. . . .

“She says, ‘Aaaaah, I can’t stand the pressure!’

“Within . . . two minutes you hear a pop! She gets up, walks out, no pain, no broken toes. It was strange.”

For a time, Bergantino said, he vacillated between psychotherapy and psychic healing, until one night a noted healer came to him in an out-of-body experience, a hostile encounter that ended with a sort of psychic sucker punch. “It was like two little electrodes in the side of my head-- Zzzzzzzzzzzz ! And I was rolling from one side of the bed to the other for a minute and a half.”

The experience persuaded Bergantino to leave psychic healing alone and tend to the more peaceful vineyards of psychotherapy.