RUMINATIONS OF A PSYCHIATRIST
I was trained in psychoanalytic psychotherapy but found myself working as a staff psychiatrist on a locked unit of a state mental hospital. Talk therapy was not practiced here, so I had to learn about my patients—all chronically and seriously mentally ill long-term residents—by reading their records. Of course, that is not the same thing as getting to know them. And I wanted them to get to know me, I wanted them to feel safe with me and to accept me, a stranger, as their doctor. So I came up with this idea. What better way to show them who I am than by showing them who they are in my eyes?
From time to time during quiet moments and in public spaces, I would stand with the occasional patient and, in the course of conversation, casually re-tell their story as I understood it. I did this in terms not of their illness and its progression and the treatments and their effects, but in terms of their ordeal and strengths. The retelling was not about accounting for their disorganized and psychotic thinking or their obvious inadequacies and failures, but rather about their grit and endurance in the face of such trauma and adversity.
I commented on the stamina called for surviving. I acknowledged the effort it must take for them to endure the disorganization of thoughts and isolation as well as the fear driven by voices. I was hoping in this acknowledgment of their humanity and their battered integrity that was buried deep in the chaos of their lives—and by giving that chaos names—to demonstrate my respect for them and, through this, earn their trust.
I quickly gained confidence in this strategy, a confidence earned not by my patient’s rapt attention to my words but by the rapt attention of the inevitable cluster of patients who would discretely gather within ear-shot to eavesdrop and listen to these stories. I was confident that it was not boredom or nosiness that brought them close-up, but rather it was their thirst for healing. While not directed towards a patient’s recovery or progress (and certainly not their insight or self-awareness), my secret wish was that this story-telling might provide a quiet moment, a moment of peace that comes with feeling you are, at that moment, seen, heard, and cared about. At least that.
Looking back, I am reminded of small children at bedtime. How, alone and in the dark, they can sometimes be overheard speaking aloud to themselves, re-capping what they did and saw that day, as if to hold onto that experience in memory and re-experience the wonder and satisfaction of it. After all, for a child who has never been to a zoo, let alone absorb and process so many sights, movements, smells, and noise, it is not just the animals that make up this accomplishment. It is the surviving the loss of the familiar and holding course while encountering the exciting unknown.
Dr Climo is the author of Psychiatrist on the Road: Encounters in Healing and Healthcare, an account of his Locum Tenens experience.