The Curse of Cassandra and Insights by Psychiatrists

November 26, 2014

Who hasn’t been at a public gathering and, after identifying yourself as a psychiatrist, heard someone respond nervously, “Can you read my mind?” Just as Thanksgiving can be compromised by family conflict, being a psychiatrist can at times feel like a curse in our public lives.

PSYCHIATRIC VIEWS ON THE NEWS

In Greek mythology, Cassandra was cursed for her ability to predict the future. No one listened to her. One of the consequences was the ruinous fall of Troy to the Greeks. She herself was captured, and then killed.

Unlike Cassandra, psychiatrists and other mental health professionals do not do so well in predicting the future, although perhaps we wish we did. We are notoriously unreliable in predicting suicide or homicide, for instance. So, we are not cursed for that ability.

Psychiatry has many blessings, as I wrote in my "Thanks to Psychiatry" blog about 4 years ago. Once again, on this Thanksgiving, we should give thanks for these blessings.

One of our blessings, especially if we are knowledgeable about psychodynamics, is to have hindsight into the past to provide insight into the present. This process can be enormously beneficial for many patients and satisfying for psychiatrist and other psychotherapists.

However, just as Thanksgiving can be compromised by family conflict, being a psychiatrist can feel like a curse at times in our public lives.

This “curse" is familiar to all psychiatrists. Who hasn’t been at a public gathering and, after identifying yourself as a psychiatrist, heard someone respond nervously, “Can you read my mind?” While you laughingly discount that to preserve our little secret, as I often did by saying I was "off work," we can indeed read minds and behavior (verbal and nonverbal). At least some of us think so.

Even in psychotherapy, patients are often uncomfortable with our ability to "read their minds." The truth, or the search for the truth, can be very painful before it ultimately brings relief and positive change. It is often worth warning the new patient about that sequence.

For the sake of normality and everyday functioning, people forget or repress what is emotionally uncomfortable. No wonder severe trauma is often dissociated out of conscious awareness. Who wants to be reminded of that in the presence of a psychiatrist?

We professionals have to do something different, for our self-knowledge becomes an important aspect of our therapeutic abilities. In addition to our own psychotherapy, a la Freud and his interpretation of his own dreams, we can have the same mixed feelings about analyzing ourselves, as least as far as that can go.

Since I retired from clinical work, blessings and curses seem more obvious. I miss the blessings of working with patients, but only now realize the curse of how much that took out of me emotionally.

Outside of clinical work, there are also blessings and curses. For old patients, and perhaps would-be ones, I seem less stigmatized to them, making more normal interactions easier.

I am often sought out to be involved in community and societal issues, but I am kept at arm’s length after in invitation is accepted. Serving on a community board is much different than a professional board, and I think that is due to what having a psychiatrist on the board means.

While I know that I can provide helpful insights into human behavior, situations, and organizations, many seem to feel ambivalent about that at best. For instance, while I would assume that a major transition from a long-term beloved leader would cause some grief and anxiety about the future-which may need some sort of organizational response-others may deny that such responses exist and insist that everything will turn out just fine.

This Psychiatric Views on the News column is another way to try to connect with the public, and for psychiatry to engage more in societal issues. From the comments on this website, it seems that some useful interaction is occurring, although every now and then a diatribe against psychiatry pops up. Goodness knows, there are many social issues that have important psychological aspects to them.

Still, I struggle to find the best balance for the right time to say something in public. Like some people, should I go the non-verbal route out in public with a sign that says "free hugs from a psychiatrist"!? Alternatively, I can shut up professionally and try to respond like everybody else. Certainly, woe to the psychiatrist and his or her loved ones if you act like a psychiatrist in your intimate relationships.

Others have wondered, too, what to call my role. Psychiatrist at Large? Psychiatrist PRN? I like “Public Psychiatrist” best, as it refers to the “public citizen” title Ralph Nader gave himself in order to serve the public in whatever way he could. This feels somewhat narcissistic and uncomfortable to me, but some have turned that preference of mine into an honor I achieved many years back from the Assembly of the American Psychiatric Association, as a “Hero of Public Psychiatry.”

The public expresses its ambivalence about psychiatry by embracing pop psychology and self-help. If that works, there is no need for psychiatrists, is there? We professionals can use that desire for simple information and help in what we would hope to be a therapeutic way. Doing so for me is an outlet of my continuing desire to help others psychologically and to opine.

This year our yearly holiday card will have a different focus than in the past. It will have a “therapeutic” intent, conveyed by the title “(How to) Have a Healthy and Happy New Year,” with select quotes on how to make Thanksgiving, Hanukkah, Christmas, and New Year’s better, such as:

• Resolve to laugh just a little more this year
• New study shows that middle-aged women can improve health in the decades to come by drinking regularly-but modestly
• Be kind whenever possible. It is always possible

Yes, these are sound bites that you might find elsewhere in the media, but at least I chose them from my professional perspective and I am available to discuss them further. If you would like to receive a copy of this card, just let us know and I’ll have Santa bring you one.