Tales from the New Asylum: Pulling Teeth

Psychiatric TimesPsychiatric Times Vol 28 No 3
Volume 28
Issue 3

Consider your pearly whites. You probably take 'em for granted anyway. When was the last time you flossed?

"To represent castration symbolically, the dream-work makes use of ... falling out of teeth..." 1

Oh, the shark, babe, has such teeth, dear
And it shows them, pearly white
Just a jackknife, has old MacHeath, babe
And he keeps it  … out of sight.  

Consider your pearly whites. You probably take 'em for granted anyway. When was the last time you flossed? 

Now, imagine taking a pair of nail clippers in your hand. Lift them up to your grill. Open wide. Get a good purchase on that incisor. You're gonna need to clamp down hard. Harder still. Understand - it's not gonna come out in one easy pull. You're probably gonna have to rock it back and forth - loosen up the soil around the roots. 

I need to be honest with you - there's gonna be some blood. Your fingers are probably gonna get slippery with it. Quick - dry 'em off and re-grip - let's not draw this out too long. The blood trickling down your chin and onto your shirt is gonna draw attention for sure, so focus on the goal. It's really loose now. . .  almost there. . .  one last tug. . .

Finally. You got it. How do ya feel? Any better? Hmm. Maybe just a bit, but you can't be too sure.  After all, this is the third time you've been through this.  And just like the last two times, the  burning torment subsided for about half a day.  And then - the return.  Always the return.  There must be something still in there, otherwise the pain would be gone. 

The doctors don't believe you anymore, and this makes you feel hopeless. It's your pain! You're the one who can feel it, not them! But they say they've done everything - dental exams, bone extraction and debridement, prescription pain meds, mandibular nerve block injections, multiple MRIs. Nothing. But all that doesn't really matter, because you can definitely feel something. You're not making all this up. If you were going to make something up, you'd certainly choose a less excruciating condition. 

No - you're sure.  It started only a few weeks into your 25 year sentence. Oh yeah - your sentence. . . for rape. Let's not dwell on that okay? No need. It only brings back the shame. Deep shame. The look on your family's faces. They all know you were found GUILTY, and by implication, full of sin. That prosecutor - what did he call you? A "sadistic predator"? A "dangerous sexual deviant"? You had suspected for a long time that something was not quite right. But now you know - there is badness in you. 

How did it get there? Maybe it has always been there, buried deep? Or maybe. . . maybe you let it in yourself? Yes. That seems plausible. Your mother and father are upstanding, God-fearing people. Innocent people. You alone have been found "Guilty," and you alone allowed the badness to take root in you.

What is this doctor saying? Why does she ask about your "feelings" and your crime? The problem is your pain - in your teeth!  Although it seems drastic, you would rather have all your teeth removed than go on experiencing this kind of pain. Will you ever be able to forgive yourself? Well, you think your mother has forgiven you, but she would say that anyway. Oh, but you didn't really answer the question did you? The doctor still wants to know. . . will there come a time when you can forgive yourself? This irritates you a bit. Why should that matter? It's so clear - badness is embedded in you. You have, and can still, hurt people. Forgive yourself? What's the point? Plus your teeth are really starting to hurt now.

The doctor says something about "non-forgiveness. . . causing problems to go on and on, sort of like your tooth pain has gone on." And on. The doctor tells you that there's good news and bad news. You know which you want first. So does she. 

The bad news is that your pain isn't going to go away all at once. It may take a while, and you may have to live with some amount of pain. The good news... (you just had an intense flash of pain) is that she does have a plan she thinks will lower your pain. And it doesn't require removing any more teeth. You're not completely sold on this, but you're willing to try the medication she recommends. Are you willing to also meet with her and maybe talk? About feeling like a "bad person"? You're more interested in the medication, but you agree anyway.

Mostly because she is taking your pain seriously.



1. Freud S. The Interpretation of Dreams. In: Strachey J, ed. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume V. London: The Hogarth Press, 1953; p. 357.
2. Mack the Knife" lyrics. Bobby Darin version. At: http://www.bobbydarin.net/macklyrics.html

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