Psychiatrists

A frequent theme in the TV show Houseis that patients lie. Maybe not a theme, maybe a mantra of Dr.House's, that is usually part of the flourish that makes the showwork. Without the lie, the writers of the show would generally nothave the gotcha moment. I have no doubt that most patients do lie totheir physicians, after all, it is much easier to present the personwe want to be, rather than the person we actually are. While I havemuch to say about physicians, they are only slightly related to thispost.

A recent Science Friday was about themovie, book and case history source material of Sybil. I think I may have seen some clips of Sybil,but I have not watched the movie, or read the book. I also have notlistened to the Science Friday because listening to the people whocall into radio shows is like putting a cheese grater to myintellect, and I come out of listening to a Science Friday 3 IQpoints lower than going into it. So, full disclosure, I do notreally know what I am talking about when I refer to the specifics ofthe impetus for writing this post. Thus, I will attempt to notreference them very much.

In the ScienceFriday, apparently, psychiatrists and/or psychologists have theirknickers in a twist because some new analyses have been publishedabout Sybil (the person who inspired the story, not the movie). Further, the case is frequently used as an example of a mental healthclinician becoming too involved in a case, and lost objectiveassessment. This makes me wonder, does one necessarily wantobjective assessment in a mental health clinician?

Everyone wouldprobably benefit from talking to a psychiatrist (I will henceforthlump all mental health clinicians into one label, I will try to stickwith psychiatrist). Emotions are complicated, and often times we arelimited by who we feel comfortable talking to about our most complexemotions. Even still, I have no interest in speaking with apsychiatrist. How can I acknowledge the potential benefit, but haveno interest in engaging in some sort of therapy? I have ahypothesis, but no answer.

Imagine going intoa job interview, and telling the interview committee about yourselfin earnest. You would never get a job. They want to hear how wellyou can sell yourself, and the committee attempts to get a glimpse ofwho you are by analyzing how you present yourself. The committee isnot being honest with you either. The committee never starts theinterview with the problems of the company, and they dance aroundthem when you hit tender topics. I see going to a psychiatrist as avariation on the same theme.

I picture (though Ihave never done it) going to a person who will take loads of personalinformation about you, that clearly identifies you, then talking toyou about your problems. What are they doing? They are sitting overthere judging you! You have voluntarily given someone power over you(the opinion of a psychiatrist can affect your ability to obtainvisas, job offers, security clearances, etc.), then are both expected(from their perspective) and required (to get effective treatment) totell them the truth. Will this person act as an emotionally attachedfriend who wants the best for you? No, their goal is to maintainobjective assessment! Why would any sane person want to findthemselves in this situation?

Howmany movies have been created where the sane are assumed insanebecause they do not accept the benefit of telling/admitting theirproblems to someone who has power over them? Countless, I imagine. I know that people are more likely to talk to friends about someissues. I have some friends that I feel comfortable tellingeverything/anything to. Without them, I would be lost much more thanI am, but they are feeling their way through life with equaluncertainty as I, which is probably one of the reasons that I amattracted to their friendship. These friends are dear, and helpful,and committed to what is best for me, but, they do not know what theyare doing when it comes to assessing my true mental health, and theyare usually just as lost when it comes to what to do to findhappiness in life. So what about the other side? What if there wasa trained person who did not know you, kept no records, and only maderecommendations to you, i.e. no power over you, would you be likelyto tell them the truth?

I wouldn't.

Atfirst when I started wondering these things I began thinking about ascene in the movie Demolition Manwith Sylvester Stallone and Wesley Snipes (my mind works this way, inabsolute honesty). In the scene, Wesley Snipes' character wants touse a public computer terminal that looks much like a payphone (Iguess they did not see smart phones coming). The terminal is in useby a person engaged in conversation with the computer where thecomputer is asking the person questions, and the person is lamentingthat lately they just don't feel happy, and doubts their self-worth. I think Snipes then throws them into a bush, which is a bit of funfor us to watch. In the dystopian universe of DemolitionMan it is unlikely that thiswould be anonymous, but it could be. My anonymous psychiatrist is aperson, rather than a computer, but operates in much the same way. Iwonder if I would talk to this person, and while I think I would bemore likely to talk to a person who was anonymous, I still probablywould stick to silence.

Once every twoweeks or so Wayne walks through my building. Wayne is an employee ofa contractor who provides support to employees. Apparently, one mayspeak to Wayne about anything, confidentially. GNS provides thisservice to keep employee's “happy.” I am too cynical to see itthat way. I see it as GNS sending a goon around to spy on theemployee's mental health, so I generally try to politely avoidtalking to Wayne.

Wayneis the anonymous psychiatrist! He is the service that I imagine, heis the human version of the Demolition Mancomputer. Yet my base assumption is to not trust him with mytroubles. I do not trust him becausehe is interested, yet not invested. In the same way that I do nottrust the psychiatrist. Which means I will only trust someone withmy emotions who is emotionally invested in me, which, for me,invalidates the entire ethos of the psychiatric profession.