I am not practicing psychiatry now, but very much continue to regard myself as a psychiatrist and know I will return to providing patient care at some point. My absence from working directly with patients has given me some distance and perspective on the work I had done with the thousands of people I evaluated, treated, or consulted on.
My strongest feelings, both of accomplishment with some patients and feelings of shame with others, relate to one aspect of my work: my ability (or lack of it) to show care for the personhood of the people I worked with.
My breaches in therapeutic rapport ranged from small to large. For example, I remember one patient, a man in his late thirties who had progressively lost his sight over the previous five years from macular degeneration. One day he gave me a catalog of swimwear for men and women that he had received in the mail. As expected in such a catalog, all the models were young and attractive. I took it from him, said a brief thank you, and otherwise never referred to it again. I was both confused by this communication and felt I had more important topics to discuss with him. It was only later that I realized that this was an incredibly important gesture on his part. One can easily imagine all the possible meanings associated with this act: his grief over his loss of vision that prevented him from ever again seeing people or things of beauty, his desire to connect with me as two men working together sharing a minor transgression, his grief over his loss of attractiveness to others and of a chance to become a successful professional like his brother. In addition to all the possible “communications” this gesture held, it was also I believe an outright gift: here, enjoy these beautiful people and do it for me since I cannot see them anymore.
But I never paused to acknowledge or find out any of this. I feel ashamed not because I left potentially valuable psychological material unexplored, but because I did not cherish or even become aware of his gift, of his reaching out to me to connect in some way. I remained ensconced in my “professional role” of asking about symptoms and medications. I did not break out to being a healer or, to put it more in tune to my view of it, as a facilitator of self-healing.
In another case my failure was on a larger, more fundamental level: a woman came in to see me, suffering from depression after the death of her six week old daughter two months previously from a shaken-baby incident by her boyfriend, who was convicted of manslaughter and imprisoned as a result. I sat there listening to her story and experiencing her grief and despair with a reaction of extreme discomfort. At the time my daughter was about 4 months old and I could not stand to be in the same room with this person with her pain, listening to a tragedy that seemed so relevant to me. I felt like I was strapped in my chair, unable to move. I was completely emotionally unavailable to this woman. I prescribed her a medication and gave an appointment to return in two weeks. I was not surprised she never returned. I would not have either.
I actually feel worse about the first case I shared with you. It is much more a part of everyday practice. In the second case, I had the excuse that I was emotionally overwhelmed and simply did not have the capacity at that moment to do better. Not that that is good, but it relates to only that case because in all my years of practice I have never felt that level of being emotionally overwhelmed and unavailable.
So, looking back, what I have come to believe is that the most beneficial and healing part of what I did as a psychiatrist was to be open and vulnerable to the pain and travails of those who sought my help and, even more broadly, to the personhood of those individuals. I have come to see that ‘facilitating self-healing” entails allowing and encouraging a person to connect or reconnect with others around them who care for them (for in depression and anxiety, this sense of connection may not exist or no longer be perceived), to achieve a sense of belonging, to recapture a sense of the meaningfulness of life and of how others do or could rely on them, and to reconnect with their spiritual longings, whether to nature, the universe or God. (BTW, as I often write, I am secular and never impose any religious beliefs on patients. I do, however, understand the power of spiritual or religious belief and belonging, and do not feel shy in helping a person reconnect with their faith or faith community.)
Until next time,
“We learn, grow, and become compassionate and generous as much through exile as homecoming, as much through loss as gain, as much through giving things away as in receiving what we believe to be our due.”
– David Whyte