Psychiatrists

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

A recent Science Friday was about the movie, 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 not listened to the Science Friday because listening to the people who call into radio shows is like putting a cheese grater to my intellect, and I come out of listening to a Science Friday 3 IQ points lower than going into it. So, full disclosure, I do not really know what I am talking about when I refer to the specifics of the impetus for writing this post. Thus, I will attempt to not reference them very much.

In the Science Friday, apparently, psychiatrists and/or psychologists have their knickers in a twist because some new analyses have been published about Sybil (the person who inspired the story, not the movie). Further, the case is frequently used as an example of a mental health clinician becoming too involved in a case, and lost objective assessment. This makes me wonder, does one necessarily want objective assessment in a mental health clinician?

Everyone would probably benefit from talking to a psychiatrist (I will henceforth lump all mental health clinicians into one label, I will try to stick with psychiatrist). Emotions are complicated, and often times we are limited by who we feel comfortable talking to about our most complex emotions. Even still, I have no interest in speaking with a psychiatrist. How can I acknowledge the potential benefit, but have no interest in engaging in some sort of therapy? I have a hypothesis, but no answer.

Imagine going into a job interview, and telling the interview committee about yourself in earnest. You would never get a job. They want to hear how well you can sell yourself, and the committee attempts to get a glimpse of who you are by analyzing how you present yourself. The committee is not being honest with you either. The committee never starts the interview with the problems of the company, and they dance around them when you hit tender topics. I see going to a psychiatrist as a variation on the same theme.

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

How many movies have been created where the sane are assumed insane because they do not accept the benefit of telling/admitting their problems to someone who has power over them? Countless, I imagine. I know that people are more likely to talk to friends about some issues. I have some friends that I feel comfortable telling everything/anything to. Without them, I would be lost much more than I am, but they are feeling their way through life with equal uncertainty as I, which is probably one of the reasons that I am attracted to their friendship. These friends are dear, and helpful, and committed to what is best for me, but, they do not know what they are doing when it comes to assessing my true mental health, and they are usually just as lost when it comes to what to do to find happiness in life. So what about the other side? What if there was a trained person who did not know you, kept no records, and only made recommendations to you, i.e. no power over you, would you be likely to tell them the truth?

I wouldn't.

At first when I started wondering these things I began thinking about a scene in the movie Demolition Man with Sylvester Stallone and Wesley Snipes (my mind works this way, in absolute honesty). In the scene, Wesley Snipes' character wants to use a public computer terminal that looks much like a payphone (I guess they did not see smart phones coming). The terminal is in use by a person engaged in conversation with the computer where the computer is asking the person questions, and the person is lamenting that 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 fun for us to watch. In the dystopian universe of Demolition Man it is unlikely that this would be anonymous, but it could be. My anonymous psychiatrist is a person, rather than a computer, but operates in much the same way. I wonder if I would talk to this person, and while I think I would be more likely to talk to a person who was anonymous, I still probably would stick to silence.

Once every two weeks or so Wayne walks through my building. Wayne is an employee of a contractor who provides support to employees. Apparently, one may speak to Wayne about anything, confidentially. GNS provides this service to keep employee's “happy.” I am too cynical to see it that way. I see it as GNS sending a goon around to spy on the employee's mental health, so I generally try to politely avoid talking to Wayne.

Wayne is the anonymous psychiatrist! He is the service that I imagine, he is the human version of the Demolition Man computer. Yet my base assumption is to not trust him with my troubles. I do not trust him because he is interested, yet not invested. In the same way that I do not trust the psychiatrist. Which means I will only trust someone with my emotions who is emotionally invested in me, which, for me, invalidates the entire ethos of the psychiatric profession.