July 8, 2007
The Lack of Consistency
What fascinates me the most in psychiatry is the inconsistency of the messages we send to our patients. The famous phrase “Be yourself – act naturally!” seems to be very profoundly and comfortably adopted by the profession, and indeed developed even further. We all know that oxymoronic and self-contadictory requirements drive people mad, especially if the person being required is somehow dependent on the one making the request. And yet, the system that is supposed to treat madness is full of this.
(On a side note: I was ambivalent for a moment whether I should have written “the system that is supposed to bring sanity”, but decided that “to treat madness” is more accurate).
The inconsistency is everywhere. We want a patient to build an open and trustful relationship with his doctor. Yet, we pay little attention to the fact that a relationship is a mutual thing, and thus we excuse the doctor from actively participating in it. Now, have you ever tried to build a trustful relationship with someone who you address by title and last name, who sees you for five minutes a day on weekdays, who meets with you only because it’s his job, and whom you completely depend upon? It is obviously impossible. Moreover, it is harmful. We ourselves, put in the same shoes, would try as hard as possible to manipulate this person in order to get out, rather then be open and try to befriend him! But we still demand that the patiens do it.
We forbid the patients to swear, to talk sex or violence. But we allow and encourage them to watch TV where they see violence, swearing and half-naked women. (The issue of half-nakedness is a separate story; to put it briefly, when I see a naked woman, I may or may not get lusty, depending on the circumstances; but when I see a half-naked woman with the word “CENSORED” floating upon her breasts, I will get not only lusty, but also angry. It this something they on TV try to promote?)
And how about the balance between freedom and responsibility? In my understanding, if you are free to do whatever you will, then you must be responsible for your actions, but if your freedom is abridged, so must be your responsibility. That would be fair. Not so in a psychiatric hospital! There, your personal freedom is severely restricted, but you still can be held accountable for your wrongdoings. For example, should a delusional schizophrenic man, locked up because he supposedly doesn’t know where or who he is and can’t account for his actions, accidentally enter a female patient’s room and touch her, only because the staff that was supposed to watch him was elsewhere, he may end up being registered as a sex offender! That is incomprehensible! I mean, if I’m mad, I’m mad, aren’t I? And if I’m not mad, let me go!
We say to the patients that drug dependence is bad, and give them drugs to become dependent upon. We tell a depressed person that he should not kill himself, and arrange that he always have access to pills – the easiest means of suicide.
The examples are legion. What is common in all of them is that the communication is happening on two levels: the overt and the hidden; and the messages they carry contradict each other. In effect, you don’t know what to do, for whatever you do can be held against you on one of the levels. I don’t know if it was designed this way or is accidental, but such style of communication surely doesn’t help a mentally unstable person to regain his sanity.
Such inconsistency is common in everyday life, too; but in life you can walk away from it if you don’t like it. How is a psychiatric patient to deal with it is unclear.