July 8, 2007

The Lack of Consistency

Posted in psychiatry at 6:12 by skpsycho

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.

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4 Comments »

  1. podyh_gir said,

    Well, you can easily go away from the one who you think is being inconsistent. But I’m sure he thinks he’s acting correctly and absolutely logically.
    What I think is inconsistency is too natural to get rid of. After all, somebody may think you’re being inconsistent while working in a field you don’t really seem to believe in. Or do you?

    Oh, for some time I wanted to ask you how specialists like you manage to stay sane and consious around mad people?

  2. skpsycho said,

    Well, good point! I am actually not sure whether I want to do it or not. It’s not that I don’t believe in the idea of psychiatric help per se, it’s the implementation of this idea in today’s America that makes me nervous. And my only hope is that I may be able to practice it differently, although being a part of the system. So I don’t think I’m being inconsistent – I am actually being quite open about my doubts and fluctuations.

    And, I’m not trying to manipulate anyone. The inconsistency I was trying to describe in my post had more to do with manipulation. Basically, dishonest manipulation is what I meant.

    Stay sane around mad people… hmm, maybe it’s not that difficult, really. You just have to have another world (like music for me), where you can go to disconnect from your job. And… the way I see it now is that the “mad” are really just very, very unhappy people. You certainly can become unhappy too if you get caught up in their patterns of dealing with the world… if you don’t have some external point of reference.

    But that’s just words, of course. I haven’t worked as a psychiatrist for a long enough time to know for sure. Maybe you do get caught up no matter what…

  3. podyh_gir said,

    I really hope not!

    Thanx for detailed answer :)

  4. […] ––skpsycho.wordpress.com […]


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