Psychiatrist woes revisited

As I said, I’ve been trying to get along at least superficially with this shrink, because I don’t think he’s stupid, which is a lot to start with. Trying to trust his judgment, though I do love the comment someone left on here about med adjustment having the feel of an eighth grade science fair.

This last appointment kind of upset me, because I think it is reflecting that underneath the quiet demeanor and all the right attitude, there’s a lot I really don’t like. I am not totally sure if my problem is with him specifically or psychology as a discipline.

The issue, or at least the one that really is eating at me, is this: I mentioned some work I have been doing in a free clinic. I mentioned and talked about a patient I really liked there recently, how she has been on my mind – in a good way, a caring way – that I hope she’s doing well. I’m glad I have met her, that my life crossed with hers even minimally, even though I may or may not see her ever again. I found her admirable, living in a difficult circumstance and remaining optimistic and not bitter. This was one of the nice points of my work recently. I’m pretty sure I told this warmly, though also mentioned my embarrassment because as doctors we are not supposed to “like” patients, but rather be cold machines who treat everyone exactly the same, based on algorithms and protocols. I mentioned something about how if I weren’t doing work in that kind of a clinic, I’d never cross paths with someone like her, so even when it sort of sucks to be at a place like that, the rewards can be wonderful and unexpected.

His comment, almost reflexively, was something like, “Of course you’d like her, there at a clinic like that and not one of your patients at the hospital. She needs you; they don’t. Just like you.”

Something about that bothered me. I don’t think that it’s even the question of whether it’s true or not – there probably is some truth to the fact that I’m a caretaker type, and even that I use taking care of others as a reason to keep myself relatively stable. I can accept that.

But there’s something basically ugly in his statement, in the worldview implicit in it. And that’s where I always get back to hating psychology/psychiatry: the idea that anything, any human behavior, no matter how noble, beautiful, intense, or intricate, is always based on pathology. Why view things like that? Does it matter if Dostoevsky wrote The Idiot about his own epilepsy and misery? If Rigoberta Menchu was dealing with childhood trauma and a sense of powerlessness?

I have plenty of horrific qualities – a massive ego, a sense of entitlement and narcissism, impatience – so why take one of my few sincerely redeeming ones – that I have a tender spot for people in hard situations – and pathologize it, make it ugly? It isn’t hurting me, and it isn’t hurting anyone else, might even be helping someone…so what is the point?

What, to someone with an extremely psychoanalytic bent, would constitute a good reason for becoming a doctor? For adopting a child? For writing a novel? There is no acceptable answer, and that’s why I always end up quitting therapy. I just realize, again and again and again, that there are no answers to be had there. The unexamined life may not be worth living; but sometimes the overly examined life needs to stop being scrutinized and start being lived. One could potentially stay on the couch forever. A lot of psychotherapists seem to think that that is a good idea.

And in that bizarre, quasi-religious system, somehow the patient is always to blame. You aren’t allowed to disagree without that being pathological. Say I bring that that conversation bothered me. That I think that that comment shows more about his worldview than anything about me.

Naturally, that’s only because I am denying, reaction forming, resisting.

Sounds as rational as any random religious belief one could choose. I could throw myself into any fundamentalism with as much success. Maybe more, because a lot of fundamentalists in other fields are happy. I don’t believe in belief systems. I believe in science, and rationality, and also hope and tenderheartedness and beauty.

So then I wonder. I know most psychiatrists hate their jobs in the end, they burn out, realize they went into it for the wrong reasons, often go into it because they are melancholy at their core. But I don’t think I want to be talking about anything too personal with someone who sees the world as differently from me as this. Psychiatry is a nihilistic discipline at its core, believing in little of anything other than pathology. That’s why I always tell myself not to waste my time in going back. And somehow, whoever I go to for drugs always manages to sell me the whole package.

I guess that despite my wretched suicidal depressions, my lack of faith in much of anything, my unrelenting intensity and horror at the world, somewhere, deep down, I am something of an optimist. I do think that someday, if we work hard enough, things might not get exactly better, but they can get less bad. I believe in the power of small deeds, kindness, contact with others. Moments of something like grace down here in the mud, moments when despite it all, we look up and see the sky.

Should I mention this? Just quit, find someone else for meds? Because now I doubt I can quit therapy without his ego getting all blown into things and him pretty much firing me.

And why do I end up going back, despite my better judgment and reminders and promises to myself to quit wasting my time, to stop looking for answers from a religion that offers none?

I guess I need therapy to answer that question. (Note the sarcasm.)

Sorry I haven’t posted

I’ve been working hard – extremely hard – at my new job. The mood has sort of evened out as I’m back on the old good med routine. The shrink seems much less diabolical when I am well medicated, though seems to think that I should try another experiment with changing meds soon, which, after seeing the results of the last six months, makes me doubt his perspicacity a wee bit.

Since I haven’t been writing much, try this great blog that I found today. A good starting post is here. An MD with BP, and he just transferred from emergency med to psych and he told his bosses. And he takes reboxetine, so I’m hoping to get the dirt on what that’s like, as it is next on the ever-growing list of drugs the shrink thinks would be good for me that I refuse to take.