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.)



  1. i feel what the shrink said to you is awful…always trying to find some kind of alterior motive or in His world, some unconcious motive…i certianly don’t blame you for wanting to leave him. If i could get meds from someone else, i would be outta there in a flash. You are doing good and kind things for all the right reasons and there does n o t have to be some stupidly psychoaniacally made up reason for kindness. Never has been, never wiil be. (Not in the book of t, anyway…for what that’s worth…! ha, ha). Much love and caring thoughts to you, i think you are doing sooo very admirably.
    And, as always, your writing is beautiful.

  2. I had a shrink that made me feel that way and I put up with it for far too long. I finally got a recommendation from a trusted friend and found a new doctor and she’s made a world of difference. I’ve made more progress with her than I ever would have with the old doc. Bottom line – if you’re not 100% happy with the treatment you’re getting, start looking elsewhere. No matter what you may think, we all deserve the best medical treatment available – especially when it comes to psychiatric treatment.

  3. I was back today – the excuse this time is he claims he said it “positively” and not “pathologically.” That I put on that interpretation. This is why I hate shrinks. I’m sort of spiraling into a minor depression (I had a few really great high days so that’s ok with me) and it just made me angry – but I’m too sad to really get angry – so I didn’t argue.

    Then he went into all this shrinky bullshit about how he understands my fears or whatever and that he could probably help me “if you want it.” I got mad (but again, too depressed to really get good and mad). Once again – if this is useless, it is because I “didn’t want it” enough. I called him on that one…explained that that is exactly what I hate.

    Titanium Rose – I would look elsewhere, but this guy has actually been the best of many bad ones. I quit him once before about 5 years ago, but finally decided he was the best of many bad.

    Anyway, I left without making another appointment, partly because I don’t have the June schedule, but also because who knows if I will…?

    Thanks for the good thoughts everyone.

  4. The therapy bit of it is hard– you have to find someone you jibe with. Credentials don’t mean they get you, are able to be helpful to you. I do find CBT helpful, for the feedback and questions my therapist poses, but she rarely comments, just keeps asking questions. While I laugh at her at how Rogerian she is sometimes, it works for me. She’s good at neutral reflecting. Sounds like this guy didn’t have a good sense of you.

    That said. . . I think if you’re disposed to think psychology useless, you’d be better off either taking some time off and doing some reading on your own, or having an up front discussion with your next therapist in the first session, as a “ground rules” type session. If they don’t blink or get defensive, maybe it’ll work. Can you find someone for just med management on the doctor end, and then take your time about interviewing social workers/therapists? I have found most shrinks make shitty therapists– mine do better working in tandem with a therapist who’s strictly emotion/feeling centered.

    Fingers crossed.

  5. I think bipolarlawyercook said it best. You have to find the person who’ll fit you best. It’s like shoes, really. They might look good, and they might be useful, but if they don’t fit well, then you won’t wear ’em.

  6. Sounds like a councillor I went to once when I first moved away from home. Like you said about shrinks…many burn out. I don’t want to be one personally. I think I could be a good one, but not a happy one. And in the end, that would make me a bad doctor.

  7. I agree with bipolarlawyercook about finding a social worker or some such for a counselor instead of relying on your shrink for therapy. You said something like doctors are supposed to stand back and rely on algorithms and something I can’t remember. That explains how they (and you) can distance yourselves from patients so that you don’t become devastated when one passes or does something dumb. But it also makes them lousy therapists.
    I finally found a real gem of a counselor and took nearly two years. He’s got good intuition about when to say certain things to me and has helped me tremendously already and I’ve only been seeing him for about 3 months.
    Good luck – I’m sure it’s harder when you’re a doctor and all, but underneath you’re still a woman. You’re still human. Hang in there.

  8. Somehow i missed the point. Probably lost in translation 🙂 Anyway … nice blog to visit.

    cheers, Coma!

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