psychobabble

pontificatrix

pontificatrix
Bio
I am a resident in psychiatry at an academic medical center. My blog posts describe patient encounters I have had in the course of my training, both past and present. Names and identifying details have been changed. My blog conforms to the information-privacy standards detailed on http://medbloggercode.com. If you believe you have been a patient of mine and have concerns about the effects of this blog on the privacy of your medical record, please let me know and I will be happy to withdraw any offending material.

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SEPTEMBER 21, 2008 8:10PM

truth to power

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Mr. B. behaved like nothing so much as a cornered animal in the locked psychiatric unit.  Behind closed doors, he admitted his demons to his worried mother, who relayed them to us; but to the doctors he was close-lipped and angry, hiding with insults his fear at what had happened to him.

His threatening, hostile stare fairly made the air vibrate in the room... yet the moment the attending asked of him, frankly and without guile, "Why are you staring at me?" the spell collapsed, deprived of all its power.
"I'm not staring at you," was his only, weak recourse.
 
So, the unspoken derives its power from its very mystery.  To make explicit is to deprive of power. The psychotic patient knows this, perhaps better than we.  Psychotic patients often seem in touch with a deeper, animal reason. 
 
But it was nothing so simple as the attending's bare words that disarmed him.  I pictured the same patient on a gritty street corner, leveling his rapier gaze at a fellow thug.  The same phrase spoken in an equally hostile tone by a burly, puff-jacketed swaggart would have but escalated the situation.  It is the opt-out, the calm inquiry, the untroubled curiosity, that undercuts the threat.

Good therapists wield this tool with skill and precision.  They refuse to play the game, choosing rather to analyze it.  All of us, as humans, have some understanding of this complex social game.  We approach and retreat, feint and parry, dance an endless dance of human relations - all without a word, a world of interactions parallel to but separate from our explicit verbal exchanges.

People who play the game well become leaders, extracting what they wish from others while retaining their loyalty and affection.  People who have a shallow or incomplete understanding of it become recluses, frustrated at every turn by interactions that go awry.

But whether they play it well or poorly, in the normal course of human behavior the game is never made explicit.  To make it explicit is to undermine it entirely.  The therapist does this in a controlled manner, slicing the game out of its skin and dissecting it apart, displaying its innards openly to his patient's wonder and, perhaps, dismay.

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psychosis, sociology, therapy, health

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Have you read psychiatrist Robert Lindner's "The Fifty Minute Hour"? One part became the basis for cult film "Rebel Without a Cause", but another part was more frightening to me. He relates how one patient sucked him, the psychiatrist, into his warped universe and almost trapped him there.

The hidden things of the unconscious must remain hidden, or, as you say, they lose their power. That is the whole objective of psychanalysis, to make the fantasy reality, and thus to destroy it.

P.S. Any friend of Freud is a friend of mine.
I hadn't heard of the book before, thanks for the tip. Despite my avatar, I'm still not sure how I feel about psychoanalysis per se. I tend to think Freud's contributions to the field were more about the big ideas (the existence of the subconscious, the idea of 'talk therapy' at all) rather than the specifics of his methods.

I do find it very interesting that the mere fact of being inexplicit bestows significance. I can't think of an explanation for it at all, though if I come up with some hand-waving in the future that'll be good for at least a few more blog posts.
I agree about Freud's contributions. I also think that a longer history of Psychoanalysis was off-putting for many as they saw soooo many patients whose analysis went on forever. In many cases this may be due to transference on the patients part, and the ego of the analyst on his or hers.

But there are many ex-patients whose analysis did not continue interminably, and who consider themselves "cured', or at least able to discard their previous crippling fantasy.

Comedian Christopher Titus has made a career of his.