"The writer should seek his reward in the pleasure of his work and in release from the burden of his thought; and, indifferent to aught else, care nothing for praise or censure, failure or success." - From The Moon and Sixpense
A Psychologist's Thoughts on Clinical Practice, Behavior, and Life
The COVID-19 crisis has fast-tracked change in the delivery of health services though diagnosis and treatment recommendations via audio-video have existed in a more primitive fashion for decades. It is thus unsurprising that start-ups are bolstering their product with the promise of near instant service. Have a headache/backache/sinus problem/fever? they ask. There's no need to worry! For a small sum per month you can consult a doctor as often and whenever you wish, change doctors at your whim, all being top notch! Yeah…
My objection is not that these services are delivered via audio-video since the accessing of health services without travel is a welcome development. But will these companies meet their vow with sufficient quality staff? How many doctors will sit before their computer on a 24/7 basis, and how low must their wages be to assure the company a healthy profit?
The rudiments of this service have long been provided by health insurers using nurses and telephones. Can the only thing that these startups are adding is killer advertising? Hmm…now that would be a cynical judgment.
Moreover, the major public health crises derive from habits. The choices of poor diet, alcohol and substance abuse, and unhealthy lifestyle are not easily changed without lengthy contact with one clinician. But we must be modern, mustn't we?
A middle-aged woman told her physician, "I've never had a chronic illness and don't think I can develop one." "That's a good delusion. Keep it," the doctor replied. Yet delusions have a bad history, being associated in many minds with horrific scenes from countless horror movies. But delusional thinking can have benefits too.
A person whose life has been a succession of personal disasters from psychiatric hospitalizations to painful injury to poverty develops the delusion that the FBI is watching them. Similarly, a soldier on the battlefield, close by comrades who are being killed, tells themself they will survive. In the first example, the delusion may protect the person from suicide, since if the FBI is watching them, they must be of great importance and is thus worthy of respect. A soldier's delusion of certain longevity keeps them fighting and increases their and their comrades' probability of survival.
Yet delusional thinking is, of course, generally destructive since only through reality-based thinking can the problems of living be resolved. The anxious depression that accompanies delusional thinking is proper since this type of thinking reduces situational adaptability and thus increases personal peril.
The stress of creativity has long been known. Dedicated artists struggle all their lives, seeking financial success which is rarely achieved, motivated by what one might call their "creative addiction." But creativity, though not healing, can also grant meaning to an artist's life, rescuing them from life-long despair as they seek perfection in their work. These include such survivors of dreadful childhoods as Edvard Munch and Thomas Wolfe. Thereafter, Munch led a nomadic life and Wolfe's relationships were notoriously troubled as both unconsciously sought, through their creations, the good-enough parenting which they lacked as children.
Thirty-years ago I was asked to treat an eight-year-old child who, stricken with leukemia, had been discharged from the hospital to die at home. Though fearing the emotional turmoil, I felt unable to refuse the request, feeling that he needed someone.
The boy looked terrible at our first meeting, holding a white enamel tray lest he vomit. I introduced him to "our friends," the stuffed animals in my office (Bertram Bear and Darrell Dog and Barry Bird and Gregory Gorilla) while we played a board game. He looked healthy at the following sessions, not bringing a tray, and playing and interacting with our friends comparably to my other young patients. He seemed so normal that I embraced the frequent delusion that his doctors were wrong and he wasn't dying. Then one day, when he became too ill to travel, I went to his home and spoke with his parents in the kitchen while he lay in bed.
Despite my heavy work schedule and preoccupation with him since we met, I felt nothing when he died but my body reacted differently. Though continually healthy, I immediately developed an unpredictable explosive diarrhea which made me unable to perform my duty as expert witness in court. Medical tests found nothing wrong and when the diarrhea ended two months later, I sensed it was gone forever and it never returned. Had my body tried to expel the poisoning stress through diarrhea? I wondered. A primitive reaction explained by psychosomatic medicine which holds that what cannot be spoken will be expressed through the body.
Twenty-six-years later I was referred for treatment an adult who, after extensive surgery, was being heavily medicated by his doctor for pain and self-medicating himself with forbidden alcohol and cigarettes. Having become a troublesome hanger-out in her office, she referred him to me "for therapy." A first glance told me he was dying. He had no interest in therapy, I didn't see him for long, and my increased blood pressure lasted as briefly. A week later, without conscious intent, I spontaneously spoke of the boy who departed life too soon, leaving his parents and me and our friends to grieve. Then I did cry.
In a semi-rural Community Mental Health Center where I once worked, a social worker, without telling anyone, brought in a caged rooster to give to another worker at the end of the working day, parking it in a closet in the women's bathroom. When one entered the bathroom and turned on the light, the rooster crowed, mistakenly believing that it was dawn. Women leaving the bathroom and reporting having heard a rooster crow were considered crazy by the staff ("probably their time of the month").
During my first job as a psychologist at a psychiatric hospital, I told my psychoanalyst/supervisor my adolescent patient's statement. "That's psychotic," the doctor replied. Though able to define "psychotic," until that moment I hadn't grasped the power of this condition.
Similarly, when mass murder horrors become public, the perpetrators are often viewed with surprise for these men had seemed so normal. They lacked the twisted features of horror film characters and spoke coherently though of bogus beliefs. Columnists asked the usual question of "why," and provide their usual answer that "no one knows." But this is not true!
While predicting violence cannot be certain, it correlates highly with several factors: failure in life; substance abuse; the ego capacities governing thinking and behavior being inadequately developed; and having a fragmented "sense of self," sense of who they are. The killer's frequent decision, to suicide in "glory," is considered preferable to their continued painful existence.
Though their act was horrendous, these individuals are not often considered "insane." The legal definition of insanity is determined by state statute, most usually whether a person can distinguish "right" from "wrong," and rarely succeeds as a defense. But to describe them as sane does not imply that they possessed "normal" control over their behavior though, except for those with extreme limitations, this should not influence their punishment. There is evil in the world and some succumb to its temptation. Yet even for the rest of us, the unconscious is very powerful and one must respect its power.
The Disastrous Estrogen-Replacement Saga's Cautionary Research Lesson: "How easy it is to be misled in medicine by correlational and retrospective studies, and how when it comes to proving the merit of any drug or procedure, nothing short of a large, controlled, double-blind clinical trial will do." In Natalie Anger's, Woman - An Intimate Geography
Emergency Room workers are being swamped by medically healthy people who are frantically seeking testing for coronavirus. Though the present national period time is exceptional, their behavior is no different from anytime when anxiety escalates and panic overwhelms.
Anxiety is the normal, healthy experience when the mind senses danger. It can produce symptoms that mimic virtually any medical disorder: pain in the head or back; nausea or dry mouth; scarily heightened blood pressure; skin eruption; lack of appetite. All instantly vanishing when the fear that aroused them disappears. During normal times, forty to sixty percent of the people arriving at an Emergency Room who fear that they're having a heart attack are really suffering a Panic Disorder. This is the condition when the normal symptoms of anxiety are misinterpreted as a deadly medical event.
More public education about the human mind is sorely needed.
I told the following to an Irish person: As frightening as things are, they're about to get much worse. A high-level government contact told me that several thousand space ships containing carnivorous alien creatures are speeding from Venus headed for Earth, having exhausted their planet's food supply. NSA communication decrypts revealed that their favored food is IRISH STEW.