Saturday, February 02, 2008

A Patient Like Me!

Once upon a blog time, I wrote a post called "A Shrink Like Me!" I think it was about how patients sometimes just assume that I share their beliefs-- often political (ah, this Maryland, so you're mostly safe to assume someone's a Democrat), sometimes religious, often ethical beliefs and ideals.

So in honor of that thought, I titled this A Patient Like Me, but it also could have been Hard To Hear.

Paul Weston, our sometimes hot psychotherapist from HBO's In Treatment series (--you do know I've been watching that, yes?) talks to his own therapist/supervisor/person-he-likes-to-fight with about his difficult week as a therapist and he mentions that he is disgusted by the fighter pilot who bombed an Iraqi schoo,l killing 16 children. Paul has pried the man and he's cavalier, remote, says he was on a mission and followed orders-- clearly this was a mistake, the building was believed to be something other than a school-- and in his soldierly world, he'd followed orders. What's so troublesome is his apparent lack of remorse, his ease in living with himself afterwards, his ability to be so okay with the death to innocent young life that he has caused. To look at the surface, of course it's disturbing, though the man walks out the door to board a plane to Iraq. He is headed back to the site of his sin, and it's not so unusual for people to feel a need to return to a setting in which they were traumatized. Alex is just too macho to admit to either Paul or himself just how traumatized he is. His remorse surfaces in it's own way. He continues to deal with the damn spot, even if he washes his hands secretly.

Hard to hear. I sometimes have patients who talk about things that make me cringe. Early in my blog life, I wrote about my discomfort listening to criminals. As a resident, I briefly rotated through a inpatient unit for sex offenders, and sometimes their issues aren't about angst over their attractions, but simply how to stop doing them because they get in trouble. There are pedophiles who either don't believe that they've injured a child, their mission is to stop offending so they won't go to jail, and sometimes they'll talk about their deeds in a way that lacks insight and seems monster-like (please note, this is not always the case, simply an observation I made from a very short time on this unit).

So it's hard when someone comes in and talks on and on about beliefs that make me uncomfortable. Baltimore is a city with many tensions. There was a time, I'm told, where the a pool I go to had a sign "No Dogs or Jews" (this was prior to my birth and the pool's neighborhood now seems to have a dog in every household and a Jew in many). There are tremendous racial tensions. People have strong feelings about same-sex marriage and legalized gambling. While I don't really care so much if my patients have different feelings than I do about slot machines, well, sometimes it's hard if someone goes on and on, and even session after session, degrading something or someone I believe in or love.

Sometimes I just sit there. It's therapy, my job isn't to convert someone's thoughts to my own, it's to be as comfortable as they can be in their lives. And often people who rant about despicable things have no one else to listen to them. Sometimes they live very void lives-- no one else wants to hear it either. They know their views are unpopular, I sometimes wonder if they're Trying to make me uncomfortable, or if they really assume I share their opinions.
Mostly, I figure they need a place to vent. Sometimes it's hard to hear and I'd rather listen to a patient like me.


Anonymous said...

Maybe they suspect that their views might be extreme and even irrational and they want to bounce those ideas off you to see if that's really the case. Maybe they want your help in disentangling themselves from their irrational thinking patterns.

Anonymous said...

I can understand these feelings. At my internship, I have many clients who are mental ill, substance abusers, and with personality disorders.

The most troubling is that the people I like the most in shallow, surface ways, sometimes reveal the monsters inside.

More often, things are more complicated. Many of my clients have done some very very hard drugs. Mainlining things that I never knew could be injected.
Many of these clients have done lots of really awful crap at the height of their addiction.

Now they are sober, and my job is to help them forgive themselves.

However, not everything is as in seems. I had one guy in a MICA group tell me very proudly that he just quit smoking....

He didn't mention to me that he was currently doing heroin...

Sara said...

Aaaaaaaaaa so hard to not tell a spoiler! Keep watching!