One of the difficulties we have in talking to psych patients is realized with the dawning truth that we are not curing anyone.  Working in those conditions of not curing, you both, patient and psychiatrist, have to come to terms with each others’ agendas.  The physician says, “(‘I’m a failure.’)  I can’t cure anything.”  Now eye contact is even tough.

“If I don’t look them in the eye, some other emotion will surface and they’ll stop crying.”

Rachel was crying and crying hot and hard in the emergency room.  She was unable to stop the lava flow.  It was bewildering to her.  The people around her shifted their gazes.  Those who didn’t, looked angry instead, as if to say, “Pull yourself together, Woman!”

Psychiatrists have the advantage perhaps to these others in the lobby and receiving rooms and gurney shelves. Supposedly psychiatrists can grip and tug at the corner of the large sweater that is human behavior and say, “Emotions and behaviors come from the brain.”  They can imagine, if not entirely believing at a visceral to cognitive level, that the person they observe is responding to symptoms of what is happening biologically, at a cellular level. When they are tempted to avert their eyes, or look back impatient with the messy emotions, they can say, “This is medical.”  Impatience with emotional chaos from psychiatrist to patient, is equivalent to the ER doc saying to the trauma patient, “How dare you bleed in a public area?”

When someone cries on the medical unit, you may hear, “Nurse! Call the psychiatrist! There’s an emotion on the ward!” Later when things are calm, I walk out and they say, “Doctor!  You’re amazing!  What did you do?”

“Well, I bit off the head of chicken and sacrificed a goat on the patient’s chest.  Then I said, take this pill and everything will be as it should.”

Luckily I have several chins now, and when I gesticulate, their quiver contributes to me looking very capable. As if I could cure something.  I don’t know much about art history but, The Thinker, a bronze sculpture by Auguste Rodin, is probably what that Frenchman’s psychiatrist looked like when they both came to terms with the fact that psychiatrists don’t cure anything. (Heresy.) At least he got to get nude while he did it.

Talking to psychiatric patients can be that difficult.

There are studies on patient satisfaction that demonstrate that patients don’t like us when they think we give them bad news.

You see the predicament here, don’t you? So, some of the difficulty the world at large may be having with talking to psychiatric patients is that we have distorted perceptions of good and bad news. We may have difficulty with our own humanity, frailty, infirmity, and seeing it out there “without a scarf on” for decency, is a hard reminder.

We will never be cured of so many things. All of us. And the best we can hope for…

What is the best we can hope for?

(We are all gluttons and all hope for many unpublishable things but please! Just humor me.)

Say: “I hope to be healthy with disease.” There. Now we will all speak better to each other. It all starts and ends with Me.

Questions: Have you ever had difficulty talking to a psychiatric patient? Have others had difficulty speaking with you? Why do you think that is? What could help? Please tell us your story.

Self-Care Tip: Hope to be healthy with disease. 

(I bet Carl D’Agostino could make an excellent cartoon with this rich irony to work with! That’s right Carl! You heard me! Maybe a blue ribbon with a hole in it?… Ah heck. I’m sticking with practicing psychiatry and leaving the toons to you!)