Monday, November 23, 2009

Talking the Walk (6)

Idiocy...and Beyond

Are you anti-psychiatry? I have been asked that many times since publishing The Lily Pond. The answer is a clear No. I don't think I would be standing here, and possibly not standing anywhere, if not for the excellent psychiatric care I have received for the past five years. The third section of The Lily Pond gives a view of that care, which includes managing a crisis as well as embarking on the writing of this book.

Lest this be mistaken for a ringing endorsement of the mental health system, let me add that those five years are the only time–in a psychiatric career stretching back more than thirty-five years–that I have felt myself to be in good hands. My previous shrinks ranged from passable (possibly) to lacklustre to frighteningly bad. To put good health care into perspective, I’d like to read a portrait of the kind of care I’d come to settle for. If you find it funny, be sure to listen for the punchline at the end, which comes at my expense.

Heather and I called my Toronto shrink The Idiot. I had been seeing him once a month for several years, whenever I needed my prescription refilled. He wouldn't phone it in to the pharmacy or write for more than one month: he wanted to bill for the office visit. The appointment lasted for half an hour. He spent at least half of that time, every time, finding my file folder, fixing his coffee and stirring it by the machine. Sometimes more time was wasted because he couldn’t remember my name. He would come back with a file for Barrens, or Burnez, or Marks, or Michaels. He never did learn my name in the several years I saw him, and he mispronounced it each time I told it to him again. When I showed up for one appointment and the nurses said, with nasty looks, that he had moved–only one had any idea where his new office might be–I guessed that his privileges at that hospital had been suspended. He worked now in a little brick building over a pharmacy; he seemed to have cut a deal with the pharmacist, since he urged me to fill my prescriptions downstairs and sulked and made difficulties if I wanted to go elsewhere. He had the insufferable bombast of the dullard still vested with authority. After the 9/11 attacks, he treated me to a thirty minute harangue on Egyptian politics; that was the price of pills that day. He raised the dosage as I requested–as I increasingly needed–but asserted his authority by lecturing me on my condition, making inane speculations, sometimes rationalizing his own laxness by flattering himself for having the sagacity to know when a patient was capable of self-monitoring. But eventually, if you have been seeing for years a doctor you call The Idiot, you have to ask yourself: Who is? Seeing a doctor you find contemptible is a position of the utmost precariousness. He broke most of the ethical rules of psychiatry, but that wasn’t what scared me most about him. What frightened me was that I could wind up in hospital under his care, and then he would have the power to do as he saw fit with me. I knew more than a little about what that could mean.

Yes, that’s how bad it can get. But the joke is really on me. I am the other fool and incompetent in the passage, someone whose sense of self-worth and personal horizons had shrunk to the dangerous point where he would accept that level of care and not look, not feel he could or should or must, look for better.

I think that good psychotherapy is necessary for every person suffering from mental illness. People tell me that resources are strained and this is not possible. Really? It might save on excuses if we agreed on this premise at the outset: There is enough money to do whatever we decide is worth doing. And its corollary: if we’re not doing something, it’s because we haven’t felt collectively that it’s worth doing.

Even the most effective drug treatment–and I know people whose lives have been literally saved by mood stabilizers and antidepressants, to name just two classes of drugs–still leaves unaddressed many issues of self-understanding, self-acceptance, self-forgiving that cannot be left out of mental health. In addition to being enormously helpful, psychotherapy is extremely interesting, mysterious and unpredictable. When it is fruitful, it is not only challenging but also suprising and even exciting.

Go to a physiotherapy clinic, a gym, a chiropractor’s office, a massage therapist, a medical supply store, a mattress shop or a furniture store, and you’ll meet people–all of us, sooner or later–willing to invest time and energy and dollars on ways to help weak and ailing body parts. Is the psyche worth caring for even half as well as we care for our ankles, knees, necks, and backs?

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