theantipsychiatrist.com

Carburetors, man.
That’s what life is all about.
– Paul Williams, “Upholstery”, 1974

Overheard on the Wards…

“Oh my God, what that’s smell?!”

We all reflexively sniffed, with casual awkwardness, toward our own armpits – or rather, ‘axillae’, the medical term for ‘armpits’.

We then shrugged at each other –

“Gawd, this hospital reeeeeks!” She held her hands over her nose, nasally bookending her statement with some solid old-school New Jersey emphasis. Maybe I had gotten used to the smell. She was Dr. Pamela Tcherkoff. Doc-tor Pamela Tcherkoff. Fifty-ish, a stout, cross-fit build, dressed in a man’s suit and tie. A nurse with a doctorate, marching rigidly like a human bobblehead, she misleadingly introduced herself to everyone as “Doc-tor Tcherkoff”. She was a newly minted senior something-or-other at the Department of Mental Health. A friend of a senior hospital administrator, her visit was meant to be less critical than a friendly hello. A chitchat, koffeeklatsch, with the ‘community’ folks.

She had not counted on Ms. Lenora Rosenberg having furiously flung her own feces all about the combination entry/exit way as she was shown the door earlier in the morning. In fairness, I suppose no one really counts on that. There is only so much disinfecting one can do –

“I do apologize for the smell, Dr. Tcherkoff,” a colleague stepped forward –

“Krist, I’m gonna be ill,” Dr. Tcherkoff stumbled forward and teetered –

“Dr. Tcherkoff?” I stepped forward with my colleague, each of us taking an arm, and –

“BLECHHH!!!!”

She vomited with tremendous force. I slickly sidestepped the gummy projectile, and poor Mr. Michael Jackson – a patient on the psychiatric unit, not the dead pop star – was struck square in the face. Mr. Jackson was in the hospital because of an utterly incapacitating fear of contamination. A germophobe who would not wipe his own anus without wearing several layers of hypo-allergenic gloves. A phobia-stricken man whose absolute worst fear was –

“WAAH! –”

Krist, he screamed in mortal terror –

“Oh, just get me the fuck outta here.”

“WAAH! WAAH!! –”

Without so much as an apology, Dr. Tcherkoff nearly crawled back to the outer door. I held it for her, the smell of partially digested alcohol now getting the better of the dissipating fecal cloud –

“WAAH! WAAH!! WAAAAAGH!!! –”

Twenty percent of all practicing physicians are impaired on at least one substance at any given moment. The estimates for nurses vary widely, anywhere from five to forty-seven percent –

“WAAH! WAAH!! WAAAAAGH!!! –”

Mr. Jackson could care less –

“WAAH! WAAH!! WAAAAAGH!!!! –”

In psychiatry we talk, and write, of defense mechanisms. Mental fortresses we construct and remodel over the years to keep us going, in some cases to keep us alive. (Keep in mind that according to psychoanalytic theory – that is, Freudian theory – long since bullied and beaten up by the ‘scientific’ community, but validated and proven beyond doubt, over and over again, by the advertising industry – no one is ‘well’; there are just some of us who keep ourselves better defended than others.)

Denial is a primitive, but powerful defense mechanism, and modern medicine is grossly premised on a two-way street of denial. Patients either refuse to acknowledge they are sick, or the extent to which they are sick, or, they wish so badly to be sick, to be taken care of, that they refuse to acknowledge they are not sick – at least by post-historical algorithmic standards. Too, doctors toe a party line now of ‘evidence-based medicine’ – a random, statistical construct easily manipulated by pharmaceutical and insurance companies – so blindly that they often refuse to acknowledge the evidence before their own eyes.

Within this morass, my own doctoring skills, as previously noted, are otherwise as mediocre as the next guy’s.

There used to be twelve magical steps to psychiatric enlightenment. This was a program developed through Alcoholics Anonymous as a means of engaging alcoholics to come to terms with their (presumed) moral failings through religion. And initially there was some success.

With the death of a Western God, however, the program has been groping, more recently turning to thinly veiled Eastern religion as a means of engaging folks (i.e., rather than engage in ‘prayer’, ‘clients’, against all logic, empty their minds in a process called ‘mind-ful-ness’). In addition, the idea of having any sort of moral failing has not sat well either with a more ‘educated’ clientele, and addiction has, accordingly, been re-conceptualized as a ‘disease’. Since then, despite the fact that the success rate of such step-wise programs has declined significantly, the format has been adopted as an easily manualized ‘solution’ to most other forms of psychiatric illness.

So, what then, practically speaking, has been the response to the increasing failure of the Twelve-Step program? Why, more steps, of course. And so I think I will structure this thing, following the lead of the latest noncommittal, nonspecific, a-religious, gender neutral, disorder-neutral multi-step program, a program that promises to lead all XX and XY-units toward a spectacularly amorphous ‘level’ of ‘empowerment’. (Consider it less an autobiography than a guided tour through my own [considerable] moral failings.)

Much of the material here, heavily disguised of course, has been taken from my experience in emergency rooms and hospitals in Hartford and New Haven, Connecticut, in downtown Boston, and most recently in a community hospital with an academic affiliation that just happens to be centered among the most affluent neighborhoods in the Boston area.

As Roger Miller sang, ‘It takes all kinds to make a world…”

On that note I will start this thing, next time around, with my brief brush with inspiration…

A frequent question of many of my patients is, “What do you think, Doctor?” This is very often a difficult, at times complicated, question. It is also a question most physicians do not answer honestly. Actually, it’s a question most people never answer honestly. Medicine, psychiatry included, has evolved, like most scientific endeavors, into dogma over the past few years especially. This blog is an attempt at honesty, at inquiry, at a renewed call for critical thinking.

emartin@theantipsychiatrist.com