With Apologies to Ferenczi, who wondered whether it was the psychologist or the paiient. After lo, these many a year, I no long wonder.
I have always been curious about the lives people lead behind the curtains. On the rides back from Hebrew school in the darkling shades, I tried to peep into people's windows from the sanctity of my father's car. I could see the backlit rooms, fireplaces, dining tables, couches. I saw the shadows of the inhabitants moving about. I wondered if they were happier than me, more fulfilled than me. I would go to school and wonder about the home lives of other classmates. I would wonder what type of parent the teacher was, what kind of marriages they had.
I guess I hoped that someone would wonder about me. Externally, I was extremely quiet and inhibited. Shy and anxious around others. Awkward, both socially and physically. A be-spectacled bookworm, immersed in chapter books like "Happy Hollisters," "Cherry Lane," and "Nancy Drew." Enthralled and ashamed of my fascination with Tolkien's "Lord of the Ring Trilogy." Why? There wasn't a female character worth a damn in it (Don't tell me about Eowyn--the minute she decides to love Faramir, it's all over and she is domesticated) Worse--not a Jew in sight. How can anyone create a fantasy world bereft of Jews? I decided to make the Tooks honorary Jews--they weren't respectable, they were clannish, and they were unimaginably wealthy. They seemed like fun. They were somewhat outside of hobbit society--just like the Jews--perennial outsiders, even when they are inside. At some point, someone always cries out, "Cheap Jew." Or, in LOTR, "Fool of a Took." No one ever says "Fool of a Brandybuck." Or, "Fool of a Baggins." And yet, Pippin is the most intuitive of the lot. As Frodo becomes increasingly redundant as the narrative gathers steam.
So, an inhibited bookworm eventually earns a doctorate. And becomes an inhibited, bookish psychologist. Who still wonders about the lives her patients lead. And quickly became frustrated with the nuthut atmosphere of the hospital based clinic. It's all about numbers, not people. People don't matter. So the children whose mothers (there are no fathers among the urban poor) are selling their Ritalin--the psychiatrist just denies it. And continues the script. The children who have an ADHD diagnosis but steal and set fires and sexually abuse others--retain their ADHD diagnosis and their Ritalin. So they become a more focused psychopath.
It was impossible to help the children. You can't talk to their mothers--"I'm not the crazy one." Then they run right to the psychiatrist and complain about the psychologist.
Worse, the psychosocial intakes of the children are a parcel of lies. The children are often blamed for being too needy, too whatever. Mothers are not receptive to working with their children. They don't remember developmental milestones, or the milestones are biased by current anger. They blame the child for all the family problems. And the cure is medication--first, the various ADHD drugs. Then, they complain about the child not sleeping--so its Benadryl. Then they say the meds are like water--so, add an antipsychotic. Psychotherapy is not valued. The chld's functioning is not valued. No medication cures learning disabilities. Teacher's can't do it all. If you want the child to read better--they have to read at home. If you want the child to do better in maths--they have to do maths at home. If you want to see your child succeed in school, they have to see that the world of academia is not separate from their domestic landscape. Parents need to be reading and doing maths--not video games and television and drugs and alcohol.
Adults are no better. If an adult complains about ringing in the ears, instead of being referred to an audiologist, its auditory hallucinations. If they complain of pain, its somatization disorder. I have learned to diagnose Adrenal Insufficiency, Pernicious Anemia, and Alice in Wonderland syndrome (Todd's disorde). It doesn't matter. The psychiatrist continues to prescribe anti-psychotics and no referrals given to Endocrinology or Neurology. Patients come in high or brag about their drug/alcohol use. However, when the psychiatrist asks them, they deny it. So no referral to a dual diagnosis program is made--after all--numbers, census, etc. The fact that the synergistic effects of alcohol/marijuana/cocaine/heroin use with psychotropic drugs is unknown....oh, I forgot--they're not curious.
I wonder whether or not anxiolytics need to be so frequently prescribed among adults. So many psychiatric patients smoke several packs of cigarettes/day, washed down with liters of caffeinated cola/coffee/energy drinks. Instead of taking a Klonipin--drink your Oats/Macademia/Coconuts. They're cheaper than buying all those packs of cigarettes.
In other words, neither the psychologist, social worker, nor psychiatrist is curious about unusual presentatios of perceptual issues. If someone says the room becomes larger or smaller frequently, that is probably not a visual hallucination. If someone complains of ringing in the ears, that is probably not an auditory hallucination. If someone complains of hearing music from their childhood--that is also probably not an auditory hallucination.
I used to read Oliver Sack's books. He portrays himself as a curious neurologist who is not apt to resort to psychopathologizing his patients. From him, I learned of Bonnard Syndrome, Alice in Wonderland syndrome, musical hallucinations, etc. I sometimes read English psychology journals, which speculate that auditory hallucinations are a relatively normal phenomena ( and underreported--guess why). Whoops? Did I mention I'm still a shy, awkward bookworm psychologist?
So I refuse to work in hospitals and clinics--nuthuts are not for the curious. And I wring my hands at the malignant nature of the medical care offered to the urban poor. And women. And children.
My motto: Be curious. I wish more medical professionals would take that one up. Or at least stop being the wrong answer to Ferenczi's question.