Excerpts from God's Shrink
Under normal circumstances the province of psychotherapy is practiced privately. What is said behind closed doors remains there. The patient can sing like a bird, but the therapist is ethically and legally bound by confidentiality. A brief postscript in a chart may summarize the generalities of what transpired; however, that's about it. I can truthfully say that in all my years of practice, I only gave up three patients. The first involved serious child abuse, and the second concerned an individual who was imminently suicidal. These were clearly based on a duty to warn and protect.
The third case, which is the focus of this book, has nothing to do with legalities or ethics. It has to do with a patient whose initial claims represented the most elaborate and complex delusional system I've ever encountered. I was given express permission to tell the story in a public forum. Indeed, I was encouraged to do so. Most everyone could use a shrink now and again. We all have times in our lives where we could benefit from some support and direction from someone who, for the most part, is objective and outside the loop—an individual with the training and experience to help guide us through turbulent psychological waters.
There's no mystery as to why I think this way. I was trained formally and conservatively at fine schools, and in my practice I have prided myself in being a level-headed therapist. I have never trusted quick fixes or simplistic interpretations of complex human behavior. My organizing philosophy is to try to integrate and understand people from as many angles as possible. Viewing others on just one level of experience is hopelessly reductionistic. We are, of course, an amalgam of highly interrelational genetic, biologic, familial, and sociocultural factors. In point of fact, we are contextual psychological beings.
Becoming a seasoned guide wasn't just based on schooling and experience with patients. What I learned about others came in large measure from a deeper understanding of myself. I had been through my own challenges and dramas in life. I had stared into the mirror and analyzed everything from a thousand angles, sometimes with the help of my own therapist.
Individuals seeking treatment arrive for many reasons. People come to me for answers, often expecting that I can turn around a lifetime of dysfunction in less than an hour. Sometimes, I can't do that in a hundred hours. For the most part, patients want an epiphany. They're looking for an a-ha! moment where it all comes together in one sweeping instant—a nanosecond where confusion, self-doubt, and questioning disappear and their world at once becomes comprehensible.
Their hope is that they will stop feeling a sense of isolation and finally get what they believe others already have. They will no longer be looking from the outside in.
Their body, mind, and spirit will come together in one dramatic understanding that goes beyond intellect and emotion.
For most of us, it won't play out like that. We'll spend our lives trying to sort out a huge puzzle by moving pieces about that sometimes fit and more often don't. In the end, we might discover that playing with the pieces was really just a way to occupy our minds. I once estimated that I've spent some sixty thousand hours behind a closed door listening to people's problems. That doesn't include the hundreds of thousands of hours thinking about those problems. There really is no off duty when your mind is locked into the drama of other people's lives.
When prospective patients would ask me what I specialized in, I would think to myself, I specialize in emotional pain and suffering, though I settled for my stock phrase, which pretty much covered everything: 'I deal in all types of intrapersonal and interpersonal issues.' I've heard about anxieties of all types: fears and worries that can sometimes paralyze, though more often they slowly bleed away the joy of life; imagined and real illnesses; despair leading to depression, where each day was a struggle just to get out of bed or to decide to stay alive. There was an occasional suicide, followed by the ceaseless soul searching that friends and family go through in trying to decide the what-if questions. I had been through such a gut-wrenching experience myself early in my career.
I was working the late-night shift at a psychiatric hospital while putting myself through medical school. One of the patients on my unit had been on suicide watch for a week. We had decided in staffing earlier that evening that he had improved enough to take him off of close observation. I don't recall the details of our last conversation together, but I do remember him going to bed and my wish that he 'rest well.'
Less than half an hour later, when doing my rounds, I found him hanging from a sheet tied to a pipe in the ceiling. I had sat a mere twenty feet away at the nursing station and not heard a sound. I can still clearly see him all these years later, slowly twirling around in a counterclockwise direction, and thinking how grotesque he looked. There was nothing peaceful about his death. It was violent and tragic.
I had tried to console parents who had lost a child through illness, drugs, war, or accident. Many times, I'd witnessed the devastating effects of substance abuse.
Certainly, people made each other crazy. Thousands of sessions involved relationship issues ranging from serious to trite. There were major crises involving domestic abuse, lying, and infidelity. There were also squabbles where the couple bickered over the silliest matters. Spouses would badger each other where I secretly visualized a tiny piranha gradually killing an elephant through not one bite, but a thousand.
Like any therapist, I have lots of war stories. I once dismissed a patient by referring him out, once I realized he was an unrepentant pedophile under court-ordered treatment. I politely returned a pair of panties that flew across the room and neatly landed on my lap with an invitation to play. I decided long ago in my career that I would try and listen well, offer encouragement, and firmly rest on the fact that I had very few definitive answers to many of life's trying events. Every person had a unique story and circumstance, and I had learned to believe that I could help the most by presuming the least. At the same time, I quietly held the opinion that I had more or less heard it all. That's not to say I felt cocky or couldn't be humbled. Plenty of people reminded me that they would not act in a completely predictable way.
Marriages survived when I was sure they'd fail. A lover would come back after a prolonged absence. Terminal cancer turned around. An endlessly relapsing drug addict, defying the odds, contacted me years later to let me know that he and his new family were doing great. There were many sad stories and successes as well. Even so, after all these years, there wasn't anyone who was going to really challenge my understanding of the way our minds work. The numerators would certainly vary from person to person, but the basic psychological mechanisms, the common denominators, were essentially the same. I felt with some certainty that, after thirty years of experience, I was pretty much a master mechanic practicing the art and soft social science of psychotherapy. So when a new patient named Gabriel came in claiming to be God, I knew better than to throw his delusion back at him. Instead, I simply asked him how I, as a mere mortal, could be expected to offer help to the Supreme Being. That one didn't throw Gabriel at all. He just smiled and replied, 'Well, it turns out everyone can use a shrink. Even God.' ---
©2007. Michael Adamse, Ph.D.,. All rights reserved. Reprinted from God's Shrink: 10 Sessions and Life's Greatest Lessons from an Unexpected Patient. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, without the written permission of the publisher. Publisher: Health Communications, Inc., 3201 SW 15th Street , Deerfield Beach , FL 33442. |
