The Relationship That Heals

Hi Ali, an interesting read. Though does it ever occur to you, that saying it all out here, even as 'jane' gives so much room for speculation, for the next woman I see who only shakes hands with a person, and nothing else. Jumping to conclusions? Well thats how the social mind works, you know.

Cases of sexual abuse are tough, is there a real way out? listening, not judging, ...'accepting' -- how about fighting back, the warrior -- in not so many words?

Now that we all know about Jane, [who could as well be Mary, or Sapna..] I don't know what to say. I suppose, even you need a friend. To get it all out. Sometimes the sky is the perfect psychiatrist, no?

; )

I talk philosophy, don't mind it. I know you don't. But how are we, 'to go on' unless we argue?
In the nearest language, it always works.

Did you ever get in touch with that Jane person again? Did she ever come back to see you?

Maybe she is doing really well, and maybe its because you helped her through that tough time of her life.

In your line of work, even at that time, a little help may have gone a long way.

A doctor is also a human being, with his own clear thinking and methods, that is probably why some do better than many in the same profession.

Keep helping as many as you can as you healed this woman, and the sense of well being you will achieve will give you the most self satisfaction.

If the author is himself a psychiatrist, I would give him full credit for the method he has adopted to comfort a psychiatric patient. In fact in modern day`s rush world we don`d get a little time to sit and think or talk to each other on the inner emotions of our lives.They inside create a turbulence and upset our minds.Then body adversely responds to it .A man who doesn`t tell his ill feelings or weaknesses to some one, whoever the listener may be,finds it hard to get relieved from it.The fact is that once he tells his feelings,he gets the required courage and wisdom to face it and get through it.In spiritual terms, it is called goingbeyond.Once the problem has been expressed, he himself is helped at seeing the problem from a from a different angle.And thus the problem is alleviated or atleast minimised. The same also holds true for criminal cases.Thecriminal tries to hide his crime till the time hecan resist.But he gradually finds himself gettingout of control and ultimately comes to confess allhis guilts and really feels a lot of relief. So the maxim still holds good,`Have friends, takethem into confidence and feel cool within`

Shankar,

Before this article got pushed of the main page, I thought I should convey my thanks for your thoughtful responses.

btw, I fully understand that you ``shrinks gotta eat too``. Still, `unconditional love`` just doesn`t sit well here, I think.

Was a littel surprised at your surprise that (cognitive therapy) can have neuro/pysiological effects. Why shouldn`t it work both ways, after all?

regards,

PM



Dr. Ali, this may come to you as shock, but there ARE computers in Pakistan,and many cybercafes in Lahore! :-)

krashid #144 I am not sure whether you are agreeing or disagreeing with me in my earlier post when I said that Islam explicitly condemns the concept of a ``chosen people`` (be they Jews or Muslims or any other group) and that all individuals (regardless of religion) are equal before the eyes of God. A simple indication (e.g. by writing ``agreed`` or ``disagreed``) would be enough, since I dont want to take up your time trying to explain things to an idiot like me.

well, this is the exact truth. i have no degree in psychology but i have experienced the same episodes. there r times when ppl only want to pour their hearts out. but i want 2 know y do they feel more comfortable with strangers talking about their private affairs. is it only that they dont want 2 b exploited by friends or relatives in later years?

and r u also implying that half of the treatment u can give your patients is by being a good listener instead of being a doctor?

Reading this article recalled a CSPAN?/PBS? coverage of an event on depression where Art Buchwald spoke. He described a key turning point during a severe bout of his manic depression which would make him suicidal. It seems there was this male attendent who did nothing but just hold him in his arms all through a particularly tough night. I think I remember Buchwald as crediting this person with saving his life.

I`m not sure this was the event televised, but this is the closest I could get on the Web.
http://www.med.jhu.edu/drada/buchwald.html

Sadhana

PM,

{{If this sort of human empathy is mostly what is needed to help patients, how do you justify six+ years of medical school?}}

In our medical training, we are forced to learn so much, that we often forget that empathy & compassion is as important as that knowlege.

This may come as a surprise to many lay people, but when you go through a gruelling medical training, we forget that the practice of medicine is more of an art than a science.

{{zeejah says that ``mostly love is conditionally given``. What in heaven`s name is so unconditional about a `love` that is premissed on a $50/hr fee?}}

So its not completely unconditional--but hey, give us a break, we shrinks gotta eat too, you know:)

A shrink called a plumber to fix a leaky faucet. The plumber fixed the leak in 10 mins & give the shrink his bill. ``WHAT`S this?! 50 bucks for a 10 min job!!--man, I`m in the wrong business!!`` shreiked the shrink. Upon which the plumber replied, ``why do you think I left psychiatry & became a plumber?!``

PM,

{{Ali, Shankar, would be interested in your views on Recovered Memory Therapy, since recollection of childhood sexual abuse seems to be the `popular` root of discontent in the West lately.}}

Recovered Memory Therapy got a lot of attention a couple of years ago because of some high profile law suits.

IMHO, ``recovered memory`` is complete BOGUS. I feel a lot of damage has been done to our profession because of some very biased, over zealous colleagues (mostly psychologists). The problem was the manner in which these memories were ``recovered``. I dont have first hand knowlege, since I dont use those techniques in my practice. I`ve read that those pateints were either put in a hypnotic trance or given sodium amytal to help them remember things in their childhood . Now, if a patient is in such a state, they are very vulnerable & easily suggestible. In theory it would be very easy for a therapist to insert his/her own bias into the patient`s subconcious mind. There are some radical therapists who believe almost every mental disorder is because of childhood sexual abuse.

Things started going completely out of control in the early 90s. In the 80`s , I had seen only one case of Multiple Personality disorder (MPD). It was known to be an extremely rare condition; popularised only in Hollywood. However, in the early 90`s, there was one case getting admitted to the hospital each week! We were wondering if something was in the water. Moreover, all of them claimed that they had parents & families who were devil worshippers & subjected to inhuman physical & sexual abuse in their childhood. To make things more suspicious, all these patients would go to a few select psychologists, who claimed ``specialisation`` in treating MPD. I think the patients were subtly ``suggested`` this crap by those charlatans. Then we started getting reports in the press that this was becoming a national phenomenon.

Happily, after a few damaging malpractice suits, these guys have stopped all this crap--I hope.

Essensaur,

{{Or, would it be more correct to say that SOME psychological and behavioral problems have nothing to do with a medical condition and are caused primarily by psychological factors.}}

You`ve asked a very important, though difficult question. Perhaps the best answer I can give you is ``we dont know``. ``We`` meaning the experts, scientists & researchers, whose findings we clinicians rely upon.

Even in the year 2000, ``our`` understanding of the human mind (& its anatomical representation, the human brain) is like ``our`` understanding of the universe. In other words, we know a heck of a lot about the mind/brain; but its probably less than 1% of what we need to know.

The human mind is developed through a complex interplay of genetic & enviromental factors--thus the classic argument between ``nature vs nurture``. There is a broad consensus that both factors play an important role.

The concept of what is ``medical`` or what is ``psychological`` is getting increasingly blurry. For instance, with increasing understanding of brain physiology , scientists now know that extreme shyness is a medical disorder (& given a fanciful name called ``social anxiety disorder``) & medications have been invented to help that condition. The same goes for conditions like obssessive complusive disorders & panic disorders; which were thought to be ``psychologically`` based, but now are proven to be ``medically`` based.

To make it even more complex, studies have shown that ``non medical`` treatments (ie treatments where medications are not used) like psychotherapy & behaviour therapy do cause positive alterations in brain chemistry that help a variety of conditions. Thats why some mental problems are treated successfully by non physicians like clinical psychologists & social workers.

I`m not sure if I`ve answered your question. If I havent, perhaps you could give me a concrete example & I could give you my 2 cents:)

Dr Sahb:

Kitnay paisay diyay aapnay Chowk ko? Or did you use your - as we say over here in Arabic - ``wasta`` (connections)? jk..

On a more serious note...

[[I didn’t necessarily have to do anything to help. ‘Listening without judgement’ was sometimes all that was needed.... I remind myself to just be there with them, share their pain and listen.]]

It took you all those years to figure that out?? I do the above as a friend anyway - and if that is all it really takes sometimes, why charge all that money? Maybe I should start charging my friends...... oh boy, lots of money to be made...

...well ThankGod you are not in my PPO plan.

Ali, while in Lahore, be sure to check out the Gawalmandi Food Mela and then write a piece on the psyche of Lahoris on why they LOVE unhygenic, cholestrol-ridden, fatty fatty food so much! Now THAT would be another article worth reading :) Have fun and enjoy yourself! :)

I was reading some guidelines that a local school prescribed to its teachers to identify symptoms of certain kinds of disorders in young children. They seemed so general that I wondered if a single child (or teacher, or parent, for that matter) could be considered truly normal. That triggered a chain of thought.

So this is for Ali Hashmi, Shankar and anyone else who can enlighten me.

Would it be correct to say that ALL psychological disorders are related to some medical root cause, which, if treated, would fix the abnormal behavior?

Or, would it be more correct to say that SOME psychological and behavioral problems have nothing to do with a medical condition and are caused primarily by psychological factors.

From Dr. Hashmi’s introductory paragraph, it seems that the latter is valid. In that case, I have further questions with respect to those sets of problems.

Knowing that there are basic and major differences in the culture, upbringing and social environment in the world, how valid is it to apply the corrective practices developed in the west, to patients from the subcontinent?

One would assume that there are some fundamental commonalties that transcend such differences, and therefore it is okay to apply the western techniques regardless of the origin of the patient. Yet, I understand that the Freudians basically threw out a colleague (Jung?) exactly for theorizing on those lines. But perhaps I understood wrong.

Regards, E.

Dr Hashmi,

Sorry to be the snake at the garden party, but...

in saying that you ``didn’t necessarily have to do anything to help...Listening without judgement’ was sometimes all that was needed`` and ``to just be there with them, share their pain and listen`` [is palliative], aren`t you really devaluing the role of the doctor?

If this sort of human empathy is mostly what is needed to help patients, how do you justify six+ years of medical school?

Or does the success of your profession necessitate an alienated society?

zeejah says that ``mostly love is conditionally given``. What in heaven`s name is so unconditional about a `love` that is premissed on a $50/hr fee? Sure the doc-patient relationship may come to transcend commerce in time, but in a profession that demands `objectivity` on the benefactor`s part, I wonder how much room there is for that healing spirit that always demands involvement -- human love.

Someone brought up Freud. For all his excellent theories on the psyche and libido, one wonders about the efficacy of therapy settings that so easily encourage dependency, transference and shunning of responsibility for oneself. at the risk of oversimplying, are patients really being helped -- long term -- when they leave the session feeling good that they have a parent figure willing to listen?

regards,

PM

PS. Ali, Shankar, would be interested in your views on Recovered Memory Therapy, since recollection of childhood sexual abuse seems to be the `popular` root of discontent in the West lately.

Thank you for nicely describing the bond between healers and those who seek the healing.I went through a similar experience as a medical student, something I described in an old chowk article at http://www.chowk.com/bin/showa.cgi?aliya_nov1098