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

First off (and Re #9 Sobia), my apologies to Chowk readers for inflicting another article on you all so soon.The first one was posted almost 6 weeks after submission and I assumed this one would take that long as well.I promise not to write anything else for at least another month :-)

Re#1 Scout ?????

Re#3 Shankar, very well said.Your reply would make a nice article itself.Thank you.

Re#4 Dionysus, I was actually trained at Baylor which is a heavily psychoanalytical program and the patient that I described in the article was actually in `insight-oriented long term therapy`(translation: psychoanalytic therapy) with me.Personally (and with apologies to anyone who has been in analysis), I think Freudian or analytic therapy is only marginally useful at best and the very structure of the therapy (i.e. 2-4 times a week for years) tends to exclude almost all people that I currently see (blue collar, poorly educated).I think more highly of Cognitive and Behavioral therapies with a more `here and now` focus.

Re #6,7,8 Thank you all.Yes, I think the focus of the article was something I believe in strongly(and is illustrated nicely in his book,`Sacred Hoops` by one of my idols, Lakers coach Phil Jackson), `listening without judgement`.We all tend to bring pre-conceived notions and prejudices to situations specially when it involves someone close to us and suspending those beliefs while lending a supportive shoulder is often the best thing we can offer.

Sobia ,see above.

BTW I`m going to Lahore on Saturday so you all will probably not be hearing from me (sigh of relief all round!) for a couple of weeks but after I get back, I`m probably going to write an unbearably sentimental piece about the home-land, so sharpen your knives everyone!

Cheers :-)

scouty..even if the sun isnt, lubna is :)
and isnt that just as good?
:P

zehra #2,

:))

What is this, `be kind to doctors` week? Two articles in less than 2 weeks! Whoa! :)

thank u...this was a wonderful article to read. yes, sometimes it is just the acceptance of our Self that is the main problem ... mostly love is so conditionally given.

Very nice ...very true ..very moving .A close friend of mine ..a year back went through a bad patch .I saw that person being literally torn apart by the people around her ..those who werent on the war path were busy telling her how everything was her fault ..and that there must be something wrong with her , otherwise why would all these people be after her (after her life in the literal sense of the word)

The few people she treasured as true friends ..were those who would just be there ...who would see things solely threw her watery eyes ..just listen ..without judging .

I would like to believe I ws one of her friends .I saw her crack and cry under the pressure .Knowing I was powerless in the situation..so off and on I would just comment ..`ya know if ur feeling down ..you can take my shoulder ..and do remember to dry clean it before u return it !:)

Shes doing good for herself now ..picking herself up ..and starting over ..far away from where I am ..the sadists and twisted mess ups she left behind want her back ..are beggin now..its kinda strange ...but by just being there ..and her knowin she wasn`t alone ..pushed her through ..

Ali!

I read yur first article too but this is the one which compelled me to interact

Very well written, you have touched upon a problem which i believe is prevalent all over the world these days

No one seems to have the time to sit down n just talk, listen, help

Everyone is caught up in their own worlds to even look beyond their nose

I guess the fact that someone is THERE to listen is comfort enough even if there isnt any help, we cant just bottle ourselves up, we have to let go sooner or later

Dear Ali,

Thanks for sharing this wonderful piece with us. Please keep on delivering hope to your patients and those all around you-it is the best a human being can do for the other, especially, for those who have lost it.

Shanker:
Very nicely put. I really mean it, dont take it as another one-liner.

Ali,

Another very nice article. I must say, seeing the state of Pakistani society today, if you`re serious about going back to Pakistan you`re certainly in the right field. :-)

I hope you don`t think I`m digressing, but what are your opnions on the efficacy of Freudian methods of treating patients?

Dear Ali,

This was one of the most beautiful articles I`ve read on Chowk. You have described the struggles that every psychiatrist goes through. Your writing style is excellent & I really think you should submit this article to a medical journal.



You are going to have a very successful career, no matter what part of the world you practice, because you posses the 2 most important ingredients that make a great psychiatrist (or any doctor)--empathy & compassion. That is more important than all the medical knowlege that we acquire. Kudos.

I dont mean to sound prejudiced, but I think these qualities seem to come naturally to us desi physicians than many of the American doctors. Thats one big reason why desi doctors are just as successful in private practice, when we compete head to head with doctors who went to the fanciest American medical schools (much to their annoyance).

When patients come to you, they dont care what color of skin you have, how many articles you have published in medical journals, what school you graduated from or whether you graduated from the top of your class. They ask simple questions like is the doctor a nice person, will the doctor care to listen to me etc etc. Your greatest source of referals will not be primary care physicians, but your own patients.

When I was a Chief Resident, I used to supervise 1st yr residents. I had one particularly arrogant American resident, who thought his s *it didnt stink because he knew psychopharmacology inside out. During supervision he presented a patient, who had dropped out of treatment & he couldnt figure out why. In the last session, the patient was disconsolate because her mother had just died. I asked the resident ``well, what did you do?``. He looked at me with an arrogant/surprised expression as if I had asked him a stupid question. He shrugged his shoulders & replied ``what did you expect me to do?!--I raised the dose of her antidepressant!!``

I dont mean to slam American doctors, a majority of them are compassionate & brilliant. Its the way that they are trained. Before I chose to become a psychiatrist, I did a year of internship in Int medicine & was very dissatisfied. During our rounds, we used to push the cart full of charts. We would stop outside every patient room & go through Mrs Smith`s chart to check what her latest labs, XRays & Ct scans showed. Mrs Smith would be an 88 yr old lady, all bent up with pain & moaning in her bed. We would then troop into her room & announce to her how much better she was doing because her CBC was coming back to normal & ct scans showed no evidence of cancer. The senior resident would announce that the serum potassium was slightly low, so the intern should poke her again to draw other blood tests. Besides, her IV needed to be changed & we had to search for another vein in her mangled emaciated arms that were covered with purple blotches from the innumerable pokes & jabs she had been subjected to.

Psychiatry is one of the few specialities that addresses the QUALITY of a human being`s life, rather than the QUANTITY. I believe that the former is more important than the latter. Americans have access the best, most advanced health care in the world. However, Americans are more upset at their health care providers than any other people in the world. Is it a surprise that Dr Kevorkian became so popular? Think about it.

PS. This is a most refreshing change from the usual Indo-Pak mudsling nonsense that Chowk is degenerating into.

ali, brave of you to writ eon chowk again :0

scout. you make me wnna pinch our cheeks
and tell you the sun`ll come out toMoRRow.

What a touching little narrative. You`re absolutely right about the importance of just listening to people and being there for them.

Reminds me of the time when one of my patients told me ``you`re so good to me. you`re gentle and you listen,`` just because I didn`t rush her through painful procedures, and I talked to her. And I`m not even a psychiatrist.

All the hard work pays off when someone says such a thing to you.