|
|
||
|
Sometimes a Pipe is Just a Pipe Numan M. Gharaibeh Glastonbury, CT 06033
– USA Email : n_gharaibeh@yahoo.com |
||
|
In my residency days I
was told: “there is no such thing as good patients and bad patients, there is
only good doctors and bad doctors.” To this day, I don’t know if that was my
supervisor own idea or was he quoting someone else. During that time, I took
that statement with respect and reverence paid only to scriptures. Later on,
I discovered there is no good and bad, just a mixture of the two (plus a
point of view of an observer-the beholder). However, let us presume
for the sake of simplicity that there is good and bad. Since both doctors and
patients are human, why is it that one can be bad but not the other? Is there
anything to stand in the way of patients’ behaving as “good or bad?” As long
as there is good and bad psychiatrists, there will be good and bad patients.
Not only that but the full spectrum of the mix in between. A bad patient is
definitely a value judgment. An example of what we secretly call bad
patient is the one coming to the emergency room for the twentieth time for
‘scratching’ her or his “forearms,” (not wrists). Whether we care to admit or
not we stop taking that patient seriously- he or she will not command the
same attention as someone who is just out of the Intensive Care Unit
following his or her first suicide attempt at age 55. The idea of psychiatrists
or therapists using their own feelings towards certain patients as a
diagnostic tool should be taken with skepticism if not suspicion. We may all
have at one point or another felt guilty for having strong ‘counter-transference’
reactions to certain types of patients. I believe it to be arrogance on my
part to use those reactions as “objective” data to tell me something about a
particular patient. In DSM-IV, the ‘conscious
creation’ of symptoms for some identified gain is referred to as malingering.
Whether to get acquitted of a crime, get admitted to a hospital, get worker’s
compensations, get a drug of abuse by prescription, or whatever other
material gain. I was taught to feel guilty about our negative emotions toward
manipulative patients. I was taught to control my feelings and thoughts since
they must contaminate the therapeutic process, coming from that deep dark
place called “counter-transference.” A good psychiatrist must be the masters
of his or her ‘counter-transference,” I was told. I came across
psychiatrists and therapists who believed that the psychiatrist should make
use of his or her emotions as a diagnostic tool (i.e. if some patient makes
them feel in a certain way then that is diagnostic of certain
pathology-usually a personality disorder). Somewhere along the way we got the
mixed message that our feelings are both subjective ‘counter-transference’
and ‘objective’ tests. Different scales were
devised to make our field look more “scientific,” and “objective.” A
questionnaire, such as MMPI, is now considered (by some magical logic) as
objective data. In a culture that worships numbers, it is enough to come up
with ‘scores’ to be considered “objective,” “empirical,” and “scientific.” It seems that a
psychiatrist’s feelings can be either subjective or objective depending on
his or her stature in the hierarchy of the profession. Freud’s feelings were
definitely objective data (any respected psychiatrist dares to say
otherwise?). The professor’s feelings are more objective than the fourth year
resident’s, and the third year resident’s feelings are more objective than
the first year resident. If a patient smokes a
pipe, he, or she is smoking a “phallic symbol.” However, if the doctor (e.g.
Freud or a contemporary equivalent) smokes the pipe, then it is just a
“pipe.” |
||
|
Document Code VP.0040 |
ÊÑãíÒ ÇáãÓÊäÏ VP.0040 |
|
|
Copyright
©2003 WebPsySoft ArabCompany¡ www.arabpsynet.com
(All Rights Reserved) |