Which Should You Choose — Therapists Or Friends?

I remember vividly and will never forget when a home-made bomb blasted the Alfred P. Murrah federal building in Oklahoma City, Oklahoma. It was April 19, 1995, and I was in the midst of morning rounds at a major hospital’s inpatient psychiatry unit.

A lot of people were “decompensating” — going psychotic, had beliefs the world was coming to an end and needed extra medicine.

They called it the worst homegrown terrorist attack on U.S. soil up to that time in our country’s history.

I thank the basis of my personal belief system that I was not closer to the explosion at that time, and that I was not personally involved in the later and more catastrophic attack on the Twin Towers of the World Trade Center in 2001.

However, both through my civilian training in psychiatry and my military training, I knew about “shell shock” or Post Traumatic Stress Disorder (PTSD) that results from horrible situations such as these.

In the immediate aftermath of the Oklahoma City bombing, I voluntarily extended my unpaid commentary on the local NBC Radio affiliate, where I had been hosting a Saturday night call-in show for the past year or so.

Whenever I had a break in my fledgling private office practice, and after hours every evening and on weekends, I went back to the radio station – which was then opened up to the entire NBC network worldwide – to answer questions that were flooding in from an amazed and shocked public, and to try to help everyone make sense of one of the most senseless acts in our history.

There were a lot of people suffering who weren’t necessarily psychiatric patients by any means.  We don’t often think of “normal” people having trouble adjusting to things like this.  However, we had everything from parents wanting to know how to explain this tragedy to young children to people in foreign countries wondering “why are you bloody yanks blowing each other up?”

Three of us sat at microphones in those sessions – usually the same three.  Besides me – a board-certified psychiatrist – there was another MD (family practice and environmental medicine) and one of the station’s talk-show hosts.  This was long before Fox Network, but Rush Limbaugh had already been around a few years.  So our co-host was the local tough-talking conservative radio host.

The two doctors on the show were usually in accord with trying to give comfort and start the healing process.  We expressed sympathy and suggested things like therapy and perhaps even medication in certain cases.

For “balance” – the local commentator tended to contribute things like, “Look, you don’t all have to go to psychiatrists.  You just need a friend to tell things.  Tell your barber.  Talk to a bartender.  Sometimes you just need to talk it out and you feel better and that’s all it is.”

Well, I was mad at him at that time.  I was still a relatively young psychiatrist.  I had been out for a few years, but I didn’t quite grasp all that I grasp now, and put together all the pieces.  My friend, my first psychiatry preceptor in France, was correct.  He arrived at the estimate of 70 percent.  Seventy percent of all people who seek psychotherapy need a surrogate friend and for one reason or another, don’t have the skills of the situation to find one.

So after all these years, I’m prepared to admit that in probably about the same percentage of cases, that other person on the radio with me in Oklahoma City was probably right.  There are a lot of people who just need to talk to a friend. And if that’s all you expect from therapy and if that’s all you want from therapy, don’t spend your hard earned dollars on it and don’t spend your hard earned dollars buying the services of a therapist. What you end up with all too often buying the time of the therapist without getting the services.

Now if — heaven forbid — you’re hearing voices or you’ve got thoughts — heaven forbid — of hurting yourself or hurting someone else that can land you dead or land you in jail, don’t follow that Oklahoma Rush Limbaugh-wanna-be.

Don’t go talk to your hair stylist or your bartender or even your best friend.

Don’t go to a psychotherapist either. 

Go to a psychiatrist.  Go to a medical emergency room.

Because if you’re having thoughts of doing things that might land you in jail or dead, you need to see a medical doctor.  Psychiatrists will know right away and will get you to the right place.

And if you can’t figure out how to do that, call 911 because the one side effect that is irreversible is death. 

I had to say that at least once and now it is out of the way.  However I would never deny that a lot of people — and I still think that original 70% estimate is right — need a friend and don’t have the right kind of friends.

Those people we call “therapeutic personalities” — people who like to teach each other by talking to them — tend to end up in certain professions.  So that radio host in Oklahoma City may have rubbed me the wrong way, but he wasn’t wrong. 

These people may turn up as bartenders, as barbers or hairdressers because although certain technical knowledge is needed to do any of these essential occupations, the best ones possess personal qualities that cause their clients to bond with them.

You’ve got to be careful if you take your psychologic baggage to non-psychologically trained people. Many who end up telling their troubles to a bartender usually drink alcohol — and this is not without side effects.  Immediately, there may be euphoria from loosened inhibitions, but further usage results in depression.

Long-term, of course, there is a possibility of addiction, which carries a host of complications up to and including death.

Obviously, probably not my first recommendation unless you learn how to limit your imbibing to fruit juice or seltzer water when you’re in such situations.

Barbers and hairdressers, however, have often been amazing and a couple of times, they’ve actually referred people to psychiatrists — even to me. 

Most men go to a barber less often than most women go to a hair salon.  Yes, there are men who need a “stylist” more than a barber, and I’ve heard of recent revivals of old-fashioned, upscale tonsorial parlors where affluent men can get a hot towel over the face and a shave.

I don’t know how hard it is to pour out your heart with a hot towel on your face.

Not that there is anything magic about hair professionals or the salons they inhabit.  But usually there is also a privacy issue, with other customers being privy to your innermost fears and feelings.

Psychotherapy evolved group treatment rather early in the game.  In such a setting, all the patients are sworn to confidentiality on the same level as the therapist.  However, it can be difficult to overcome one’s tendency to be open – which is absolutely necessary for any kind of benefit.

No friends – no matter how seriously they take their oath to keep your secret — can be depended upon to keep quiet about really, really juicy details.  Gossip is one of the mainstays of human civilization. Whole magazines are devoted to it, whole television networks, practically.

It’s amazing what people will say on TV, even knowing it is broadcast world-wide.

So if you choose to confide in a friend — especially a paid friend such as a bartender or a barber or a hairdresser —  no one can promise absolute confidentiality.

It’s best to just expect everyone else to know what’s going on.  Then you won’t be shocked and disappointed when the cat is out of the bag.

Remember, whatever is happening to make you distraught and wondering if you need therapy, the chances are overwhelming that it’s happened to someone else.

When Freud himself first started studying psychotherapy, he quickly found that everyone had skeletons in the closet, and a therapist must navigate them with grace and finesse.

The persons he treated (studied) were usually relatives of prominent people in the community – other physicians and upper-class business people.  These paragons of virtue, with such high standing in society, were often child abusers, adulterers, alcohol and drug abusers, and just plain inappropriate people.

A very popular and well-known cartoon shows a large meeting hall with nearly every seat empty.  Hanging across the stage is a banner that says “Society Of People From Functional Families.”

Those who get to know me and are intrigued by my knowledge and my achievements always ask me about my private life. They often seem shocked when I ask them, “If I had a normal functional family, do you think I’d be doing this for a living?”

In at least some superficial ways, I’m like all these bartenders and hairdressers.  I like to talk to people with the pretention of making them better.  It’s just that I took a very specific path to be able to do it – spending a heck of a lot of time going to specialized schools and reading a bunch of books and then a lot more years doing it professionally. 

I’ve assimilated a body of knowledge not just in that, but in general medicine and in highly specialized pharmacology. But the bottom line is, if someone wants to chit-chat with because they think we have things in common, maybe it is a good idea to go and talk to their hairdresser.

The down-side is that with hairdressers to bartenders, there is no accountability.  You can’t sue them for breaking confidentiality.  They aren’t held to any standards that require them to actually help you improve your lot.

I love to hear my husband sing a song with lyrics by his hero, Johnny Mercer, that was made famous by Frank Sinatra.

It’s quarter to three, there’s no one in the place

Except you and me

So set ’em’ up Joe, I got a little story

I think you should know

We’re drinking my friend, to the end

Of a brief episode

Make it one for my baby

And one more for the road

 

Everyone wants a one-on-one relationship.  Unless you’re lucky enough to be Frank Sinatra when it’s quarter to three and there’s only one person in the place, you can never have that kind of relationship with a bartender. A hairdresser can only do one head at a time, but there are usually a lot of other hairdressers and customers present.

So if you want confidentiality and the power to sue someone if they betray it and if it’s that important to you, you’re not going to get it with a hairdresser.

On the other hand, if you’re not necessarily interested in pure intervention — if you’re looking for friendship or support from other people who have gone through similar situations, you can probably turn up some at a bar or a salon. This is probably the easiest place to find one but is it the only place, or the best place?

Of course not. Any place that people can band together, anyplace there’s group of people in one room, you are very likely to find someone else who’s had an experience similar to yours.

When I ask people, “What else do you do outside of your house and who else do you need?” I would say about 70 percent of the time, the answer would involve religion.

Religious people tend to be very open about hearing your problems.  However, when they propose to you a solution, it will often be to pray.  No one in most sects will ever be able to teach you how to pray, how to focus your thoughts, how to achieve what you want.  They’ll just say, go pray and it may make you feel good and it may not.

I am neither for nor against religion.  But I want people to do things in life that make them feel better. And so many times, when people have gone to religious, authorities they report that they are advised, “I’m not going to church enough.  I have to go more often.  I don’t study.  I need to do more often.  I need to do this.  I need to go to this kind of meetings.  I need to do good works.”

From a psychological point of view, this type of guilt-trip may be making a situation worse.  Perhaps the religion itself is part of the childhood memories that made you feel poorly in the first part. 

You have to address the question, the same as you would with a therapist — Is religion helping?  Now sometimes it does and if religion is your joy and exaltation and you can get in the state where you are happy and pleased and feel calm and feel the love of what you believe is eternal washing over you, then pursue religion.

But if it makes you feel poorly, this may not be the way to find the solace you want. 

So if you’re looking for a friend, try earthly friends among those who offer their friendship regularly to make the people they deal with, feel better and if you’re looking for a Divine Friend, look at the filter through which that Divine Friend comes to you.  Religious structures can cause people sadness or cause them joy.  Find your joy.  Find your inspiration.  Find your well being.  

Another question I often ask people is, “What inspires you?” Religion?  Maybe, but not as often as one would think.  A lot of people get from religion a group identity which they know is depressive.  How about a feeling of gratitude for listening and for talking to me.

This is the feeling people often get from their barbers, from their hairdressers and yes, sometimes even from their bartenders.

The time during which they felt real good had nothing to do with their hair or imbibing alcohol.  It is the human contact and the feeling that someone is listening, or even caring.

Know when you felt good.  Know what makes you feel better. Very often it will be a relationship with another person.  But more often it is a friend or family member rather than somebody you’re paying to do a service.  The bartender or barber may be anonymous and you may see a different one each time.

If you go to someone and they’re always saying things to make you feel better, that’s kind of a one-sided relationship.  It has been known for a very long time that if you’re seeking a true-friends relationship that you think is going to do you good, you have to keep the other person involved.  After all, they’re not getting paid insurance dollars like a therapist is. 

So if someone is listening to you and helping you feel better, keep them as a good friend too.  It sounds trite, but the golden rule still works — do unto others as you want them to do. 

If someone is going to listen to your problems, listen to theirs and you will have found the golden nugget of truth far more precious than psychology and psychiatry that makes life livable.

Well that’s how it goes, and Joe I know your gettin’

Anxious to close

Thanks for the cheer

I hope you didn’t mind

My bending your ear

But this torch that I found, It’s gotta be drowned

Or it’s gonna explode

Make it one for my baby

And one more for the road

 

Music written by Harold Arlen and lyrics by Johnny Mercer for the musical “The Sky’s the Limit.” (1943)