Uncertainty Is A Tough Mistress

The first person I remember who approached me telling me clearly and articulately that uncertainty was his problem was Dr. W.

Not that he was (or ever could have been) a medical doctor.  He was an engineer who had been laid off for being somehow “supernumerary” from Boeing Aircraft in Wichita, Kansas.

Very stable, very “establishment, a former president of the synagogue (where we had met) the late Dr. Larry Weller was the kind of guy who wore a necktie around the house, just because he was more comfortable that way.  His wife was a sharp-as-a-tack social worker.  He was continually thankful for this, as his two adult children were living and working elsewhere and the two of them could keep their home and live fairly well (with the occasional flight to New York to visit relatives) on her salary.

He was bored crazy, of course.  I had suggested he volunteer at the only place in Wichita, Kansas that I knew pretty well, the University of Kansas School of Medicine, Wichita Department of Psychiatry.  He was pretty good at statistics, and the faculty, especially the department chair, was always complaining about how they could never do any research because they did not have a statistician.

You guessed it.  He actually loved statistics so he preferred calculating by hand to using even the simplest form of mechanical assistance, like a calculator — but there was nothing for him, so they used him like a (male) secretary while I said nothing.

Giving him something to do – anything — so he did not wallow in his own misery while his wife was at work was certainly a piece of the puzzle, but clearly not enough.

We soon became fast friends and I spent some of my time – since I was single then – with him and his wonderful wife.  I was sitting across from him, over a glass of orange juice, at his kitchen table, when he came up with this one.

“Psychiatry does not teach you how to deal with uncertainty.”

It took minimal probing to determine that he had asked some variant of “how do you deal with uncertainty?” to everyone at the Department of Psychiatry, from the department chairperson down to the secretarial assistant.

The answer is something called “cognitive therapy.”  It is the use of fairly conventional, “objective” thinking to “correct” feelings that make you feel dreadfully rotten.  Dr. Larry was some kind of scientist, after all, so this should be a “slamdunk.” Cognitive therapy is, after all, what people of some intelligence often use intuitively to get through life.

I certainly had.  When I first learned its basic principles, I had been a bit surprised to learn that it was considered “therapy.”

Larry went on to rhapsodize about how miserable all of his buddies at Boeing had been for the months when they did not know who would be kept and who would be let go.  The political scene at that time was one of military contracts waxing and waning and the company had a policy of laying off and rehiring certain staff several times a year as demand increased or decreased.

Yes – this was a community that prayed fervently for war and voted for the most “hawkish” candidates – personal feelings aside.

Not Dr. W.  He was more rational and intellectual – which is why we got along so well.

I told him that if you always prepare for the worst case scenario, then everything else looks good.  He seemed to think that the worst case scenario would have been being unemployed and out on the street.

But I told him that would not have happened, as their house was (mostly) paid for and his wife was a respected social-worker.

I got him thinking factual and practical.  He was a good engineer and responded quite nicely.

Like most men, he thought that he was somehow “less” because he did not have regular employment.  This is not only a false belief, but a potentially destructive one in times of a poor economy.

He started smiling a little, and said he felt better about things.

His wife called me when she got home, and told me that Larry had said he had a wonderful conversation with me.

He had indeed.  I do not charge for friendship.

There was absolutely no reason for either him or his wife to know what a wonderful hour of cognitive psychotherapy we had done together.

There was only one place I had not been able to take him in that conversation.

I got a suboptimal wince when I mentioned the possibility that he might create his own employment.  Perhaps there was a way to “consult” over the phone to help other engineers who did whatever the hell it was he did with airplanes.  Or even a way to tutor kids who wanted to be whatever the hell he was with airplanes.

No.  He did not want to look at the potential variability in income — even now, when he did not have any at all.

He simply was not the entrepreneurial sort, and had no desire to become that sort.  I know more now about entrepreneurial types mostly because that is how I eventually evolved when the medical business went through the weird changes of the 80s and 90s (and is still evolving in weird ways).

When I was quite young — even when I was 20 years old and went to medical school in France, and reviewed medical schools alphabetically thus turning up at and matriculating at the University of AMIENS — I did not consider myself a risk-taker.

Before boarding the plane to Paris for the first time, my Mother-Of-Blessed-Memory saw fit at that moment to remind me that I could always come home to my parents who would always love me and find a nice place in Boston to learn to be a French teacher.

I felt more than a little angry when I boarded the stairs to the plane right after telling her I felt more like an ancient Greek soldier going off to war, who would say “I will come back with my shield or upon it.”

One of the smartest things I ever did was to make no attempt whatsoever to explain to her what that meant.

It meant I would not be a coward in battle, losing my shield to someone who was stronger and more aggressive and would take it from me.

A soldier who lost his life would have his body sent home, lying on his shield.

It was a concrete, graphic, and perfectly accurate description of how I felt about becoming a doctor.

My effort was literally do-or die.

My poor mother had been more afraid than she admitted, I guess.

She had actually tried to give me a worst-case scenario, so that I would know I could handle my options.

I don’t think she understood I was both too hard-headed and too naive to even think of such options.

I still think of this scenario — me ready to board the plane — as a great example of when cognitive therapy simply does not work.

My Mother-Of-Blessed-Memory, talking to neighbors who sat by her on the concrete stairs in front of the old house where I grew up, may still have been one of my best role models for how a psychiatrist talks to people.

But it did always seem to me that the people to whom she gave advice had happier lives than she did.

I always found it tough, if not impossible, to forgive the Harvard professor –whom I later learned was also an ordained priest, presumably in his spare time — psychiatrist who had told her that Brother-Of-Blessed-Memory needed no psychiatrist but her, as she had all the skills.

That Priest/Shrink thus condemned by mother to a life of servitude to a demanding son, and my brother to a life of being infantilized by his mother.

This delivered a mess into the hands of my husband — who is luckily both angelic and brilliant — when she died and he came to California to live with us.

Did I mention that Dr. Priest never came up with the correct diagnosis for Brother-Of-Blessed-Memory?  I did, as soon as I was technically able.

Of course, neither he nor my parents would accept it.

In what is perhaps its best incarnation, psychiatry should simply be a help with problems in living.

Me, I seem to have developed the personality of being a chronic risk taker.  People look at my resume and curious how I can have done so many things and still be under 90.

Earlier it was my headstrong and naive quality.  It was my first French preceptor in psychiatry who told me that my naiveté was a great strength — especially because it was coupled with at least a modicum of intelligence, as well as a willingness to speak truth.

With maturity comes the knowledge that things sometimes can and do go wrong.  For me, there is no doubt that my life would not be this rich without risk-taking, and the resultant experiences.

I continue to get strength, some from my view of the universe but mostly, concretely and on a daily basis, from my husband.

He never fails to tell me that, whatever the future holds in its worst case scenario, it is something we can handle.