High Tech-High Touch Psychiatry


The first psychiatric office I rented had two mildly to moderately comfortable chairs in the center, facing in the same direction. We all know that psychiatry started with the patient lying on a couch, staring at the ceiling, and remains that way in “New Yorker” cartoons.  Those of us in the know, we know that Freud was actually a pretty shy guy, not liking to stare his patients in the face, but rather letting their subconsciouses roam freely while staring at the ceiling.

We also know that the subconscious is a scary entity, full of (imagined) murder and rape and pillaging and such. The ideal when I trained was to sit face-to-face across a desk from the patient.  Nobody I know actually did that.  The reality slipped into 90 to 120-degree angles, exactly like what the classical psychiatrist Harry Stack Sullivan recommended.

Of course, Harry Stack Sullivan also recommended women doing this sort of thing wore tweed skirts and saddle shoes, so when I read his stuff I wondered if brightly colored dressing me was doing the right thing for a living. Seating two people in similar chairs facing in the same direction is magic. People 180 degrees across from each other get into arguments with diametrically opposed viewpoints quite easily.

Bandler and Grinder, the fathers of Neurolinguistic Programming, even had an exercise in their workshops where teams of people switched between the two positions while discussing a controversial topic (our example was “abortion”) and “felt” the difference. My husband and I reach great insights when he is driving and I am in the driver’s seat.  It is no accident he likes me to record what I say although it is often hard for me to remain fixed on a microphone.

I want my patients to tell me things.  I sit next to them on a large sofa in my office. It has developed they “spill” the contents of their hearts and souls.  It is getting harder and harder to control their outpourings in the allotted time. Perhaps the body of knowledge described above may be useful to an interior designer, but not to a psychiatrist.  Not since the ascension of the computer in psychiatry.

I see the patient either directly across the table from me, or in whatever seat can be crammed into the room I am allotted.  I can type, but I am an imperfect typist.  I prepare the software before the encounter and finish the note afterward.  Of 30 minutes allotted, only the central 10 are spent with the patient.  I have to watch the screen every once in a bit to correct my mistakes. I saw an “uncomplicated” patient a few days ago.  She greeted me and a colleague monitoring my computer acumen before sitting down.  She went on to basically rattle off: “I am safe and not going to hurt myself or others.  I am doing about as good as I ever will; no voices and I sleep ok and there are no medication side effects.  Can I wait three months until I see you again?”

This is the dehumanization progress has brought me and what I do.  I will rattle through, too and get the job done. I have not yet found a way to rise above the depersonalized state of my profession. Maybe some of that is talking directly to my folks on Facebook. https://www.facebook.com/estelle.goldstein.

More to come.

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