Pleasing Daddy — And Failing

I had never seen this slightly disheveled 52 year old woman before and she was crying her heart out. Her father had died 24 hours earlier from what she could only call an “all over the place” kind of cancer. His struggle had been long and hard and she thought she had done a good job of preparing herself psychologically. But still, the depth of her grief was pretty immense, so I managed to get her to talk. She said that all her life, she felt she had never been able to please her father, and now she knew she never would. He wanted all kinds of academic achievements and prestigious jobs for her, none of which she got. It simply made her feel like a failure.

Well, even though I am mainly a “pill pushing mama” to the world, I wanted desperately to say something to ease her pain. It would not help much if I told her the truth of what is going on, that she was crying not for dad, but for her own feelings of inadequacy.

I jumped right in with a piece of self-revelation. My own father of blessed memory wanted me to put his name on the side of a building at Harvard, for the world to take note. I tried to explain to him that even though as a doctor I did not expect to starve, in the 21st century it was something far more likely to be done by a company. I did not have that kind of money. I know that he loved honors, and got him some plaques and such during his lifetime. But I told him a couple times that while I would think of this if and when I had that kind of money, it was not something he could expect. He tried for a while to negotiate it. Smaller college. Smaller building, still impossible.

So I told my patient I really did not think I had pleased my father either. She smiled and the tears ended. “You just made me feel better. A lot better. I don’t know how you did it but I know now I will be okay.” What I did was to encourage her to feel that the big hoo-hah pill-pushing psychiatrist was also inadequate in the domain that concerned her.

The early psychiatrists, like Harry Stack Sullivan or Freud himself thought that self-revelation by the psychiatrist is horrible. We were supposed to be some kind of “blank slate” on which patients could write their own feelings, which we could read and “help” them. Now, I can’t and won’t even try to do any of the analytic therapies, where you flip someone on their back and listen to whatever is on their mind for about five hours weekly. People train in this, and have patients who seem to value the resultant self-knowledge.  In today’s world of psychiatry, anything I do has got to be brief. There are actually some manuals of cognitive behavioral (teacher-like) therapy that say this is a good thing. I absolutely was not thinking of such manuals. If I can say or do something to help someone feel better, I will. I use normal informal conversation like human beings use with each other. I treat other people with niceness and respect.

That was all I could or would think. I wanted to minimize the size of her worry. I was able to do that with comparing it to a situation of my own. Sometimes I don’t want to think about how lopsided the relationship is between doctor and patient — doctor has all the knowledge, patient has the capacity for passivity. I said something that made her feel better — a simple human good deed, I think. I will admit I patted myself on the back for having thought of it, and making it work.

Sometimes empathy and respect are worth more than the academic justification of verbal psychiatric interventions.