Surgery and Psychiatry. Though the two fields seem vastly different, a surprising number of people waffle between the two specialties when selecting a career. In my medical school class, there were at least three people who switched from one to the other at the very last second (i.e. before submitting applications for residency). Psychiatry residencies report accepting surgeons into their programs; sometimes, these surgeons have established notable careers within their fields… and something compels them to pursue psychiatry. (People in other medical specialties also switch into psychiatry; I’ve met obstetricians/gynecologists, internists, family practice physicians, pediatricians, ophthalmologists, and anesthesiologists who changed their minds.)
Surgeons, in my non-randomized experience, also comprise the medical population that consistently express interest in psychiatry. Sometimes, this interest manifests itself primarily through teasing (as a medical student, I knew several surgery attendings who would routinely “pimp” future psychiatrists—admittedly, not me—about defense mechanisms and medications while operating!). Most of the time, though, surgeons seem to display genuine interest in the field and its theories.
People have argued that the two fields aren’t as different as they seem. Some comment that both specialties are invasive and, sometimes, outright intrusive. Both fields can be extraordinarily paternalistic, tossing patient autonomy aside. Surgeons and psychiatrists can take themselves and their work waaaaay too seriously and both can be arguably more prone to God complexes (”my intervention saved the patient’s life!”).
The (amusing) irony is that, in training, surgeons and psychiatrists often interact with patients in nearly antithetical fashions. Surgeons are stereotypically too curt, too cool, and occasionally frankly rude to patients. Psychiatrists are stereotypically too chatty, too mushy, and occasionally just too weird to patients. Surgeons barge into a patient’s room and feel around for physical pathology without warning. Psychiatrists are hypervigilant about touching patients (”but how will the patient interpret it? what will it mean?”).
I recently read a thoughtful paper about boundaries (because psychiatrists like to think about these sorts of things to the nth degree) and I was struck with one of the arguments in the paper: Psychiatrists get all worked up about physical boundaries because rigid rules about external, tangible boundaries (limits, whatever) allow for more porous and relaxed emotional/mental boundaries. Similarly, it probably serves surgeons very well to remain emotionally and mentally distant from their patients because of their constant invasion of physical boundaries. I don’t know if any of these ideas are valid, but if they are, I’m not sure who we are really trying to protect. As much as physicians might like to think that we’re doing things to promote “safety” for patients, this may actually be (read: is probably) All About Us.
Dancing and Social Behavior. Along the same lines of invasion/intrusion as mentioned above, dancing nicely demonstrates it is difficult (and uncomfortable) to invade someone (whatever that means) without cooperation. We cannot control the behavior of others; we can only try to increase the likelihood that a behavior will happen. All we have are our powers of influence and persuasion.
A lead recently asked me to dance and had already taken my hand. A mutual friend of ours, a follow, scurried up and started talking to me (albeit quickly, as she knew that she was intruding upon our dance). The lead then took her hand as she finished up her speech.
He then started dancing with us both, leading turns… while she was still talking. He was doing this because he could and, admittedly, it was amusing. He eventually let go of her hand (once she was done talking!), sending her gracefully away, and continued to dance with me.
It was only afterwards that I felt impressed with what had happened. He had enough confidence that we would both follow his lead(s). The other follow and I easily agreed to be led, even though we were clearly engaged in a conversation. It would not have been difficult for us both to let go of him and refuse to cooperate with his shenanigans. Coercion was not involved. The entire episode was voluntary.
Context mattered, of course: The three of us were on the dance floor and music was playing. People dance in those situations. She and I were clearly not engaged in a conversation of grave importance. It’s considered bad form to not follow a lead; that’s part of the dancing social contract.
Follows agree to be influenced and persuaded and, in our own ways, we can influence and persuade our leads. Leads don’t have to take our cues to give us creative space, but they usually do… because it increases the likelihood that (1) we will continue to follow, (2) something novel and fun will happen as a result of the shared experience, and (3) we will dance together again in the future. Are any of us actively thinking about all of that in the moment? I’m not.
Sometimes, we’re just not aware of how much influence (and power) we actually have.
29 Feb 2008 | 6 comments.
Link-o-Rama (XI).
Periodically, I fall into a writing slump. It’s not that I’m lacking ideas for stories and posts… the ideas just seem lackluster. And then there’s the whole issue of time. And creative energy. The Muse flies away and takes my qi with her. Feh.
>> The Advantages of Closing a Few Doors. John Tierney essentially writes about loss and how much we don’t like it in this piece for the New York Times. (This is applicable for those of us who are undergoing mass termination during this time… like, I don’t know, people who will soon be moving thousands of miles away where most everything will be new and shiny and alien and scary and wonderful and thrilling and unknown.)
>> Yet Another Study On Antidepressants, And No One Notices The Timing. The Last Psychiatrist (a moniker that still makes me wonder…), as usual, skillfully examines bias and considers implicit messages in the deluge of “scientific” information. I want to be able to think like that. With greater ease.
>> Micropack Land Sport. If you run, this is a cool contraption to have. My keys don’t jangle as I slog (though I am slogging faster now, thank you very much) along the sidewalks… which also means that my leg doesn’t sustain slight abrasions from my (cold) keys jangling in my pocket. And it’s completely unobtrusive. I totally forget it’s there.
>> Bureau of Communication. It’s Mad Libs crossed with Evites or e-mail. It’s cute in that geeky sort of way (which some people find more cute than others).
>> Yawning + fluoxetine = orgasm? There’s apparently a case report of a woman who took fluoxetine and, when she yawned, she would experience an orgasm. (I can’t access the original paper in its totality.) This is not the usual case of sexual dysfunction associated with SSRIs (selective serotonin reuptake inhibitors).
27 Feb 2008 | 1 comment.
The Man and His Manifestations?
>> Grover Cleveland, the only American President who served two non-consecutive terms, would probably frown upon Senator Hillary Clinton’s current bid for the Presidency. For an article in The Ladies Home Journal in 1905, he opined that “sensible and responsible women do not want to vote. The relative positions to be assumed by men and women in the working out of our civilization were assigned long ago by a higher intelligence.”
>> Isaac Baker Brown was a gynecological surgeon in England. In 1866, he published a book entitled, “On the curability of certain forms of insanity, epilepsy, catalepsy, and hysteria in females”, in which he argued that surgical removal of the clitoris (clitoridectomy) could potentially cure the ailments listed in the title of his monograph. He commented:
Long and frequent observation convinced me that a large number of affections peculiar to females, depended upon loss of nerve power, and that this was produced by peripheral irritation, arising originally in some branches of the pudic nerve, more particularly the incident nerve supplying the clitoris, and sometimes the small branches which supply the vagina, perineum, and anus.
Two abstracts on Pubmed suggest that the medical establishment in Victorian England did not warmly welcome this publication, though the practice apparently continued in other parts of Europe (presumably for the same indications). You can read Brown’s book here (and the above quote, along with the other conditions that clitoridectomy could allegedly prevent, are on page 7.)
>> Sue and his colleagues wrote a paper last year entitled “Racial Microaggressions in Everyday Life: Implications for Clinical Practice“, which is geared towards psychotherapy relationships (though it is certainly applicable in other contexts). It discusses “microassault” (explicit racial derogation characterized primarily by a verbal or nonverbal attack meant to hurt the intended victim through name-calling, avoidant behavior, or purposeful discriminatory actions), “microinsult” (communication that conveys rudeness and insensitivity and demeans a person’s racial heritage or identity), and “microinvalidation” (communication that exclude, negate, or nullify the psychological thoughts, feelings, or experiential reality of a person of color).
The authors touch upon the idea that Caucasians may read the paper and think that the authors are too sensitive. What’s that line from To Kill a Mockingbird? “You never really know a man until you stand in his shoes and walk around in them.”
No, I’m actually not feeling particularly angry. After all, how can one feel angry when one lives in a city that looks as gorgeous as this?
25 Feb 2008 | 2 comments.
Presence.
He’s an older man who almost always wears khaki pants and light-colored dress shirts with white buttons down the front. His lips are thin, as is his hair. When he smiles, his face glows with mirth. When he doesn’t, he looks continually bored and/or unimpressed.
In his former life, he was a bartender. These days, he’s a pharmacist. He’s been dispensing drugs and information about drugs for almost as long as I’ve been alive.
Though his pharmacological expertise is impressive, this is not necessarily the primary reason why resident physicians consult with him. (Or, more accurately, this is not the primary reason why I consult with him.) He’s really good with patients. Though not taciturn, he doesn’t say that much… and when he does talk, he often reveals insightful commentary about human behavior and interactions.
He has wisdom.
We recently talked about presence.
“Someone once criticized me for not having presence,” he said. “I said, ‘Thank you.’ He didn’t like that response.”
I chuckled. This pharmacist is well known for suddenly (and silently!) appearing when needed. He often doesn’t answer pages. He just shows up. Sometimes, it’s a bit disconcerting. I think he likes that.
I paused, considering his comment. Indeed, he easily disappears in a group, though when he speaks, he commands respect. People readily shut up and listen.
“Well, I don’t know about that,” I began. “You do have presence. You just know how to turn it on and off as needed. Some people lack that skill.” My mind conjured up memories of people who blustered through a tender moment that was never theirs, anyway… and people who shrivelled underneath the spotlight, though the attention was well-deserved.
He raised his eyebrows, considering my remark. “Yes, this is true,” he replied. “Using presence appropriately is a skill.”
We were standing in the cafeteria line. He had taken a cup of coffee—half caffeinated, half decaffeinated, no cream or sugar—and what looked like a block of coffee cake. As I had not taken anything, I silently excused myself out of the queue and stepped behind a large, cylindrical post in the foyer, next to the condiments and plastic utensils.
After he had purchased his items, he strolled towards the foyer. His face was again wearing that bored/unimpressed mask, though when his eyes alighted upon me, he suddenly began to laugh. His shoulders quivered with amusement.
“Why are you laughing?” I warmly asked, smiling.
“I knew that you were behind one of the posts,” he explained. “But when I looked up and couldn’t see you, I wondered. Why I think this is so amusing, I’m not sure.” He continued to chuckle.
Still smiling, I said nothing. We walked out of the cafeteria and disappeared into the hallway.
23 Feb 2008 | 3 comments.
Invisible.
I had the opportunity to wander through Pike Place Market today. Seattle has been blessed with gorgeous weather for the past few days; it’s been clear and sunny. Squinting never felt so good. The Pacific Northwest is absolutely stunning when the sun is out.
After purchasing some cookies (you know how it is), I sat on the concrete island at the north end of the market and gazed out at the glittering blue waters of Elliott Bay and the distant shadows of the outlying islands. The snowy peak of Mt. Rainier was poking out above a ring of clouds. People—tourists and locals alike—milled through the stalls, surveying the random items for sale: brightly colored tulips, bars of honey soap, fresh shrimp, framed photographs of the Seattle skyline (I shall likely purchase one to take with me when I move), silver rings, blood oranges.
Indigent people also routinely wander through the area. There is a small park (it’s really just a lawn) with a few totem poles at the north end of the market. People congregate there to eat, sleep, talk, take photographs, watch other people, and deal drugs.
Last year, I had strolled through the market with an outreach worker at the homeless shelter. Our mission was to simply survey the area for people who appeared to be chronically mentally ill and homeless.
To my surprise, they were everywhere.
Suddenly, I saw the old man wearing four jackets, two hats, and two pairs of pants who hadn’t shaved in probably over three months. He was hobbling along the sidewalk, gesturing to himself.
Underneath the stairwell was a middle-aged man in dirty sweats, staring blankly at the far wall.
Crossing the street was a woman, with hair akimbo, clutching a cup of coffee and swinging her arm over her head as if she was preparing to lasso the passing cars.
A man who wasn’t wearing any shoes, revealing his dirty, grimy socks bespeckled with holes, walked the perimeter of the park, eyes downcast and muttering.
Small gaggles of tourists automatically parted around him.
We had no idea if these people were homeless, chronically mentally ill, both, or neither. However, their appearances and behaviors were incongruent with people who have material and social supports.
“This is really sad,” I commented to my guide. “I’ve never seen these people when I’ve come to the market in the past, though they are clearly here. It’s like I’ve trained myself to ignore them, to not see them.”
“Right,” he replied. “It’s like they are invisible.”
We continued to walk along the sidewalk. He pointed out a man on the other side of the street. He was wearing a puffy jacket and a black backpack was slung over his left shoulder.
“That guy right there? With the backpack? When he gets drunk, he gets totally out of control. He thinks that everyone is attacking him, so he gets pretty violent. He looks like he’s sober right now, though it’s still early.”
The man disappeared into the mob streaming along First Avenue.
While nibbling on my cookies today, my eyes floated over the tourists with cameras dangling around their necks, the corporate types in khakis and fleece (it is Seattle, you know) chatting on their cell phones, the high school girls wearing too much eyeliner and tight jeans, elderly couples noshing on nuts and cheeses, and stall vendors playing with their fingers in the pockets of their aprons.
When I saw a man in a puffy jacket with a dark backpack on his back, I blinked in recognition. I looked around the market again.
A man pushing a cart stuffed with bags, blankets, and crates. A woman in a three dirty sweaters smoking a cigarette, an overstuffed bag at her side. A group of three young men, pulling items from their pockets in quick exchange.
They were no longer invisible. They were there the whole time.
21 Feb 2008 | 3 comments.