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THE BARRIER OF UNSHARED EXPERIENCE
SALLY SATEL, MD, NY TIMES - During our first year as psychiatric
residents at a veterans' hospital, any patient could reliably stump my
colleagues and me by asking one simple question: "If you weren't in
Vietnam, how can you possibly help me?" We hadn't been to Vietnam. We
were in high school during the worst years of the war. And no, we had
never been ambushed, cradled a dying buddy in our arms or dodged land
mines. It was a mocking question, really "Were you in Vietnam?" and
it left us tongue-tied and apologetic.
What were the patients really saying to us? Nancy's patient, we
determined, was testing her perseverance: would she really try to know
him? The veteran John was seeing, it soon became clear, was keeping him
at arm's length to conceal a heroin habit. Matt's patient the one who
told him haughtily at the start of every session, "Really, now, college
boy, this will be pointless" was so ashamed of his tattered life that
he had to demean his therapist.
My patient, Rich B., was a former tunnel rat, a wiry soldier who could
navigate the Vietcong underground networks. His diagnosis was "anxiety."
Mr. B. was in the habit of quizzing me disdainfully. What were the dates
of the Tet offensive? What happened at My Lai? Do you have any idea what
it's like to go down in a tunnel?
At first I was defensive. But then I said: "Of course I don't know these
things, Mr. B. You do. Tell me everything." That seemed to break the
ice. Our therapy became a bit like a tutorial, and the patient realized
I valued his knowledge.
In passing, he would mention trouble with his 16-year-old daughter and
how their pitched arguments agitated the whole family. Yet when I tried
to discuss his home life, he brushed it aside, saying, "So, let me tell
you about the time ... ."
After two months, Mr. B. was feeling less anxious and missed fewer days
of work, but dealings with his daughter remained volatile. I told him it
was my turn to help. "I was never in a tunnel, Mr. B., but I was a
16-year-old girl once." He assented; finally, there was enough trust
between us. . .
http://www.nytimes.com/2007/06/12/health/psychology/
12essa.html?ex=1339300800&en=f1e6a3c959c30626&ei=
5088&partner=rssnyt&emc=rss
||||||||||||||||||||||||||||||||||||||||||||||||||||||||
THE BARRIER OF UNSHARED EXPERIENCE
SALLY SATEL, MD, NY TIMES - During our first year as psychiatric
residents at a veterans' hospital, any patient could reliably stump my
colleagues and me by asking one simple question: "If you weren't in
Vietnam, how can you possibly help me?" We hadn't been to Vietnam. We
were in high school during the worst years of the war. And no, we had
never been ambushed, cradled a dying buddy in our arms or dodged land
mines. It was a mocking question, really "Were you in Vietnam?" and
it left us tongue-tied and apologetic.
What were the patients really saying to us? Nancy's patient, we
determined, was testing her perseverance: would she really try to know
him? The veteran John was seeing, it soon became clear, was keeping him
at arm's length to conceal a heroin habit. Matt's patient the one who
told him haughtily at the start of every session, "Really, now, college
boy, this will be pointless" was so ashamed of his tattered life that
he had to demean his therapist.
My patient, Rich B., was a former tunnel rat, a wiry soldier who could
navigate the Vietcong underground networks. His diagnosis was "anxiety."
Mr. B. was in the habit of quizzing me disdainfully. What were the dates
of the Tet offensive? What happened at My Lai? Do you have any idea what
it's like to go down in a tunnel?
At first I was defensive. But then I said: "Of course I don't know these
things, Mr. B. You do. Tell me everything." That seemed to break the
ice. Our therapy became a bit like a tutorial, and the patient realized
I valued his knowledge.
In passing, he would mention trouble with his 16-year-old daughter and
how their pitched arguments agitated the whole family. Yet when I tried
to discuss his home life, he brushed it aside, saying, "So, let me tell
you about the time ... ."
After two months, Mr. B. was feeling less anxious and missed fewer days
of work, but dealings with his daughter remained volatile. I told him it
was my turn to help. "I was never in a tunnel, Mr. B., but I was a
16-year-old girl once." He assented; finally, there was enough trust
between us. . .
http://www.nytimes.com/2007/06/12/health/psychology/
12essa.html?ex=1339300800&en=f1e6a3c959c30626&ei=
5088&partner=rssnyt&emc=rss
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