Turning dramatic neuroses into ordinary occurrences

During my psychiatry rotation in medical school, I had the good fortune to work with a doctor who saw a wide range of patients: schizophrenics, developmentally delayed, and depressed patients, among others. When I first met him, I thought he looked like a jolly Santa Claus. We talked a bit about his background. He’d gone to seminary school before deciding to become a doctor, which must give him an interesting perspective on the practice of medicine, and healing people emotionally and mentally.

He was extremely effective with his patients, and I wondered why. Here is what I’ve been able to come up with:

His interactions with patients were like performances. Everything he did was intentional. He didn’t fidget during the patient interview. He didn’t break eye contact with the patient or write notes in stony silence unless he wanted to make them think about what they’d said. Even when he looked at the patient over the top of his glasses and said, “You’re bullshitting me,” it was meant to make them feel a certain way. He was in total control during the interview.

He considered each encounter with a patient therapy in its own right. In order to accomplish this, he mixed different therapies together—CBT, supportive, insight-oriented, a splash of psychodynamic—so the interview was structured differently for each patient.

To him, medications were just a small part of treatment. He said that his goal was represented by a Freud quote: “to have the patient turn their dramatic neuroses into ordinary everyday occurrences.”

It was very calming for patients. I saw them open up to him in ways that I hadn’t seen patients open up to other providers before, because they felt like with him, they were normal.

However, I don’t think I, at my stage of training, could replicate this style yet. Every patient is different, and knowing when to inject humor, and when to be quiet, and when to use sarcasm, is a skill that is built on years of practice.

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About the friendly intern

Ask a question: The Friendly Intern My personal blog: Pathos and Pathology
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