Psychiatry – Page 153 – Art Smukler, MD

Do you remember the kid’s game, Would you rather? Would you rather have pins in your eyes or your ears? Would you rather eat only hotdogs or only ice cream for a week? And on and on…

What came to mind is the true story of a grade school friend, I’ll call him Donald, who was charged with medicare fraud. Donald was a GP and sentenced to 6 months in a federal prison. The prison happened to be located on the same air force base in Florida, where I was stationed as a major (a psychiatrist) during the Viet Nam era. That’s important, because I have first-hand knowledge that this base, located on the Florida panhandle, was really a beautiful place, with views of the gulf and powdered sugar beaches.

One “interesting” experience was the time that the base rabbi “invited” the medical staff to join him and his family as they hosted a bagels and lox brunch at the prison. The rabbi was a colonel and his “invitation” was actually a direct order. That morning dozens of doctors and prisoners shared the buffet overlooking the bay. Surprisingly, it was a pleasant experience.

Donald was incarcerated a few years after I had completed my tour of duty, but the same rabbi was still hosting his monthly brunch. I assumed that Donald took full advantage of this prison perk.

A few years later, a reliable source told me that after Donald got out of prison he decided to get divorced, give up his practice, and start a new life. Donald was heard to say, “Those 6 months were the best 6 months of my life. I never realized how miserable I was until I was sent to prison.”

The last I heard, Donald had moved halfway across the country and was living “happily ever after”.

Our lives are finite and if we don’t make the most of them we waste a very precious, irreplaceable commodity. As most cancer survivors have learned, every moment that we are alive and comfortable is a treasure.

What we show the world is often just the tip of the iceberg. Our true selves are often below the surface, undiscoverable to the world and often to ourselves. Listening with the Third Ear (Post#1) to our own thoughts and feelings, exploring the contradictions, fantasies and dreams that come to mind, letting our mind wander and then examining why it went where it went is one way of examining the hidden iceberg. Are we happy? Is hidden anger causing our depression? Who hurt our feelings and made us angry? Why can’t we allow ourselves to be angry?

So, would you rather be in prison or be married? It may be best to figure it out without having to have a bagel brunch with the rabbi.

Thanks!

Ten years ago, a 14 y/o boy (I’ll call him Brian) began treatment for depression and insecurity. Brian was an attractive, soft-spoken young man who was aware of feeling depressed, but had trouble articulating exactly why, except for the fact that he felt lonely.

A few months into weekly psychotherapy, he shared that he was being tormented while playing in a touch football game with other middle-school boys. Jack, one of the boys, kept knocking him down or hitting him without any provocation. Brian’s eyes filled with tears. “What can I do? I tried talking to him, but he just ignored me. I asked him why he was doing it, and he just laughed. We play every day at recess, and I really don’t want to stop because of him.”

“Any clues as to why he’s so mean?”

“None. I didn’t do anything.”

We spent the hour exploring all possibilities and came up empty. Towards the end of the session, I leaned forward in my chair and looked Brian square in the eyes. “Brian, I’m going to make a recommendation, but if you tell anyone I’ll deny it.”

“What? What do you mean?” Brian asked, obviously intrigued.

“I want you to knock Jack down, so hard, that he has trouble getting up. You’ve tried talking to him like a decent person. It got you nowhere. He’s not reasonable and not nice… Knock him down hard, but don’t kill him or break any bones.”

Brian just stared at me.

“Brian, you’re a really good guy, and what he’s doing isn’t fair.”

Brian just kept staring.

“Any other thoughts?”

Brian shook his head.

“Okay, see you next week.”

Brian nodded, stood up, gave me a sheepish smile, and left. I sat for the longest time staring at my diplomas. Did I do the right thing? There were no classes on helping nice kids battle playground bullies in my psychiatric residency.

The next week, Brian walked in the door, and before he even sat down said, “I did it!” He had a huge smile plastered across his usually worried face.

“What? What did you do? Tell me all about it!”

“We started playing and Jack went back to pass. I aimed my head for his stomach and knocked him down as hard as I could. When we were on the ground, I got on top of him and just stared him in the face. Then I got up and walked alone back to school.”

I encouraged Brian to tell me in detail how the whole thing went down. As the story unfolded, it became clear that Jack was actually on the same team as Brian. In effect, Brian had knocked down his own quarterback! I said, “Wow, that was really making a statement.” Then we both laughed and hi-fived.

It’s not often in therapy that there is a pivotal moment when things change. But, this was such a moment.

I treated Brian all through high school and saw him during holidays until he graduated college. Brian became an all-state wrestler in high school and was a varsity wrestler at a well-known university. He remained a sweet, caring person, had good friends, and a good relationship with his family.

When Brian learned to defend himself, he also learned to value himself. A person with good self esteem doesn’t let himself be bullied.

Thanks!