Inside the mind of a psychiatrist – Page 94 – Inside The Mind of a Psychiatrist

Let’s not dwell on the past

We’ll start from now and go forward.

Sometimes clichés are just shorthand for inane assumptions.

Not using information from our past is like trying to build a hi-rise and leaving out the foundation. It looks good until that first Santa Ana wind hits it’s eastern facade. Boom. No substance. All show.

The problem, and it’s a big one, is that our past is often hidden from our conscious thoughts. It’s there directing what we do, and we’re blithely assuming that we are making logical, conscious decisions. The truth, as difficult as it may be to accept, is that the child part of us, the infant, desperate to have his needs met, is often the puppeteer controlling our “adult” behavior.

One major example that I see all the time, is how we “adults” choose our spouse. On the surface, it’s all so straightforward. We meet someone, feel attracted and connected, and make a conscious decision to spend the rest of our lives with this person. Simple, right?

Not in my opinion. We handpick spouses who unconsciously meet a deep need from our childhood. For example, we consciously pick someone who we love, yet so often, our choice has many of the same flaws that our father or mother had. The same hurt is now re-lived, here in the present, just like it happened when we were little. Over and over, like a Chinese water torture, until the pain is so great you join 50% of your peers and get divorced.

What’s the answer? How do we stop being driven by the baby puppeteer?

Ah, we need a super-hero to help us.

Enter Freud, wearing a cape and driving a black Freud-mobile (an eco-friendly, convertible Tesla). After carefully removing his cape and settling into his well-worn, easy chair, what does the great man do?

He asks about your past. He helps you see the similarities between your life as a child and how you are now reliving that same life with your wife. Most importantly, he helps you see YOUR part in perpetuating this flawed reliving of an old bad movie.

It takes a while to tease out the past from the present, but eventually the immature puppeteer is exposed, and then the REAL YOU can make healthy choices and not be driven by a past that you can’t understand.

If you enjoy reading, Inside the Mind of a Psychiatrist, you might also enjoy Dr. Smukler’s novels, Chasing Backwards, a psychological murder mystery, Skin Dance, a mystery, and The Man with a Microphone in his Ear. All are available as paperbacks and eBooks.

Once upon a time, psychiatrists spent uncountable hours during their training learning how to do psychotherapy. They studied the vagaries of the unconscious, had intensive training presenting cases to highly trained supervisors, read volumes on how the psychiatric greats treated their patients, and helped train psychologists, social workers, MFTs and other therapists to do therapy.

Then Insurance companies sold the concept of managed care. The mantra was simple. Treat symptoms not people. Don’t take time to understand someone, just take the depression and anxiety away. Time is money. A good psychiatrist is one who doesn’t use time, but fixes things quickly. Medication is the cure. Psychotherapy? Leave it to the other therapists.

Well, the insurance companies did what they set out to do. All the money they were paying psychiatrists ( and I can assure you that those fees were no where near what surgeons or other specialists made) now went to the middle managers who were paid to limit care. Big business defined what was good psychiatry and what was bad psychiatry.

So what does it all mean? Should psychiatrists be happy prescribing medication and just let other therapists do psychotherapy?

To me, psychiatry is a specialty that is a combination of medicine, psychology and poetry. Only psychiatrists go to medical school and have the opportunity to understand the complete person. The mind and the body always work together. One can’t exist without the other. To just prescribe meds is the equivalent of removing only the top of the iceberg. What about the main part of the person, the part that was formed back in childhood, the part that psychotherapy reaches.

In Brave New World, the dubious answer to human pain was the drug”soma”. We can’t let that happen in our society. Just using drugs because they are a cheaper way to calm the masses and save money is short-sighted and hurtful.

Psychiatrists used to be masters of the mind. They used their unique skills to help all psychological professionals understand what people were all about and how to help them combat the psychological torture that was ruining their lives.

Limiting a psychiatrist’s skills to prescribing medication starts at the top. If training programs let this happen, they are short-changing all of us. If psychiatrists just want to make more money and not learn how to be masters of psychotherapy they are no longer masters of their profession. Master carpenters, master electricians, master cardiologists and masters of anything are an important part of creating a society based on excellence. Excellence is what we should strive for.

Is psychiatry dying?

Not in my office…