31 yo. To 34 yo Psychiatry Residency, University of Manitoba

Psychiatry was very hard.  Surgery was tiring. It was athletic. Late nights, long hours, so many patients, so many people.  But almost like a mechanics shop with a whole lotof cars and trying to fix them with the engines running.

I remember a lung surgeon saying to me, “I do rounds before the patients are awake because I don’t want to talk to them. I don’t really want to know them as people. I’m a technician. I’m there to fix their lungs. Often I have to take them out. You’ve got great hands and will make a great surgeon one day. The trouble is you like people too much. You like to talk to them, listen to them, get to know them. If you want to be a great surgeon you won’t have time for that.”

 General medicine was a lot of memorization. Community medicine was looking at the bigger picture, public health and population considerations. 

Psychiatry was hard.  Everything I believed had another side to it.  

“Psychological mindedness is the ability to tolerate the ‘tension of opposities’.  

The mind and heart must twist and torque and spiral.  The soul is pulled.

 I would spend time with women who killed all their children. I’d spend hours with pedophiles. I’d be with victims of every heinous crime imaginable. I’d talk to people who believed they were the devil. I’ve met Satan dozens of times. I’ve met fewer Jesus Christs. Patients would be in communication with aliens. I’d have people who were the richest and most powerful in the land and yet they had a kink. The multi millionaire international banker who liked to dress in diapers. Every sexual flavour was represented. And all of them were selling.  

I was reading everything I could get my hands on in psychiatry too. I devoured the text books. But where the real gold was was in the journals and writings of the greats.  There’s a marvelous book called the ‘Discovery of the Unconscious.”  It’s hard for people looking back to understand the importance of Freud and his colleagues.  In the age of Rationalism everything was mental and up front. No wonder the soldiers dressed in bright colours and stood opposite each other lobbing lead at one another without ducking. Meanwhile the Indians of North America were hiding behind trees and shooting the solders in the back.

Psychiatry was total warfare. The ‘coping mechaniS ms’ and ‘defence mechanisms’ people learned and used, were guerilla warfare at it’s finest. I’d meet boys and girls who were sold into sex slavery by their mothers. I’d meet incest victims and talk to fathers who didn’t want a stranger to hurt their children so he said that’s why he introduced them to sex so young. I’d talk to hundreds of escorts and prostitutes. The doctors who paid their way through college doing tricks and the men who’d been criminals and buried bodies and now told me about it.

I’d learn so much about guilt and shame and covert and overt aggression. I’d learn that another system would control the behaviour of the group, relative influence upon relative influence.  I’d chart out the mind as Freud did. I’d begin to see the transactional analysis in groups as I once learned ion exchange in kidneys.  

My mind would expand and twist.

I’d walk a mile in the shoes of the psychotic patient. I’d enter their reality. I’d share spines with patients. I’d sit in locked quiet rooms. I’d be attacked again and again.  It was all so dangerous but not the physical attacks, the being held hostage, the black eyes, the wards gone crazy. The dangerously insane women’s ward where the women tore off their clothes and violently attacked the guards while older women were shoving me out the door while the young naked women were keening.  The men would throw shit at the walls.  They’d paint their cells with equations in shit. 

I’d come home and Maureen would complain.  She was always depressed. Her mother was always depressed. They were always tired. They had this mother daughter contest.

My own parents were simple , straight shooters, kind.  I was surprised at how uncomplicated they were. I learned to love to spend time with my father. My admiration for my brother and sister in law grew.

I had friends like Frank who were amazing individuals. I felt so inadequate. I really felt such shame and guilt. All that I believed and did made so much more sense in a different way. I saw my courage as reaction formation. Everything I believed was the cause of some other force I hadn’t considered.

I was writing.  I was reading. I was loving the adventures of Dr. Carl Jung, R. D. Lang, Karen Horney, Scott Peck. They all may as well have been 19th century explorers because they found continents. They mapped this whole other world.  People had killed them in the past. My patients who were seers and clairvoyants. My manic patients really did know what was going on. There were no unidimensional explanations for their psychic behaviour.  Walking onto a ward day after day and having a stranger tell you what you ate for breakfast and all manner of things of your past that they shouldn’t  know and telling you about your wife and her conversations and bouncing off the walls.  I’d try to package everything in the ‘right’ way. It must be a ‘heightened’ awareness. They saw food on your beard. That’s how she knew. 

But even in psychiatry we didn’t talk about the uncanny.  I’d eventually ask spiritual leaders to assess my patients whose psychosis was other than textbook with a great religious flavour. One in ten were not psychotic but having a spiritual experience according to the priest or rabbi or minister. I would talk with these holy men and discuss their understanding of my patients visions. Some would be discharged to monasteries rather than home.

I was working with a French Canadian psychiatrist who would take me to the catholic monastery and I’d see the priests with melancholia, the most depressed people I’d ever seen, who could not eat or sleep but never wanted to suicide. I’d see the miracle of medications in the brain injured and see that the worst cases of schizophrenia had no apparent injury. Word salad speech and hebephrenia and nothing physically wrong. 

I’d learned to hypnotize people to do therapy and now was doing hypnotherapy., I was trained in ‘Amytal interviews’ and over and over again learned the tricks of the psychopaths and sociopaths. All the lies. I’d lived in a tiny villlage now my world was opened to the universe. I was doing psychodrama in groups. I was learning systems theory in family therapy.  I studied “prisoner’s dilemma “.

I studied anthropology. Reading books about culture written by the psychiatrists and psychologists who came from those cultures. I was studying the ways families and communities adapted. I was still flying into the north and seeing natives from mostly Cree, Ojibway and Inuit community. I was learning how Cree were as different from Ojibway as Chinese from Japanese. I was also seeing the incredible ignorance and grandiosity in the system. I had individual teachers who were genius.

I ‘d spoken to Dr. Harry Prosen, this brilliant man with incredible vision and insight. He could be so wise and he so kind.  I’d ask him how I could be the best. I told him I wanted what I saw in Dr. Mark Prober and himself. I said I wanted to be a psychoanalyst but we had no psychoanalyst training in Winnipeg. There were two psychoanalysts and I had one as my mentor for a year. It was difficult and even more difficult dealing with his narcissism. The analysts had each bought a house in the city and immediately had to buy bigger houses when the other bought a bigger house. It really was that ridiculous. But while they had their eccentricities their insights into others and themselves were profound. I was so moved by ‘focal’ psychoanalytic psychotherapy.It was always like looking for the one log in the log jam that stops  the energy flowing. I’d find that log and watch the whole being heal.  

Psychosomatic medicine was the most mystical and uncanny. Literally people who could not walk walked.  I was daily ‘blown away’ by what I saw in psychiatry. It was a whole mystical magical world with patients in a circus in this part of the hospital attached to this ‘real’ world by corridors. Once  you’d step through the doors you were on a different planet.

I entered psychoanalytic training myself. I arranged for a much admired psychiatric psychotherapist, ‘don’t get one who is working in the university. There are a number of people who are outside the system. The university is too incestuous and political. These are people who I’d recommend.” 

There was one name that Dr. Nady El Guebaly, Harry Prosen and Dr. Bebchuck all recommended. I approached him and explained my desire to become a psychoanalytic therapist. I wanted to be his patient. For the next 2-3 years I’d go once a week, sometimes more. It was as profoundly disturbing as a heart surgeon watching his heart removed and another one put in to replace it.  I was not who I thought I was.

I began to change. I was changing. Psychiatry training changes you to the core. We had a group which met and discussed this. We had the brilliant and handsome  Dr. Pierre Leichner to guide us. I was against him for his obvious political connection to the staff but personally he really was a big hearted character, his wife and he, shining lights in the community, their flare for fashion ahead of it’s time in Winnipeg.  

We’d get to know our teachers and staff people intimately. We’d dine with them and talk with them. The conversations to all hours in their offices were deeply moving. What Oxford had been. The sharing of ideas , the discussion of Adler and Reike and considerations of Beck and Rogers. I loved the Milan school of psychotherapy. I’d become fascinated with Dr. Falconer’s Structural Family therapy and even more moved by the work of Dr. Milton Erickson and Jay Haley and their strategic interventions.

We’d work behind two way mirrors. We’d ‘predict’ and ‘prophecy’ what our questions would lead too. Our staff men and women would ask us to enter into the room and ‘ask him why he hit the children’.   

“I predict he will say this’ but in fact if you wait ‘he will tell you this.’  From his family history you see the relationship with the mother and father, he’ll somehow re reenact this. Watch for the tone of voice. Watch for the body language”. 

“Watch for when she dissociates. The clues are so subtle. Watch for the little girl. It will just be a flash. That’s where the angry is. It’s not what he says but what he feels.”

Sure enough we’d go in and interview and do therapy and all thes magicians and holy men and women who were our staff persons would unfold with uncanny routine. Nothing was sacred. There were no surprises. It was like everything people said and did had a neon light explanation. There were endless cues and we’d have them pointed out individully and in group,.

I’d do therapy and record the hour weekly, sometimes twice weekly then meet with my supervisor and go through the recorded tape minute by minute for as many hours the supervisor asking what I though, what I felt. Everything was transference and counter transference.  It was total immersion.

Meanwhile in my therapy, I’d be saying.

“She’s always talking about her mother. Her mother this. Her mother that.”

“How do you feel about her mother?”  

“I hate her.”

‘Why.”

“She’s sucking the life blood out of my wife.  Whenever she’s with her mother she returns hating me and has horrible headaches.It’s blatant but she refuses to acknowledge the association.”

“How doesn’t that make you feel?”

‘Frustrated.”

“Hold that feeling. Our time is up. I’d like to know about other times you’ve felt just like that in your life, in your childhood, in your family, in your school.”

I’d spent months talking without any comment and then my psychoanalytic therapist would have these little spurts of discussion. It was called technically something.  Mostly he’d listen. I’d learned to ‘free associate’.  Counselling isn’t anything like psychoanalytic psychotherapy. Years of free association later I’d try to explain to those who were ‘counsellors’ how they differed but they didn’t understand. 

Counselling is like massage compared to surgery.

As I began to sit with my own patients and let them free associate and learn to free associate I’d have that feeling like I’d have meditating with a monk. There was this great ocean we’d join in and sometimes I’d feel like I was drowning when the patient was drowning. I’d be the child with them, the adult with them and let go of the control and director and the parental role of the ‘counselling’ mode. 

I’d learn to trust the ‘process’. I’d come away often and want to kill myself as my patients did. I’d spend days reflecting on why I shouldn’t . I”d understand their views from their view. I’d become one. I’d meld. I’d do the borderline thing in therapy and join like some kind of Spock mind meld and then I’d find the knot that Laing described as needing untying. Then I’d ask the question that would lead to the ‘aha’ for the patient and overnight the behaviour changed with ‘insight’. Insight psychotherapy was profoundly rewarding but the most difficult and needing the greatest level of training.  It was fine surgery and fine needle work.

I’d learn that some many counsellors just retraumatized patients. I’d learn from the greats how not to bludgeon patients.  Doing hypnosis they’d know what they needed to know but it was all in the ‘timing’ . They were not ready for the insight. They had to be ready. I was studying zen at the time and so much was zen.  

“So he was raped by his father and that’s why he raped his daughter.” As Emerson wrote, “the red slayer thinks he slays and the slain thinks they ar slain, they know not well the ways I keep and turn and toss again.”

There were no black and white and all was grey and the victimizer had been the victim. The reason everyone likes counselling and cop shows and the courts because they have their villains. They’re into tribal revenge. They’re ancient history. The court is about primitives and barbarians. There’s no science. There’s nothing like the therapy sessions where two kids are lost in a sandbox trying to find the way out together. My way is never their way .  

Insight therapy doens’t work with addiction.  Kernberg and Kohut studied the field and found that individual diagnosis required individual therapy. The counsellors like the original therapists want to have one hammer and call everything a nail. I’d later train in ‘brief therapy’, ‘grief therapy’, ‘relationship therapy. ‘Supportive therapy’. ‘motivation therapy’, and 12 step facilitation therapy .I did former CBT. Still to I meet people who thinks it’s the ‘latest and the greatest.’ Just the other day I heard someone talking about B.F. Skinner. We’d be trained in all this and every week observed for hours and have hours to explain and discuss what we were doing.

Psychiatry is like surgery.  

It’s so far removed from general practice that it’s alien.  

I felt alien a lot in psychiatry. I felt like I walked out of this psychedelic world back into the suburbs when I left the psychiatry wards. It was core city.  What was tomorrows fashion was todays disease.

I had the greatest teachers.  Many of my teachers got the Order of Canada despite having me as their most inquisitive and challenging student.