I’ve a desire for a small folding table for the living room, card table size. This is twice the size and half of it is used for books that should be put away. Just a surface for more clutter.
‘I have anxiety,’ she said. Dark hair, round innocent appearing eyes, they’d lifted for a second then returned to studying her hands on her lap. She wore a grey blouse and navy blue dress slacks. She was plain in some ways but attractive in her minimalist way. A touch of lipstick, not eye shadow.
“Can you describe your anxiety?” I said. There’s hundreds of ways to response. Erick Erickson the psychiatrist father of American Therapeutic Hypnosis said the cup is one the fire but the handle isn’t on the cup but rather in your hand. The point is to get the cup off the fire. The correct response is indicated in the increasingly flow of information. Alternatively ‘how long have you had anxiety’ would be a close ended question with the possibility of yes or no. Describe though is an open ended word. I once thought in these terms learning the trade and skills. Now it was intuitive.
“It’s a dark hole. I wake up everyday afraid. I don’t know what it is. It’s a feeling I have like something bad is going to happen, It never goes. It’s always there. It’s sometimes so bad I don’t want to live. “ she was crying now wringing her hands.
I imagine one days writing books based on what I’ve seen and learned.
Now it was right to ask the question. ‘When did this first begin. Can you remember a time you weren’t anxious.” I preferred a pen and paper. But now I’d typed into the computer and wrote not for us, not for the patient and I, but for the parasites and money men, the lawyers and administrators who know noting about humans and anxiety but see everything in the reductionist world of money and power. I want to be paid and left alone to heal so I kow tow. There’s no privacy. No confidentiality. Any such thing said so stupidly by juniors is false. I’ve known so many threats and lost so much money defending patients and the space of therapy. Older I regret the lost of prestige and power that I would have kept playing along and playing the game.
She says,, “I don’t remember a time I wasn’t anxious.” She stares at me now. Eyes piercing. Another life time the therapist would have been a pastor who at that moment would have reached for his cross. She looks haunted but today as a psychoanalytic psychopharmacologies I am protected by different ideologies. I’ve a a tool box of solutions but I long ago learned that it’s not about tools but rather about timing.
“Can you tell me more.”
“No body understands.” Her voice has taken on the edge of fingernails on winter glass.
“Who have you spoken too about this.?”
“Everyone.” She says.
I used to love letting a story unfold. Gently peeling back the layers of the onion. Teasing out the secrets and the deeper sense. I started in surgery and the process has always reminded me of cutting through the inflamed and damaged flesh to what lies beneath, a source of the abscess, the foreign object, the disease. Now I’m expected to work for the government. Management offers euthanasia now. It’s just a job they tell me. I’m to hurry. The aim is to keep the factory moving along. Don’t wait too long. Everything is speed and turn over. There’s endless layers of management and lawyers and philosophers but the waiting room is full and there’s no more psychiatrists being trained. The new man has a new drug and offers the new drug as the solution to all. It’s panacea in a pill. The discussion is mostly about the pills and which one fits. I’m not even sure a pill is the answers.
‘Whose everyone?” I ask.
“Nobody believes me.” She says.
“What don’t they believe?” I ask.
“You know.” She says looking at her hangs, her brow wrinkling, breath shallow
“ I don’t know.” I answer. Uncertain. It would be so easy now to derail this pain and ask if she’s ever tried this pill or that pill, had this therapy or that. They came to my office and didn’t care how many suicidal people I’d seen who no longer were suicidal. They dfidn’t care all the mess I’d seen and how the patients were different today. They didn’t acre about that. They complimented me on the fact that my notes were typed. They did want me to use a format developed for nurses because the management and their lawyers didn’t want to learn what doctors learned .They wanted us to communicate in the simplest least way so it could be discussed on television or in the newspaper. I had to dumb everything down to a level of the high school student. No one studied science. I used to write for another doctor but now doctors have so little time for each other we’re all running about doing other peoples work. A colleague said recently , they wonder why there’s a shortage of doctors but the mismanagement is so absurd they have CEO’s sweeping the parking lot with feathers. We all laughed.
‘You must know.” She said
“Tell me.”
“We’re all going to die.”
“Yes,” I agreed.
“It’s all meaningless.” She leaned forward with her hands now resting on her knees and her head uplifted , eyes again staring straight into my soul.
“It can be but it doesn’t have to be.” I silently thank Victor Frankl and all my teachers and the men and women who went before me. I knew it was meaningless . I’d read Ecclesiasiates. .I knew of the bonfire of varieties. I had even studied ‘Denial of Death’ the psychiatric classic . But I also knew my smug rich colleague in the next building would already have diagnosed depression, most likely Bipolar II and be offering antidepressant medications and mood stabilizers and some anti anxieties and talking down to her as a parent explaining to a child , mansplaining or mothering her, and reassuring her and distracting her from the ‘long dark night of the soul’ and her epiphany, I had watched so many phoenix rising. I’d given actual birth to so many babies, not from men, but from women, mother and child in that toughest of separations. I knew the process. I waited for her next move. I’d offer all the medications and treatments my colleague did eventually but I’d run late and my work would be messy and I’d type what she told me and review it later.
I’d offer her choices and learn what she wanted and discuss neurotransmitters and conflicts and the desire to be loved and belong and be respected. I’d mention Jung and Freud and wander about and somehow she’d tell me so much more, so very much more. I’d use band aids of course. We begin with band aids but I wanted to know so much more and was curious as to why she was there beyond assumptions. What did she hope for?
She settled back in the chair , spent.
“Yes,”. I said.
And therapy began.
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