Friday, May 30, 2008

demon rum

I'm on an outpatient neurology month, mostly a pretty calm scene compared to the inpatient psychiatric wards - until Ms Q arrives on the scene.  Forty-five minutes late for her appointment, she stumbles in on the arm of the fellow, mascara streaking down her cheeks.  "She's intoxicated," the fellow murmurs gently in his refined hint-of-British, hint-of-Indian accent as he steers her to a chair.  

"I hate it, I hate it," she sobs incoherently.  An overpowering odor of alcohol wafts about her.  She has been swigging from a bottle in the car all the way from home, over an hour away.  I shudder at the thought of the unsuspecting commuters who shared her road.

I am assigned to calm her down; my few months' worth of psychiatric education have won me this one.  I murmur soothingly, knowing there is little useful diagnostic information to be obtained from her right now.  She is a blond beach girl, far from home; and it shows in her long yellow hair, bright pink lids and lips, pink toenails in metal-ringed sandals.  "I hate you," she rages.  "I know you're trying to be empathetic, but you don't understand.  Look at you - you're young, you're pretty, you have cute shoes..." She dissolves into a bathtub of drunken tears.  Cute shoes... emblematic of the good life.  I sigh and pat her on the back.  Miss Sunshine, in need of some perspective at the least.

But she is right, of course.  I don't know what it's like to be an alcoholic.  I have worked in recovery programs, and noticed that the addiction specialists with drug histories often seemed more effective than those without.  Regardless of training and other forms of institutionalized expertise, in the addict's own head it is important that his therapist "understand where he's coming from."  All that training is for naught if you can't even get the addict to listen to you.  For people with their own drug histories, that door is already wide open.

One wouldn't expect one's cardiologist to have his own history of heart attacks; nor ask one's internist if he's tried the antibiotic or diuretic he suggests for you.  Yet psychiatry is somehow different, removed from the clearly delineated ethics and protocols that apply in other areas of medicine.  

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