February 6, 2007

When the psychiatrist thinks the patient is just an...

... asshole. And he writes a nice essay that gets published in the New York Times, where you can't come out and say "asshole."


Ron said...

Ah, but is he a completely integrated asshole?

Can we come up a psychiatry where "asshole" is an identifiable category? How about "nutjob", or "dingdong?" Maybe there would be more public support of psychiatry if you could just proclaim not that someone has OCD, but that they're just "batshit crazy." Who couldn't relate?

Peter Palladas said...

James Thurber was clearly right all along - there are some people who are just plain inferior. Nothing complex about that Mr. Adler.

Let's hear it for good old-fashioned sin. About time moral disorder made a comeback.

Mea culpa, mea culpa, mea maxima culpa - I have hand-stitched embroidery copies, framed and available for all consulting rooms.

Day of Judgement 'doom paintings' in authentic mediaeval ochres done on site.

Flat-pack confessionals ready for dispatch, with full instructions and screws.

'Penance on prescription' - 10% for bulk purchase.

'Sheep 'n' Goats' consulting rooms - when you know your guy is bad not mad just half an hour in a 'Goat' and repentance guaranteed or your money back.

Pete the Streak said...

As my Grandmother told me when I was a kid, most folks are as happy (or nice) as they decide they want to be.

Tim said...

"But if some people turn out happy and good despite a lifetime of withering hardships, why can’t some people be mean or bad for no discernible reason?"

And "To put it another way, some mentally ill patients can be mean or bad just like anyone else, and this is not a problem for psychiatry to fix.

The culture of therapy (did you catch how the mayor of San Francisco, after being discovered having an affair with an aide who is the wife of his campaign manager, is now seeking treatment for alcohol abuse, a la Mark Foley??) combined with human secularism makes it difficult for society to recognize that some are just evil (unless, of course, you're the object of the Left's scorn, in which case you're both diabolically evil and stupid, see G.W. Bush).

Pogo said...

Funny article. And true.

A few years back, I had a patient that saw me for one reason: he wanted to have the psychiatric diagnosis "Manic-Depressive" expunged from his record, or at least refuted. He told me, "I'm not manic, I'm just an asshole."

My professional reaction to this three-time convict (assault, robbery) was "I see".

He came back from the new psychiatrist who wrote in the medical record:
"Patient insists he does not have Manic Depression, but is instead merely an asshole, with which I would agree.". The patient was quite satisfied.

So yes, you can come out and say it. Although there's not a billing code for "asshole", "rectal pain" should suffice.

vnjagvet said...

Pretty good article. The concept that a cigar may sometimes be just a cigar, has now achieved a somewhat broader application.

joated said...

So, does this translate as "Meanness"="asshole"?

Joan said...

But must we turn everything we don’t like about our fellow humans into a form of psychopathology?

I honestly never thought I'd see such a question asked in the New York Times. I count it as a sign of the impending apocalypse.

Either that or an expanding willingness to embrace reality by previously resistant professional communities. Hope springs eternal.

Rockeye said...

Doctors and nurses will often dismiss foul behavior by patients because they are "sick." I'll never forget the shocked expression on a patient's face who after repeatedly hitting a nursing assistant caring for him that I was going to call the police if he did it one more time. I told him that the police would determine if he was in his right mind or not, and if he was he would be charged with battery. If he wasn't in his right mind then he would be considered mentally incompetent, with all the legal ramifications of that. It had never occured to this (and many other) patient that being ill isn't blanket immunity for any foul behavior.

vbspurs said...

completely integrated asshole

Isn't that the operation Castro just had?


TMink said...

Great posts Tim and Pogo. I did some training in a state mental hospital. The doctors would refer to people with especially bad reality testing as "she is real crazy." Works for me, everyone knew what they meant.

Kinda like the cartoon; "Just plain nuts."


Fried Lice said...

I think Rockeye has nailed it on the head. As person suffering from mental illness, I am very familiar with the mental health care system. It is a sad fact that many people working in health care simply don't call patients on their bad behavior. People with severe mental illness are badly socialized to begin with. On top of that, the people around them expect them to act crazy and fail to set any firm boundaries. This situation sucks for the caregivers who have to put up with abusive behavior, but is doubly bad for the mentally ill people. If no one dmeands that they behave politely and no teachs them social skills, the mentally are doomed to fail, even if their medication eliminates their psychosis.

Fried Lice said...

Sorry about the typos. I hit the publish key before I could fix them.