March 15, 2011

the liars club

After almost three weeks of my rotation on psychiatry, I’m still fighting not to become cynical of everyone. Every day I talk with people from all walks of life, of all ages – all of whom have had horrible things happen to them, have done horrible things to other people, and feel trapped in a world where only horrible things happen. It makes sense that they develop alternate realities – whether that’s an altered perception of the world or an altered perception of themselves.

I know this, yet recently I’ve spoken with a lot of patients who are about my age, come from pretty similar backgrounds to me, and at least generally seem like people I could have gone to school with, played soccer with, or even have been friends with. Because they seem more relatable to me, I have a much harder time not believing them – a much harder time thinking that they aren’t really seeking help with 100% of their capacity, because I hope that that’s what I would be doing if I were in their situation.

Talking to a friend about his own experience with addiction, he said that it took him over a year to get to the point where he was able to see the distinction between the persona he was trying to convince everyone (including himself) that he was, and the person he really is, and even longer than that before he was able to leave the persona behind and accept himself as he really was.

In my interviews with patients, both the ones I can relate to and also the ones I cannot, many seem to feel like victims, but sort of guilty that they feel like victims because some part of them recognizes that they’ve hurt a lot of people. Sometimes that guilt is obviously real, sometimes it’s hidden, and sometimes it’s totally false but it works.

Many people I talk with have had experiences that make it hard to trust people – including themselves, that have shown them coping behaviors that work temporarily but end up causing more harm than they can prevent, that have proved to them that manipulating the system to get what they want not only works, but is right because they know they’re good people and the system is mostly designed to mess them around.

I keep thinking back to what my mom said about all problems being caused by people not feeling either valuable, loved, or competent – and how grossly obvious the effects of that are at my work. Because when people don’t feel one or all of those things they develop coping mechanisms to protect themselves from feeling those things more, and also to try to gain those things in potentially unhealthy ways.

But all that means that my biggest struggle every day is to look people in the eye, ask them incredibly intimate questions about their struggles, relationships, and fears; about their most retched moments and the things that are the most important to them, and then decide if I should believe them. It takes so much emotional and mental energy for me to sort through what is real and what’s not, what they think is real and what they know is not, what’s important to figure out if it’s real and what’s really not – all of it preventing me from forming any sort of actual trust with any patient I meet.

My hope is that in my medical career that’s not true, at least not most of the time; I hope that I can find a place in medicine that lets me trust, that lets patients trust me, and puts me in a position where I can use that trust to help them get better.

“I remember, I remember when I lost my mind.

There was something so pleasant about that place

Even your emotion had an echo

And so much space

When you’re out there, out there

You’re out of touch

But it wasn’t because I didn’t know enough

I just knew too much”

-Cee-Lo, from the song Crazy


  1. Wow, I love this. Well put my amazing friend!

  2. my aunt, who is a social worker who works with children who are new refugees in the US and have gone through more trauma than I can probably imagine sent me an email the day after I wrote this reminding me to "always believe the suffering". I think this is wise advice. What I'm trying to learn is to figure out not if someone is suffering, but if it's for the reasons they think, or if it goes much deeper than they or I realize.