Thursday August 23, 2007

Dear Ms. Miller,

In response to my mail of august 22, “psychiatry and abuse”, you ask how I reacted to the abuse. At first, I must admit, I was confused. Probably because I was made to feel “crazy” from an early age, I found it hare to believe at first that the explanation to my patient’s “illness” can be so simple and horrifying: that of a tragic, outrageous “mistake”. I remember presenting “my case” in front of the staff. I told about the story of abuse, but was afraid to say straight that the patient sounds reliable and I think she has been misdiagnosed. After all, the young doctor is expected to find “signs of illness” in his patients, and to present as many of them as possible as proof of his “competence”. So I said that I don’t know if what the patient said happened or not – I cannot reject the option that it did happen. The senior doctor replied in an irritated tone, half-smiling, that the story of abuse sound “too unbelievable”. This remark made me furious, for the first time. I asked him if he does not read newspapers. There was silence, as if a bomb exploded in the room. Most of the female staff looked pleased, and the senior doctor withdrew and admitted that yes, it is possible. However despite this, he refused to reconsider her diagnosis or her drug regimen. After the patient was discharged, I talked to her several times. I asked her to describe what she went through, and I reacted in anger – I think I even “faked” some of this anger because I knew, from reading trauma literature, this was the “right thing to do”. However I must admit that because I am too a survivor of sexual abuse, it is hard for me to find in me much genuine empathy. I never got any real empathy to my own abuse. This barrier made it impossible for me to treat the patient long-term. It was also difficult for me because the conversations were informal and I did not trust myself in respecting her limits or being able to stand up to my own limits. She did express much anger toward her parents in the safety of our conversations, but still usually could not stand up to her rights with them. I tried to encourage her in that direction. I know she stopped taking her drugs, and shortly after that I stopped our conversations.

N., Israel.

AM: Thank you very much for your honest and frank answer. Your story reminds me of my own experiences with the Freudian colleagues. They always followed the rule that we should not believe in what the patients tried to remember, and the patients accepted this willingly because they wanted to avoid the pain of the truth and hoped that their memories were only fantasies, made up stories. When I insisted on the reality my colleagues became irritated, all of them.