Thursday, February 5, 2009

Psycho-Logical


M. C. Escher: "Night and Day"


You start a conversation you can't even finish it
You're talking a lot, but you're not saying anything
When I have nothing to say, my lips are sealed
Say something once, why say it again?

Talking Heads


1. Where has Anonymous gone? For weeks, months maybe, a comment (acerbic, incendiary, ingenious as the case may be) for virtually every lowly post, but suddenly nothing, and with no explanation. Is this just a camping trip, off the grid? Should I be concerned? Was it something I wrote? Sure, there are lots of other bloggers--and commenters--in the Internet sea, but I just don't understand...

2. In the era of increasingly mechanized, rapid-fire medicine, no refrain is heard so often as the deep need of patients (that is, all of us, eventually) to have their stories listened to, at length if need be. I'm a big believer in this, as it is usually therapeutic--except when it isn't. Another artifact of our medical non-system is massive redundancy, as folks are shuffled between various providers across disciplines and up and down hierarchies.

Every now and then I have significant past records on a new patient before the first appointment. I like to get the story au naturel from the source, but I do always skim through any records I have beforehand in case any glaring discrepancies come up. Sometimes it happens that once a patient learns I have records, he becomes disinclined to go through a story that has obviously been rehashed many times. "Don't you have it there?" he says, pointing to the chart. (Where I work now he may be there under pressure, not entirely by choice).

Well, in a way I have the story, and in a way I don't at all. Obviously I have ways--not always effective--of trying to get someone talking. But just as one has a right to waive informed consent, one has a right not to cough up a life story upon request.

3. Many people seem fascinated by forensic matters, but I never have been, whether in life, popular culture, or psychiatry. Abstractly, the problem of evil is compelling, but in practical terms I find wrongdoing and mayhem to be merely sordid and sad. So the dimension of psychiatry that involves trying to figure out whether someone is lying or "gaming the system" is not my favorite.

Some clinicians are surprisingly jaded about disability status. Once someone has obtained disability status, they believe, they are beyond the pale, that is, consciously or unconsciously motivated not to get better, and condemned to a life of wanton passivity. I'm probably just naive, but I find it easier to unambiguously identify those who cannot work than those who definitely could and merely won't.

Disability payments are not large in the overall scheme of things (i.e. in middle class terms), and seemingly shouldn't offer so much temptation. But many of the people seeking it aren't in the game for middle class stakes anyway. No, their options are closer to minimum wage, which may not pay a great deal more than disability would. And it's odd how persistent unemployment starts to make people feel a lot more disabled, when logically of course they should feel merely unemployed. And a criminal history can make it a lot harder to find a job. As one repeat felon memorably told me the other day, "I need a bailout."

Of course it's good for one's self-respect and dignity to work, or even to keep trying to find something. It's also good for the waistline to exercise regularly and eat more vegetables. Wisdom cries out in the streets...

8 comments:

Pete said...

I do hope Anonymous comes back as I liked his/her comments. I don't have anything to add to your wisdom today (it's been one of those days) but I've seen that disability / employment issue in action. I also feel sorry for those with a criminal record but here in SA we're so scared of crime that it's understandable.

Novalis said...

As I reread the post, I should specify that by "au naturel" history-taking I did not mean one of its several possible meanings, i.e. disrobed. (I shouldn't have to state the obvious, but I try to maintain a modicum of taste and a minimum of lawyers here).

The birthday suit might get people talking, but probably mostly the clinic staff.

Anonymous said...

I don't speak therefore I am not?...i think not; but i still am.
Ive been committed...to committments, that is (me committed? I definitely think not!...yet..no, never!...maybe...how can YOU be sure? I only speak for my selves).
Very busy, brain limited.
I was concerned for your concern...
thanks for stroking my ego..it means tingly much.
Ive still read your 'lowly' posts though...oh, how you do scrape the dregs and serve them up sparkly clean!
...no, just kidding....very meaty posts (not just cosmetic)
'au nautrel history taking' = history making + many possibly terminal psychological complexes + renaissance in psychiatry?
....yes, I think I speak for everyone here and assume youre always in bad taste by default,unless stated otherwise....that's a more than fair assumption, i think.. (do i need to state the obvious?)

'wanton passivity' for a few more days.

Novalis said...

That's a relief--I was afraid that the blog's transcendent banality ("dregs" indeed) had sent another one around the bend. But I can see you're in no danger from me...

Gerard said...

Perhaps, but now that he's back you do need to adjust his meds and empty his drool cup.

Never a rose without a thorn.

Novalis said...

Now now, if you're like that, Anonymous won't want to come out and play.

Fortunately most of the meds cause DRY mouth anyway...

Dr. X said...

It does seem that the dignity of work is less compelling as disability payments increase.

http://www.nytimes.com/2008/09/21/nyregion/21lirr.html

Retriever said...

It depends what a person is getting disability for. At work I see a lot of folks milking the system for disability for "oh my back!" then getting another job off the books after.
But I am having conniptions now w MDs recommending we seek disability for a kid. No other way to get a safety net for him (I had thought that recent laws extending a parent's ability to share insurance coverage w kidsi to 26 would help, but now we are all facing layoffs, so don't know how to pay for his care in future....Gaaaaah.