(contains a small amount of difficult material)
John has described some examples of treatment that was poor – that failed to help. It put me in mind to write about trust between psychiatrist and patient – how it comes into being and how it doesn’t. And it struck me that you can only best do that by looking at specific examples and seeing what conclusions can be drawn.
The second time I met with my new psychiatrist I was struggling with my thoughts again. I told him that I was having very intense thoughts about putting a knife through both my hands. This was very different to the calm I felt about dealing with the devil – this time I was miserable, and feeling threatened and oppressed by my own mind. I couldn’t shake the images and thoughts. I remember the interaction very clearly. He paused and let silence in. For long enough for me to feel like I was being listened to, but not so long that I felt awkward in it. Then he leant in towards me, rested his elbows on his knees and asked me:
‘Do you think this has a religious connotation?’
‘Yes I do’….
More on why I don’t trust people down the line, but for now I’ll just say that I walk through the world behind formidable barriers. At this point in time – early days of doing psychiatry – I let no-one in and trusted no-one. But the reason I remember this consultation so clearly was because the actions of my psychiatrist gave me a glimpse that he might be trustworthy, even if I couldn’t fully trust him yet. I felt helped in that moment, and when these moments of connection happen with a psychiatrist or therapist I think they’re very precious. Because communication is difficult, so when it works it’s a moment to remember and appreciate. The 2 elements that I appreciated so much were (1) allowing silence in – understanding that I needed space to think and speak while my thoughts were so disordered, and (2) leaning in a bit towards me signalling that I was being listened to, and that what I had to say was important. I dare say he acted intuitively, and it might feel as if I’m making a fuss over nothing, but I felt as if (a) I was being listened to, and (b) he was making every effort to understand me from my point of view.
The first psychiatrist I saw inspired no such trust in me. There was no connection – no moments where I felt helped or even listened to. I’d describe him as an ‘old school’ type – aloof, distant, superior. No leaning in to hear me better, no space for my story to unfold. He diagnosed me in 45 minutes then wouldn’t hear me say that I thought there was something else going on. I called him the Man in Black because he wore a black pinstripe suit with crisp white shirts. I hung on in there for a year because I knew I needed psychiatric help. Thankfully he whisked off for a sabbatical, and I found my new psychiatrist, who I’d be with for years.
But even while I was seeing the Man in Black I was formulating this idea about trust :
You can’t wait for someone to demonstrate to you that you can trust them before you go ahead and trust them. Trust doesn’t work that way. You have to place your trust in someone openly and willingly from the outset. There’s risk in this and we need to be prepared to be vulnerable. Sometimes that trust will not be repaid, but many many times it will – and these are precious moments.