Lincoln, Massachusetts, United States
As a retired psychiatrist, I have been thinking about the mystique that surrounds our profession.
Psychiatrists seem to trigger three provocative associations that set them apart from other physicians. The first, sometimes interpreted as a wish, is that psychiatrists read minds and therefore know what is concealed or hidden inside someone’s head. The second is the sense of vulnerability that comes with facing such an invasion of privacy. Unlike other medical specialties, psychiatry is not about a particular part of the body but rather about the person. The third association is the authority to give labels that often become impossible to shed and can become a personal encumbrance. In customary language, you have diabetes, hypertension, or cancer but you are schizophrenic, depressed, or paranoid.
People may feel both impressed and apprehensive as they approach a psychiatrist, in either a social or clinical setting. One can feel eager to be really seen, but at the same time skittish about really being seen. In other words, to draw near but also hold back. This is sometimes called the approach-avoidance phenomenon. At such moments, self-awareness is heightened. It’s natural to want to reconcile those opposing urges. Life, after all, is about moving ahead and getting things done, not sitting on a fence and obsessing. But being of two minds is not a failure or even a decision. It is fine to keep a distance while also staying in touch. It is fine to hold onto those dual urges and continue to be of two minds. The risk of falling into obsessive thinking with its self-absorption and self-doubt actually disappears. The urge to approach and the urge to avoid comfortably and honorably co-exist.
A potential or prospective patient (including a psychiatrist-in-training) has intuitively applied a “mystique” into his or her awareness. When I put myself in their shoes, my gut and intuition speak first in the language of feeling. Words and thoughts follow feeling. And that initial feeling is tension.
In the era before Homo sapiens, an occasional genetic mutation causing ambivalence or hesitation would surely have meant early death. For modern man, the mind has expanded beyond self-preservation. Ambivalence can be an asset, an expansion of mental reach. It allows us to think about ourselves, inviting progress rather than merely coping. This is part of our evolution. But some of those instincts towards self-preservation still remain in our DNA, perhaps in a modified form. The impulse to keep a distance while staying in touch can still be observed in animals today that begin their hunt by avoiding getting too close too soon, while not breaking visual or olfactory contact.
Is there a genetic connection between today’s predators who instinctively don’t move when their prey look their way, and today’s humans who instinctively block out a traumatic experience, what we call “denial”? Both behaviors have self-preservation as their common denominator, the former, a living “self” needing food, the latter, a functioning Self. Given this, might a layman approaching a psychiatrist cast the doctor in the veil of mystique, not as an insight into the doctor’s abilities, but rather as a DNA residue of a primitive pre-sapian reflex to stay in touch while also keeping a distance?
The word “shrink” is simultaneously a serious title and a witty pun. Its roots began in tribal rituals in parts of South America where traditional healers would shrink heads of important deceased people and then use them for ceremonial, religious, and medical purposes. Shrink, then, a stand-in for “head shrinker,” carries awe, respect, honor, and healing. At the same time, at least in today’s popular usage, it carries an association of witty triviality. The relevant thing, though, is that it becomes just another version of keeping in touch while maintaining a distance, a variation of our being of two minds.
Psychotherapy is about a patient essentially looking into a cloudy mirror. The presence of patients’ eagerness and apprehension confirms that they are of two minds. They have projected onto the psychiatrist the aura of mystique, but it was not as a cognitive decision. It was, as I’ve come to see it, simply a gut reaction to a message they carry. A patient is clearly both hunter and prey and has a special need for the psychiatrist-therapist to wear a cape of mystique. The need is to enhance trust that self-preservation will be assured.
The psychiatrist, in other words, never possessed the mystique to begin with. It was bestowed by the patient who, instinctively not cognitively, did what felt necessary under the radar of cognition. The so-called “mystique” of the psychiatrist actually belongs to the patient, whose mind does not know this, but whose gut does.
LAWRENCE H. CLIMO, M.D., is a Vietnam Vet, board-certified psychiatrist, and writer. He has practiced psychotherapy and psychopharmacology in inpatient and outpatient settings and been a teacher, administrator and forensic consultant. His articles have appeared in professional, academic, and popular journals and magazines, and he is the author of three books, The Patient Was Vietcong: An American Doctor in the Vietnamese Health Service, 1966-1967; Psychiatrist on the Road: Encounters in Healing and Healthcare; and Caregiving: Lives Derailed (under the pseudonym Eli Cannon). He is retired and occasionally writes occasional Op-Eds for Psychiatric Times.
Highlighted in Frontispiece Volume 14, Issue 3 – Summer 2022