Saturday, May 10, 2008

The Psychoanalysis of Oliver Sacks

First, a couple of plugs:

Since we're still talking about the Shrink Rappers' trip to APA, I'd like to steer you to Peter Kramer's piece on what psychiatrists actually do at big psychiatric conventions.

Nothing to do with APA, but we received a nice note from a psychiatrist, and he has a site for quickly looking up DSM-IV-TR codes. Unlike Roy, I actually can't remember all the codes, so check out :

Okay, so Oliver Sacks. I heard him speak just briefly at APA at the Convocation of Fellows. He talked about musical hallucinations, and as he gave his talk, he mentioned that he's been in twice-a-week psychotherapy with a psychoanalyst for 42 years. That's a lot of decades of therapy. Roy's comment: "Kinda weird." Here's what else I know about Dr. Sacks -- I heard him talk on an NPR show a few weeks ago. He was born in England in 1933. His parents were physicians and, more specifically, his mother was a surgeon. When he was a boy, he said on the NPR show, his mother would bring home fetal body parts for him to dissect. His brother does not think he should talk about this. Dinah's comment: "Kinda weird." I'll say it tongue-in-cheek, but this alone might cause one to need decades of psychoanalysis.

Before I say any more, let me add a disclaimer. I've heard part of an NPR's Fresh Air (Listen Here) -- oh, he has a Great NPR Voice. I've read
The Man Who Mistook His Wife for A Hat. I've heard him speak for roughly 15 minutes at APA. I think I saw the movie Awakenings with Robin Williams. I've never met Dr. Sacks, I've never e-mailed him, I have no knowledge of his life beyond what I've heard him say in public. This post borrows from him, but I have no idea why Dr. Sacks has spent decades in therapy, and please don't take my fantasies as reality.

I don't know if Dr. Sacks suffers from a mental illness. Perhaps he does, and perhaps that alone warrants all these years of treatment. But maybe he doesn't; so, now we can digress into my fantasies. Dr. Sacks lives in New York City, a place where many of the worlds' psychoanalysts practice, a place where the practice remains alive, and where therapy is still accepted (or was when I was a med student there) as a means to gain self-awareness and maximize one's ability to live life to the fullest. It's not necessarily about curing illness; it's sometimes about a vaguer, more self-actualizing goal, one that may be an on-going process and one without a specified end.

To divert a bit, I once had a supervisor who volunteered to me that he'd had decades of therapy. Unlike Oliver Sacks, he wasn't a stranger, and I didn't have to speculate: I asked why. He told me his therapist served as a surrogate father, helped him to process his work, and that after he finished analysis, he wanted to continue to see him weekly rather than just bumping into him from time to time.

Personally, I believe that psychotherapy is a personal endeavor--- if it's helpful to you, do you need to justify it? Of course not, but in ways, society asks us to do this. It's expensive, it's regulated, there are not enough psychiatrists to provide care to the mentally ill, so is it right that someone who is not in active distress should take up the precious time of physicians who might be better used elsewhere? I'm told that there are only a handful of psychiatrists in Afghanistan -- perhaps we should ship these psychoanalysts there to help the chronically mentally ill Afghanistan citizens.

Okay, so the question gets even more complicated: should the long-term analysand without a mental illness pass the bill along to her insurance company? This again gets foggy -- I see patients who've rapidly recovered from a Major Depressive Episode -- if they continue to come for appointments, should the bill be passed along to the insurance company even if the patient has no active symptoms of depression at the time of the visit? Not every patient walks into every appointment in distress, and some people go up and down. I imagine ( I don't know) that over the course of 42 years, Dr. Sacks has good weeks and bad weeks, whether or not he has a psychiatric disorder.

There are many who feel that with limited resources, our society should not pay for therapy for people who don't have mental illness; subjective distress is something you should pay for on your own, and self-awareness is the same. Socrates told us that the unexamined life is not worth living; he didn't tell us who should pay to examine it.