Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists. A place to talk; no one has to listen. All patient vignettes are confabulated; the psychiatrists, however, are mostly real. --Topics include psychotherapy, humor, depression, bipolar, anxiety, schizophrenia, medications, ethics, psychopharmacology, forensic and correctional psychiatry, psychology, mental health, chocolate, and emotional support ducks. Don't ask. (It's not Shrink Wrap.)
Courtesy of CNN, here are a couple real-life scenarios I thought I'd share with you. Both of these videos represent the kind of cases that a psychiatrist confronts in an emergency room. I'd like you to put yourself first in the position of the patient: suppose you've been sick before, but never this sick (let's take it for granted none of this is due to drugs for now). You have an advance directive in place that says you absolutely don't want treatment even if you're a danger to yourself (again, for the sake of the exercise it's an enforceable advance directive). You never addressed danger to others in your advance directive because you never anticipated it could get this bad.
What would you want done?
If you were the doctor, what would you do?
Now for the second scenario. Is there anything about this situation that might make your wishes or opinions different from the first one? What's the difference? And if none, why not?
Thank you in advance for thinking about these problems. All of you who commented on my Emancipated Patient post have taught me something and I'm grateful. I'm putting this up to learn more about your ideas, opinions and wishes. Please keep talking.
At the age of 40, my father died after suffering from a heart attack while shoveling the snow. I was a toddler, too young to remember him. I understand that he liked gadgets so I'm assuming he would like the Internet, and techy toys, and that he might even have wanted a blog. I found this sermon he gave, well before I was born, and decided that I would 'invite' my late father to be a guest blogger on Shrink Rap. It was originally delivered as a sermon/lecture on Friday night, August 12th, 1955 as the second of a series on Modern Classics that Helped Change the World. Since my father is not here to respond to comments, and a recent tragedy in my family has left me feeling vulnerable, I will ask that commenters be gentle or silent. The writer is not a psychiatrist, the audience was there with an interest in religion, not mental health, and the year was 1955. I did enjoy finding this sermon while looking through family papers.
Conquering our Fears
Tonight, I would like to talk about Sigmund Freud, the father of psychoanalysis. In approaching this subject, I recognize fully my own limitations. I am a rabbi and I am not qualified to speak on the medical correctness or incorrectness of the theories of Sigmund Freud. But Sigmund Freud was not only a medical man. He also wrote on religious subjects. He discoursed at length on many aspects of religion. In three of his works, Civilization and Its Discontents, The Future of an Illusion, and Moses and Monotheism, Freud spoke about religion. And it seems to me as a religious leader, that if Mr. Freud chose to speak about religion, he should not have too much objection to a religious leader discussing the field of psychoanalysis.
Also, psychoanalysis, even in its own limited field, is concerned about many of the same concepts that religion deals with. After all, the concepts of sin and guilt used by the psychoanalysts were used by religion long before the growth of the Freudian school.
Sigmund Freud, a Viennese physician, had much more influence upon our society than we realize. He first began writing in the Victorian Era. We might call the Victorian Era "the denial of the physical." Exposure of the human body in any was was frowned upon. Some Victorians actually put little pantaloons on the legs of their pianos to hide them. And legs were never called legs -- they were called "limbs."
We might trace the frankness of today's generation to the influence of Freud. Freud, in many respects, pointed out that the physical desires of mankind were normal and, while they were to be repressed in consance with the needs of society, that we all had these physical desires. We have today a generation that is much more healthy mentally than that of the the Victorian Era. And, strangely enough, some studies seem to indicate that morally the present generation is on a par with the Victorian generation.
The mention of Freud generally tends to make the average man react in a number of ways. He either laughs nervously or tells one of the endless series of jokes about psychiatrists and psychoanalysts. Very frankky, I do not fully understand or subscribe to the Freudian theory. There are many schools of though among Freudians and they often disagree. But among them there seems to be agreement on a number of points-- adn I would like to discuss these particular viewpoints.
Freud's greatest contribution to mankind's thinking was in his understanding of man's fears, and his logical explanation of many of them. We may say that there are some logical fears. A man crouching in a foxhole with shells passing over his head is logically afraid. The Army has an expression "only a fool is not afraid." If we stnd in mortal danger of life or limb, we are afraid. The urge to preserve our lives causes us to be afraid. Horses in a burning barn tremble from fear. the sensation of fear in times of danger is a logical fear.
But we also have illogical fears-- fears that on the face of evidence do not warrant the reaction we get. Some people get into an elevator and become panicky. They cannot stand the crush of other persons, the feeling of closeness. Few of us enjoy riding an elevator, but not many of us are intensely bothered by it. The starting and stopping of the elevator annoys us and we do not relish the closed in feeling. But some people-- luckily, relatively few in numbers-- become violently ill when they are foeced to enter elevators or closed places. They have what is called "claustrophobia" or fear of closed places.
We might say that one of Freud's greatest contributions to our civilization was his insistence that a person had to grow up in order to live happily. Not only grow up physically, but grow up mentally and emotionally. Freud discovered that many people's fears and anxieties stemmed from the fact that somewhere along the line in their development, they failed to develop emotionally. While they might be 24 or 25 in terms of years, they still had some emotional attitudes of the three year old. Thus, as has been explained to me, a child at a certain stage of normal development might hate his father. Usually, we grow out of that stage-- but some people are unable to do so. But, say the Freudians, they realize that it is not socially possible to hate your father, so they, at a later age, may turn their hatred into such a way that they "take it out on themselves" or become neurotic. Their mind interprets this hatred in a number of ways-- by hating himself, by not coping with life's problems or in other fashions. The Freudian analyst will attempt to get the person to understand what is bothering him, and get him to act out his difficulties. He may have to re-live the stage of life where he failed to develop emotionally as did other people. The psychiatrist or psychoanalyst acts as a guide and as a participator in this emotional drama. Now, I am not competent to judge whether or not the Freudian theories about infant and child influence on later life are correct. Certainly, the whole of the psycho-sexual development of the infant is beyond my understanding. But the major point that Freud makes seems to me to be a very true one: that we have to grow up emotionally as well as physically-- that a person who is emotionally immature is unhappy. In other words, only the truly mature person --mature in the emotional judgements of life-- can be happy in our world. The emotionally immature person is constantly being confronted by situations that he cannot handle and each situation makes him more and more neurotic.
And this seems to have a particular relevance to religion. Freud was not especially fond of organized religion. He felt, and this statement appears in his book, The Future of an Illusion, that religion is a technique by means of which a person afraid of life tries to find a haven of false security. There is no doubt in my mind that Freud's statement were conditioned by the fact that there is a great deal of infantile faith in the world. We hear quite often of the desirability of a 'child-like faith." Child-like faith means a willingness to let God do everything, to throw yourself in the lap of the Almighty. You want to be wealthy-- believe in my faith-- say some religious leaders. You want to be mentally sound, join my church, say some ministers. An yet religions, just as individuals, can be mature emotionally. A religion can preach and teach an abiding belief in God and in the ethics of man. At the same time, it can say, as Judaism says, there is no easy way to gain an understanding of yourself and of mankind. Study-- concentrate and work for true understanding and you will achieve it. Judaism, I feel, has been such a religion of maturity. Judaism glories in the freedom of the mind to investigate and seek its own answer. Even Freud, with all his disbelief, felt this. In his message to the Vienna lodge of B'nai B'rith in 1926, on the occasion of his 70th birthday, he mad this statement: "Because I was a Jew, I found myself free from many prejudices which limited others in the use of their intellect." Ours is a religion of maturity, a religion that demands a minimum of prejudice and a maximum of intellect.
Another facet of Freud's work that is of interest to me because of its religious significance is that we can often tell a great deal about the personality of a person and his adjustment to life by even one action. Thus, a person comes to a psychiatrist with the urge to continually wash his hands, Lady Macbeth fashion. The psychiatrist can tell a great deal about an individual with this urge. It becomes the key to his entire personality and emotional makeup. Many of us use similar bases upon which to make personal judgments. I once spoke to the head of a rather large firm and he told me something which I though was most interesting. Before he hired an executive, he took him out on the golf course, provided, of course, the prospective employee could play golf. And the company head cheated shamelessly and openly. He kicked the other man's ball into the rough. He deducted strokes from his own score. He felt that the other man's reaction to his cheating would reveal quite a bit of hidden character. If the man was silent and acquiesced, the employer felt that that he was too meek and did not have the ability to assert himself. If he became furious, then the employer considered him unable to cope with situations. If the prospective employee i ndicationed htat he objected but did so diplomatically, he was then hired as a person who wouldexpress an opinion and was able to handle a situation intelligently.
How many times do we get angry at people for relatively minor acts? And when are we taken to task for this violent reaction to something trivial, we say "He showed his true character when he did that." You know, ministers and rabbis and priests have very simple tests for a person's true religiousity. The judge a person on the basis of just a few facts: Their attendance at service, their community interest, their relationship with their neighbors. Isolated acts speak very loudly about the total personality of an individual.
Another contribution of Freud to our understanding of ourselves was his explanation of many of our common fears and anxieties. I believe we have all watched a child approach a new toy. The child, if he is very young, seems afraid of the toy. He approaches it gingerly and nervously. After a t time, he picks it up and plays with it. Soon, he is playing with it wholeheartedly. He understands that the toy will not hurt him. Equally so Freud, by explaining that man's secret fears and anxieties can be understood and conquered, takes much of the dread out of our mental processes. It is only in the last century that mental disease has been regarded as illness rather than a devil to be exorcised. And it is considered to be a curable illness, rather than an incurable manifestation of evil. Religious groups, and among them is Judaism, have often taught that man can subdue his own passions and desires in terms of his personal needs. In other words, man has nothing to fear from himself. Man has conquered the heights of Everest and the depths of the sea. He has harnessed the atom. The last great frontier of our world will probably be the frontier of man's mind. And, while we may not fully understand the work of Freud, certainly we have benefited from his exploration of the unconscious mind of man. Once we learn to deal with our fears in an informed manner, then we will be close to achieving the goal of the Hebrew sage who said that man is slightly below the angels. Indeed, man conquering the last frontier of the mind, can enter a new golden age, bringing greater glory both to himself and God. Amen.
"I want the same scenario as the cancer patient. I want to say, as someone who is presently competent to make decisions, that this form of intervention was not life saving for me, it was harmful to me personally and drove me further from care. I want to be able to opt out of all forced treatment in case of psychiatric emergency…"