{"id":38554,"date":"2013-07-09T12:52:13","date_gmt":"2013-07-09T16:52:13","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=38554"},"modified":"2013-07-09T12:58:55","modified_gmt":"2013-07-09T16:58:55","slug":"no-laughing-matter","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2013\/07\/09\/no-laughing-matter\/","title":{"rendered":"no laughing matter&#8230;"},"content":{"rendered":"<div align=\"justify\">One of my most frequently told stories [maybe already told here before but I can&#8217;t find it] came from my days running the psychiatric emergency room at Grady Hospital &#8211; Atlanta&#8217;s inner city charity hospital. I was recently graduated myself and supervising a resident &#8211; a &quot;city boy&quot; with tons of education. He had been referred a case:<\/div>\n<ul>\n<div align=\"justify\">The patient was a thirty something year old African&middot;American man who had grown up in rural Alabama with his grandmother living at the end of a dirt road on a large farm. He had been to school &quot;some&quot; but was only semi-literate. When his grandmother died, he set off for Atlanta. He got a job in a furniture factory and lived in an apartment. He&#8217;d come to the Grady ER complaining, &quot;<em><strong><font color=\"#200020\">My nerves is bad<\/font><\/strong><\/em>.&quot; He was given some medication and was referred to the clinic. <\/div>\n<p align=\"justify\">The resident took a history and began to explore his life and situation. He said the man answered his questions, but didn&#8217;t seem very engaged, often looking at him <em>oddly<\/em>. He often repeated, &quot;<em><strong><font color=\"#200020\">Doctor, my nerves is bad<\/font><\/strong><\/em>.&quot; <\/p>\n<p align=\"justify\">After a few visits, the resident reported that the man had seemed frustrated, but then blurted out, &quot;<em><strong><font color=\"#200020\">You think my nerves has something to do with my life!<\/font><\/strong><\/em>&quot;<\/p>\n<p align=\"justify\">The resident was a little taken aback, and responded, &quot;<em><strong><font color=\"#200020\">Yes<\/font><\/strong><\/em>,&quot; and started to explain, but the patient interrupted him. &quot;<strong><font color=\"#200020\"><em>Why didn&#8217;t you say that<\/em>?<\/font><\/strong>&quot; he asked.<\/p>\n<\/ul>\n<div align=\"justify\">In case it&#8217;s not apparent, this story is about two people with a cultural gap as wide as the Atlantic Ocean even though they were from the same region, a gap even wider when this happened nearly forty years ago. I&#8217;ll have to admit that at the time, I could hardly keep a straight face listening. And I couldn&#8217;t hold my smile in when the resident reported the next session. Fortunately, he smiled too:<\/div>\n<ul>\n<div align=\"justify\">&quot;<em><strong><font color=\"#200020\">Doctor, I think you was right. I went home and threw out that no count woman living with me spending all my money on beer for her no count friends. And I told that no count boss of mine I wasn&#8217;t working no more seven days a week. And I feel a whole lot better. Thanks.<\/font><\/strong><\/em>&quot;<\/div>\n<\/ul>\n<div align=\"justify\">A grateful patient, but an even a greater teacher. So many lessons. Start where the patient is. Make no assumptions. etc. etc. This story is from a long time ago &#8211; before the DSM-III. I&#8217;ve always told it as an example of basic things that some people don&#8217;t know &#8211; in this case how emotions are complex signals, guides we all use in negotiating life. This man didn&#8217;t know that, something inconceivable to this urban, educated resident with a college degree in the humanities. This patient literally thought he had something wrong with his nerves &#8211; like they were broken things.<\/div>\n<p align=\"justify\">But the story means something different to me now. What brought it to mind was a <a href=\"http:\/\/1boringoldman.com\/index.php\/2013\/07\/08\/a-shameful-misuse\/#comment-246780\" target=\"_blank\">comment<\/a> on the last post. I doubt that anyone would argue with the idea that a system as complex as emotions are there for a reason &#8211; no matter how you think we arrived at our current design. &quot;Emotional problems&quot; refers to times when the emotions don&#8217;t function as they should &#8211; times when we&#8217;re anxious when there&#8217;s no apparent danger. But if you could be a fly on the wall in the offices of a lot of physicians, even psychiatrists, I&#8217;m not sure you&#8217;d think that the usual function of emotions is much recognized &#8211; by patients or doctors. Often, you&#8217;d notice that the doctor doesn&#8217;t say the obvious thing when a person complains about how they feel, something like, &quot;What&#8217;s going on?&quot; And even if that question gets asked, the patient goes on to describe the unwanted feeling in more detail, rather than talking about what&#8217;s &quot;going on&quot; in his or her life and times.<\/p>\n<div align=\"justify\">Working in a rural clinic, it always jars me a bit when the patients persist in talking about their uncomfortable emotions in isolation. I&#8217;m not used to that. But I wouldn&#8217;t be, practicing as a psychotherapy type seeing only referrals in a sophisticated part of the world. When I first came to the woods, I thought that was it &#8211; a different group of people. But I actually doubt that&#8217;s all of it. I think some of it is iatrogenic &#8211; something these patients are used to after seeing GPs or PAs out here in the southern wild. I&#8217;ve taken to saying things that I once would&#8217;ve felt funny saying in the past.<\/div>\n<ul>\n<div align=\"justify\">&quot;I know you want to tell me about your bad feeling, and I want to hear about that. But feelings are part of the package, and they&#8217;re supposed to tell us something about our reaction to things. So first, let me hear something about your life, and the stuff that might not be going so well.&quot;<\/div>\n<\/ul>\n<div align=\"justify\">I made that up, but I expect you get the gist. I&#8217;d like to report that they immediately open up and reveal their innermost secrets, but alas, this is the real world. It&#8217;s harder than that, because in the course of what follows, you&#8217;ve got to help the person see that you&#8217;re not just being nosy or indicting, and that&#8217;s a different pathway every time. <\/div>\n<p align=\"justify\">I&#8217;m not talking about Freudian &quot;resistance,&quot; veering away from painful topics. That&#8217;s the same in Appalachia as it is on Harley Street, 5th Avenue, or Peachtree Road. I&#8217;m talking about people who are used to getting a pill for what feels bad &#8211; often an un-needed pill, or even the wrong pill, or worse, yet another pill. I think that&#8217;s in part a byproduct of the current era and reflex prescribing. And when I ask about current medications, I hear way too often, &quot;he was in a hurry&quot; [&quot;he&quot; being the GP or PA]. <\/p>\n<div align=\"justify\">So in former times, the resident and I smiled together as our patient learned the most basic lesson there is to learn about emotions and their function. However, it&#8217;s no laughing matter at all to think that so many physicians are acting as if they don&#8217;t know it either&#8230;  <\/div>\n","protected":false},"excerpt":{"rendered":"<p>One of my most frequently told stories [maybe already told here before but I can&#8217;t find it] came from my days running the psychiatric emergency room at Grady Hospital &#8211; Atlanta&#8217;s inner city charity hospital. I was recently graduated myself and supervising a resident &#8211; a &quot;city boy&quot; with tons of education. He had been [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-38554","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/38554","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=38554"}],"version-history":[{"count":12,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/38554\/revisions"}],"predecessor-version":[{"id":38566,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/38554\/revisions\/38566"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=38554"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=38554"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=38554"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}