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(Ben Clarkson for The Globe and Mail)
(Ben Clarkson for The Globe and Mail)

A psychiatrist's double bind Add to ...

A soft knock propelled me to open the door in time for my next patient. The corridor was buzzing with action; patients sitting in designated chairs along the walls, a colleague rushing at a pace that could only mean business, secretaries huddled in a group, laughing.

My patient wasn’t laughing. She was withdrawn, curled within herself like a potato bug, as if her modus operandi were to turn herself into a small ball.

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I had an hour to see her, to hear her story, followed by 20-minute weekly sessions, then bi-weekly, with gradually decreasing frequency. I could do it. I was trained for this. To be efficient. To be able to get to the core of a life problem within a short period of time in order to see as many patients as possible. And there were many patients to be seen.

I recalled the first visit to my own therapist. When I called to schedule the appointment, his own kind, baritone voice answered the phone, not a busy secretary’s.

I received detailed instructions and the code to his office door.

“You’ll enter a small waiting room”, he said. “The waiting room has two doors. One opens to the corridor, the other to my office. My office has an additional door, through which my previous patient will leave – you’ll have complete privacy.” I thought I heard a hint of pride in his voice regarding this arrangement. I felt better already.

I entered the world of psychotherapy not knowing what to expect. How the hell could it help, just talking?

I’ve talked before. I have friends and family I can talk to: What’s the difference? Yet, gradually, in the privacy of this shrine for the individual soul that was the therapist’s office, in this sacred place free of malice, motives or moral judgment, I could set my soul loose.

It had been cooped up for so long, it didn’t even know it. And my soul, like anyone else’s, seemed complicated. Different layers protruded every time: at times hopelessly depressed, irritating in its entrenched helplessness; at times arrogant and devaluing; at times just plain cheerful, at others frozen with anxiety; at times caring and compassionate; at times brilliant, at others thick; at times lazy, at others driven with ambition. It was all there.

Letting it out into that attuned and understanding comfort enabled my soul to live in peace with all its parts. Later on, understanding different theoretical frameworks both in psychotherapy and in the physiology of the mind, even if contradictory, enlightened my soul further and helped it flourish.

I went back to my patient, back to the medical model of diagnosis and treatment.

I was looking for symptoms in order to make a diagnosis, symptoms you can see, symptoms she could tell me about in a superficial encounter. She had helplessness, hopelessness, suicidal ideation; she’d lost weight; she had difficulty sleeping and concentrating. It was not difficult to make the diagnosis – she had depression.

I knew what to do about it. Without the need to delve into the depth of another human soul, I knew what to do, I knew which medication to prescribe, I also knew I could recommend psychotherapy, but I knew she wouldn’t be able to afford it.

I could not afford to create that sacred place for the soul in which she could untangle her layers, understand the source of her depression and climb out of it. I did not have the time: It was no longer in the culture of my profession.

She was just depressed, a simple medical problem requiring a simple pharmacological solution. My soul felt cooped up, restricted. I needed Prozac (and fast).

Gili Adler Nevo is a psychiatrist in Toronto.

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