Self-Development

See No Evil, Speak No Evil

Monkeying around with my shrink

At first, it was just a joke that I wrote on my blog: I called my psychiatrist the Silent Shrink. But now it’s become more of an annoyance and deficit rather than a joke.

The guy is a master of the nonverbal, and his body language isn’t really providing clues to compensate for his silence. If I don’t ask questions, I’d know nothing of my condition or my symptoms. But I’m adult enough to know you must be your own advocate. You can’t depend on anyone but yourself.

And yet he is definitely not stupid; he’s just non-reactive. All my other shrinks/therapists reacted to my disclosures. If I said I felt depressed, cried a lot, thought about past failures, worried about future illnesses, I’d get some feedback even if it was minimal. With this current shrink, I get a weak smile. I think I see the wheels turning, but perhaps I’m being presumptuous.

It’s not as if I’m waiting for him to solve all my problems, but I’m beginning to feel like I’m doing all the heavy lifting and he’s coasting. It’s not like these sessions are charity. I pay a goodly sum for — -this silence.

And yet he’s a really nice guy. When I first began seeing him, I was hot for taking ketamine. I’d read all the articles and seen some of the clinical data and wanted to banish my depression forever. I thought ketamine would be the answer to all my mental woes. I even thought about writing a book about “My Cure from Chronic Depression.”

He was suitably informed on ketamine. He had done the reading but had not actually prescribed ketamine. I was his first. But I didn’t have to beg or plead. He was receptive. This helped solidify our relationship. And even when the ketamine turned out not to be all I had hoped it to be, the fact that he had listened to his patient and collaborated with me as he would a colleague, meant a lot.

But there should be more to a therapeutic relationship than asking the patient a few questions about sleep, side effects from meds, and appetite. I have to fill in all the deep pauses in conversation. I manage to do it because I believe he’s trained me quite well to keep up my part of the conversation. Still, my part is growing whereas his is, well, shrinking.

In the beginning, I made excuses or came up with explanations for his non-verbal style. Perhaps he wanted me to feel in control so he let me take the lead in communication. Perhaps his quietude was based on reading the literature on traditional Freudian psychoanalysis, where the therapist says nothing and listens to the patient project all his feelings onto the therapist. I think they call it transference. Maybe he was experimenting.

Maybe the fault lies in me. Maybe I am projecting my feelings onto him, but doing a lousy job of interpretation. So far I seem to be reflecting his demeanor, role modeling somewhat. I’ve become less emotional and more discursive.

I cannot fault him for evading my questions about the meds, and he always seems to be conscientious about notetaking and ensuring a steady flow of my meds. If I ask him about a certain new drug advertised on TV, he always answers. But the answers are so concise, they border on robotic.

And yet I think — or hope — he cares about me. I need him to care because sometimes I wonder if I’m paying enough attention to my psyche. Or too much. Once, when I asked him whether I might be depending too heavily on the meds and had too high expectations for the resolution of my chronic depression, he disagreed. So it’s not that he’s a sycophant. He has his own views and opinions. Still, they seem frozen, maybe too entrenched.

He’s never revealed much about his personal life except I know he lives in my suburban development and jogs/walks regularly. I’ve never seen him, but that may be because I exercise so rarely. He suggests I get a little fresh air, but does not chastise me for my opinion on “boring” exercise.

I know virtually nothing about him. I didn’t know much about my other therapists, but somehow I feel that I could have asked them personal questions more easily. But of course the chronically depressed/anxious patient, who has only about 20 minutes per session, learns not to waste time with irrelevant questions.

Generally I glean some personal info — for instance, that a therapist has a dog, was married, had a child — from various pictures placed around the office. In my shrink’s office I don’t notice any photos. At least they’re not visible from where I usually sit, which is on a couch.

What do I want to know about him anyway? I want to find clues that humanize him a little more. The truth is he comes off as being a bit cold. Of course the shoe is on the other foot now — I’m no longer the young naive person seeking psychological assistance from the older, wiser professional. Today I am the older one, and he is the younger. Maybe I see him as cold because that’s how medical schools train the new style of shrink. Or maybe he’s just cold.

This doesn’t bother me as long as I feel he has the experience and background to handle my run-of-the mill depression. Of course just the other day my diagnosis suddenly changed from chronic treatment resistant depression to bipolar depression. It was a sneak attack that had little effect on my treatment.

He didn’t announce it in a big dramatic way. It was more of a by-the-way you might be bipolar depressed based on a question I had about a new med on a TV commercial. His response was almost too casual, too off the cuff.

I learned you’d don’t have to be a flaming manic depressive with giant ups and downs to be bipolar. You don’t have to be manic (as it was defined a few decades past)and spend huge sums of money, have sex with strangers, or dance naked in the streets. All you have to do to qualify as a bipolar depressive is to be irritable. And I’m irritable in buckets.

So I guess I qualify. Does it make me feel better? No. Should he have been more precise and forthcoming with his intuitive feelings that I might be bipolar depressive? Yeah, I would’ve liked hearing it directly from him instead of playing detective.

Perhaps the perfectionistic part of me is just too darn picky, and I can’t help but criticize him. If so, I’ve chosen his silence as my main focus of criticism. It could be that simple. Or it could be that he’s just shut-mouthed.