“Pathology” is a damaging story

“Pathology” is a damaging story

A few days ago I was driving home from the beach in the evening. I was taking a mountain road because there would be a lot of people returning home via the main routes, and so coming around a curve I saw a dog crossing just ahead of my car. I didn't have to break but I thought "what an idiot! Sometimes animals do stupid things."

I then recalled that the dog had something in his mouth, some piece of food wrapped in aluminum foil and that I had seen, a moment before, that there had been two dogs on the other side of the street.

So I realized that the dog had been far from stupid: seeing the approaching car and calculating EXACTLY the moment to make his move in the two dog  standoff over a single piece of food, he had acted with sure-footed aplomb, grabbing the morsel and crossing in front of my approaching car so that it would have been impossible for the other dog to follow it immediately.

So if someone brought us this "stupid dog" that does "dangerous things" and we set up a behavior program to "reduce self-harm" would we not miss the real story of how this is actually a very smart dog? And would that dog not begin to think of itself as self-destructive and hell bent after hearing so many authoritative voices talk about him in those terms?

I'll give a human example: One of my patients was recently discharged from a therapeutic community for drug users and referred to me for follow-up.

The big anxiety surrounding her discharge, after a stay of three and a half years is that in November, during a three day weekend home leave she took some money out of the bank and went on a cocaine binge.

It was obvious to some clinicians that she was not ready for discharge and that once outside she would need to be watched carefully for signs of irresponsibility, loss of control or for dangerous associations or behaviors. Her mother, an anxious woman in her own right was terrified at the thought that this dodgy, unreliable monster was coming home.

Just like the stupid, suicidal dog of my first assessment the image of this young woman was that of a person who, as soon as she rounded the corner would scurry away and grab some drugs. Now, it was a couple of months since discharge and she hadn't done that, but for some people it was only a matter of time...

Usually I find myself the odd man out in these collective assessments, the one that does not really get the point, and usually I haven't considered myself talented in the area of drug abuse because I trust my clients and believe what they tell me. In drug abuse, I'm told, you have to distrust whatever they tell you because they are masters of deceit and manipulation.

So, here is how I see it, fool that I am:

The November leave was the last time Maryann would have the chance to revisit the scene of the crime, so to speak and not be afraid of herself, that is not be afraid that she would not stop and destroy herself. That is because she was guaranteed a re-entry into the community treatment center and whatever she did would be confined, limited to those three days. So she did something intelligent, the way I see it, because she had an opportunity to revisit her habit, have some fun, see how much or just how little she liked drugs and reassess a whole host of calibrations that she hadn't had the opportunity to reassess during her forced sobriety. She would never have done the same thing if she had been simply discharged and was on her own.

What's important is the image that is reflected to the patient as a result of this way of understanding her behavior. Just like the dog she proved to have made a courageous and timely move, one that she needed to make for her own reasons that are too many to list but are not trivial or simply escapist and one that she could only make at that time, because she had a three day leave and she would have to return to her treatment center, confess, be scolded, scare everybody but she would not die. Once on her own that would never have been the same. So it was the last time. It was her stag party. An occasion to revisit all of her memories, all of her pleasures and all of her deceits in complete safety from herself.

Now if a host of experts and authorities tell you that you are a degenerate and that all that has been done for you has resulted in nothing what are the chances that you will relapse?

And if a fool of a shrink tells you that you are in fact unconsciously intelligent and have made an important, courageous and timely gamble and that you succeeded in whatever you wanted or needed to achieve, what are your chances now?

People are not one person. There is a multitude of identies inside each of us. And when we address somebody we address one of their personalities and call them up and ask to talk to them. Whomever you call will answer.

  • May I speak to Maryann the degenerate please?
  • Speaking! What's up?
  • I just wanted to tell you that you are a waste. Nothing has worked for you and you'll destroy yourself. It's my expert opinion.

Or:

  • May I speak to that very smart, very clever cookie, Maryann?
  • Yes?
  • I just wanted to tell you that you made a very cool gamble, a very accurate calculation back in November and I have complete confidence in your unconscious ability to choose the best for yourself. It's my expert opinion.
  • Thank you.