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Upon Reflection

Author: Charles Oseroff, M.D.
Publication Year: 2010
Edition Winter 2010
Type of resource: Newsletter

It must be someone else’s license hanging on my office wall. I’ve been a doctor for that many years?! It can’t be. But taking a deep breath and surveying the landscape of my life I have to admit it does make sense. I can’t argue with two adult children (an oxymoron) in colleges across the country, and I’ve had more surgeries than vacations the past three years. Life does catch up with us. At parties people ask me what I do, and twenty five years into it there’s still a marked reluctance to say. Do you think of yourself as a mental health professional? If I say it, does that mean I think of the rest of the world as mental health amateurs? Does oversight by the Department of Mental Hygiene mean we must supply our patients with mental floss to keep their minds clean? With such unnatural and condescending metaphors implied and spoken, no wonder we struggle so much with stigmatization.So I’ve come to think of myself instead as a professional story listener, as opposed to a storyteller. It’s the perfect compliment to what the rest of the world is doing. People want someone to listen to them and I want them to talk. Much story telling of course is for profit, entertainment, political or power purposes. But for the sufferer of a twisted tale, an unjust event, a mysterious conspiracy, we are there for them to come back again and again . . . to share their story as many times and as many ways as they need to in order for them to have some say in the content of the next chapter. After twenty five years of practice, this is the only thing that makes sense to me. This is what gets me out of bed and into the car every morning. This is what levels the playing field and allows me to prosper while sitting in mine fields of emotional time bombs and psychic destructions. During most of my office time I’m surrounded by children and young people who are no longer living in their homes. Their lives full of foster parents and social workers and family members struggling to unshackle each other from dismal, unhappy pasts. Many of their stories have been told countless times, either by them or to them, in the company of too many people, many they hardly even know. The other quieter, more slowly paced piece of office life is spent listening to people like myself struggle to make sense of their pain and confusion so they can do right by their families, knowing or at least believing that their parents, for whatever reason, chose to bypass that chance for themselves. As complicated as stories are, and as are the people I’ve met who live and rewrite them, the tools of our trade are simple. In fact, there’s only one tool of any merit to a genuine listener, a therapeutic ear, an empathic presence. Fortunately, it is also a skill that gets better with age and isn’t at risk to dull with time or leave one’s memory or be outdone by the wave of technical, chemical and electronic improvements flooding the workplace; the ability to wait. Waiting of course has a dictionary meaning and can be misunderstood, misapplied and abused as can anything else. But in the context of listening to my patients while I listen to myself and my reactions to my patients, and then to their reactions to my reactions, it is possible to experience the awe, the surprise, the understanding, the timing and the therapeutic punch that waiting brings. Waiting, we tolerate uncertainty and hold anxiety at bay. Thus positioned in a patient’s life, his story of suffering makes sense to us without finding ourselves drawn in to or thrown toward impulsive interventions. At this stage of our lives and of our practice we make decisions not because we are pharmacologically branded or institutionally loyal, not because we like or dislike the person before us, not because we are tired or in a hurry or don’t want to be called after hours and not because we don’t know what to do and feel compelled to do something.  We finally act, or speak, or instruct or prescribe or refer because of one other skill that sharpens over time, that doesn’t suffer from the growing distance from residency and from the heavy mantle of having to establish for ourselves a place the world ; the ability to recognize what it is that we were waiting for. This is something I didn’t have to put in my doctor’s bag as I exited the medical licensing exam. It was something as I reflect back on early career endeavors, that at the time felt more like a sense of intense, thinly veiled expectancy; like a righteous cougar waiting to pounce on a hapless answer. It began to change in the direction I now find myself when board certificates started coming in the mail. And of course there were the mistakes, thank goodness for mistakes. Without them, and the guidance of those who knew they would come, my own story of what I do never would have become small enough to be the helpful tool it is now. It is a bit ironic I think, that to be professional we have to be personal, quite the opposite of that oxymoron, the business of medicine. Treatment is not an entrepreneur-based venture. You have to wait for yourself to show up and recognize that is what you were waiting for, in order to be able to do the same for someone else.    


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