The armchair psychosphere has posed a question:
Why, when so many of my patients are adamant that they do not have an illness, are they so keen to demand Disability Living Allowance, Incapacity Benefit, and free bus passes for those with a disability?
But doctor, why don’t you ask your patients? Wait, let me slow down. Ask yourself why you are asking not your patients, but the pro-capitalist psychosphere. Does the free market psychosphere speak for your patients?
The question, of course, is not a question but tit-for-tat; a cynical comment on patients who cynically milk the system, and it’s just another weekend in the psychosphere, dragging useless eaters through the mud.
Imagine instead that the patients you describe are sincerely conflicted. Of course, you wouldn’t have to imagine their motivations at all if your patients were willing to talk to you, but maybe imagining the worst of them is more fun than having to learn about things you don’t want to know.
Lets assume, for laughs that your patient is sincere. She denies mental illness while demanding alms for the mentally afflicted. Yes, it is a contradiction. We could call this experience an inner conflict.
If only there was someone smart who could take the wheel from there, who could point to the empirical evidence and gently aver that despite heroic efforts to lead a functional existence, living without electricity while going through 14 jobs year after year, that the record alone makes one a reasonable candidate for the categorically unemployable, and even more sadly, it might be time to come to grips with the underlying reasons she’s become unable to take care of herself. The very same reasons that put her on the plate before you, captured so plainly in a bio-psycho-social layer cake.
Do I have to take you people to school? Who can illuminate the interplay of relevant biological, social and psychological factors in my life? Me? I’ve got my own fish to fry, defending against a secondary and discredited identity as “mentally ill.” Let’s call my fishfry a “defense mechanism.” Cuz denial aint just a river in Egypt.
Does that answer your question? It should.
If only there were people around familiar with the pathogenesis of mental illne–oh hey wait, here we go, Dr. Dinah at Shrink Rap admits she too has been perplexed for years, for years, with what? With the heartrending specatacle of decompensation, with the sheer enormity of the insoluble waste, the size, breadth and scope of the loss? No, with
“the relationship between mental illness and the ability to work.”
Oh. For years, mind you. Evidently the relationship of “cause and effect” can’t quite put her mind to rest. Cause and effect holds no water when dealing with the devious patient population-
“What I don’t get is how we know when people can’t work versus when they won’t work.”
If only there were some way of getting to the truth!
Dr. Dinah then cites some of the “absolute sickest patients” she has ever seen (3 people) who manage to hold down jobs in spite of it all, one an award-winning medical practitioner, another a trained professional, who is so disordered Dinah would recommend applying for disability in a flash, but alas, “it’s never come up.”
What are we to make of patients who refuse to renounce their professional status and assume the social position of card-carrying crazy? Who are these people that stubbornly refuse to trade in their lucrative income for a monthly disability check of 500 dollars?
More to the point–if these patients can work, why can’t the others?
But there are so few answers in the psychosphere, where ponderous docs gather, wandering and pondering in a world of innuendo, of educated guessing, hinting on tip-toe, planting seeds–
“And so, when I see a patient who left work a few years ago, whose symptoms are now controlled with medication, who says they can’t work and gets regular payments, I’m often left wondering.”
Could it be the parasitic lifestyle of psychopathy, mentioned in the comment thread, where one helpful reader spells it out-“malingering” comes to mind…”
Perhaps…perhaps not, one is left simply to ponder and fret and what-if and wish into the void. Like why, Dinah wonders, (“as a physician, tax-payer, and non-smoker”) are disability benefits allowed for the purchase of cigarettes? She wishes it weren’t so, as a physician, tax-payer and non-smoker, subsidizing my nicotine habit just doesn’t seem right.
Never mind that smoking is both pleasure (perhaps the only pleasure in the life of a mental patient), but a physical addiction, known to be harder to kick than heroin.
Ok, not known experientally to a non-smoker, having never started then struggled to quit, still, a non-smoker could stretch a bit and find a way to relate to what that’s like. If only there was some non-smoker around who understood the human psyche, the conflicts, problems, neuroses and addictions, but that brings us back to the implicit question, are mental patients people?
“…when someone tells me they don’t have the money for their $1/script medicaid copay, but they’re nursing along their $7/day cigarette habit…oh, some moments are hard.”
What makes the moment hard, Dinah, is known in your circle as an “empathic failure.” Empathy is a win all around, its development will make these moments less difficult, and improve the therapeutic alliance, and who knows where that could lead?
This might take some time, judging by the final ponderment; an adroit confession, as any self-disclosure is to be considered adroit, when it’s used as a weapon:
“I’ll get off my soap box. Did anyone see where I put my Diet Coke?”
You can’t call her a hypocrite, she beat you to the punch. The soda addiction has been cheekily acknowledged, her own frailty is off the table. Though you might be touched by the charming and womanish admission of a personal foible, and hasten to reassure, yes people are people, we all have our foibles. Or, as James Baldwin famously put it, we contain the other, hopelessly and forever.
Look into my eyes when you take away my cigarettes.