In this subscribers’ Substack section, I want to share a big lesson I learned from a half century as a psychiatrist. We are all bozos on the bus of life. The good news is that we don’t have to stay that way. We can change. As the old joke says, How many psychiatrists does it take to change a light bulb? Only one, but the light bulb really has to want to change. It’s also like the line from Socrates, snooty but true, that the unexamined life is not worth living.
OK, Socrates. You’re a smart guy. How do you do this examination thing? As a psychiatrist I was trained to do examinations. First and foremost I had to figure out what was true. Without the truth we’re like blind people walking through a forest. Such walks do not end well. Knowing where the trees are is better than walking into one. So how do we open our eyes? Ah, that’s the question my patients and I asked a million times, or at least it feels that way. Figuring out what was true was rarely easy. It took time. The light bulb really had to want to change.
Patients came to get help for problems they couldn’t solve themselves. Of course, some needed the basic medical business of “diagnosis” and “treatment” to be attended to. But all of them needed to discover the truths about their world, their problems, and themselves. I learned over and over the lesson of Socrates 2.0, that the examined life was worth living, and that knowing what was true put people on the path to better lives. It was a case of choosing to walk into trees or living with your eyes open. I was also daunting task for anyone, and humbling to be asked to help.
But now in our time of deception the job has become harder. Talk therapy is not just learning about yourself, but the world around yourself. To quote the teacher Ram Dass, "When you think you're enlightened, go and have dinner with your mother."
I had that literal experience when a young woman came to me for a session but with “nothing to say.” I waited. She stayed quiet. I asked her to tell me the first thing that came into her head.
“Lettuce,” she said.
“What about lettuce?”
“I’m trying to remember my mother’s favorite kind of lettuce.”
“Why is that?” I asked.
“Because she’s coming to dinner and I haven’t seen her in ten years.”
Oh. Two points for Ram Dass. There was a lot on her mind, and she just needed a little help to get there. The truths about the relationship were about to take center stage.
Now let’s do a thought experiment, What if your mother were a tweet? I know. It’s a wild question. But bear with me. How would you handle her when she popped up on your computer? Would you believe everything the tweet said? Would the tweet make you mad, afraid, or guilty? Would you tweet back? What if you liked what she said? Would you act on it and pass it on? What if the tweet were really a bot from some organization trying to manipulate you? How would you feel then? There’s a New Yorker cartoon that shows two dogs sitting at a computer, and one dog says to the other, “You know? They don’t know we’re dogs.” How much intel do you get from the internet that’s from dogs?
Getting the real deal from information is trickier now than ever. It’s business as usual for a psychiatrist to preach that we get our intel from our deep inventory of personal experiences. But that’s only part of the story. We also get them from friends, teachers, scholars, scientists, priests, and most powerfully, the computer. How much of what you experience is true, and how much is friendly intel, and how much is intended to mislead you? Using the tools of psychiatry I hope in the weeks ahead I want to take you on a trip that identifies where deception comes from, and how to peel back the veil to see the truth beneath it.
A perfect case in point comes from my work with drug addicts. When an addict came to me, more often than not they wanted me to give them drugs. Experiencing a craving addict is one of the darker wonders of nature. Addicts will lie, feign withdrawal, make promises they can’t keep, steal, and manipulate you in the most imaginative ways. The hurried ER doc has no patience for them. Their families have often given up in fits of rage and despair. But I learned that the theatrics were a deception in the service of a terrible need. When I peeled back the veil I saw a human being in the grip of a cruel and seemingly unending craving for drugs. The patient lied to me, and the act of lying was the truth. Acknowledging the truth was the beginning of wisdom, healing, and a better life. Everyone tells the truth. You just have to be able to know when the truth is lying to you. You have to know how to peel back the veil. That’s the journey I invite you on.
Ah, yes. I remember. “What’s the evidence for that?”
Brilliant! Greetings from Tokyo 😊