Practice Patient

There is this intering article in which a psychiatrist reflects on a year of trying to learn psychotherapy with a practice patient. Here's a bit on the nature of one patient.

Mr. R met his first trainee when he was 19 and realized that a parallel universe existed where evil beings were impersonating his family members. There were years of homelessness, hospitalizations, and unhelpful medications. Drug and alcohol binges followed like aftershocks.

Then life settled into a sort of stability. Though his symptoms persisted, they persisted against a backdrop of steady housing and decades in the same clinic. It was a combination that upheld him. He led community meetings in the day program. He took a volunteer job at the snack bar. He became famous for his jokes, lifted from Reader's Digests in the waiting room. Simply through the ticking of years he acquired a tenure. He was an eminence. Trainees assigned to him felt themselves lucky.

He showed up promptly for our appointments. He was responsible, never in crisis, and answered questions he had already answered a hundred times about his family and the particulars of his illness

Here's a snippet reflecting the last therapy session:

''Doctor,'' he said, ''how many psychiatrists does it take to shingle a roof?''

I smiled hopefully. ''A lightbulb joke?'' I said. ''How many psychiatrists does it take to shingle a roof?''

''Depends how thin you slice them,'' he said.

Fifteen years have passed since Mr. R left me with that joke. I have not forgotten him. But wherever he is, whatever he's doing, I sincerely hope he has forgotten me.

Even the psych in training realised that they really didn't do any good for this guy. Ever.

In any other profession, they know, people would expect actual expertise and results. Even the practice patient seems to have known this.