Tuesday, August 28, 2007

Don't Shrink Me


I was surfing the NY Times website and came across this article by Ronald Pies, a psychiatrist in the Boston area. Dr. Pies talks about a wonderful nurse he worked with in the psychiatric emergency room and his surprise when he walked on to the inpatient one morning to find this same wonderful nurse, now admitted as a patient with a severe major depression. Dr. Pies talks about wanting to save his colleague, and recounts how over the course of an 8-week admission, the patient's symptoms didn't respond to two different anti-depressants. He later runs into the patient, now cured of his atypical depression by an outpatient doc who recognized his atypical symptoms and more appropriately treated the patient with an MAOI (an older type of anti-depressant). Dr. Pies laments that he missed the diagnosis because the patient was a VIP of sorts, that he didn't get approached in the same way, with the same freshness and thoroughness, that a stranger would be, and he refers to Jerome Kroopman's book, How Doctors Think, as a reference for the celebrities-get-worse-care phenomenon.

We've talked about these issues here at Shrink Rap, asking whether
docs as patients fare worse, and we even discussed a New Yorker article by Dr. Kroopman a few months ago. Here at Shrink Rap, we do it all.

I thought: I should write a blog post about this NYTimes piece. There's a lot to write about-- we could talk about Atypical Depression, missing diagnoses, the use of MAOIs in treatment today, treating people we know. Oh but it's August, I'm feeling lazy, I let it go. And then today, I was reading Clinical Psychiatry News, kind of psychiatry's version of a tabloid, and I saw a letter by the same Dr. Pies. He wrote to discuss how the term "Shrink" is demeaning, how we shouldn't use it. This, of course, inspired me to write this post, I'm still not sure what it's about.

There are some words that feel very powerful, some that squeeze me. Shrink isn't one of them (obviously). I don't generally refer to myself as a shrink--- except in Shrink Rap posts where it flows out pretty easily-- but when others do, I don't cringe. If it's supposed to be a derogatory term, demeaning, hurtful or vengeful, laden with stigma and rife with belittlement of my chosen profession, none of that has jelled in my heart. The term evokes nothing in me, it's not what I feel when I hear people utter racial or religious slurs. Should it be? Did I miss something big? I know Roy isn't nuts about the term "shrink." ClinkShrink, I'm guessing, has incorporated the word as part of her internalized identity.

I don't know Dr. Pies. I wonder if he'd like Shrink Rap, of if he'd just cringe at the title, shun the three psychiatrists who use a derogatory term so lightly, ducks and all. Gosh, are we just a bunch of quacks?