Jan 10·edited Jan 10Liked by Martin Greenwald, M.D.
How about a patient who is not undergoing an acute psychiatric crisis with an obvious physiological underpinning? How about a person who has struggled for decades to achieve normal productivity, in the midst of recurrent depression and anxiety, despite taking a hefty dose of a SSRI? I don't see much progress for the latter, probably more common, situation.
I see what other gleaned from this emotional sharing. I got something else, maybe because as I read it took my mind to a completely different direction. I see the fragility of humans as was mentioned. The strength, focus, endeavor to produce and succeed in the path we chose.
The janitor of a school making sure the floors shine, the lavatories are hygienically clean because he wants to do his job to the top of his ability. The surgeon who has read the case, spoken with the patient, and then during scrubbing in envisioning each cut of his blade, protecting the tenuous tubes and wires that connect A to B, and succeeding at fixing this patient's problem. The notorious, ruthless courtroom lawyer who slices and dices and wins all of his cases. It's instinctive to want to do your best, be better, grow, be strong both physically and mentally and not veering off this path.
We've been trained to receive failure, or the knowledge we can not fix it, or encounter criticism with stoicism. "Don't be weak". "Take it like a man". "Buck up, do better". "Don't be a baby". But I, as growning older and wiser, found it's ok to want mommy, to curl up and self-soothe. and to want to stop being an adult. By allowing yourself these thoughts and those behaviors while accepting it as part of you, not all of you, makes you able to be that sweat soaked janitor or top notch surgeon or successful court room attorney tomorrow.
Jan 13·edited Jan 13Liked by Martin Greenwald, M.D.
I'd like to hear more about the psychological process of the 29 year old schizophenics fiancee. Did he leave easy or was it a messy, guilt-ridden process that haunts him to this day? I want to know because I am that fiancee -- only I stayed. My long-term partner has schizoaffective disorder. We've gone through several suicide attempts and a stint in a locked psych ward. Drugs help but never enough. And yet I stay and stay, year after year. Is my staying a kind of strength or a sign of weakness, my own version of mental disorder? Is care taking a virtue or a pathology? Seems to me that "society" says that people should do what's best for them as individuals.
These questions are only peripherilly related to the subject of your post but it's a topic that is top of mind for me right now so I wanted to share.
I don't know the long-term effects on the fiancé, but I recall that the split was more mutual than many. She knew things were getting harder and also felt things had changed since she got sick, and so wasn't fighting to keep them together.
I wouldn't say that your staying is a sign of weakness or mental disorder on your part at all, even if you're conflicted about it sometimes. Caring for other people certainly is absolutely a virtue, regardless of what "society" says.
Thank you for sharing this somber and beautiful essay. There are so many pieces to reflect upon, but I’ll constrain myself to your mention about gratitude for our well-being. I am no psychiatrist but the importance of this trait for positive human functioning seems painfully obvious. Yet it seems there is some sort of social-psychological virus devouring our capacity to be grateful. Can we blame this on material abundance, our digital compulsion, or our westernized attitude of comfort at all cost? You nailed it with “One can’t be a real person without having experienced some kind of genuine loss.” Ironically, the hard lessons of life can (not always) help us see the fragility of our lives and to be grateful for what we have.
"He who learns must suffer. And even in our sleep pain, which cannot forget, falls drop by drop upon the heart, until, in our own despair, against our will, comes wisdom through the awful grace of God.”
Acknowledging the reality of loss, so important, but to do this genuinely, in clinical settings I find hard. Especially when the volume starts to add up and the days are long.
Excellent and important read, if not a bit demoralizing.
This is so good, a much-needed reminder that it's through the wound that the light enters. Not a counsel of despair at all but, just as you say, profound encouragement to relish our lives and our connection to others. Keep up the good work! Your patients are lucky to have you.
Thank you Dr Greenwald for sharing these thoughts. Working in oncology for the past 15 years also taught me a lot about the fragility of life and the importance of time well spent...
How about a patient who is not undergoing an acute psychiatric crisis with an obvious physiological underpinning? How about a person who has struggled for decades to achieve normal productivity, in the midst of recurrent depression and anxiety, despite taking a hefty dose of a SSRI? I don't see much progress for the latter, probably more common, situation.
Thanks for this post, something worth reading and re-reading.
I see what other gleaned from this emotional sharing. I got something else, maybe because as I read it took my mind to a completely different direction. I see the fragility of humans as was mentioned. The strength, focus, endeavor to produce and succeed in the path we chose.
The janitor of a school making sure the floors shine, the lavatories are hygienically clean because he wants to do his job to the top of his ability. The surgeon who has read the case, spoken with the patient, and then during scrubbing in envisioning each cut of his blade, protecting the tenuous tubes and wires that connect A to B, and succeeding at fixing this patient's problem. The notorious, ruthless courtroom lawyer who slices and dices and wins all of his cases. It's instinctive to want to do your best, be better, grow, be strong both physically and mentally and not veering off this path.
We've been trained to receive failure, or the knowledge we can not fix it, or encounter criticism with stoicism. "Don't be weak". "Take it like a man". "Buck up, do better". "Don't be a baby". But I, as growning older and wiser, found it's ok to want mommy, to curl up and self-soothe. and to want to stop being an adult. By allowing yourself these thoughts and those behaviors while accepting it as part of you, not all of you, makes you able to be that sweat soaked janitor or top notch surgeon or successful court room attorney tomorrow.
Beautiful comment!
I'd like to hear more about the psychological process of the 29 year old schizophenics fiancee. Did he leave easy or was it a messy, guilt-ridden process that haunts him to this day? I want to know because I am that fiancee -- only I stayed. My long-term partner has schizoaffective disorder. We've gone through several suicide attempts and a stint in a locked psych ward. Drugs help but never enough. And yet I stay and stay, year after year. Is my staying a kind of strength or a sign of weakness, my own version of mental disorder? Is care taking a virtue or a pathology? Seems to me that "society" says that people should do what's best for them as individuals.
These questions are only peripherilly related to the subject of your post but it's a topic that is top of mind for me right now so I wanted to share.
I don't know the long-term effects on the fiancé, but I recall that the split was more mutual than many. She knew things were getting harder and also felt things had changed since she got sick, and so wasn't fighting to keep them together.
I wouldn't say that your staying is a sign of weakness or mental disorder on your part at all, even if you're conflicted about it sometimes. Caring for other people certainly is absolutely a virtue, regardless of what "society" says.
Thanks for your reply. It means more than you know.
Thank you for sharing this somber and beautiful essay. There are so many pieces to reflect upon, but I’ll constrain myself to your mention about gratitude for our well-being. I am no psychiatrist but the importance of this trait for positive human functioning seems painfully obvious. Yet it seems there is some sort of social-psychological virus devouring our capacity to be grateful. Can we blame this on material abundance, our digital compulsion, or our westernized attitude of comfort at all cost? You nailed it with “One can’t be a real person without having experienced some kind of genuine loss.” Ironically, the hard lessons of life can (not always) help us see the fragility of our lives and to be grateful for what we have.
Beautiful post, Martin!
A beautiful ode to what is really important in life. Always take time to acknowledge and share your love with those who you feel that way about.
As Aeschylus said.
"He who learns must suffer. And even in our sleep pain, which cannot forget, falls drop by drop upon the heart, until, in our own despair, against our will, comes wisdom through the awful grace of God.”
Acknowledging the reality of loss, so important, but to do this genuinely, in clinical settings I find hard. Especially when the volume starts to add up and the days are long.
Excellent and important read, if not a bit demoralizing.
This is so good, a much-needed reminder that it's through the wound that the light enters. Not a counsel of despair at all but, just as you say, profound encouragement to relish our lives and our connection to others. Keep up the good work! Your patients are lucky to have you.
Thank you!
What a powerful piece, so good Martin.
A reminder that we are here for just a time. Thank you for this;
Thank you Dr Greenwald for sharing these thoughts. Working in oncology for the past 15 years also taught me a lot about the fragility of life and the importance of time well spent...
This is a wonderful essay, brought to mind the experience of watching my father waste away.
This is wonderful. Beautiful, thoughtful, and true. Thanks.
Many thanks
I have a similar terrible story from medical school I cling to, thank you for reminding me of the beauty of our work.