The man is fighting with anxiety for more than 30 years. Half of the known psychiatric medication has been used on him without any significant result. He is on maximum doses now and he acknowledges that he is absolutely horrified of encountering me for the first time. Moreover, he began fearing our meeting for one week in advance; just the simple thought that he is going to see a new doctor made him stay indoors for the last week. Yet, because he needed medication and because there was nobody to come to me and spare him of the fear, he had to come somehow to my office. His entire body is shaking while talking to me, he is sweating continuously and his voice is barely audible.
Nice, isn’t it?
This is what psychiatry means. Anybody interested out there? Hello?!
My job is one of the lowest paid medical specialties. It is also by far one of the most emotionally demanding. I consider old-age medicine (geriatrics) to be worse, because you also get a full-package of psychiatry, oncology (cancers) and death at the same time. So, just in case you want to save the world, or you suffer from a messianic syndrome of self-sacrifice, psychiatry is a good start for your career. But I digress.
Actually this patient is not the worst I saw recently. At least he came alone. Some weeks ago I saw one that came with his aging father because he wasn’t able to stay on the chair because of trembling. He was scared to such a degree that he had to constantly eat small pieces of bread; apparently, eating had a calming effect. No, he is not a bulimic. He is just so freaking afraid that he has to eat that bread all the time and that is somehow reassuring. I know, it’s mind-blowing.
Well… returning to the first patient, he told me something interesting that is worth conveying to the internet void. He has a teenage daughter now – unbelievable, isn’t it?! – and that girl has also some relationship and emotional issues – not surprisingly. At some point in our discussion, he said something like this:
“I feel guilty because I brought my daughter to this world and she must now struggle with life and with her own fears. It is my fault because I wanted to have a child. And now it’s hard to see her wrestle with so many problems. I am afraid of future and also of death. And I am horrified to understand lately that not only I will die and I fear it every day, but my daughter will also have to die and she also must feel this fear. By bringing her to life, by offering life to her, I also offered death to her. It was unescapable and it is unbearable to witness her struggle.”
Well… the psychiatry books don’t teach us how to respond to such a deep existential questioning, isn’t it? The psychiatry books teach us how to give medication and occasionally (or not) pharmaceutical companies struggle to push a recommendation in their favor in the international psy guidelines. But I guess nobody has a good pill for “the guilt resulting from the awareness of giving to another person the gift of life and the poison of death at the same time”. In order to answer this question – the patient is looking at you and waits your feedback – you can choose to either be a coward and push back with the known strategy “what do you think it’s the answer?”, or you can be brave, read some more books, live life a bit, and then give a different answer, actually your opinion. And then see if your opinion opens a door in your patient or not. Why? Because you need to be modest enough to accept that your opinion is not the only one and possibly not the best. But, you can have the courage to take an active role in your relationship with the other.
I learned late in life not to search for excuses for what I do or what I decide. I don’t have to explain myself and I don’t have to excuse myself or the things I decided to do. I did what I thought is right (or good) and period. Did ever God presented his/her excuses for creating the human being, especially the thinking human being that can become aware of the horror of being alive (because the mentally retarded ones don’t really care)? No, God didn’t excused him/her-self. He/She never explained him/her-self. He/She simply brought into existence all that is. Same for the Devil (if you believe in him). Did the Devil mumbled the slightest sound that resembled to an excuse for giving us the curse of knowing the difference between good and evil? No. He did what he wanted to do without any other comment.
That is, both God and the Devil take full ownership of their decisions and actions. And then, they assume them.
What did Adam when God asked him about his acts of insubordination and about breaking the rules? He freaking blamed Eve! He said that she made him commit the sin. And what Eve did? She blamed the Serpent. And what the Serpent did?
Well… the Serpent remained silent. He didn’t say a word. Why? Because the Serpent, being a god, takes full ownership and presents no excuses. He does something and… period.
Resembling God – or resembling a particular god – is an ideal we aim to. That is why these stories are told. We, as human beings, aim to become our better version. And a better version is when we learn to Accept what is given (or humanity), we Decide to do something (such as bringing a child in the world) and then we Assume (the fact that we bring the child to the world against his/her wish, awarding him/her both the life and the inevitable death). Acceptance, full ownership of the decision and assuming stuff are all very hard things to do. It takes years to learn to live with the consequences of our choices. And it also takes intelligence to understand what I am talking about.
Of course I didn’t tell to the patient the story of God, Adam and Eve. I play safe. I don’t know if he is a believer or an atheist. I prefer to use things that work in any case and in any inner environment. But I did tell him about making decisions and assuming them. He understood the situation – he is intelligent – but he still felt guilty to see his daughter struggling. I told him the magic words: “It’s her problem!”
When we decide something, when we do something, of course there will be people who will suffer because of what we did. It is unavoidable. That’s how life is. But it is up to them to find resources or find a solution. It is their struggle, not ours. We did what we wanted and we assumed that our decision will cause suffering. But we wanted that thing and we did it. And here ends everything for us. No more excuses from our part. It’s time to let the others take their own responsibilities and deal with what we left to them. It’s their fight – if we can say so. It is no longer ours.
I don’t know if what I told to the patient rings a bell in his psyche. I always assume that what I do is in vain. But, keeping in line with the subject, I don’t care. I did what I thought to be right in that given situation. What will be, if will ever be something, will be. From my part, there will be no excuses.