The person who walks into a psychiatrist’s office looking for help is not necessarily the patient.

Often, they are simply the family of the patient.

Sometimes, they themselves have something – possibly a disorder, but maybe just an emotional or attitude problem — that would seem somehow lesser in magnitude than the psychiatric diagnosis the person who is or should be the patient has actually got.

Depression among caregivers of the elderly is but one example, for there are studies published on caregivers for virtually any imaginable chronic debilitating illness, with cancer and stroke at the top of the list.

All too often, the person in my office who is trying to tell me what the problem is ends up telling me that they feel someone else in their family is acting in ways that are putting them under pressure.

I am still amazed at how many people think that a psychiatrist has ways of making other people do things. Ways of imposing their will on others.

People seem to think that I am somehow really smart and really persuasive and can make other people change.

They tell me that their lives would be better if their son or mother or husband would do what they are supposed to do.

I usually glance heavenward (yes, psychiatrists can believe in God) and say “I don’t think I could even make my husband do anything he really did not want to do.”

I have to be careful that people do not think this means I am a rotten psychiatrist.

A typical counter from a patient is “Even with hypnosis?”

I don’t do much of that sort of thing, really. I am not at all convinced, even if I did, that I could (let alone “would” or “should”) do anything to make people do what they really did not want to do.

I am careful. Also, the law is very particular about such things. You know – the Constitution, civil rights, and such.

I love to do neurolinguistic programming (NLP).

I have done a lot of it and had some wonderful success stories. People who do both hypnosis and neurolinguistic programming have likened it to a light trance.

I tried NLP once when I was seeing a certain young depressed patient in the prison system. I will never forget the young man of color from Mississippi, who was profoundly sad because he had been imprisoned in California, a state which was too “citified” for his liking.

We created a “resource state,” heightening the sensory memories of walking along with his girlfriend in a meadow in Mississippi, holding her hand, and stopping to watch squirrels at play.

A tear rolled down his cheek — a single tear down the cheek of someone whom the guards had told me was a “hardened criminal.”

Me, I didn’t even know squirrels were indigenous to Mississippi. I had seen my first living squirrel at age five, walking with my parents in Harvard Yard, and was not happy that my mother did not snap his picture with her brownie camera, so I drew a portrait of him when we got home that remained in the family album for a very long time.

This was before my music and humor aficionado husband introduced me to the wonders of the hilarious Ray Stevens recording of “The Mississippi Squirrel Revival.”

I was happy that my patient could better survive the rigors of a California prison by remembering Mississippi and knowing that he would ultimately return to his resource state again.

Fortunately, he did not get squirrel-o-phobia from Ray Stevens. Of course, THAT I could have cured easily!

But I don’t want to make light of this patient’s condition. He was not a well young man. I discussed him with his primary care physician. The chief of the prison department of psychology was soon at my door to tell me, as politely as he possibly could have, that things like hypnosis and NLP were simply not things that one did.

They represented controlling someone’s will, he claimed. Of course, he knew neither hypnosis nor NLP, so his authority rested comfortably on a civil service exam rather than classroom or book-learning.

I never tried using such methods in a prison setting again. Only private practice.

And yet, in private practice, I have done and will continue to something a lot of psychiatrists and psychologists consider controversial, still.

It is called “self-revelation.”

It has taken some perspective to be able to do this.

When I was growing up, I thought my family was pretty normal. My parents told me that Daddy being a Harvard man and Mommie being a graduate of the Commerce High School, were more educated than others and thus, a bit superior and aloof.

All three — my mother, my father and my brother, all of blessed memory — met the criteria for bipolar, otherwise known as manic-depressive illness.

My brother had Asperger’s syndrome, definitely full blown. It is my belief my father had it too, although his was somewhat less obvious.

They all had various amounts of “character pathology.” There was not much in the way of them feeling “superior” or “distant,” since I had few of the family gatherings and rich friendships I heard friends (and later, colleagues) describe.

The three people mentioned above are now dead as doornails (like Marley in the immortal Dickens’ “A Christmas Carol”). I do not think I could conceivably offend anyone by telling about their role in my life.

I fantasized when I was young about “curing” my brother. He was a bipolar Asperger’s. This was obviously connected to my desire to practice neurological surgery, my frustration with it, as well as my subsequent career in psychiatry.

I dealt with the “craziness” in my family by becoming a mental health professional.

So many people have told me about their troubles dealing with bipolar parents or spouses, or with relatives with personality disorders (like narcissism). Some have cried to me, and sometimes I have repressed tears.

I think one of the great dangers of my profession is becoming too distant from a patient, and dehumanizing the patient.

I think one of the problems with medicine in general is that of “norming” — of seeing similarities in patients and classifying them quickly. Oh, I can see the necessity of doing things like this at least a little bit. I mean, there will just never be as many types of pills as there are patients.

So if I think it will help someone, I will tell someone something like, at the very least:

“Do you really think that if my family was totally normal, I would have chosen to do this for a living?” Such openness – formally called “self-revelation” is strictly “Verboten” according to all academic training.

If an example is required, I will never forget what my mother of blessed memory said when (after I was already a physician) I learned she had put remedies I had sent her in a cupboard and not taken them.

“I knew you when the two halves of your little behind could fit in the palm of my hand. Why should I listen to anything you say?”

The only answer I could come up at the time was,

“It’s bigger now.”

My parents often bragged about me to other people, I later learned — but I really felt lots of the time they were looking for things wrong with me.

I learned that there were things I could not change. They distrusted medicine, psychiatrists, and medication. Their characters were something I could have no influence upon.

The challenge of real adult love is knowing who and what someone is, and loving them still.

My parents did the best for me they knew how.

I love them, and their memories, and there influence on me — nurturing my education, treating education as the most precious of resources and making me want to save them — ultimately thus, making me a researcher and brain aficionado and a psychiatrist.

So I sometimes tell patients about something I read many years ago, in what is not actually much of a medical journal, Seventeen Magazine.

I even remember being less than seventeen years of age when I read it. That is about the extent of my rebellion – under-aged magazine reading.

The magazine told me: “It might not be your fault that your parents made you the way you are. But it is your fault if you stay that way.”

I ask patients, “What do you have to do to be happy?” In my case, it took becoming a psychiatrist, for I totally love what I do.

Our choice of educational and professional path in life — well Freud, father of us all said something to the effect that most of us spend our lives making up for what was missing in our childhoods.

Knowing that simple fact can help us guide or lives to satisfaction, even to joy.

The end

Author's Bio: 

Estelle Toby Goldstein, MD is a board-certified psychiatrist in private practice in San Diego, CA.

Practicing Medicine Since 1981

In her medical career, she has studied in Europe and Canada as well as the USA. She has attended specialty training beyond medical school in the fields of general surgery, neurology and neurosurgery and psychiatry (specializing in psychopharmacology).

Experienced In Many Situations

She has worked in a variety of positions, including:

Fireman/EMT
Medical school professor
General and Orthopedic surgeon
Brain surgeon
Army Medical Corps psychiatrist
Prison psychiatrist
Community Mental Health Center staff
Consultant to a major transplant hospital
Drug researcher
“Whatever It Takes!”

She currently has her own indepenent clinic in San Diego where she is concentrating on what she calls Mind/Body medicine — or Integrative Medicine. Her practice is cash-only, doesn’t accept insurance or government payments, and she operates on the concierge, or “private doctor” practice model to give her patients the absolute best quality of care and the highest level of confidentiality.

Dr. Goldstein’s philosophy is “Whatever It Takes!” Her goal is to do everything possible to solve whatever problem she is presented. This includes seeing patients as quickly as possible — not making them wait weeks for an appointment. This includes making appointments days, nights, weekends or holidays. This includes making house-calls. And it includes using the best, most innovative treatments available — most of which are unknown to standard, mainstream doctors.

Her focus is on transitioning patients away from prescription drugs and onto natural substances. She is also a master practitioner of Emotional Freedom Technique, a powerful and dynamic form of energy psychology that usually brings quicker results than traditional psychotherapy.

The Expert’s Expert

She has written an advice column in a daily newspaper and hosted a weekly call-in radio show, and now is enjoying the freedom of speaking her mind on this blog.