God made us dumb for a reason

 

What a masterful job of psychotherapy I have done recently! The impressed and moved clients. There’s the pathological liar whose lost inner little boy we found. The obsessive-compulsive personality disordered teen whose flaw we question only obscurely in a winsome relationship. The Man Who Invented Childhood Trauma who managed not to go insane and whom we keep from the tsunami urge to homi­cide, month after month. All those who are seen for the first time in their lives. Exactly, who feel seen for the first time in their lives. These people turn dark and deep, and shake, and some­times hold back a lifetime of tears which they know they must unload.

But for variety, let’s say, I am one incompetent ignoramus! The teenager whom I saw for a year and did not touch in the slightest: Anxious and suicidal on day one, the exact same stubbornness day three-hundred-sixty-five. The young woman who seemed eminently WNL to me, vital, strengthening sessions. But she believes she might have Asperger’s. Goodness! She may be right! How have I missed that? How do I still look, and see in a blur? The seventeen-year-old who has attended weekly for over a year, reveals she has never really heard a word I’ve said, who we suddenly discover to have Depersonalization Disorder, to be out of this world. Never caught a clue!

This isn’t old age, I believe. It’s blindness, coexisting compatibly with clear sight, even x-ray sight. I’m not sure what to do about it other than import a bunch of conventional categories into my diagnostic interview, a wider range of Mental Status Exam questions into the simple “biopsychosocial” interview. But I deeply resist doing that: It’s impersonally clinical, and I am creating a relationship of discovery and care from the start. I feel stuck, slightly helpless. I feel like saying to new people: “Don’t fool me, God damn it!” Don’t hide your problems in your pleasant person­ality, in your attractiveness.

Yours truly: an old dog learning old tricks at age sixty-nine.