August 20, 2008

Psychiatry and Literature

My MLS in library science has probably enabled me to help more patients than my MSW in social work. Shrinks put DSM numbers on people; librarians only label the book. Matching someone up with the perfect book for his present crisis can save years of meds and shrinkage. A friend of mine, who is the psychiatric social worker at Montifiore Hospital in the Bronx has an office full of books. Chris says lots of patients unknowingly come to his ER for the best book for them in read in the present crisis in their lives. They don't need admission. I do know there is some magic in making the client/book connection. A high school librarian characterizes librarians as the last alchemists.

Rarely explored is the role that a common literary experience plays in therapy. If a client refers to particular books, poems, songs, I would try to track them down. If I didn't have time to read them, I at least skim them long enough to understand the basic themes or characters.

I always pay careful attention to the books my clients carry into the session. That is my first question. "What are you reading? Can I see the book? I gget my best book recommendations from my clients." I love it when clients ask me my favorite novel. During my initial intake, I ask them if they have a favorite novel. I often ask them what they are reading if I know they are readers.

I had two clients who were reading the same novels as I was. I am comfortable revealing the coincidence since I think it indicates a strong therapeutic alliance. If a client brings up a movie she has seen this weekend and I saw it too, I would certainly reveal that. Some rather strict Freudians would rather spend the session analyzing why the client needs to know what you are reading and seeing, rather than answer a simple question.

In my experience, just as clients of Freudians have Freudian dreams, clients of Jungians have Jungian dreams,clients of therapist/ librarians spontaneously talk about books.

In my 20's I was a supervisory editor for Basic Books, the American publisher of Freud and many other psychiatry books. The psychiatrists I encountered were mostly refugees from the Nazi's. They were immensely cultured, learned men, deeply committed to music, literature, and art. Too many psychiatrists today are narrowly educated pill pushers who are ignorant of the classics of world literature. Patients could go to a psych ER, give the name of their favorite literary character, recite the plot of the book as their symptoms and be admitted as a paranoid schizophrenic. Maybe this could be a successful reality show for English majors.

I have gone to psychiatric conventions and introduced myself as Dr. Jane Austen. It pains me how few shrinks get the joke. In my generation, not knowing Jane Austen meant you hadn't graduated from high school. All the drug reps get the joke however, and are delighted at more evidence of shrink's ignorance.

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