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|Clinicians Digest Mar/Apr 2008 - Page 8|
My Psychosis, My Self
Psychiatrist Michael Garrett, professor of clinical psychiatry at the State University of New York Downstate Medical Center, believes it's important for his psychiatric residents to understand that psychotic thinking falls along a cognitive and emotional continuum they share with their seriously disturbed patients. "If you want to have a real conversation with a psychotic person," Garrett says, "you have to believe and feel in your bones that you're genuinely respecting the person's experiences, and not just diagnostically labeling and pigeonholing them."
In a series of exercises, Garrett puts psychiatric residents in touch with their own thoughts and perceptions that offer analogies to psychotic states, and then explores and deepens them. Imagine, he tells the residents, you're on your way out the door and suddenly realize you've got to make a quick phone call. After the call, you get into your car, drive a few blocks, get caught by a red light, and while you're stopped, a friend whom you haven't seen for 10 years crosses the street right in front of your car. You realize that if you hadn't made that phone call, and if it hadn't lasted exactly as long as it did, the two of you would have missed each other.
Garrett asks the residents if they've ever had a similar experience, and several invariably have. They recall having briefly thought at the time about things like fate, feeling the subtle pull on the mind of some process—benign or, in the case of paranoia, malevolent—operating beneath the surface of things. Then they recall talking themselves out of their irrational thoughts by accepting the randomness of coincidence or mulling about the statistical probability of the encounter. "Now, what if such things happened to you weekly or even daily?" Garrett asks. "What if you couldn't talk yourself out of your irrational thoughts?"