The Unconscious Doctor
In pain. Scared. Terrified actually. Heart racing, blood pressure elevated. Slightly clammy. Moving from states of association to disassociation. In and out of my body. Eyes darting around the room. Bright lights. The buzz of the aircon. Hard plastic chair under my butt. Jiggling my left leg, unconsciously trying to discharge the increasing sense of danger inside me. Keeping it together. Clenching my jaw, muscles in my pelvis, neck and shoulders. All switched on without my knowledge. I don’t want to be here. But I need to be here. I don’t know what is going on inside my body. But I know I need help. I hope this doctor can make me better. Tell me what’s going on. Give me some pill to make it better. Help me feel a little less scared. Swallow the lump in my throat, push the rising tears back down. Take a deep breath. Remind myself not to come across as crazy. Tighten my jaw a little more in the process. Fake smile.
‘Hi Doctor.’
All of that before the consult has even begun. A deep threat response. A fragmented psyche. An internal external disconnect. Suppressed emotions and the unvoiced request to please please please help me.
Doctor looks at his screen to see my patient details, that I filled in outside in his cold reception area.
Every time I fill in one of these forms, I contract a little more, my grief rises in my chest, and then I stuff it back down and the light in my eyes becomes a little dimmer. Symptom after symptom. All these things wrong with me. Not healthy. Sick. A bad apple. Useless. Stupid body. A waste of space. Lists of medications reminding me how damaged I am. I sheepishly pass my form to the receptionist. Some of these ladies are very nice actually. They take time to smile and ask how I am. They must feel so sorry for patients like me. They are quiet as they look at the form and input the information into the system for the doctor. Occasionally looking up to share a sympathetic smile. Depending on the day, I can smile back and engage in fake chit chat. Sometimes, the sweet pity I feel radiating off them, activates my own self-pity. Pathetic. I am pathetic.
Doctor continues to look at the screen as he begins to talk. I may as well not be there. All I am to him is my patient history in the computer. I look down at my lap as he recites my symptoms and medications. Yup, I’m paying for this. For this highly educated man to look at his screen and tell me what I wrote down 30 minutes ago in the next room. I feel bubblings of anger in my stomach and my heart drops in my chest. He is not gonna be any different than the other doctors. I already know. Hopeless. I push the emotions down and exit my body and continue to watch the consult from a less offensive vantage point; up in the corner of the room.
Doctor finally looks up from his screen and surveys me with squinty eyes. I am forced back into my body as my heart rate elevates further and my entire body braces. Why is he staring at me like that, with his evil eyes?
There is usually an evaluation at this stage. A comment that sums up his impression of me.
You don’t look so bad, or you look very pale. Your weight is too high or you look too skinny. You’re too young to be this sick. Or the worst question: Are you experiencing depression?
These comments are all non-medical. These are cursory judgements based on a single fucking glance from a man with no idea who I am or what I have been through. And these make me feel more broken than ever. More shame than before. But I can take it. I am used to feeling broken and shame. Common-place these days. Part of who I am. But to question my state of depression? Are you fucking kidding me? Of course I am depressed! I am in pain, I have mysterious symptoms that you and every other doctor I have seem can’t help me with! I can’t function like a normal human. Everything is hard. My life sucks! And you are asking me if I am depressed? And I think your subtext suggests that this could be the cause for my mysterious symptoms! Fuck you doctor!
My screams live silently inside me. My physical pain surges.
As my whole body transforms into a suit of armor, I quiet the fire in my belly. I feel my eyes turn stone cold. And I simply utter: ‘No. I’m ok. Not depressed.’
If I share my truth, my utter desolation, apathy, anger, fear and grief, I’ll be dismissed for sure. Sent off to a shrink, doped up on uppers, downers, equalizers. And left for dead.
It is not ok to say how I really feel. I have learned this very well.
Doctors like a fighter. They like a good stoic patient who doesn’t make a fuss. Who takes her pills like a good girl, and comes back for the next scheduled appointment. They like a patient who exists only in 15 minute intervals and does not bleed into another patient’s time, or into the greater space between appointments.
The doctor-patient relationship is ripe for paternal transference. For a girl who wants daddy’s approval. To be a good girl. To be seen and not heard. For a girl who will never be good enough. Never be well enough. Never be loved enough. The feelings of worthlessness and abandonment echo in the unconsciousness and leave a metallic taste in my mouth.
Unconscious is right. All I know is that I feel like shit. But I need to press on. I need this doctor’s help. I can’t manage alone. I have a growing sense of anxiety that I cannot consciously connect to the fear of abandonment and a disorganized attachment style. (Help me daddy, don’t leave me daddy. I cannot survive alone daddy. I hate you daddy. You are cruel and mean and will never give me what I need.) There is a part of me that feels wild. And there is a part of me back up on the ceiling looking down at myself.
I have 15 minutes.
15 minutes to try and let doctor know that I am not Ok, that my symptoms are worse, that my pain is not manageable. 15 minutes to try and give him enough information to set me on a better trajectory for recovery, or at least a better quality of life. 15 minutes to save my life. But I must not let him know how a little piece of my heart is dying and another little piece of my heart is already dead. Or that a part of me is disassociated and up on the ceiling and that pretty much all of me is terrified and that I just want to lie down and go to sleep and have my hair stroked and for this all to be over; as if it were some bad dream. I cannot stand it! I must not let him know that when he glares at me, or tells me what I am, that I shatter into a thousand fragments and piece myself back together with silly putty, just in order to open my mouth and say I’m ok. I must not tell him that he is both my hero and my villain. In fact, I don’t know any of this. All I know is I have 15 minutes.
So I send all my messy unfelt feelings down into the depths of my soul. I take a breath and say exactly what I need to say so he can help me.
Like a drone, I list my symptoms, the ones that are worse on a scale of 1-10. So he knows what to do.
All he can do is issue me a script for some medication, to make the pain go away, so I can cope a little better. A little longer.
That’s all doctor can do.
If only he knew, what was going on inside. But it isn’t safe to let him know. Because I will be crucified.
I thank doctor for my script.
‘See you in 2 weeks doctor.’
Nothing has changed. I am still stuck inside myself. Suck with these physical symptoms. Feeling wild, fragmented and terrified. I pop a pill and accept my little lot. My inner light dims a little more.
Regardless of origins of relational trauma, there is an emotional element to complex health conditions. Complex or chronic illness in themselves can be traumatic, as quality of life is often affected when patients experience overwhelming physical changes. For many patients, there is an experience of hopelessness and shame about their condition that go unvoiced. For some, there is deeper emotional content that goes back to either early attachment and/or experiences of trauma. The doctor-patient relationship is one in which a clear power dynamic is at play. The psychology of both the patient and the relational dynamic is not often considered by medical professionals. While I am not suggesting that doctors take on the role of psychological processing, I question what would happen if there was more education around this for medical professionals. Some questions to ponder:
Could the doctor tune into the patient a little better?
Could the doctor help to reduce the patients sense of fear, simply with a moment or two of human connection, that is not focused on the medical condition?
Could the patient feel safe enough to express their truth, without fear of retribution (in this case being categorized with a shameful mental health label)?
Could questions be asked that help perhaps identify opportunities for support that goes beyond medication? Psychotherapy, Down-regulating touch therapies, Myofascial release, Movement, meditation? And could this be done in a way that does not attach a shameful stigma and detract from the existence and reality of the physical condition?
Could we find a better path to integrated recovery if we knew what was really going on inside?
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Natalia Rachel is the Director of Soma Clinic and works with complex health and trauma recovery. Through her own experience of complex illness and recovery, she holds an empathetic position as a therapist. She now creates safe spaces for recovery through authentic relating and re-integration of the fragmented self. Natalia Rachel has a strong interest to increase awareness about the psychological experience of complex health patients, with a view to improved patient care.
