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Introspections   |    
The Force That Through the Green Fuse
William Houghton, M.D.
Am J Psychiatry 2009;166:651-652. doi:10.1176/appi.ajp.2008.08101583
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The bench in my waiting room is full. I glance at the patient record on the laptop, put it in suspend mode. Once memory is stirred, it brings up much more. Psychiatry is a juggling match between my left and right hands: the effort to be exact on the one side, the pulling of wayward emotion on the other.

George has come once a year for 10 years. He comes for the script of an antipsychotic pill that he breaks in half, or quarters, and takes according to his own recipe—part pharmacology, part economics, and part magic. Years ago he stared at me with wide-eyed suspicion, said little. Today his eyes move easily around the room and back to me. He smiles, complains of his lousy job, and if I remember to ask, talks of the charcoal sketches he does at home.

Catherine is a 70-year-old obsessive widow dried up to a wrinkly husk. She obliterates me with the minute details of her house, devoid of any live emotion. My smile grows fixed and I dream of my upcoming break, the weather on the 5-minute walk to the coffee shop. “Nice talking to you,” I say. (Hard work, this.)

Next: Jon is soaked in 30 years of vodka. Been through years of flossy inpatient programs, and none of them quite took. He used to say he was a drinker, yes, but not an alcoholic. Now he admits he’s an alcoholic but there’s no help for it. He comes for the benzos that ease him through the night, though he flatters me that I’m the one friend he can trust to talk with. He brings a carefully rehearsed joke (I laugh a little harder than it is worth). I wonder if I do him good or ill. His bottle is his baby, his one true friend.

No Julie on the bench. For 10 years we were fellow travelers. Then despite my best caring, she saw me along with her family as transformed into evil, and she disappeared. Five years later a postcard arrived, asking why I did her wrong, the card dropped in a mailbox in a small town on the coast of Oregon. Traced, she does not live there. I picture her walking the foggy streets of Seattle. No Julie will come to my waiting room again.

Karen is here. She blares insults at her family and neighbors and now at eBay customers. When she was a small girl, her father sold her to the men at the bar. Twenty years ago she led a street gang and stole Harley-Davidson motorcycles (an inferior product but quite marketable, she said). She used to live on the street, but for the last 8 years she has lived with a man, and now for the first time they are buying a mobile home, a solid place with a foundation and a big yard in a park. She plans a housewarming party. I cannot hide my joy.

Peter joined a therapy group of mine several years ago, telling the others he was too afraid to approach women. The spastic muscles and scissors gait of cerebral palsy did not stop him from using his good brain as the editor of a magazine and playing piano in a trio. Given some group support, he was off on a series of affairs with dazzling, needy women. He loved them—they sucked him dry. He quickly learned that stability is the key requirement. After he left the group, I got a phone message he was getting married and an expectant father. Now he’s here with a sensible woman, voice strong, and a bassinet with a 6-month boy. The child is flawless, asleep with a crooked smile. I cannot take my eyes off him.

When I first meet someone, I know nothing and I see nothing of the root, the branch within.

Ditto Patty. Ten years ago she sat in the corner, barely audible, now married and confident. She swings one of those space-age capsule cradles by two fingers, carefully tuned to the 4-month girl, Sydney, within. I lean over to Sydney. Her eyes lock on my face and she grins. Her mother says, “I never knew my heart could be so big.” (I know what she means.)

The psychiatry resident I supervise rushes in clutching the mammoth volume of Hales/Yudofsky/Talbott. (Does he consult it in a session?) He is entering psychoanalysis and certain this will generate an all-new invulnerable version of himself. (No need to break the spell yet.)

A woman on the bench in the waiting room stops me to say, “I’m Marion Schultz. Your father delivered three of my children and took care of my mother. He was so kind.” I thank her and feel again I am up to my eyeballs in Wisconsin here.

Next a worried woman says, “My family doctor is not in the plan, so they cannot refer me to the endocrinologist.” I grunt but can think of little to do. These rules in contracts, these lines in the sand, are not my boundaries. What keeps me seeing patients, drives me, is something else. No, what keeps me going are all these wise fools drenched in hope and my chance to share in it with them.

The force that through the green fuse drives the flower

Drives my green age, that blasts the roots of trees

Is my destroyer.

—Dylan Thomas

Address correspondence and reprint requests to Dr. Houghton, 819 N. Cass St., Milwaukee, WI 53202; puck1595@worldnet.att.net (e-mail). Introspection accepted for publication December 2008 (doi: 10.1176/appi.ajp.2008.08101583).

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