0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Introspections   |    
The Importance of Cookies
Jonathan Benjamin, M.D., M.H.A.
Am J Psychiatry 2009;166:1110-1110. doi:10.1176/appi.ajp.2009.09040480
text A A A

Almost a year ago I was working briefly as a roving consultation-liaison psychiatrist in primary care clinics. I was called by a family physician in despair about a middle-aged man with a drinking problem. The patient, a skilled technician, had been repeatedly sacked and was currently unemployed. His wife was at her wits’ end. The family physician and I agreed to see them together.

When I arrived, an air of defeat already pervaded the room. Yet Mr. A himself seemed a really sweet person. His wife did her best to be helpful and factual, rather than angry and judgmental. We reviewed the facts: Mr. A had only begun drinking noticeably in his early 40s: first it was social drinking, but then he would drink more than his friends; then he began to drink alone on his way home from work, then on the way to work as well. He had already had convulsions during withdrawal, and his “liver enzymes” were elevated.

Mr. A, who showed problems with short-term memory, alternated between trying to minimize the problem and promising to reform. The physician had clearly been through this before. Mr. A: “Doctor, I’ll come every other day to the clinic so you can smell my breath; you’ll see I haven’t been drinking.” Dr. B: “Oh, Mr. A, how many times have you made me these promises?”

Suddenly I had an idea. I said, “Mr. A, I like the idea of your coming to the clinic every other day, but I do not like the idea of your reporting in disgrace. How about if you learned to bake a little? On every visit you could bring the team a cake or cookies you’d made.” (The clinic had about 15 staff members.) “You could also do a little clean-up in the kitchenette, or sort some mail. That way we could all pretend you were volunteering, and not just on parole, as it were.”

The couple agreed to try, and I went back to a regular clinical and administrative job and forgot the incident. The other day, at a professional meeting, I ran into Dr. B. He told me enthusiastically that Mr. A had been sober for 8 months and had a new job. His wife was thrilled.

I felt a real rush of warmth. It is not every day we see a “quick cure” in psychiatry. Even if this one is not long-lasting, the patient and his wife will have enjoyed a few more good months or years together. But why was the intervention helpful (if it was the intervention that helped)? Was it my empathy with his status as “the accused”? Did the family physician’s despair finally break through to him? Was it some combination of these? Perhaps it was the cookies.

Address correspondence and reprint requests to Dr. Benjamin, Sherutei Briut Clalit, 52 Tzahal St., Haifa 35515, Israel; zola@netvision.net.il (e-mail). Introspection accepted for publication April 2009 (doi: 10.1176/appi.ajp.2009.09040480).

+

References

+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Articles
Books
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 9.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 33.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 49.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 28.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 2.  >
Psychiatric News
APA Guidelines