Psychiatrists are interesting creatures (interesting when you aren’t court ordered or blackmailed into seeing them in which case harsher words appropriate). I have always been fascinated (and sometimes enraged) by the power dynamics of the ‘therapeutic’ relationship. Power is imbedded in patient-therapist discourse in a very literal way making the deconstruction of power relationships easier. There is a passage in Jean Paul Sartre’s “Nausea” which does a beautiful job of characterizing the arrogance of many (but not all) psychiatrists and the power dynamics of therapy. Thought I’d share.

‘What will you have, Doctor?’

                He studies her gravely. That’s what I call a handsome face. Worn and furrowed by life and passions. But the doctor has understood life, mastered his passions……

                He looks at the little man with fierce eyes. A direct gaze which puts everything in its place. He explains:

‘He’s an old crackpot, that’s what he is.’

                He doesn’t even take the trouble to show that he’s joking. He knows that the old crackpot won’t take offence, that he’s going to smile. And sure enough, the other man smiles humbly. An old crackpot: he relaxes, he feels protected against himself; nothing will happen to him today. The queer thing is that I feel reassured too. An old crackpot: so that was it, that was all.

                The doctor laughs, he darts an engaging, conspiratorial glance at me…..I don’t laugh, I don’t respond to his advances: so, without stopping laughing, he tries the terrible fire of his eyes on me. We consider each other in silence for a few seconds; he looks me up and down with half closed eyes, he classifies me. In the crackpot  category? Or in the scoundrel category?.....

                He has all the best wrinkles: horizontal bars across the forehead, crow’s feet, bitter creases at both corners of the mouth, not to mention the yellow cords hanging under his chin. There’s a lucky man for you: as soon as you see him, you say to yourself that he must have suffered, that he is a man who has lived. Moreover, he deserves his face, for never, not even for a moment, has he misjudged the way to keep and use his past: he has quite simply stuffed it, he has turned it into experience to be used on women and young men.

                Monsieur Achille is probably happier than he has been for a long time. He is agape with admiration; he drinks his Byrrh in little sips, puffing out his cheeks. The doctor certainly knew how to tackle him! The doctor isn’t the man to let himself be fascinated by an old crackpot on the verge of having an attack; a good tongue-lashing, a few brusque, cutting words, that’s what they need. The doctor has experience. He is a professional in experience: doctors, priests, magistrates, and officers know men as thoroughly as if they had made them.

                I feel ashamed for Monsieur Achille. We are of the same sort, we ought to make common cause against them. But he has left me, he has gone over to their side: he honestly believes in Experience. Not in his, nor in mine. In Doctor Roge’s. A little while ago Monsieur Achille felt peculiar, he had the impression of being all alone; now he knows that there have been others like him, a great many others: Doctor Roge has met them, he could tell Monsieur Achille the story of each one of them and say how it ended. Monsieur Achille is simply a case, and a case which allows itself to be easily reduced to a few commonplace ideas.

                How I should like to tell him that he’s being duped, that he’s playing into the hands of self-important people. Professionals in experience? They have dragged out their lives in stupor and somnolence, they have married in a hurry, out of impatience, and they have made children at random. They have met other men in cafes, at weddings, at funerals. Now and then, caught in a current, they have struggled without understanding what was happening to them. Everything that has happened around them has begun and ended out of their sight; long obscure shapes, events from afar, have brushed rapidly past them, and when they have tried to look at them, everything was already over. And then, about forty, they baptize their stubborn little ideas and a few proverbs with the name of Experience, they begin to imitate slot machines; put a coin in the slot on the left and out come anecdotes wrapped in silver paper; put a coin in the slot on the right and you get precious pieces of advice which stick to your teeth like soft caramels…..

                They would like to make us believe that their past isn’t wasted, that their memories have been condensed and gently transformed into Wisdom. Convenient past! Pocket-size past, little gilt-edged book full of fine maxims. ‘Believe me, I’m talking from experience, I’ve learnt everything I know from life.’ Are we to understand that Life has undertaken to think for them? They explain the new by the old – and the old they have explained by the older still, like those historians who describe Lenin as a Russian Robespierre and Robespierre as a French Cromwell: when all is said and done, they have never understood anything at all…behind their self-importance you can distinguish a morose laziness: they see a procession of semblances pass by, they yawn, they think that there’s nothing new under the sun. ‘An old crackpot’ – and Doctor Roge thought vaguely of other crackpots, without being able to remember any one of them clearly. Now nothing Monsieur Achille can do will surprise us: BECAUSE he’s an old crackpot!

                He isn’t an old crackpot: he is frightened. What is he frightened of? When you want to understand something, you stand in front of it, all by yourself, without any help; all the past history of the world is of no use to you. And then it disappears and what you have understood disappears with it.

                General ideas are more flattering. Besides, the professionals always end up being right. Their wisdom recommends you to make as little noise as possible, to live as little as possible, to allow yourself to be forgotten. Their best stories are about headstrong characters and eccentrics who have been punished. Why yes, that’s how it happens and nobody will say anything to the contrary. Perhaps Monsieur Achille’s conscience is a trifle uneasy. Perhaps he is telling himself that he wouldn’t be like he is if he had listened to his father’s advice or his elder sister’s. The doctor is entitled to speak: he hasn’t made a failure of his life: he has known how to make himself useful. He rises calm and powerful above this piece of flotsam; he is a rock.

Satire and sarcasm at its very best!