Category: Psychology

Caretaker versus Doctor

It is not unusual for me to deliver a particular admonishment to family and patients.  Sometimes people need a simple reminder; others need a figurative beating about the head and shoulders.  This warning is critical to the care of the people we love.  The essence of the advice is this-function as a caretaker rather than as a doctor when treating a loved one.

The definition of a human being invariably dwells on our fragile and temporary existence.  The most primitive of tribal cultures always includes a medicine man to counter this fragility.  Whether the setting is composed of desert nomads or slick urbanites, people consult specialists that smooth and extend their existence.  Once the specialist is consulted, patients arrive at their own decisions regarding treatment.  The specialist consulted may be termed an internist or shaman, yet both are healers that direct our behavior in pursuit of health.  The mission of all health specialists is to provide specific directions for others to follow.  Whether the treatment is eagle feathers or a new drug, the aim is to cure sickness and extend human life.  Neither the shaman or internist provide day-to-day physical or emotional care.

Most family members of ailing patients want to be as helpful as possible, and this is where the trouble begins.  Caregivers may cajole or force a loved one to comply with the directions of the health specialist, and find themselves ostracized by the one they are seeking to help.  There is no guarantee that the behaviors proscribed by the health specialist may cure or even be helpful.  Most long-term follow-up studies of actual patient compliance hover around five percent after one year.  Stated another way, ninety-five percent of people do not follow doctor’s orders.  Most people take more or less drugs than proscribed, and rarely comply with non-drug behaviors suggested by the physician.  The caretaker who is frustrated with their loved one’s lack of compliance are very likely to be poorly compliant themselves.  It’s good advice for the other guy.
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All doctors can be replaced, though all caretakers are not replaceable.  Parents often comment that “I’m just a mother or father” when confronting disease in their children.  This often gives voice to the parent’s sense of helplessness and feelings of inferiority to the specialist.  The response I frequently employ is, “There are many doctors, but you are the only mother there will ever be.”  The emotional support of a mother, father, husband and wife are indispensable and irreplaceable.  Strangers may provide excellent physical care, but their actions do not have the emotional importance of close relations.  Occasionally I will turn the phrase around, stating to the parent, “I’m just the doctor, you’re the parent.”  It is an effort to reinforce the importance of the caregiver’s emotional support.

Even if you are a health care provider, do not fulfill that role with your loved ones.  There is no shortage of opinions regarding our health, but there is always a shortage of love and support when the chips are down.  Nagging a loved one into compliance with the doctor is more likely to result in bitter feelings than better health.  Such nagging may be taken as a need to control, rather than the need to see the patient regain their health.  As a parent, best friend or spouse, remember that the relations built over a lifetime cannot be replaced by a stranger-no matter how educated and skilled.  The non-specific factor in all forms of recovery is love and support.  Leave the specifics to the specialists.

Psychology and the Casey Anthony Trial

To view the psychopathology of other people can be alluring.  It makes us feel better about ourselves in comparison.  It may school us on the type of people to avoid.  It can satisfy the disturbing need to view a bloody wreck.  Perhaps it is sheer voyeurism that makes the Casey Anthony trial so fascinating.

Other trials have caught the public’s attention.  Dreyfus, Scopes and even Simpson appeared less concerned with psychological details than the Anthony trial.  The psychological status of the defendant at the moment of the crime seems increasingly important in recent history.  Perhaps it is a mitigating factor that should be considered.  On the other hand, establishing the psychological status of a person in the recent past is difficult, let alone the distant past.

Neglecting the past altogether,  it is difficult to capture the current psychological status of an individual.  The use of multiple tests and informants greatly increases accuracy and reliability.  This is assuming the defendant and informants have no motivation to deceive.  Consider a situation where the defendant and witnesses have strong motivation to lie about their history and  past psychological status.  Now paint an accurate picture of the defendant’s psychological status at a specific moment in their past.  Finally, avoid any bias in the interpretation of the defendant’s behavior, secondary to the awareness of the report’s possible ramifications.

Establishing causal links between past behavior and psychological status is fraught with error.  Factors unknown to anyone, including the guilty, may play a role.  Merely because an action is improbable does not make it impossible, and psychological tests search for the probable. The evidence of forbidden behavior may remain deeply buried within the brain of the guilty.  It may be buried on purpose, or as a consequence of trauma.  Depression and substance abuse may distort recollection, even when well-intentioned.  Unfortunately, psychological tests are not able to completely pierce the fog of deception, examiner bias, amnesia and random acts of criminality.
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The Anthony trial is certainly a compelling mystery.  To watch it unfold before one’s eyes is to be quickly seduced.  The public is invited to take a peek through the window of a family in free-fall.  The tension is  pleasant because we will not suffer any consequences.  The public are free to be voyeurs that need not fear the police.  We can slowly view the wreck in progress, without holding up the people in the rear.

Suicide, incest, murder and substance abuse have been mentioned as symptoms of this diseased family.  The focus is not on the treatment of their malady.  The focus is on the eradication or isolation of the pathological agent.  The mission is less one of research and discovery, than one aimed at assigning blame.  Punitive measures are employed rather than reinforcing the healthy bits that remain.  The pathological agent will be destroyed or isolated, and the body of the family will be left to decay.

The Casey Anthony trial is a psychological phenomenon that invites a voyeuristic public to take a peek at this diseased family.  The psychological factors that attract viewers may speak to a disease that infects the public at large.  The degree to which diseased behavior in one person causes subsequent criminal behavior in another person is highly subjective.  Making assumptions about this person’s psychological status at a specific moment in the past is nearly as subjective.  Whether to watch the Casey Anthony trial is the most subjective choice of all.