Writing: A Pathology?

The young doctor had a whimsical cartoon of the human brain over the words “thinking cap,” framed and hanging by the door of his office. I liked it better than the small oil painting on the other wall, and the giant, sensuous Georgia O’Keeffe flowers in the otherwise sterile labyrinth of the Jefferson University Hospital outpatient psychiatry department.

Why is only one person in the psychiatrist's office allowed to take notes? (Photo by Roger H. Goun, via Flickr/Creative Commons)

“Why are you looking over there?” he asked as soon as he had settled into the chair at his desk, opened my manila chart, and swiveled around to face me, perching on a tasteful olive-colored microfiber loveseat with matching white and green pillows.

I was tempted to do my best Haley Joel Osment face and tell the doctor that this building used to be a courthouse. Is it fair to say that only a psychiatrist would hang an appealing picture on the wall and then ask why you are looking at it?

But especially when you’re just a few weeks out of the hospital, you have to be careful with shrinks you don’t know — a lot of them don’t appreciate humor, at least from patients. And yeah, I mean the hospital with locked wards, no shoelaces, and bathroom mirrors that are actually shiny metal sheets bolted to the wall.

A real live mental patient

One psychiatrist said I had adjustment disorder, and another called it depression. I called it the desperation of months of agony from the black, bulging discs on my lumbar MRI. But for four days and several thousand dollars, my brain was the psychiatrists’ very own neurochemical experiment.

I was so well-spoken, one of my attending MDs told me. Would I mind giving an interview to some students, since I could express myself so much better than most of the other patients?

Since my attending doctors were all off tormenting someone else (excuse me; “taking a team approach”) when a saucer-eyed first-year med student named Cody knocked on my door, I grinned from my hospital bed, where my knees were raised to keep pressure off my spine.

“Hi, Cody,” I intoned. “I’m a real live mental patient.”

Because I do have a 20-year history of depression and have been in treatment for over a decade. In my experience, a lot of psychiatrists make you feel like the only thing you have to be proud of is the fact that you haven’t actually attempted suicide.

Not that I judge people who have.

“What are you writing?” the Jefferson psychiatrist asked, cutting through my thoughts after I had recited my health history. He sounded uncomfortable. I had brought my reporter’s notebook into our session, to take notes, the way I always do — on trains and planes, at plays, movies, trips abroad, and yes, hospitals. No other doctor has ever minded my bringing a journal, and my editors don’t complain, either — I publish a couple hundred articles every year.

But the Jefferson psychiatrist was a pretty good one: sympathetic to pharmacological side effects, pleasantly deadpan enough for me to believe that nothing would surprise him, but with questions that were timely, nuanced, and tailored enough for me to know that he was smart and he was listening.

Telling the truth (oops)

So I was honest with him. I admitted my long history of clinical depression, and my conviction that inpatient treatment was a very bad call because of how important my work is to me. How grateful I am that physical and mental illness don’t prevent me from doing work I love, and doing it well. How writing is often the only thing that quiets the black storm inside my head.

The good doctor took me off the hospital meds that had paralyzed my guts for weeks. He said I was obviously a “highly functional” individual and declared my disorder treatable through psychotherapy.

So what is wrong with me?

“Has anyone ever talked to you about a borderline personality disorder?” he asked, stretching back a bit in his chair.

No, not like multiple personalities, he added. (And I don’t judge that, either.) I am not Broad Street Review’s associate editor on some days and a different person on others. Instead, I have coping mechanisms that aren’t constructive, the doc explained.

“OK, so what is it I’m coping with?” I asked.

“After only one session? How should I know?”

Specifically, he added, my psychological history points to an obsessive compulsive personality disorder.

“So in your opinion, what obsessive compulsive behaviors do I exhibit?”

“Well, there’s the writing,” he said.

Shit.

A compulsion or a career?

An hour on the internet provided, if not a spotlight, at least a battery-powered flashlight. Workaholic habits, a hyper-intellectual orientation, embarrassingly frequent mental hamster-wheels, aversion to emotional displays, perfectionism, an eye-roll inducing devotion to ethics, and a burning desire to get my words exactly right all the time? Well, yeah.

But a rigidly controlling attitude, a refusal to adjust to others’ working styles, hoarding items of no sentimental value, and getting so bogged down in the details that I can’t complete tasks? Not so much.

Especially in the days of WebMD, I guess no diagnosis is a total bull's-eye.

There are a lot of things I wish I could explain to my latest psychiatrist, like the abject comedy of seeing my well-worn reporter’s notebook as pathological, when he charges over $400 per session (perhaps he could try freelancing and see if writing a lot signifies a mental disorder). I wish I could explain that, since I was ten years old, I’ve needed to write almost as much as I need to eat and sleep, and that to me, writing is as consuming and illuminating as it is soothing.

How often does your best bad coping mechanism coincide with a way to make a living that you absolutely love?

I’m not afraid to admit that I have major depressive disorder. And if nothing else, an obsessive compulsive personality disorder, while a tad weird to process and sort of terrifying to admit, is an interesting new lens to try on the habits that drive my family bonkers. Off to therapy I go! (Again.)

I know myself. I know a lot of writers. And I always figured psychiatrists, with their lucrative jobs, imposing status, relatively normal working hours, and plush, well-decorated offices, would put us ragtag writers in the Diagnostic and Statistic Manual of Mental Disorders one way or another.

Or is that my illness speaking? I guess we’ll never know. This article, at least, is finished.

Our readers respond

Craig Meritz

of Philadelphia, PA on May 28, 2014

Insightful and well written. Reveals the Dr. Dilemma. Two Docs, 3+ opinions. And in Psychiatry / Psychology, it has to be much worse. Clearly because no two people are alike. For Example: Coping with Pain. Some people try to smile thru it. Some people get angry and withdraw. Some get angry and want to share. I'm speculating you fall into that last category. Now you, as does everyone, have to figure out how to deal with it. Hopefully with help from friends, family and the occasional professional.

Susan Washburn

of Taos, NM on May 28, 2014

Great article. I posted it on Facebook for my writer friends with the comment that your self-knowledge was a mark of extreme sanity. As is your sense of humor. And the OCD and black moods? The former is a requisite for self-editing and the latter is a spur (albeit a painful one) to creativity. I'd say the psychiatrist might have a pathological need for structure and categorization.

Dan Rottenberg

of Center City/ Philadelphia, PA on May 28, 2014

All of us have psychological issues. Many if not most psychiatrists enter the field in order to work out their own issues. But few of us possess the courage that you've demonstrated in discussing your issues so openly. In so doing, perhaps you'll embolden others to tell their own stories and, in the process, help reduce the stigma associated with mental illness.
As for taking notes: Psychiatrists aren't the only people discomfited by note-takers. Doctors, politicians, business executives, actors, auto mechanics, sidewalk drug dealers— just about everyone adjusts their behavior in the presence of a note taker. Quakers call this phenomenon "Christian witness"— the process of deterring bad deeds just by observing and recording. When I used to walk Town Watch, the street corner hustlers would scatter whenever I whipped out my notebook, even though I was merely scribbling gobbledygook. Try it sometime— it works!

Alaina Mabaso

of Elkins Park, PA on May 28, 2014

Thanks for your responses. Craig, I believe I and probably a lot of people go through all three of those pain coping mechanisms at different times. Just depends on the day.

Very true that doctors do like to categorize us, when most of us just won't fit into any one category (especially these wacky creative types). Whatever my true diagnosis is, I know I want to keep writing, and that's enough.

Roz Warren

of Bala Cynwyd, Pe on June 04, 2014

I tweeted this. Does this mean I'm crazy too?

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