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Who's The Crazy One: Dealing With Psychiatrists

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There was an episode of Larry David's Curb Your Enthusiasm in which Larry felt it necessary to discontinue therapy as a result of running into his therapist on the beach and seeing him wearing a thong bikini. Not quite as dramatic, last summer my wife and I pulled into the parking lot at our local pool; Shari went in ahead of me and unwittingly set up our spot right next to the new psychiatrist I had just started seeing, primarily for a meds consult. In our first session, however, when I mentioned that I was also seeking a psychotherapist, he declared himself a "One-Stop Shop," and told me that he'd been trained as an old-fashioned, lie-on-the-couch, Freudian psychoanalyst. Since psychoanalysis normally requires three to five sessions a week, I knew it would be way beyond my limited mental health co-pay. Nevertheless, since he was presenting himself as more than merely another Eli Lilly franchise, I began sharing the details of my intimate story with him, drawing on my years of experience and skill as a professional therapy client.

Then his cell phone rang.

And then he actually answered it, after a word of explanation to me: "It's my residents." As if I would think, Oh, it's your residents, then by all means, of course you have to take the call! When his conversation was over, he explained that had he not taken the call, he would have had to play phone-tag all day, and his residents would have "freaked out." Furthermore, he said, I shouldn't feel slighted, and I too should feel free to take calls during our sessions, and in that way, it would be a "win-win situation." Oh, sure, I thought. I'll take an hour out of my day and pay you a fee, open myself up and pour my heart out, and then stop midstream to either listen to you talk to your residents or else take a call myself from my friend Marty in California, who is often apt to call me in the middle of the day to ask if I've ever heard the solo album by the deceased Dennis Wilson of the Beach Boys, or something equally urgent. No, I don't think so.

Fortunately, my brother is a psychologist, my brother-in-law is a psychiatrist, and therapists, counselors and social workers abound among my close circle of friends, so I did a quick e-mail poll about the incident. I received responses ranging from my brother's unequivocal advice that I "Dump him immediately. It is unethical and unprofessional," to my take-responsibility-for-everything Landmark Forum friend who said, "You can use the situation to look at your own feelings about it, and negotiate an adult relationship with him." Several others suggested that I think of him solely as a medication dispenser, not a therapist, and just roll with it for now. I opted for the negotiation approach, and called him to request that, barring emergencies, he not take phone calls during our sessions, and he agreed.

But then I saw him at the pool (thankfully, not wearing a thong.) His only interaction with me there was an attempt at humor: "I'm on call, so my beeper might go off while I'm at the pool," sort of making light of my request, which some of my poll-people would have undoubtedly deemed inappropriate as well. The rest of the afternoon we managed to act as if the other didn't exist, even as we kept swimming by one another. I was practicing using my snorkel mask, so I mostly saw him from the neck down, underwater, and found myself thinking of him as a rare, tropical "Therapy Fish."

The whole incident brings to mind some of the other odd experiences I've had with mental health professionals over the years. I fired my most recent psychiatrist of three years when he consistently failed to return phone calls, offering the rather lame excuse, "I have 500 clients, and there's only one of me. I have to triage the calls, and you didn't say you had a gun to your head." Using his logic, for awhile I actually liked when he didn't return my calls, because that meant I obviously wasn't in great need and was doing a lot better than I thought. I also liked him because he was clearly making things up as he went along. For example, I once called him in a panic during a rough stretch and he informed me, "What you're going through is WAY BEYOND a medication solution. You'll just have to ride the wave of your emotions." When I next saw him in person, however, he said, "Don't give up on drugs, there are lots of them we haven't tried yet." So I said, "But on the phone you said I was WAY BEYOND a medication solution." He looked puzzled for a moment, then explained, "Oh, I must have been in a different mood that day." Just my luck, the man who is supposed to be monitoring my mental health is a MOOD-SWINGER!

Then there was the eccentric but brilliant psychiatrist I saw in Big Sur, California. For our first, get-acquainted session, we met outdoors, sitting on the grass, while he casually masturbated his male dog, and in a later session offered to spank me, but apart from those minor quirks, he was quite good at what he did. And I've already referred on these pages to the obese female therapist at Esalen Institute who once sat on my head for 20 minutes so I could "re-experience being smothered by my mother." (I try to find a reason to mention this incident in nearly everything I write, as it always gets a laugh. It's kind of like a public speaker who uses the same opening line every time because it never fails to win the audience over. The "sitting on my head" bit is gold.)

Other therapists I have known and loved? Donald, the gay pastor, who told me he hadn't realized he was gay until he turned 44, when his father died. I was 29 at the time, and that single passing comment left me acutely aware of my father's health ever since, and I'm going on 58. One sneeze from my Dad can still launch me into homosexual panic. The pastor dominated our sessions with endless stories about himself, and it got to the point where I would have to interrupt him to say, "I'm afraid our time is up for today."

Then there was Gabriel, the former belt manufacturer-cum-primal therapist, who, when he wasn't doing therapy, rented out his loft in Greenwich Village to a pornography company, a fact I discovered when I came in one day to drop something off for him, and discovered my friend Jeannie from our group, naked, on all fours, performing various acts that should have been illegal. They were actually between shots, and Jeannie paused the action for a moment to wave to me from across the room. I waved back. Gabriel, meanwhile, was suggesting to the director that they use me for the next scene, disguised as a Hasidic rabbi at a whorehouse. I turned the offer down, and got kicked out of therapy soon after, ostensibly for my refusal to take my pants off in group. How do I manage to find these people? It's a gift, I think.

My first real spiritual teacher, Ram Dass, himself a former Harvard professor of psychology, used to explain that while one's true, essential self was eternally pure and whole, our temporal personalities might still need the occasional tune-up, and he referred to therapy as "fender and body work." Implying, I think, that as long as your engine is in good working order, the rest is merely cosmetic. I suspect he might agree now that the relationship of personality to essence is a bit more complex and interdependent than that, but one thing remains certain: when getting fender and body work, it is always wise to get several estimates up front.

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