Healing and harming from the inside-out
I'm currently reading J.G. Ballard's novel, published in 1973, Crash, a scathing and disturbing social commentary on human progress, hubris, and self-destruction. In 1996, it became the eponymous film by David Cronenberg, one that explores those themes through the same motif as the book—symphorophilia—the act of obtaining sexual pleasure from staging or causing car crashes, oftentimes reenactments of real-life car wrecks involving famous people.
While Ballard's work has never landed squarely on the nose of social criticism and didacticism, it still skirts the prescient and current fetish Americans seem to have with playing fast-and-loose with progress, but also, specifically, with illness.
For some people, being sick or in pain comes with a payoff.
For others, it costs them everything: their quality of life, their careers, community, friendships, and sometimes even families.
People pretending to be ill, in pain—or in rare cases, Munchausen Syndrome—for attention. Sometimes people feign pain as part of drug-seeking behavior for pain killers. Some people even make themselves sick, drinking or ingesting small amounts of poison to create a health crisis or chronic health conditions that required medical attention and care.
It happened so often they made it into a disorder of the mind. Hypochondriasis.
The above photo is from one of my favorite family movies starring Eddie Murphy—a remake of Dr. Doolittle, Murphy's portrayal sandwiched in between two powerhouse actors, Rex Harrison and Robert Downey Jr.
Mrs. Parkus, above, played by actor Cherie Franklin, is allergic to shellfish in the film.
To avoid having to go to the hospital, she oftentimes does this:
Yes, I know.
Crab, softshell crab, all shellfish, Mrs. Parkus.
And so Mrs. Parkus has the hospital call Eddie Murphy's character, Dr. John Doolittle, because only his "care" will do. According to the young doctor who pages him, "She's scared. She wanted her doctor. It's a beautiful thing."
And as she leans over the exam table to receive her epinephrine (likely) injection, she sighs contentedly, with relief—but not as if she's in a J.G. Ballard novel.
She sighs because something about receiving medical care makes her feel good, safe, cared about, and like she matters, not just to Dr. Doolittle, but in some sort of larger schema.
This brings me to another cinematic gem, What About Bob?
This one, a little closer to home for both patients and anyone in the "caring" profession.
Bob Wiley, played by Bill Murry, is a bag of neuroses. While he befriends everyone he meets, and while he's a good worker, Bob needs constant reassurance from mental health professionals. After pushing personal boundaries and using unassuming, seemingly benign forms of manipulation, he eventually drives his therapists to madness.
One such therapist, while frenetically packing up his office, calls Dr. Leo Marvin, played by Richard Dreyfuss, and strokes his already-massive ego by telling him he's referring a patient to him, someone only Dr. Marvin could possibly help since he'd recently become the center of national attention with a new book called Baby Steps.
Bob ingratiates himself with Dr. Marvin's family while they're on a summer vacation at their lake house, specifically relating to his children, a young teen, Anna—who has grown tired of her father's clinically-infused communication style, and Siggy, Dr. Marvin's wraith of a son, who is much too dark and cynical for his age (Anna, Sigmund, get it?)
One evening, as Siggy and Bob settle in for a 'sleepover' amidst promises to Dr. Marvin that Bob would leave, first thing in the morning, Siggy opens up to Bob.
Siggy: I mean, my Dad just dropped me in the water, without warning me first. I mean, I nearly drowned! My whole life flashed before my eyes!
Bob: Wow, you're lucky you're only twelve.
Siggy: It was still grim.
Siggy: Bob, are you afraid of death?
Siggy: Me too…there's no way out of it. I'm going to die. You are going to die. We're all going to die.
Bob handles Siggy's existential crisis by telling him that when he's afraid of something, he fakes something worse. Because 'if you're faking it, you don't have it, right?' Then, the two of them go on to "fake" Tourette's Syndrome while jumping on the bed.
Like ya do.
The medical professionals in my family—hell, my own husband—hate the movie. My husband even has a "Bob" clause (the actual name of the clause) in his contract (he's an attorney) that sets clear, personal, and professional boundaries about what is and is not acceptable behavior between himself (the professional working with them) and his clients.
When I first watched What About Bob? I hated it too because I worked in the lower echelons of the social work field.
I wanted to go further, maybe even go into psychology, so it was a relatable offense, having someone from work get too close, too attached.
Now, though, I love the movie. I love it in so many ways, it's impossible to count.
I think the reason I love these films is because both of them yank medical/mental health professionals by their stiff collars, off their self-and-societally-appointed pedestals and into the worlds of their patients—into the world of helping people (and animals, I suppose), who are in real pain.
In What About Bob's case, the film shows how thin the line is between 'mentally sound' and 'mentally unsound' based on our immediate surroundings and support systems (or lack.) It also shows us how truly caring about another person can heal another human being —something the egotistical Dr. Leo Marvin was incapable of, but his family was not.
Hey, if I had to choose between being in a relationship with Bob or Dr. Marvin, there would be no contest.
Anecdotal stories began flying through the medical community about how to deal with 'attention-seeking' patients probably around the time the DSM became more and more medicalized, but they didn't need to fly far. There's a long and sordid history of doctor-patient conflict and a lack of faith in one another.
And for good reason.
From The New Yorker, writing about Porochista Khakpour's book, Memoirs of Disease and Disbelief:
“You know,” a doctor informed one of them after failing to find the source of her symptoms, “sometimes people subconsciously want to be sick.” It’s tempting to think of this reflexive, paternalistic skepticism directed at female patients as a remnant of a bygone era. And yet there’s a class of illnesses—multi-symptomatic, chronic, hard to diagnose—that remain associated with suffering women and disbelieving experts. Lyme disease, symptoms of which can afflict patients years after the initial tick bite, appears to be one."
-- Lidija Haas, "Memoirs of Disease and Disbelief," (May 28, 2018.)
As patients presented with more and more ways the human body could go wrong, the medical community began using the newly-sanctioned DSM-IV to diagnose, then refer patients, to therapy.
In other words, if indeed these people simply needed to feel good, safe, cared about, and like they mattered, well.
That was too tall of an order for their family practitioner or PCP.
But here's the thing.
With rising medical costs, due, in part, to a veritable lack of preventative healthcare and the over-medicated population here in the U.S. (specifically), people are showing up at healthcare facilities with pain, ailments that can't be explained by blood tests or other diagnostics.
Side-effects of medications weren't on anyone's radar back in the 20th century, and they're not on the radar now.
Side effects, contraindications, interactions, adverse events.
In other words when medical treatment actually becomes harmful.
It happens with such frequency throughout the world, but specifically in the United States, it feels like a form of gaslighting when I tell a healthcare practitioner or mental health professional that I've been permanently disabled and traumatized by the medical community.
They don't really…disbelieve me, but they say things like "Well, you must be very sensitive to medications, hmm?" Or "…whether *I* believe you or not doesn't matter. It's about you processing your experiences and your past traumas, then learning ways to move on…"
No, no. It fucking matters.
I'm not a convicted felon, you are not my defense attorney.
I'm someone moving into her 53rd year of life and I need preventative care, but also, I need to know that if something happens to me—some horrific neurological event that my husband is in no way trained to handle—that when I go to the hospital, I'll receive high-quality medical attention and care—CARE.
That basic expectation of care shouldn't be something I have to worry about as I'm having a stroke or while I'm in a Parkinson's freeze.
But I don't have "Parkinson's." I have "parkinsonism"—notice the small "p?"—and there's no way to tell the difference between idiopathic Parkinson's and parkinsonism.
Funny thing about Parkinson's disease, they don't treat you like you're an attention-seeker, even though they don't know why people with Parkinson's go into freezes, even though there's no way to predict them, only that the daily medications for Parkinson's usually help, unless you have parkinsonism, or as it's called on the Parkinson's Foundation website at parkinson.org, "atypical Parkinson’s disease or Parkinson’s plus." (Notice the big "P"? Thank you Parkinson's Foundation peeps for treating us like human beings. Sometimes feeling validated is as simple as that.)
Unfortunately, when it comes to parkinsonism, there are no medications that can help, especially in my case, since medications caused it, along with other neurological movement disorders, including AKATHISIA—a condition that's hotly debated on every level as to whether or not it's an actual neurological movement disorder.
Let me help y'all out with that: IT DOESN'T MATTER WHEN WE DESPERATELY NEED MEDICAL HELP AND CARE.
The vast majority of people who have been victims of iatrogenic harm are not anything like Mrs. Parkus—eating at Joe's Crab Shack then running to the ER for care. We're not like Bob Wiley, lonely and in desperate need of human connection, so we burrow our way into a healthcare professional's life.
I dread finding a new therapist. I avoid going to the doctor at all costs and hate how many healthcare providers I'm forced to see because of iatrogenic harm.
I have a life. A full-time career I love, a couple, actually, and a huge array of things I want to do that I can no longer DO. So I NEED actual medical care.
What I want and need are mental health professionals who can step into the terrifying possibility with me and US that one day, they or someone they love might come to medical harm so they can develop an understanding of what it's like to feel totally un-cared for.
We are not begging for attention. We have been hurt, violated, and thrown away by the ironically-named system of CARE and it's unconscionable we know more than you about what's happened, or is happening, to us. Is it that hard to log on to PubMed and read about how to do your jobs?
Much like Ballard's novel, the many anecdotal stories dismissed as "merely anecdotal" must serve as genuine, dire warnings of a cultural trend that has been so thoroughly ignored, even waving the latest studies and evidence under a prescriber's nose doesn't matter.
And the most disturbing trend of all is how people in the caring professions have become so adept at ignoring, dismissing, detaching, and distancing themselves from patients and clients, so commonplace, someone like Bob Wiley would be in prison by now. And Mrs. Parkus?
Hard to know.
Good thing for her, at least in a fictional world, she has a doctor like Dr. John Doolittle, who doesn't 'do little,' but who does much for the people (and critters) who need him most.