Reverse Psychology

post by Scott Alexander (Yvain) · 2015-07-18T04:25:14.000Z · LW · GW · 1 comments

Contents

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  II.
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[Content warning: suicide]

I.

It all started when I made that phone call.

I was really bad. All the tenure-track positions I’d applied to had politely declined, and I saw my future in academia gradually slipping away from me. Then the night before, my boyfriend had said he thought maybe we should start seeing other people. I didn’t even know if we were broken up or not, and at that point I couldn’t bring myself to care. I sat on my bed, thinking about things for a while, and finally I called the suicide hotline.

“Hello?” a woman’s voice answered on the other side. Somehow, just hearing someone else made me feel about five times better.

“Hello,” I said, a little more confidently. “I’ve been thinking of committing suicide. I need help.”

“Okay,” she said. “Is there a gun in your house?”

“No.”

“All right. The first thing you need to do is get one. Overdosing on pills is common, but it almost never works. You can get a firearm at almost any large sporting goods store, but if there aren’t any near you, we can start talking about maybe jumping from a high…”

“What the HELL?” I interrupted, suddenly way more angry than depressed. “You’re supposed to @#!$ing tell me not to do it!”

“This is the suicide hotline,” the woman said, now sounding confused. Then, “Are you sure you weren’t thinking of the suicide prevention hotline?”

“Give me a break! I took a psychology class in undergrad, I know what a suicide hotline is!”

“I’m sorry you seem to be upset. But this is the suicide hotline. It’s like how there’s the Walk For Breast Cancer, but also the Walk Against Breast Cancer.”

“There’s the what? But…I was in the Walk For Breast Cancer! I thought…”

“It sounds like you have some issues,” said the woman, politely.

“Ugh,” I said. “Yeah.”

“Do you feel like you need professional help?”

“Yeah.”

“I do have a free clinic with an opening available tomorrow at three PM, would you like me to slot you in for an appointment?”

So you’re probably wondering why in the world I would take an appointment arranged by the suicide hotline that wasn’t a suicide prevention hotline. The answer is – were you even listening? A free clinic? With an appointment available the next day? Normally I was lucky if I found a place with an opening in less than two months and a co-pay that wasn’t completely ruinious. You bet I was taking that appointment before someone else snatched it up.

Dr. Trauer’s office looked gratifyingly normal. There was a houseplant, a diagram of the cranial nerves, some Abilify® merchandise, and on the wall one of those Magic Eye stereographic images that resolved into a 3D picture of the human brain. Dr. Trauer himself looked like your average doctor – a little past middle age, a little overweight, a short greying beard. He motioned me to sit down and took the paperwork I’d been filling out.

“Hmmmm,” he said, reading it over. “29 years old, postdoc in biochem, recent relationship trouble…mmmm…you did the right thing.”

“In coming here?”

“No, in considering suicide. After getting rejected from a tenure-track position, your life is pretty much over.”

“WHAT?”

“I mean, here you are, hundreds of thousands of dollars in debt, with only one area of expertise, and now you’ve been rejected from it. I can totally see why you might think it’s worth ending it all.”

“But…there are lots of other things I can do! I can get a job in industry! I can work in something else! Even if I can’t find a job right away, I have parents who can help support me.”

“Industry!” Dr. Trauer was having none of it. “A bunch of bloodsuckers. Do you realize how bad work in the private sector is these days? They’ll abuse you and then spit you out, and once you’ve been out of university too long nobody else will want you.”

“Lots of people want biochemists! If I work for a company for a few years, I’ll have more experience and maybe that will make me more attractive to employers! What…what kind of a psychiatrist are you, anyway?”

“Cindy didn’t tell you?”

“Cindy?”

“The woman on the phone.”

“She didn’t really tell me anything!”

“Well,” said Dr. Trauer. “To answer your question, we’re dark side psychiatrists. This is the state’s only dark side psychiatry clinic.”

“Dark side psychiatry? Really?”

“We’re a…well, some people say sect, but I like to think of it as more of a guild…dedicated to improving negative mental health. Think of it this way. When you’re a hijacked murder-monkey hurtling toward your inevitable death, sanity is a completely ridiculous thing to have. And when the universe is fifteen billion light-years across and almost entirely freezing void, the idea that people should have ‘coping skills’ boggles the imagination. An emotionally healthy person is a person who isn’t paying attention, and our job is to cure them.”

“There’s more than one of you?”

“Oh, yes. There’s a thriving dark side psychiatric community. There are dark side psychopharmacologists – you’d be amazed what a few doses of datura can do to a person. There are dark side psychotherapists who analyze and break down people’s positive cognitions. There are dark side child psychiatrists who catch people when they’re young, before sanity has had a chance to take root and worsen. And there are dark side geriatric psychiatrists, who go from nursing home to nursing home, making sure that the elderly are not warehoused and neglected at exactly the time it is most important to ensure that stroke or dementia does not protect them from acute awareness of the nearness of death.”

“That’s awful!” I said.

“Is it? Look where sanity’s gotten you. You want to kill yourself, but you don’t have the courage. Work with me for ten sessions, and I promise you we can help you get that courage.”

“You’re a @#!$ing quack,” I said. “And if you think killing yourself is so great, how come you haven’t done it yourself yet?”

“Who says I haven’t?” asked Dr. Trauer.

His hand went to his face, and he plucked out his right eye, revealing an empty void surrounded by the bleached whiteness of bone. I screamed and ran out of the clinic and didn’t stop running until I was in my house and had locked the door beside me.

II.

“…and that’s pretty much the whole story, doctor,” she told me. “And then I looked to see if there were any real psychiatrists in the area and someone referred me to you.”

“Well,” I said, my face unreadable. “I can certainly see why you’re complaining of, how did you put it, ‘depression and acute stress disorder’.”

“Not so acute anymore. It took me two months to get an appointment at your clinic.”

“Oh,” I said. Then, “Sorry, we’re sort of backed up.” Then, “Okay. We’ve got a lot we have to work on here. Let me tell you how we’re going to do it. We’re going to use a form of therapy that challenges your negative cognitions. We’re going to take the things that are bothering you, examine the evidence for them, and see if there are alternative explanations.”

“What do you mean?” she asked.

“Well,” I said. “It seems to be this Dr. Trauer incident that’s traumatized you a lot. I can see why you would be stressed out. The way you tell it, it sounds absolutely terrifying.”

“You don’t believe me,” she said, not accusatory, just stating a fact.

“I think it would be helpful to examine alternate explanations,” I said. “I’m willing to assume it happened exactly as you tell it. I can see why you would think Dr. Trauer wanted you to commit suicide. But are there any alternative explanations for the same event?”

“I don’t see how there can be,” she said. “He outright said that he thought I should kill myself.”

“Right. But from what you know of psychiatrists and therapy – and you did say you took some classes in undergrad – are there any other reasons he might have said something like that?”

She thought for a second. “Wait,” she told me. “There’s a technique in therapy called paradoxical intention. Where you take a patient’s irrational thought, and then defend and amplify it. And then when the patient hears it from someone else, she realizes how silly it sounds and starts arguing against it, and then it’s really hard to keep believing it after you’ve shot it down yourself.”

I nodded. “That’s definitely a therapeutic method, and sometimes a very effective one. Do you have any evidence that this is what Dr. Trauer was doing?”

“Yes! As soon as he said I should commit suicide, I started arguing against him. He told me that if I couldn’t get a tenure track position there would be no other jobs available, and I told him there would be! Then he told me that the jobs would be terrible and I’d never be able to make a happy life for myself with them, and I argued that I would! That must have been what he was going for!”

She suddenly looked really excited. Then, just as suddenly, the worry returned to her face.

“But then what happened with his eye? I swear I saw him take it right out of the socket.”

I nodded. “Can you think of any alternate explanations for that?”

Thinking about it that way, it only took her like five seconds. She slapped her head like she’d been an idiot. “A glass eye. He probably had some kind of injury, had to put in a glass eye, and could take it out any time he wanted. He must have thought it would be a funny gag and didn’t realize how traumatized I’d be. Or he wanted to scare me into realizing how much I wanted to live. Or something.”

I nodded. “That does sound like a reasonable explanation.”

“But…don’t people with glass eyes usually have like scar tissue and normal skin behind them? This guy, I swear it was just the bone and this empty socket, like you were seeing straight to his skull.”

“You’re asking the right questions,” I said. “Now think a little more.”

“Hmmmm,” she said. “I guess I was really, really stressed out at the time. And I only saw it for, like, a fraction of a second. Maybe my brain was playing tricks on me.”

“That can definitely happen,” I agreed.

She looked a lot better now. “I owe you a lot of thanks,” she said. “I’ve only been here for, like, fifteen minutes, and already I think a lot of my stress has gone away. All of this really makes sense. That paradoxical intention thing is actually kind of brilliant. And I can’t deny that it worked – I haven’t been suicidal since I talked to the guy. In fact…okay, this is going to sound really strange, but…maybe I should go back to Dr. Trauer.”

I wrinkled my forehead.

“It’s not that I don’t like you,” she said. “But he had this amazing free clinic, and what he did for me that day…now that I realize what was going on, that was actually pretty incredible.”

“Hold on a second,” I said.

I left the room, marched up to the front desk, took the directory of medical providers in the area off the shelf, marched back to the room. I started flipping through the pages. It was in alphabetical order…Tang…Thompson…Tophet…there we go. Trauer. My gaze lingered there maybe just a second too long, and she asked if I was okay.

“Um, yeah,” I said. “It’s just that he doesn’t – he doesn’t take your insurance. That’s the problem.”

“It’s okay,” she told me. “He said it was a free clinic. So that shouldn’t a problem.”

“Well, uh…the thing is…when you see out-of-network providers, your insurance actually charges, charges an extra fee. Even if the visit itself is free.”

She looked skeptical. “I’ve never heard of that.”

“It’s new. With Obamacare.”

“Really? How high a fee is it?”

“It’s…um…ten thousand dollars. Yeah, I know, right? Thanks, Obama.”

“Wow,” she said. “I definitely can’t afford that. I guess I’ll keep coming here. Not that there’s anything wrong with that. You’ve been very nice. It’s just that…with Dr. Trauer…well…sorry, I’ll stop talking now. Thanks a lot, doctor.” She stood up and shook my hand before heading for the door. “Seriously, I can’t believe how much you’ve helped me.”

No, I thought, as she departed you can’t. I told her she was asking the right questions, and she was, but not all of them.

For example, why would a man with only one working eye have a stereographic Magic Eye image in his office?

I picked up my provider directory again, stared a second time at the entry for Dr. Trauer. There was a neat line through it in red pen, and above, in my secretary’s careful handwriting, “DECEASED”.

Before returning the directory to the front desk, I took my own pen and added “DO NOT REFER” in big letters underneath.

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