Monday, June 1, 2015
I was watching the FX comedy program Louie (Season 5 Episode 5) and encountered one of the funniest scenes I have seen on television. Louie is a neurosis based comedy, but it is also a show that many people will not be comfortable with because of content that results in the MAL warning. In this episode Louie takes his 10 year old daughter in to see Dr. Bigelow played by Charles Grodin. I heard that Grodin came out of retirement to play this character largely because he was impressed with Louis CK's technical expertise in filming the program. We met him in an earlier season when he was trying to dispel Louie of the notion that he has done anything to get rid of his back pain and instead focuses on the philosophical predicament of the three-legged dog that he is walking. After an introduction to the state of that animal he asks Louie: "What is the only thing happier than a 3-legged dog?" I won't give away the lesson but you can find it on YouTube.
In this episode, Louie has brought his 10 yr old daughter Jane in to see Dr. Bigelow. There are some preliminaries about whether she had a rash on her arm for 2 days or 30 days that has since cleared. From there Jane goes on to consider: "Weird things in my head." She is feeling like "I am sweating on the inside of my face" and builds this description with several "and then" clauses until she comes to a fantastic conclusion. Dr. Bigelow looks at her and without skipping a beat gives her a response that I have both heard from physicians and takes care of the problem. It also immediately shifts the frame from: "Is there something unusual about the way that Jane thinks?" to this being a completely acceptable exchange between a 10 year old and an old family doctor. I am not going to disclose Dr. Bigelow's punch line for those who have not seen this episode and I encourage you to watch it. It is worth it for this one scene that is so artistic, with timing so great, and it is the best acting from a child actor that I have ever seen. It is incredibly funny. I laughed out loud when I saw it and still laugh when I think of it. Dr. Bigelow's comment is an example of the implicit message: "I am taking you seriously at the neurotic kid level and not commenting on your behavior like you are a little adult." It also caused me to reflect on my childhood as a neurotic kid.
Neurosis is an old word these days. To me it always meant conflicted either in reality or at some symbolic level. If therapists are involved, the conflicts end up being conceptualizations based on their theoretical models. No matter how you cut it, anxiety is the common affect and there is usually a lot of it focused around unrealistic patterns of worry. The child psychiatrists that I know dismiss many of the eccentric behaviors they hear about and are unconcerned about what a lot of parents seem very concerned about. I have not assessed or treated children in over 25 years. My work comes at the tail end of childhood neurosis. The 18 year olds in high school and college students who become suicidal after their first boyfriend or girlfriend breaks off the relationship. It has given me the opportunity to advise them why they are hurting and about life in general. They seem to understand that by the time they get to my age that those problems in life will not hit them nearly as hard. I reassure them that when that happens, meeting me will be a distant memory and I will probably be the only psychiatrist they will have ever met.
But it wasn't that long ago that I was a neurotic kid myself. I won't disclose the full breadth of what happened to me so bear that in mind when you read about some of these incidents. The first bad sign was that I have never really slept well. Sixty years later that is still a problem. I am a chronic insomniac. I also recall vivid nightmares as a kid, with frequent visits from a being I called a "Deathalow." The Deathalow would just walk into my room at night and look very scary. It was the kind of behavior you see in a lot of horror movies, so this is probably a common experience. My parents and everyone else were puzzled because nobody had ever heard of a Deathalow. But they finally caught a glimpse of the inner workings of my mind when I started pointing at Catholic nuns and screaming: "Deathalows." Some time later, I pieced together the fact that Deathalows were a composite of a very bad chalk drawing of my grandmother's face in a nun's habit.
Just a few years later I was sitting in our living room watching television and I saw what appeared to be a Sir Walter Raleigh like figure walking up behind my father and preparing to stab him with a dagger. I shouted out what was happening and my parents freaked out. My mother was a frequent caller to our family physician and his advice was clear: "Stick him in a tub of ice water." No visit to the ER to see the crisis team, just ice water. They did so immediately, and while I was there I watched the comedy/tragedy masks on the walls in the bathroom laughing and crying while snakes slithered up toward the ceiling. That was at least until I cooled off. Then all of the hallucinations vanished. But it was the death of a family member that was all I needed to develop the longest preoccupation that I had in childhood - death and physical illnesses. For a while I was preoccupied with having cancer, rabies or being poisoned. I recall one incident after a Soviet nuclear test when we were warned about a large cloud of fallout passing over northern Wisconsin. We were advised to stay indoors. At the peak of that fallout, I can recall seeing radioactive particles floating in the air. The rabies preoccupation was the longest. I played football almost every day and was always alert to the presence of dogs. At one point, I thought that a dog may have had rabies and I had inoculated myself with the virus after I fell catching a pass. For months, I monitored myself for the development of symptoms of rabies. I would get up several times a night to look in the mirror to see if my physical appearance was changing (I was up anyway).
Around this time, I started to get nightmares about a large glass pyramid. There were several tiers of panels in the pyramid and on each panel was the face of a woman wearing Kabuki make-up shouting in a shrill voice: "Chinese ghosts!". In each case, I would wake up extremely anxious and wonder why I was dreaming that dream. And then... one night I decided that I really did not have to walk into that pyramid. It had a very long entrance-way. I thought before I fell asleep that night: "Just wake up if it looks like you are going into the pyramid, You don't have to go into that pyramid." And I was right. I woke myself up before the entrance to the pyramid and it was gone. I never dreamed that dream again. But the neurotic behavior in the daytime was harder to get a handle on for a long time. I had to tell myself that I had no control over if I lived or died. In some cases, I got some very negative feedback on the poisoning hypothesis as in: "Are you accusing me of poisoning you?" I eventually forced myself to think of other things. Eventually that forced aspect was gone as I developed more interests. As my reading and research in other areas increased, my worries about cancer, rabies, and death dissipated.
Throughout all of this, I never saw a counselor, therapist, or psychiatrist. I got the "Dr. Bigelow advice" from our family physician with treatments ranging from "throw him in a tub of ice water" to a rather primitive creosote-like nasal lavage that all of the kids in my family got if we went in to see him for a cold. I am convinced it was an aversive therapy to keep us out of his office. I have never seen that treatment used anywhere else in medicine.
This merely scratches the surface of my experience as a neurotic kid. It may be why I got such a laugh out of Dr. Bigelow's advice. And of course it also causes me to wonder what would have happened if I had received psychotherapy or medication for these "symptoms." Would I have encountered one of the wise child psychiatrists I know or somebody who thought I was psychotic? I was definitely not as calm about it back then as I am recalling it now - there were after all snakes on the walls!
But I eventually turned it around on my own and became a guy who can appreciate the humor in being a neurotic kid and somebody who can relate to them.
George Dawson, MD, DFAPA
Supplementary 1: No guarantees on how you will find Louie. I find much of his comedy brilliant, but some is also cringeworthy so as always watch at your own risk. The segment I am talking about is less than 2 minutes long about 2 1/2 minutes into Season 5 Episode 5.
Supplementary 2: To all my psychiatric colleagues out there, I did think about these disclosures. Hardly anybody reads this blog and I don't anticipate doing any transference based psychotherapy. I think it is also pretty obvious that you reach a point in your life where all of these neurotic behaviors are irrelevant. All of the other main players are dead or forgotten and there is no emotional impact. The experiences themselves are history and have been for 50 years. That is how I chose the disclosures. In part they were also modeled on some disclosures I have read in books written by psychiatrists who disclosed things that happened to them as adults.
Supplementary 3: The more I reflected on the historical context of neurosis, the more I realized that it means something different now than when I was a kid. When I was a kid, it meant that you were crazy in the popular sense of the word. Nobody had a nuanced appreciation of mental illness and how anxiety or obsessions were different from psychotic disorders. Today, I think neurotic behavior is reinforced to a point. For example, the parents who say: "He or she is 12 going on 30" and seem to see their children as small adults who may need some competitive advantage like cognitive enhancement.
Supplementary 4: The glass pyramid graphic is a download from Shutterstock for non-commercial use only and this is a non-commercial blog.
Supplementary 5: A useful interview question for adults with anxiety and depression: "There are all kinds of theories about how people get anxious. One of those theories is that our minds come up with stories to fit the level of anxiety that we have. That can be transmitted from one person to another. Looking back on your childhood can you recall anyone who seemed to transmit their anxiety to you?