Would you recognize yourself in print?
What if the person with whom you've spilled your deepest, darkest secrets blabbed to the world about the content of your conversations? You've shared your worst fears, the highs and lows of life, the dirty details of your personal relationships, and now that person's turning you into an anecdote in a psychiatric best-seller.
Would you object to appearing in such a book? Would you take issue with the way you're described? Would you take offense to a psychiatrist's clinical description of your problems and hang-ups?
Those are all good questions, and they're at the heart of a discussion about whether or not it's appropriate for mental health professionals to use real patients -- carefully disguised or not -- in psychology books written for general audiences.
Gary Greenberg, a psychotherapist who runs a private practice in Connecticut, writes in the New York Times that he's reconsidering the standard practice of using patients as book anecdotes. This move is hanks to a lawyer, who was concerned patients might recognize themselves in Greenberg's books, and a patient who did recognize personal details in the text.
Perhaps a good litmus test for psychiatrists is to ask themselves how they'd feel if they saw their doctor's latest volume in a bookstore, opened it up, and read a chapter that describes their most embarrassing problems and their conversations with the doctor.
How the patient sees himself mirrored in a therapist's eyes is important. For a doctor, it's an integral part of bedside manner. For a psychiatrist, it's a fundamental part of therapy.
Every good therapist knows that it takes time to win the trust of patients. Rarely does a patient arrive for her first session and spill her guts to a stranger, even a stranger she's paying to help her through her issues. Trust takes time and familiarity, and part of that involves reassurance that the person doing the listening isn't acting as a moral judge.
But what if a patient sees his worries described as "paranoid or narcissistic ravings," a descriptor Greenberg uses in his New York Times column? What if, in person, a patient believes her therapist is a patient and compassionate person, but in print the therapist cavalierly describes the patient's problems as immature and ridiculous?
If a therapist's goal, her reason for working as a professional in the mental health field, is to help patients, then it's difficult to argue that turning real people into whimsical stories or harrowing anecdotes helps accomplish that goal.
If we're being honest, it helps the therapist or psychiatrist. With a book, they're looking for name recognition, and to move copies. It's a different animal than a scholarly journal, meant for the eyes of fellow professionals with the ultimate goal of advancing the field of psychiatry.
In a scholarly article, an author isn't concerned with whether the text is dry, but a non-fiction author with an editor focused on the bottom line is under more pressure to make the text readable, to pluck the sexiest anecdotes and polish them to a shine so a passage is not only informative, but entertaining.
"Psychologists have been struggling with the tension between confidentiality and the need to publish their findings for more than 100 years," Slate's Brian Palmer wrote in a 2012 story. "Sigmund Freud expounded on the duty to publish in his 1905 book about 'Dora,' a patient who had lost her voice due to hysteria. Freud argued that the interests of society sometimes outweigh the confidentiality concerns of an individual patient."
The Hippocratic Oath would seem to disagree, especially these three points:
- I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
- I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. Above all, I must not play at God.
- I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
There's nothing inherently wrong with writing popular psychology books meant for general audiences. There's obviously a market for that sort of thing, and it's not a stretch to say that educated patients are usually better patients.
But there is a point at which the responsibilities of being a health professional are at odds with the goals of an author, especially an author whose job is to make his books entertaining. Psychiatrists, psychologists and therapists owe it to themselves, and their patients, to ask themselves whether they're serving the goals of their patients, or their writing careers. If it's the latter, then it's time to put the pen down.