The Kleenex Reflex

One of the things I've noticed about the way psychiatry is practised here is what I like to call the Kllenex Reflex. A box of tissues sits on every table in every consultation. What's incredible however, is how skilled everyone is at using it. Before the first tear has even slipped from an eye, before a voice even chokes, the psychiatrist has offered the box of tissues, and so smoothly that it doesn't look awkward, or affected, but just right for that moment. It says "I know you're about to cry and I'm responding to that." (Edit: I just re-read that and it sounds like psychobabble, but it's how it was described to me.) And having been on the receiving end of it, it really works.

In all seriousness though, I'm really enjoying watching good psychiatry here. There's a general misconception in medicine that psychiatry is 'easy', that it's just a matter of asking a few questions and prescribing a few drugs.

But it's a bit like one of those Magic Tricks Revealed shows. You can learn how the trick is done, and you can repeat it in front of your friends, but it really isn't just about knowing the moves. You need to have just the right slight of hand, the perfect timing, and the ability to engage your audience. It's the same in psychiatry, in order for the patient to respond to you and engage with you. Done well, it's an art form. It's almost sexy. It's certainly inspiring.

When it comes to my turn, I think I know what I'm doing, but my questions, in comparison, seem clumsy and awkward, to the point of being painful. But then, suddenly, out of the blue, you get a 'click' like the one described by Samuel Shem in Mount Misery, and voila, (rabbit from hat) you feel, at last, that you might just be getting there :-)