Wednesday, October 27, 2010

Gary Small's "The Naked Lady Who Stood on Her Head"

I don't usually read books by psychiatrists about their cases. I generally view psychiatry dimly. The "talking cure" strikes me as not only expensive, but slow and also ineffective. But this book was suggested to me and the title is seductive, so I got it and started reading.

The writing style is fine, so it is easy to get into the stories. The cases are interesting. I don't buy all the "talking cure" stuff, but I accept the descriptions are fairly factual about some pretty bizarre people and their problems. I'm sure Gary Small is a nice guy. I just can't see that having "weekly sessions" for several years -- which must run into $50K or more -- is a "valuable" cure. Taking pills makes sense. Going to group therapy makes sense. From my readings, a lot of these problems will simply "go away" -- that's the placebo case -- and others are about as effectively treated by having a series of heart-to-heart talks with friends. So I have a hard time justifying a class of people who extort -- sorry, live off -- other's problems by spending an hour a week for them for years at a time charging a stiff fee.

So what do you get if you read this book? Some vignettes of bizarre character traits: the sociopath who marries two women, a guy who thought he had dementia but was merely drinking too much water an causing his electrolytes to fall to dangerous levels, a woman who mismanaged her diabetes and would go into a diabetic shock as a way of getting back at her mother, a shopaholic, etc., etc.

Lots of fascinating stories. If you want to get acquainted with the zoo of "human types", this book is a good introduction.

From the Afterword of the book:
When I think back on the unusual cases I have dealt with throughout my career, I'm surprised by how many there were and how hard it was to decide which ones to include in this book. Some were unusual because of the rarity of the diagnoses; others were noteworthy because of the complexity of the relationships and situations. Many had an element of emedical mystery, and as a young psychiatrist I sometimes found myself stumbling upon the correct diagnosis and treatment without even realizing it.

Each of these unusual cases -- whether it was a mute, naked woman standing on her head or a man who thought he would be more comfortable with only one hand -- also contained an element of the usual issues that we all struggle with at some point in our lives. ...

... Almost all of us will face emotional struggles during our lives. Whether we use humor, denial, or some other defense mechanism to cope with these struggles, taking some moments to reflect on how our minds work usually brings us insight and relief.

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