MADMAN - John R. Suler, Ph.D. - copyright 1995
Chapter 22 - Tests
"Hi, Jon," I replied blandly, "I've got to get back to the unit."
"Say, you look like you've seen a ghost. Was it one of ours, or theirs?" White puffs of crystallized breath chased each word from his mouth.
"All ghosts are one of them, aren't they? So what's with the hat?"
"Ah! Preparation for the snowstorm, of course."
"Oh, right. I forgot."
"Forgot? Forgot the snowstorm? Never lose touch with the weather. It's the very pulse of our psyche. I guess they didn't teach you that in graduate school."
"Psychometeorology wasn't my speciality. Listen, I really have to get back to the unit. See you later."
I stepped on the gas. Jon put his hands to his mouth and called out after me. "Maybe you should consider broadening your current specialization. Meteorology is much more precise."
As I left the car, the cold wind lashed at my bare neck and face. I retreated into my thoughts to escape. I have to check the bathroom and resident's lounge for my journal. But how could it be in either of those places if I found the cover on the unit - assuming that that piece of cardboard was the cover. Possibly someone found the journal in the bathroom or lounge, ripped off the cover, and brought it to the unit. But who? One of the staff? I couldn't imagine any of them doing that. One of the patients? But patients aren't permitted to leave the unit unless they have a pass, and even then they usually are accompanied by a staff member or another patient. Then again, it's possible that one of them had the opportunity to sneak out of unit - to sneak out and steal my journal.... Shit! I'm paranoid again, seeing plots everywhere! "Maybe you need to heal thyself," Hippocrates said in his stony voice.
"That bullshit is getting a bit boring!" I answered as I wearily climbed the stairs. Just because he's the Father of Medicine he thinks he can comment on everything. Those Greeks thought they were so smart. So what that they had half a dozen outstanding geniuses - all of them the equivalent of an Einstein - living at the same time in Athens! That was centuries ago. Civilization has come a long way since then. We're smarter now, more advanced. Aren't we?... Maybe not. Maybe we're going in circles. Maybe we're even losing ground. After all, we're slowly destroying the planet with our so-called technological advances? And the Holocaust was only a few decades ago.
"You're over-intellectualizing again," the librarian said. "Why don't you ease up on the maybe-ing this and perhaps-ing that. You'll feel a lot better."
The cursors on the computer monitors blinked in agreement.
"If I don't intellectualize, then what do I have left?" I replied angrily, "So mind your own business!" My stomach turned, twisted, growled in pain. More anxiety? No, could be hunger - just an emptiness asking to be canceled out. After all, it is lunchtime. Have to get something to eat. That will soak up some acid and appease my hollow gut.
On the way I stopped off at the resident's lounge. No journal. I stopped off at the men's room. Still, no journal. At the urinal I tried desperately to avert my eyes, to control the compulsion to read the graffiti. But I just couldn't resist - the words were right there in front of my nose, calling me, teasing me. I just had to read them, as if I were trapped by some hated yet powerfully captivating ritual:
"Jesus saves."
"She blinded me with science."
"Look up... look down, the joke is in your hands!"
But there was a new one there - up high and to my far right, near the corner of the room, too far away to see clearly. I squinted and strained my eyes to read it. Reluctantly, the words came into focus:
"While alive be a dead man."
I blinked - and it was gone.
"Chicken noodle soup," I grumbled to the catatonic kitchen aid with rotten teeth. He held the ladle over my bowl and began pouring ever so slowly. Both of us stared into the gentle flow of noodles and yellow juice. The soup approached the top of the bowl, but, locked into his stupor, he showed no signs of stopping. He kept pouring. The soup passed the brim, where surface tension held it for a moment, then spilled down the sides. But he kept pouring. A puddle began to spread across my tray. I yanked myself out of my stare and shouted "Stop!"
He looked up at me, studied my face. A faint glint of light entered his otherwise deadened eyes. He had noticed something. "Don't say it!" I thought to myself, "Please don't say it."
The mute man finally let some sounds out of his mouth. "You sure look bad," he said.
I had reached a new low. Even the walking wounded pitied me.
I tried to avoid the table where Sheikh, Ron, and the med students were sitting, but Sheikh flagged me down. "Come, sit with us!" he called out across the room. By the looks on their faces, I could tell that Ron and the students were not entirely in agreement with Sheikh's decision. "Please, God," the medical students were thinking, "May we never become like him." Of course, I could have been projecting.
All their eyes were on me as I sat down. "I know," I said without looking up, "I look terrible. I'm coming down with the flu, I think, but I'm hanging in there. I'll do my best not to get too close to you - or sneeze on your salad."
The med students giggled. It eased the tension a bit.
"You were on call last night, were you not?" Sheikh asked.
"Yeah, I was. Didn't get much sleep though. I guess that's what triggered this flu."
Ron stuffed his hands into the pockets of his white lab coat. "Actually, research suggests that environmental stresses and deprivations may not have a substantial effect on contracting viral infections."
Everyone ignored him. Sheikh put his hand on my shoulder. "It would be a good idea to take some time off. "
"Yeah, I know," I mumbled.
"Believe it or not," Bob Lawrence injected into the quiet, "sometimes I wish I would get sick. In fact, I'm surprised that I haven't so far. I really need a break from the hectic pace of all these rotations. I just finished radiology last month, I've got psychiatry for another two weeks, then oncology and gerontology."
"You were in radiology?" I asked.
"Yeah, last month. Why?"
"Who is that woman who works there - the one with dark hair, attractive?"
"I don't remember there being a woman there."
"Are you sure?"
"Well, I think so." He looked to his peers, "You guys did that rotation too. Do you remember her?"
They just shrugged their shoulders. "We weren't there very long," Bob said somewhat apologetically. "It's possible that we didn't meet all of the staff."
My disappointment must have been obvious. "Never mind."
"Anyway," Bob continued, "even though I haven't finished all my rotations, I think I know what residency I want." The other two med students perked up at the mention of this. Choosing your residency is no small matter. It could determine the rest of your professional life. "What?" they asked inquisitively.
"Psychiatry."
"Is this true?" Sheikh said. He sounded pleased.
"Yeah, though I haven't told too many people yet. I'm a little reluctant to. I've mentioned it to a few friends, and when I do they always look nervous, like they're afraid I'm going to start analyzing them, or something. They always say something like 'Gee, I better be careful now about what I say around you - ha, ha!'"
"It's one of our occupational hazards," I said. "People don't really understand our profession. It's all a bit mysterious to them. Sometimes they worry that we can see right through them, and so they feel uncomfortable around us. And we feel uncomfortable too. We want people to understand us, to understand our work. That's why many psychotherapists mostly choose other therapists to be their friends."
"But it must be nice to give advice to friends who aren't in the profession," Bob said, "if they need help with some problem they're having."
"I guess so. But to tell you the truth, I've found that family and friends often don't listen to my advice, even when they ask for it. They don't want to hear what I have to say - well, at least part of them doesn't want to hear it. They're ambivalent. On the one hand, they know that I'm supposedly knowledgeable about how people behave - and they want to hear my ideas. But on the other hand, they don't want to be told something about themselves that they didn't already know. It's a bit threatening. So they try to dispute or ignore what I have to say. Because I'm a friend or a family member, it makes it much easier to discount me. I'm the kid brother, or son, or the old pal from third grade - so why take me seriously? But when they hear the same thing on a T.V. talk show, or read it in a book, THEN they believe it! ... It kind of upsets me. It makes me feel.... forgotten."
I paused to catch my breath, and immediately became paranoid. I was rambling again, although I imagined they were interested in what I way saying. Ron pointed his pen at me, preparing to toss in his two cents, but I beat him to the mark.
"You know," I said more calmly, "we psychologists have our strengths and weaknesses, just like everyone else. We're just normal people too, right?" I punctuated my remark by crossing my eyes and twitching one shoulder. They all laughed - even Ron. For a moment I felt close to them, and a surprising sense of well-being washed away some of the stress that had been mounting inside me. I remembered something my analyst had said. God, he was right! I feel so alienated from people! I need to connect!
"So what are you guys thinking," I said to the medical students.
"Is lunch always like this?" Bob replied warily.
We laughed again. "Only when you eat with us shrinks."
"So I've noticed," he replied with a warm chuckle.
I felt lighter, more natural than I had in days. "Say, there's something I wanted to ask you medical guys. I saw this doc yesterday - on the other side of the building from the inpatient unit. He was in his fifties, maybe - kind of lanky, with a rumpled suit, carrying a lot of books. Anyone know who he is?"
Ron answered me. "That's Lloyd Williams."
"Lloyd Williams!" I said with surprise. "I didn't know he was here!"
"Many people don't," Ron said, "because he doesn't have any formal connection to the inpatient or outpatient staff - and he doesn't talk much to anyone. In fact, people rarely ever see him. He's on some kind of special lifetime fellowship to pursue whatever work he wants, although no one seems to have any idea what it is he's working on."
"Excuse me," Bob interjected, "this may sound a bit ignorant, but I've never heard of him."
"He was very big about ten years ago," I said, "one of those genius types who shot to fame when he was young. He got an M.D.and Ph.D. from Harvard, worked at Austin-Riggs for awhile, published in Science when he was only a graduate student. He was working on reviving Freud's Project for a Scientific Psychology - the work where Freud tried to postulate a neurophysiological basis for thinking, emotion, and the unconscious. Freud eventually gave up on the project, and never actually published the manuscript himself. Eventually it became hopelessly outdated - just a curiosity in the history of the psychoanalytic movement. But then Williams got hold of it. He won acclaim for reviving and integrating Freud's ideas with current theories about neurology and computer science. They say he would have won the Nobel Prize for psychiatry - if they gave a prize in psychiatry. Then he went on to integrate his ideas with existential phenomenology, and even mysticism. Some people were waiting for that final, seminal book where he'd pull it all together - the neuropsychological-philosophical equivalent of TOE in physics, the Theory of Everything. Other people thought he had gone too far, that he was starting to flake out. Then, suddenly, he stopped publishing and lecturing, and just disappeared.... I wonder how he ended up here?"
"No one knows for sure," Ron replied. "The gossip is that his money is from a private source - and the medical school simply offered a place for him to work."
"Regarding these people who are geniuses," Sheikh interjected, "before you joined us we were discussing grand rounds with Dr. Stein. It was most interesting, Thomas. You were, I must say, quite... quite outspoken."
"That's putting it nicely. You mean I was rather defiant, maybe even obnoxious. But I figure he deserved it."
Ron revved up. "He's an internationally recognized expert on borderline disorders and schizophrenia!"
"So what, he can still be wrong. And besides, with this patient Doe we're not talking about a borderline or schizophrenic disorder, or even an 'as if' personality. I think Stein is missing the boat with his diagnosis."
"But Fred and Dr. Stein have warned us about such attitudes," Ron replied insistently. "They told us that there's always a tendency to underestimate pathology. Inexperienced clinicians often make that mistake."
That remark made me bristle. "Then you're saying that I'm inexperienced?"
Sheikh interceded again. "I believe that we all know very much at this point in our training, but there is still much that we must learn. Perhaps our most important lesson at this time is to know when our supervisors are right, and when to trust our own intuition."
Ron was still on his own track, and partly deaf. "Dr. Stein also says that there's a tendency for new therapists to get very wrapped up in a particular case and to seal themselves off from outside input - especially from the advice of supervisors. It's like being in an isolated cocoon with your patient - you think you know more about your patient than any outsider. You think that you are the only one who really understands that patient. But he says that's when you get so wrapped up in what you're doing, you lose your objectivity. You see things that aren't really there and you fail to see the things that are. You can't tell the forest from the trees. He says that you get too close to the person and tend to underestimate their pathology. In fact, you reinforce it and become part of it."
"Maybe we shouldn't be so concerned about what Dr. Stein says," I replied. "The guy isn't exactly the epitome of mental health himself. He treats us like we're some kind of de-evolved species, and he's as empathic as a post in winter. I think we all tend to underestimate HIS pathology. But you know, this whole idea about underestimating pathology really bugs me. Throw a rock in any direction and you'll hit someone who's abnormal by somebody's definition. Remember the Manhattan Study they did in the 1960s? A team of mental health professionals went door to door doing interviews at all the domiciles in New York. They had a checklist of a whole variety of psychiatric symptoms. After all the results were in, do you know what percent of people in the city were suffering from some significant psychological problem? Take a guess."
"30 percent?" Bob answered hesitantly.
"Try again." I looked at Ron, but he was too nervous about guessing at an exact statistic.
"50 percent?" Sheikh said.
"75 percent! Now what does a statistic like that mean? The Big Apple is hazardous to your mental health? Only sickos come to live there? Or are we mental health professionals wearing glasses that make use see pathology everywhere? Maybe truly healthy people are indeed in the minority - maybe they have a secret society somewhere, with a secret handshake and funny little hats, and all. Just take a look at any institution - like this hospital, or any business or company, or any place where there's a group of people working together. It runs rampant with craziness - the backstabbing, the power plays, the simple lack of appreciation or compassion for other people. I'm truly amazed that in any institution productive work actually gets accomplished. By their very nature human beings are kind of crazy. Freud said that all of us are, at best, neurotic. And to make the matter even more complex, what's considered sick or abnormal depends on your culture. It's all relative. If Ron here stood up on the table and shouted that he heard voices from the sky, we'd give him a hefty dose of thorazine and lock him up in Isolation. But if we lived in some ancient Indian tribe, we'd listen with respect because he contacted the Great Spirits. We'd even call him our priest, provide him with a steady dose of hallucinogens, and request that he hear voices on a regular basis. Hell, Richard Mobin might be a hero in such a time and place! Or look at it the other way around. Is competition considered normal in our culture? If Dr. Stein lined us all up and told us to run five laps around the unit - and that the winner would get a 100% pay increase - would we do it? Sure, we'd run our asses off. Not so among the Zuni Indians. Some anthropologists once lined up a bunch of them in a field and asked them to race to a tree at the other end. The winner would get a prize. What happened? They all crossed the finished line at exactly the same time. No one wanted to beat anyone else out. They considered competitiveness wrong and abnormal. But it's a way of life for us, it's our national obsession."
Ron was indignant. "You're saying that there's no difference between normal and abnormal! What good will that kind of relativistic thinking do for psychiatry? It's very clear that abnormality is defined in terms of level of functioning. That holds true across all cultures. If a person's behaviors or symptoms significantly interfere with how they function in their occupation, social relationships, or any of their daily activities, then by definition we say that something is abnormal."
"But that definition doesn't hold in all cases," I replied."There are people who function very well, are successful, well-liked - the whole ball of wax - but on the inside they are totally miserable. One day they don't come into work, so you go to their house and you find them on the bathroom floor with their wrists sliced. Or they're the people who go out one day, buy a gun, and shoot children at the schoolyard. And what does the next door neighbor always say on the 11:00 news? 'He seemed like such a nice man, kind of quiet, but very polite and friendly.' We can't always predict these behaviors, no less explain them afterwards. Our theories are like those prefitted bed sheets. There's always one corner that just won't fit snug."
The medical students looked very uncomfortable, like they were shriveling. Sheikh was puzzled. "Thomas, are you saying that you think John Doe and Richard Mobin are not abnormal?"
"No, yes.... I'm not sure what I'm trying to say," I replied as I picked up an empty can of soda and began fidgeting with it. "I just think that we mental health experts sometimes like to think that we know everything about human nature, but we don't. We feel better about ourselves when we can find problems in other people. Maybe we analyze others as a way to avoid looking at our own shortcomings."
With that remark, I realized that my finger - which I had been poking nervously into the soda can - was stuck! The sharp metal hole dug painfully into my skin. I yanked, yanked again - it popped out. Then I sneezed, and a tiny dribble of gook ran down my lip. I pulled out a tissue to blow my nose and the result was an embarrassingly loud honk.
"Excuse me, Tom. Am I interrupting?"
Through my watery eyes I made out Peggy - one of the masters degree psychology externs - standing by our table. "Uh, no," I mumbled. I was glad for the distraction. "What's up?"
"Since I have this stuff with me," she said, "I thought I'd give it to you now. It's the results of the test battery on your new patients. I just finished the scoring. Richard Mobin wouldn't give me very much, so I went ahead and gave the battery to your John Doe. He seemed to love it. That's a very dynamic duo you got there. You'll see what I mean when you look at the results. Henry should have a lot of fun with you on this one."
I skimmed through the graphs and tally sheets. The results leaped off the page at me. My heart raced. I jumped out of my seat. "Excuse me, I have to go," I said without looking back.
"That was very impolite," remarked Hippocrates from the other end of the building.
"Ssssssure," agreed the elevator. I felt a pang of regret, but at that moment my primary concern was to find Henry.
Much to my dismay, Ron stepped into the elevator just before the doors closed. I didn't know what to say to him. We both just stood there and stared at the floor indicator. He was the first to break the silence, and his voice sounded a bit odd. He sounded friendly. "You know," he said, "you and I are not all that different."
I wasn't exactly sure what to make of this. Just as I was about to say something, the elevator doors popped open. There, in answer to my prayers, was Henry walking towards us. He waved, and as he approached, looked up and down Ron's white lab coat. "Yo, Ronnie!" he called out,"How's the roast beef today?"
"You psychologists..." Ron muttered while shaking his head, and then disappeared around the corner.
"Henry, do you have time for a quick supervision?" I asked. "I have the results on the test battery for my new patients."
"Oh yeah, I've heard about them. I'm sorry I missed morning report. Sure, I've got a few minutes. Come on down to my office."
As I followed him down the hallway, I felt some relief. Henry, the only psychologist on staff in the unit, was my primary supervisor for the internship. He always supported and stood up for me. We were in the same boat - or should I say we were both fish out of water, being psychologists in a psychiatric world. In some ways, he had a worse time of it than I. I was a lowly intern, but he was the very first psychologist to work on this unit, and he fought tooth and nail for every inch of respect he won for himself and our profession. He was, in his own way, a crusader.
"I hear you're having a bad week," he said as he tossed his short, overweight, but slightly frenetic body into his swivel chair."
"Word sure does get around. Yeah, things are not going well. My depressed patient that I discharged, Elizabeth Baso, died in a car accident yesterday. And my two new patients are real doozies. Fred and Stein interviewed them during grand rounds, and in the discussion afterwards Stein attacked me. Get this - he accused us psychologists of being feeble-brained because we talk about the concept of 'secondary gain.'"
His neck and round face suddenly reddened and puffed out. "Damn! Hold on a second," he said as he reached into the bottom drawer of his desk, pulled out a bottle of Maalox, and took a deep swig. "He can be such a jerk! If he'd just look at his patients for a minute and stop using them as material for his damn books, maybe he'd learn something. The guy is all intellectualizations and no common sense - especially about people. Don't tell anyone I told you this, but he had this girlfriend a few years ago - never talked about her to anyone. So one day she shows up on the unit looking for him. She's got hair teased straight up to the ceiling, bright red lipstick, a low cut blouse - and a mouth like a drunk sailor. Everyone who met her swore that she was a borderline. And I'd be willing to bet that he never even knew it. He's a genius, but THAT'S how out of it he can be sometimes."
We both laughed.
"But listen to this," I said. "In the middle of grand rounds, my patient Doe pointed out to Stein that he had dog shit on his shoe. You should have seen Stein's face. He ran out of the room like people had seen him with his pants down."
Henry rolled back into his chair, threw his wiggling arms and legs up into the air, and squealed "Wheeeeh! Wheeeh! That's great! Oh lord, I can't wait until I see him in the mail room.'Excuse me, Dr. Stein, do you smell something funny?' Wheeeh! I can't stand it! This patient Doe is great! Let's see his test data."
We spread the sheets onto Henry's desk. While he scratched his beard and looked over the data, I sat back, tried to relax, and waited.
Henry was an expert at test interpretation. He generated big bucks for the hospital when he created the testing program, which was why the psychiatrists had a hard time finding a justification to block his promotion to associate professor with tenure. Historically, psychologists first entered psychiatric hospitals as administrators and interpreters of psychological tests. Psychiatrists knew nothing about it. They also knew nothing about experimental research methods - an ignorance that eventually became a burden once medical schools started to require empirical research as a criterion for promotion. So many of them relied on psychologists to design the research studies for them. Henry was constantly being badgered by the psychiatrists to take them into his projects so they could put their name on his publications - even when their only contribution to the project was stapling papers. He flatly refused, and they resented it. They resented the fact that he was so bright and capable. They also resented the fact that he continually fought for the rights of psychologists beyond doing testing and research - for the right to be actively involved in making diagnoses and conducting psychotherapy - activities reserved exclusively for the medical staff in the old days. It was a constant battle, and it took its toll on Henry's stomach. But he never let them know. In fact, in his own unique hypomanic style, he persistently kidded them about their pomposity, made faces at their demands, and, sometimes, even got them to laugh at themselves.
"Holy moly," Henry exclaimed, "this guy Mobin is a real hurtin' soldier! His refusal to take the tests clearly indicates paranoia. He even tried to rip some of the pages out of the MMPI! Be on the lookout for violence, Tom. The few responses he gave to the Rorschach are also bad news - poor form, poor affect control, deviant thinking. On card 2 he said it was blood gushing out of a crack in the universe. And here on card 6, the bear skin rug - he says it's a knife stuck up the asshole of the universe. Both are pathognomic signs of schizophrenia. Jesus, this guy is psychotic up the wazoo! That remark about the knife is a sign of homosexual conflict and the one about blood gushing out of a crack suggests intense hostility towards women. Very strong underlying rage in this guy. It's completely disorganized his identity structure - even his gender identity is fouled up on a very primitive level. Watch him carefully. Has Fred looked into transferring him over to the state hospital?"
"Yeah, but right now there are no beds."
"O.K., keep an eye on him. So, let's take a look at Doe. On the WAIS he scored a 115, so he's slightly above the average range of intelligence - "
"But look at the pattern of right and wrong answers, Henry. On all the subscales, he gets a right answer followed by wrong answers - but exactly the number of wrong answers allowed before that subscale is terminated - and then he gives another right answer, almost as if he knew that if he got one more wrong answer in a row the test would be ended. It's like he was familiar with the WAIS and was playing games with it. His IQ is probably a lot higher."
"Hmmm.... interesting," Henry answered, "but you may be reading too much into it. The scatter of right and wrong answers is typical of patients with attention and memory deficits, including those deficits caused by schizophrenia. Peggy has a note here that some of his responses were bizarre. Let's see - here for instance - in response to 'Why do we pay taxes' he says 'Because we have to die.' And here, in response to 'What are the apocrypha' he says 'Bedtime stories.' Sure sounds like psychotic thinking to me. But let's take a look at the MMPI before we jump to any conclusions. Remember, we're always looking for converging evidence across all the test data that confirms our diagnosis. On the MMPI he has an 8-6 profile - two standard deviations above normal on the schizophrenia and paranoia subscales. That clearly indicates psychosis and paranoid thought processes."
"But couldn't those elevations could also mean eccentric or creative thinking," I added, "or an acute sensitivity to the environment, especially social events."
"Yeah, there's some of that here. But it's more typical of a schizophrenic profile. Here again Peggy has a note indicating that some of his answers were clearly abnormal. For instance, he answers true to both 'I hear voices in the wind' and 'My soul sometimes leaves my body.' And on the Rorschach he shows mostly poor form responses - he just doesn't see the shape of the inkblots like most people do, which is another sign of psychosis. Also, there are a lot of special scores and other idiosyncratic responses. Now, what's interesting in terms of the content of his responses is that he often perceives the inkblots as being masks. It's his primary response on cards 1, 3, and 5, and on card 6 he says it's either a flattened out animal or a mask. That preoccupation with masks might confirm Stein's ideas about an 'as-if' personality, but I'd still rely more on the diagnosis of schizophrenia. He puts on a mask for people, probably a very normal looking mask, but underneath he's psychotic. He also gives many white space responses. Rather than telling you what the inkblots look like, he tells you what the white spaces look like. Essentially, he subtly defies the instructions of the test and does just the reverse of what you are asking. He's oppositional, stubborn, and has a lot of buried anger."
"Look what he does on card 10, Henry. He balances it on the tip of his finger, spins it, and gives the response 'The center disintegrates and the world flies apart.' What does that mean?"
"It means he has exquisite motor control," he said with a laugh, "but in it's own psychotic way, it's beautiful. I can see why you might find this guy creative and intelligent. That card is filled with different colors and shapes. It's very difficult for even a normal person to pull it all together into one coherent image. It requires a cohesive sense of self - which Doe doesn't have. For him there is no sense of a center to his intrapsychic world. It IS flying apart. What's fascinating about the guy is that he finds a way to express that so vividly."
"Yeah," I replied, "but isn't it possible that there's more going on here than just schizophrenia? There's something about Doe that really gets to me. He seems to be aware of things that I'm not. He... sees things."
Henry threw me a quizzical look. "Hmmm, well, schizophrenics do sometimes have access to things that we may miss - it's called 'schizophrenic insight.' It can be fascinating, and very enticing, to tap into their experience... But it requires a lot of ego strength on the part of the clinician to explore that stuff - and Tom, I'm not sure you're up to it right now. You're stressed out, you're sick. I think it would be a good idea for you to slow down a bit. It's just a job, right? That's a free piece of advice," he said as he reached over and put his hand on my shoulder, "and as we all know, free advice is worth twice what we pay for it."