November 8, 2009

`The question is,’ said Alice, `whether you can make words mean so many different things.’ Lewis Carroll

Psychiatrists use words like the surgeons scalpels. With words we console and encourage, guide and caution, give hope and set limits. Psychiatrists communicate with other mental health professionals and even occasionally get understood by other medical specialists, bar surgeons.
But do our patients understand what we are trying to convey? In other words, do the words mean the same thing for us and for them?
Many of our patients say antisocial meaning asocial (“my dad is antisocial, he really likes to be alone). They use the word obsession (as in “she is obsessed about moving to Hawaii”) instead of overfocusing, and catatonic in place of stunned.
When one casually says “she is obsessed about her boyfriend”, he doesn’t mean that there1. Recurrent and persistent thoughts, impulses, or images that are experienced during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress. 2. The thoughts, impulses, or images are not simply excessive worries about real-life problems. 3. The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action. 4. The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind, and are not based in reality.
No, the casual observer means “a thought that dominates her thinking”.
People use interchangeably the words obsession and compulsion, addiction and abuse, and call substances of abuse, regardless of their chemical nature, – narcotics. Do we really understand each other?
Journalists casually use the word schizophrenic not to describe a person afflicted with severe psychiatric illness but coexistence of contradictory and incompatible tendencies in a government. As Alice said the “words mean so many different things.”
Let me leave you with a joke, which, in my view, accurately reflects perils of uncritical assumptions of mutual understanding. A little girl goes to her father and asks: “Dad, what is sex?” A bit hesitant the father carefully explains to her various aspects of human sexuality and reproduction. Afterwards he asks: “Do you have any other questions? “ “Yes,” the girl replies, “what is seven?”
`The question is,’ said Alice, `whether you can make words mean so many different things.’ `The question is,’ said Humpty Dumpty, `which is to be master — that’s all.’


One Response to “Words”

  1. BF Says:

    Bravo. Looking forward to hearing more…

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