Psychodynamic Irimi- A. Rodriguez

On my way out from work, about to exit the lobby, I heard someone call out, “Hey, doctor!” I turned around, and this tall man came up to me.

“Hey, you the doctor that discharged me with no meds, man!”

“Ummm…”

His face looked familiar, maybe from the psychiatry emergency room, but I wasn’t sure.

“Where’d you do your training? I could have ended up dead like that lady did, and your asses woulda been SUED!” He was referring to the 2008 incident when a patient died in a psychiatric waiting room and was face down on the floor for an hour before anyone approached her.

“How’d you get your license? Where’d you do your training?” he asked again.

“In...Puerto Rico”, I replied.

“Puerto-FUCKIN’-Rico”, he condescendingly said loud enough for the people in the waiting room. “Can you fuckin’ believe it?!”

I felt like yelling insults to piss him off, but...

“Have a good night” I said as I walked out of the lobby.

 Psychiatry, as any medical specialty, has its own share of abrasive patients. The difference is that patients who are involuntarily admitted have to be kept in the hospital, even if they want to leave. Therefore, there is no escaping these difficult personalities, and it prompts me to develop my own repertoire of strategies to avoid conflict and encourage collaboration. Similarly, as a practicing aikidoka, there is no escaping the discomfort of misogi and zazen, but it invites me to reflect on how my thoughts influence my experience. These two areas, psychiatry and aikido, play a significant role in my life. Although they seem pretty different, I feel they share certain elements.

There is something about mental illness that normalizes the experience of psychosis. A patient could be brought to the psychiatric emergency room because he was talking to himself and being aggressive towards his family, yet upon the initial interview he will have no clue why he was brought there and will refuse any medications. Many psychiatric patients do not want to be hospitalized; we either have to persuade them, or if they’re a danger to themselves or others, we involuntarily admit them. Once in the hospital, these patients can be impulsive and uninhibited, which exposes staff to a lot of verbal harassment and occasional physical aggression. In a public setting, a mentally ill patient may yell insults at a passerby, who could respond in kind with equal insults, physical violence, or legal action. In the psychiatric unit, we have to ignore the verbal insults or address them in a calm, step-wise fashion. Despite how irritating or provoking a patient can get, this is usually a result of their mental illness and it improves with treatment, unless the obnoxious behavior stems from their personality.   

The inescapability of working with difficult patients reminds me of sitting for misogi and zazen, which I would describe somewhere between uncomfortable and painful. Nonetheless, I find value in training my mind to deal with discomfort, but I wonder if doing zazen in a more comfortable position, such as sitting on a chair, would be just as meaningful. In any case, it prompts me to reflect on the discomfort of other people. While I sit cross-legged for zazen, and feel my feet lose sensation and the electric pinpricks in my legs, I have moments where I reflect on people enduring more dire conditions, such as being forced into a small box and being locked inside for hours as torture. I cannot imagine how that must feel, both physically and mentally. I only know that it is terrible, and this creates an awareness of events that are far from my reality, but very real.  

While zazen is uncomfortable, misogi is painful. I feel gravity pushing the bones and tendons of my ankles into the floor. My thoughts play a role in my experience: “my nerves are getting compressed, my blood supply is decreasing, my foot muscles are becoming hypoxic →lactic acidosis →necrosis”. This only aggravates the inner distress. While I curse inside, I question who decided to choose such an unnatural position, one that impedes flowing circulation and replaces it with venous stagnation. It makes me anticipate the ending, instead of staying in the present moment.        

A similar dynamic takes place in the psychiatric unit, not about the pain, but about the emphasis on working with thoughts. In one group psychotherapy session, there was an obnoxious, rude patient who annoyed both the other patients and the therapist alike. In one of the sessions, the patient arrived late and immediately became disruptive. Within a few seconds, some patients were already irritated. The therapist commented on the patient’s amazing ability to enter the room and get everyone annoyed in 10 seconds, and he was not being sarcastic. He truly meant it as a special ability and used it to challenge the other patients. “If you can learn to cope with our friend here, you will gain some amazing skills when you are out in the real world”. The therapist had a point. Instead of becoming annoyed at the patient, it was more worthwhile to develop an internal perceptual shift that decreased the influence the patient had on one’s feelings.

Zazen/misogi and psychiatry both require facing uncomfortable situations that are largely influenced by how they are perceived. They are introspective exercises in evaluating reactions and finding empowerment through acceptance. In misogi, my thoughts anticipate the motions that bring the session closer to its end, and I’m working to change that mindset.  

Ultimately, by grasping the transient nature of pain, we lighten the magnitude of the present, which permits the exploration of sensation and thought that would have otherwise been overshadowed.