Sunday, January 28, 2018

Wyman's Oppositional Treatment

One of the lessons I learned in an acute involuntary psychiatric facility is that the patient's intent is usually the opposite of the best treatment. A psychiatrist I work with has even humorously incorporated it into her repertoire, granting it the title "Wyman's Oppositional Treatment."

If you want to leave the hospital, it is likely you need to stay.  If you want to stay, you should leave.*
If you don't want any medicine, you probably need it;  if you demand medication, you probably shouldn't have it.
If you want to sleep we make you get up;  if you want to stay up we make you go to sleep.
If you have to journal it's probably interfering with your recovery.  If you refuse to journal it would probably do you some good.
The principle applies in all areas.

This is of course merely cynical, but it is based on a long career of noticing things, and when one takes it apart, it makes sense. If a person is admitted to a hospital in a crisis, it is because there is some conflict with your environment that is seriously interfering with your functioning. The point where you are rubbing up against the rest of the world, insisting that you are right and they are wrong, is the first place to check. This is trebly so when you have passed through several filters of family, friends, therapists, emergency rooms, police, or judges to land on our doorstep.

I thought of this today during our panel-discussion sermon when an APRN talked about how to decide when a teenager's isolation and anxiety were just normal developmental events and when they were signs of something more serious.  My knee-jerk reaction is that most everyone will choose wrongly, steering the wrong kids toward therapy and and away from therapy. We often only see these things clearly in retrospect: "I didn't go to a counselor then, thinking I could handle it on my own, but looking back, I probably should have gone," versus "I went to a counselor for over a year and I learned some things, but I don't think it made much difference."

The best outcome is to guess right the first time.  The second-best outcome is to figure out on your own that your first guess was wrong, and to switch to your second guess.  For the record, second guesses are not necessarily opposites. They can be 12-Step groups, changing jobs, or moving to Montana. But don't ignore the direct opposite solution.  When I was a young man, I started to avoid visiting or talking to my mother because I thought she disapproved of my choices and thought me a bit of a failure. (This was somewhat true.  She did disapprove and was disappointed.)  Yet applying the oppositional strategy worked.  I invited her down to visit for almost a week, and she came away much more comfortable with the choices Tracy and I were making, even if not quite agreeing.

 *If you ever get put into a psychiatric hospital against your will, this is a good trick to know. Tell them you think you need a long admission to work on all your issues. This strikes fear into the hearts of psych nurses, who will rapidly become your fiercest advocates for discharge.


RichardJohnson said...

My year as a Mental Health Worker, a.k.a. aide, at a private psych hospital led me to the conclusion that it was a primary goal of treatment to get the patient to agree with the staff's assessment of the patient and what treatment of the patient should be.

Christopher B said...

Well, they are sane and you are crazy so the idea would be to agree with them, after a suitable interval so they get the idea that their proposed therapy worked.

Jonathan said...

AVI, WRT to your comment re you and your mother, can you expand on how your oppositional principle might by applied by reasonably well functioning people in managing their own lives? The principle makes intuitive sense but it seems unlikely that many people could follow it consistently without being forced to.

Sam L. said...

Off topic, but ABBA comes up in this:

Assistant Village Idiot said...

Jonathan, I would just put it in the category of creative problem-solving, where you first have to realise your current strategy isn't working, step back, and consider if some opposite idea might work better. See also, the way to get someone to like you is to get them to do a favor for you, not you do more favors for them. We get locked in to beating our head against a wall, when sometimes we can just go around it.

james said...

Kenneth Roberts wrote some novels about the French&Indian war and the Revolution. A recurring character was Doc Means, who kept a copy of Galen (I think) and carefully looked up how the authorities treated the ailment before him, and then did something different.