On people wasting your time

One day I was talking to someone who said to me "I'm sorry to be wasting your time". She was very depressed. I mean depressed in the classical sense, not just meeting medical criteria. I mean being so low that you don't even feel sad anymore, you feel nothing, as if you were dead already. I said to this lady that we're human beings and you don't waste your time with other human beings, we merely share it. I have realised since making that statement that there is no such thing as one-way or one-sided relationships. Even when you love someone and they don't feel the same way about you, that is still not a one-way interaction. We're human beings, and even if we want to believe that we live in a world where there are only material things, words, and other physical things like light, sound, movement, etc., that is simply not all there is. We have a rich inner world, we create metaphysical tracts we call relationships, we create and (most of live by) social norms. As annoying and as inconvenient as it sometimes is, we simply cannot go back to saying we are just carbon-based life-forms existing in a physical world that have no impact on each other's inner or external spaces. When you console your depressed friend, it isn't just for them, it doesn't just involve them; you don't just give without also taking away from the experience.

In clinic I sometimes see people who apologize to me for wasting my time. And it's not the ones that as a doctor you usually think of as 'wasting your time', like the drug seekers and malingerers. It will usually be someone with a mood disorder who feels they are a burden to everyone, including their treating clinicians. But then they quickly point out, "I know you're getting paid, but..." Which is right, I do get paid to do my job! A few years ago a patient said to me that he was sorry for taking up my time with his depression, and "knew" that I only did it because it was my job and I couldn't kick him out. I said to him, "actually I can kick you out". He looked at me, surprised, I guess. I explained, yes, this is my room and I am in control of what happens here. If I want you out of my room, I can make that happen. Stuff etiquette, stuff protocol, stuff that constant thought in the back of every doctors head of "how will this look in court?" Yes, I told the patient, I could if I wanted to kick him out of my room, and I can even go as far as terminating our therapeutic relationship altogether, not just that day's consultation. This was not an emergency situation, and terminating the consultation abruptly would not really affect his mental/physical health, so I had every right to ask him to leave my room – if I wanted to. But then I asked the patient, and "do you know why I haven't kicked you out of my room?"

I asked this question aloud for two reasons, and one of them was to buy some time to ask myself this same question. Do I care? Really, do I care about this patient? I mean "care" as in does this person's predicament truly concern me in a sense that it affects me emotionally? Well, no. I care about my mum, my friends, my partner, my pets, and my own physical health. I can't care for or about every patient in that way or I'd make a terrible and over-involved clinician. Of course, I "care" from a healthcare/clinical point of view of wanting my clinical management to better and not worsen the patient.

I believe in being honest to my patients, so I knew I wanted to word my response to this man in the most honest way I know how, and "care" was not the word I wanted to use. Why don't I kick you out my room when you're cleared depressed and have reached out to me for medical help? The first reason is because I understand why you sought me out in the first place.  You reached out for medical help because you felt you couldn't help your own self anymore, that you're unable to be helped, and not only that but that you're also unworthy of help. Those last two points are exactly why you asked the question in the first place. The second reason I haven't kicked you out my room is because I see your potential. And I see this because I am on the outside looking in. Depression is like being inside a deep, dark, empty, silent, and very still void. I'd say it's like a well, but in reality there is not even a bottom and there are no sides for a reference point. You can't see outside of the void – and when you're truly in that melancholic/pre-suicidal depression, there is no will left to want to see outside of the well. But I'm on the outside! I'm your clinician and I am on the outside looking in and can tell you that there is something outside of the void and you can and will get outside of its grip if we do things that seem pointless right now. This is exactly what I mean when I say I can see the potential in another person. (Of course there’s no point at all in this situation to disclose to patients that I understand depression so well because I have been in that void before. In fact I think this changes nothing in terms of how well any clinician can manage this scenario. I don't have to have experienced diabetes personally, for example, to understand it and treat it.) Patients may believe they're a waste of time and space when they're depressed, but I strongly disagree on this point. I disagree especially because, as I said, I truly do believe that we don’t waste time with other human beings, we merely share it.

I believe that sharing time with other people isn't a waste of time; that of every interaction you gain and you give, that of every interaction you learn, that every moment shared changes you as you in turn change others. And yet believing this as long as I have and as fundamentally within myself as I do, a few days ago I almost convinced myself that someone was wasting my time. And then I remembered back to my own words, and asked can people actually waste your time? And, you know; no, I still don’t think I got it all wrong in the first place. What happened was that I was responding emotionally, wanting to blame others for disappointing and hurting myself. It was easier to say “you’re wasting my time” than to admit that it was me who had unrealistic expectations. I felt very drained, raped almost on a cognitive/spiritual level, for giving so much of myself when really I was asked of nothing. And then I was upset about indifference? How absurd it seems now that I've had time to re-analyse the situation. It was like I had walked past a building, said to myself, ‘hey this is a bank’ and started pouring money into it – and then I got upset and angry when this building kept only taking and storing what I gave it but gave me no returns, let alone interest or growth. And am I to blame the building or my own delusional self for this feeling of exhaustion? Myself, of course. And yet I can take this experience and say that really that no time was lost, I merely shared a moment and learnt a very valuable lesson.

¿Qué escondes, mi flor blanca?
¿Qué hay bajo la próxima capa?

¿Es un escorpión?

¿Es tu corazón?

¿Son los gusanos que te comerán viva por no dejarte ver?

¿Son mariposas esperando su re-nacer?