Tuesday, October 28, 2008

Angst and Medical Truths #4

It was about four weeks ago when I had a realization. Not an epiphany, but a realization nonetheless. Summer has usually been fairly laid back professionally, with plenty of days to catch up on paperwork, cleaning the cobwebs out of the office, do a bit of journal reading, taking the family down to the beach, etc. Certainly there was sufficient time to take a couple of nice camp-outs with the scouts (one in Jamaica!), and get in a little basketball, reading, and movies. But, otherwise, at the office, it was just busy. September usually brings spike in traffic, as kids get back to school and people are often just a bit more stressed, and more likely to schedule appointments.

This September, however, brought a tidal wave of work to the office. New consults, increased follow-ups and many, many more phone calls have made for a fast paced past several weeks.

Don't get me wrong, there's no complaint, as it comes with the territory, and busy business is certainly better than no business. I was just curious as to what was going on.

Which brings me to Medical Truths #4 :

"When you don't know, ask."

So I did.

What I found out was that people were just more anxious out there. They weren't coming in to the office saying "I'm worried about my 401K" or "I am worried about another terrorist attack." Those were conversations I have with my friends and family; patients weren't bringing it up very often. More curiously, even with patients with severe neuropsychiatric conditions, there seems to be just a bit more frequency in the appointments, and severity in their symptoms.
The anxiety appears to be pervasive, contagious, and ill-defined.

Angst is a wonderful word which is rooted in Old English (and thus, German); it's root is similar to "anger" and a close sibling of "anxiety". Popularized mostly due to the translations of Freud's work, it encompasses neurotic fear, guilt, remorse, and anxiety. Unlike Kierkegaard (who viewed angst as a fear of death and non-being), Freud viewed angst as being without any specific identifiable object. In current parlance, we might consider Freud's definition as a cross between a generalized feeling of dread and anxiety. The term angst has also been co-opted in existential thought, and certainly branches off at times from Freud, which would make for several interesting posts in and of itself. It is these variations of definition that have removed "angst" from common psychodynamic thought, reserving it usually only for the very serious, or not-at-all serious, discussants.

It does however, using Freud's definition, explain why my phone is currently ringing.


Erudite Redneck said...

Doc, I just accidentally sent you a Facebook Friend invite. I was just fiddling around trying to find ya. I did. But I hadn't decided whether to pester you. Just got a itchy clickin' finger, I reckon. Anyhoo, the invite from the guy whose initials are RM is me. If ya wanna. :-)

Anonymous said...

At least you have job security, which is more than many people can say right now! :)

Given everything going on in the world at once, it's not surprising your patients are feeling angst. My pdoc increased my Klonopin dose to help with anxiety (at least it stopped the panic attacks), but it didn't reduce the general sense of worry and dread one bit.

Thinking about the potential for so many things going wrong at once, when you're used to taking your security (physical, financial) for granted, can be excruciating. No wonder your phone is ringing so much.

Anyway, last time we talked about possibly increasing the Klonopin one more time, but I declined. A lot of these problems just have to be lived through and dealt with; they can't be medicated away, darn it. I just hope we move into better times quickly.

Posting anonymously this time.

Doc said...

Thanks. Now I have someone to send all those invites to!

Let's hope so indeed. I agree that it's nice to have security in the larger sense, and I do personally (Thank God), but there are many even in the medical field that are effected. Our state just had 5-10 per cent cuts in most government medical facilities, and I've seen a number of docs cut this year.

I hope that the election has a bit of calming on the country, as it normally does in the financial market. Then again "normal" and "financial market" have not been found canoodling in too many sentences recently.