The beast in me is caged by frail and fragile bars
Restless by day
And by night, rants and rages at the stars
God help the beast in me
– Nick Lowe, The Beast In Me
“Alright already, lady, enough about how you are sure that stress caused your cancer. I’ve been listening to you go on and on about it for like the last 15 minutes.” Such was the dark thought that, unbidden, streamed upwards as steadily and elegantly as a champagne bubble from deep within my id and up into my conscious brain during a recent genetic counseling session. The thought bubble was persistent enough that it interfered with my ability to pay attention to the issues at hand. Fortunately, my eventual awareness of it allowed me to deflate it and let it sink back down to some cryptic neurological crevice. I refocused myself, validated her concerns and explored the sources of her stress and why she thought it may have led to her cancer.
A few days later, out for a run, I lapsed into a meditative state and was able to process what happened. My patience for patients had been wearing thin that day – she was late for her appointment, I had yet another too full schedule, the office assistant was out sick, my bus ran late that morning. Bad days and bad thoughts happen; it comes with the genetic counseling territory. We all think that way sometimes (well, I hope I am not the only one).
The experience intrigued me enough that I decided to track some more of my dark thoughts during my genetic counseling sessions over the next week. I was amused by my eventual realization that my internal thought voice had an accent and tone that was much closer to that of my Brooklyn youth, whose edge has now been tempered a bit after nearly 4 decades as a NYC ex-pat.
Here’s a sampler of thoughts from my work week; some I am embarrassed to acknowledge. Honestly, I did not tell you the worst of them but sometimes it seemed as if mini-versions of Ted Cruz or Donald Trump had taken up rude residence in my head:
– “Hey, you have some nerve comin’ in here stinking of cigarettes. I mean you have cancer for Crissakes. Where are your brains?”
– “You don’t want your ovaries removed? Are you kidding me? You have a BRCA1 mutation, you’re 57 years old, and your mother, sister and an aunt all died of ovarian cancer in their 50s? I wanna’ dope slap you upside your head.”
– “What do you mean you don’t want to undergo genetic testing? You are the key person for your entire family. Without your results, we can’t establish risk and appropriate screening and risk reducing strategies for your children, siblings, nieces, and nephews. You are going to let some stupid family feud that started over some Christmas dinner a decade ago get in the way of possibly saving lives and suffering? Grow up, please.”
– “Boy, is that a really bad haircut! And those clothes! Are you aware that it is not 1983 anymore?”
– “Stop acting like Mr. Know-It-All. You may have done a lot of reading on the Internet, but you clearly didn’t understand half of it, and the half you do understand is largely misinformation.”
Confessing my dark side to the Good Readers of The DNA Exchange is difficult, to say the least. Baring one’s counseling soul is not without its awkwardness. Probably many of you are having more than your usual share of dark thoughts about me. In fact, I am having my own dark thoughts about myself at this point.
But I don’t think this means I am a bad counselor or a bad person or a potential Republican presidential candidate. These thoughts are really about the struggle between my professional self and my private self, both of which are multifaceted, changing, and difficult to pin down. Like my fellow ex-Brooklynite Walt Whitman, my self-song is contradictory, large, and contains multitudes.
My dark internal discourse is part of the ongoing, complex, and never-ending evolution of professional development. I don’t necessarily agree with the sentiments of these thought bubbles or think they reflect the “me” that I present to the world. By processing these discomfiting dark thoughts I hopefully emerge a better counselor and a better person, someone who I prefer to believe is ruled more by Good Angels than Lucifers.
This requires continual vigilance, learning, awareness of the pressure they put us under, and growth to admit to them so as to understand where they are coming from. No doubt the struggle between the yin and yang of transference and counter-transference is at play here too. The goal is to not let them unconsciously insinuate themselves into the external counseling dialog that we engage in with our patients. Probably I fail at it frequently; yet one more reason why we should pursue professional supervision and openly discuss these issues at our educational conferences.
This is our last dance
This is ourselves
from Under Pressure, written by David Bowie and Queen
The obvious truth that I can’t lose sight of is that genetic counseling is about patients, not about me, my viewpoints, or my belief that I am so damn right about everything that they should put me in charge of the world. The other truth is that darkness can be turned into a shining light that makes us better people. It is at the core of the human condition, and if we allow it, beauty, self-awareness, respect for humanity, and a deep sense of wonder can transform us. God help the beast in us all.
11 responses to “Through A Counselor Darkly”
Great post. I am all for normalizing and talking about something that is kinda “taboo” in the GC world. Sometimes my “GC brain” and my “sarcastic brain” aren’t on the same page. Thank you for writing something so relateable.
I really appreciate this piece! Thank you for always being so honest and open – it helps to know that we are not alone in our experiences/struggles.
No you are not alone and now neither are the rest of us. Thank you for shining a light on things we need to see–and discuss.
Yeah, I’ve had some flavor of those thoughts from time to time. Then I give myself a hard dope slap.
This post reminds me of a stand up bit I saw from Jerry Seinfeld a few years back. He was talking about this voice that we all have in our heads that just tells us horrible, horrible things. For example, when sitting in an apartment one might wonder ‘what would happen if I jumped off the balcony?’ Or ‘if I killed this person, how might I get away with it?’
On a psychological level I’m not sure why these thoughts come up.
To me, the voice represents the potential to go to the ‘dark side’. But as you alluded to in your post, Mr. Resta, the great thing is that we have the awareness and ability to push that voice aside and do what we know is best.
Thank you for sharing your inner processes so openly. Bravo! Indeed, I agree that we all have these dark thoughts. The only way I know to quiet the chatter and not permit it to take over my personal or professional life is to hear the voice and (try) to not be too self critical. You describe that process bravely.
I also found comfort in reading Jehannine Austin’s presidential address. She, too, shares her inner experience quite eloquently. http://link.springer.com/article/10.1007/s10897-015-9913-x
A discussion at this year’s AEC is an excellent choice.
Unconditional positive regard is HARD! Thoughts will inevitably bubble up (sometimes I think my subconscious is just trying to amuse me with a sarcastic comment rather than actually judge the patient), but as long as the thoughts don’t bubble OUT, I think we’re okay 🙂
Thank you! I am sure you are correct that those are not the worse (I know they don’t match my worst). The discussion is so true and important to realize the struggles we are all facing during what may seem like a mundane session and keep the focus on our patients. A skill not everyone has.
Awesome, thank you for the laugh at the end of a very long week!
Pingback: The Late Show | The DNA Exchange
Now that I’ve read your next post, I have insight into why you were having such a bad day: the patient was late! your bus was late! You hate being late!