The Stolen Book
October 14, 2010 3 Comments
Blog Post by James J. Amos MD, University of Iowa, USA
What I wanted to do as I took over the psychiatry consultation service this month was to highlight the usefulness of our newly published book Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry. I planned to refer to the first chapter on consultation process in order to highlight the importance of clarifying the consultation question. When I asked the residents whether they’d yet seen the copy that I’d donated to the Staff Consult Office a couple of months ago, they said indeed they had, found it useful, and held it up for me to see.
In fact, what they’d been using was the old handbook I’d written many years ago and which had been the inspiration for the published version. They had no idea where the published book was, though previous residents had used it, and some were even buying it. Naturally, it looked like the book had been stolen.
Instead of being angry or even frustrated, I was almost elated. Evidently someone had thought the book was good enough to steal. I’m justifiably gratified also that trainees like the old handbook that I’ve used as an educational tool on the consult service for many years. Now I’m at a loss on what to do next. Just donating another copy doesn’t seem right because someone will probably just steal that one too. I could try to persuade my department to simply buy copies for all the residents, but finances are proverbially tight in academic departments. Updating the old handbook again defeats the purpose of publishing the book. Making an electronic copy of the book and making it available via some sort of eReader might be one option. Those seem to be popular nowadays. Still, I can’t seem to shake the notion that it would somehow reward thievery.
It reminded me of a recent National Public Radio (NPR) broadcast on the All Things Considered program which aired August 30, 2010 and which described a study done by a Belfast psychologist, Jesse Bering at Queens University. This study found that children tended not to cheat on a game which had been fixed so that it was virtually impossible to win without cheating—if a special condition were imposed. If they had the impression an invisible entity were present in the room, they were just as likely to refrain from cheating as when a live adult was present. A similar study showed the same result with adults. The idea is that there might be an evolutionary advantage to believing in supernatural beings in that it may support cooperation, cut down on individual cheating, and govern moral behavior in human societies(Spiegel 2010). People are afraid they’ll be punished by supernatural beings and so curb antisocial acts—like stealing books. The theory has flaws of course, but I wonder if I could persuade the residents that the spirit of a very influential Psychosomatic Medicine specialist watches everything that happens in the staff consult office and will punish those who steal our book by causing our colleagues to ask increasingly strange and apparently unanswerable consult questions.
As almost every consultant knows, whether in psychiatry or any other medical subspecialty, the ambiguous consult question is a challenge almost on the level of the much written about “heartsink patient”. It refers to the sense of dread that a clinician gets when confronted with a patient whose behavior seems to unduly tax his or her intellectual and emotional resources. You could almost posit a “heartsink consult question”, usually a vague or seemingly unanswerable question that leads to grief if basic principles governing consultation process are not adhered to. I suspect that there are consult staff offices all around the globe that have a sort of wailing wall where a list of these questions are pushpinned to marvel at and add to every day.
Communication between the consultation requestor and the consultant is the key to resolving the difficult consult question. The consultant may need to help reframe the question after evaluating the patient. This may lead to a resolution of the problem or complicate it still further, but it should always be done with the goal of helping the patient and his doctors move forward in understanding each other and proceeding with treatment.
Spiegel, A. (2010) “Is Believing In God Evolutionarily Advantageous?” All Things Considered
James Amos is editor of Psychosomatic Medicine, An Introduction to Consultation-Liaison Psychiatry, published by Cambridge University Press