| Tissue, I hardly know you |
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This play on words was a favorite of Mr. Simon Solomon, Z'L, my Chumash -Torah- teacher during my elementary school years; I guess with today's sensitivity to abuse, he would never have said it at all! _option_option_option_option_optionThat said, -it popped into my mind recently when a patient asked for a tissue. We in the ‘helping profession' touch the emotions of our patients. We are also touched by their narratives. In my work as a neuropsychologist, when a diagnosis is hypothesized or presented, there have been many occasions where tears of happiness, relief, anger or sadness have flowed. I have some tissues in my handbag and un-used luncheon napkins in my desk, what I don't have in my office, is a box of tissues. I really never thought about the absence of THE Tissue Box until recently. A patient started to cry profusely. When her personal ‘stock' was depleted, I searched my bag for tissues, when they too were exhausted, out came the un-used luncheon napkins. The crying subsided before the napkins were finished. At the height of her tears, the patient looked at me and tears streaming said: How can you call yourself a psychologist if you don't even have a tissue box?! Then more stridently: "Aren't you allowed to cry here!" I answered that I guess I'm not ‘that sort' of psychologist, and thought, no here we don't have time to cry here. I have since thought about The Tissue Box situation. Why do I still not have a tissue box in my office? Firstly, I thought, the answer might lie in the difference between the practice of neuropsychology and clinical/psychotherapy psychology. Neuropsychology is the science of brain-behavior relationships. Clinical neuropsychologists focus on understanding how brain processes affects one's ability to function at work, home and school. It is no less important to know what normal cognitive and social development is, as to know how to diagnose dysfunction. Neuropsychological examinations provide a broad overview of neurocognitive and emotional functioning, including sensation, perception, basic motor functions, language, attention and concentration, memory, academic achievement, global intelligence. Higher integrative functions which are today described as ‘Executive Functions' include: self-regulation, self-monitoring and impulse control. They can shed light on the underlying causes of behavior problems, discriminating between emotional and cognitive roots. One of the most important benefits of such examinations is to document cognitive strengths which can be used to compensate for areas of weakness. Repeated assessment can document resolution, stabilization or deterioration of neurocognitive deficits and neurological disease. Combined with personality testing, it can also help to differentiate between psychological and physical problems (e.g. Parathyroid disorder vs. anxiety/moodiness). Proper evaluation can also help the consulting physician make decisions on medication, such as which medications may be contraindicated from a functional viewpoint (for example a child diagnosed with ADHD and Tourette Syndrome). Neuropsychological evaluations can pin-point specific weaknesses that interfere with an individual's ability to function, so that an effective remedial program can be initiated. So what is psychology? One of the many definitions is: The study of an organism's thoughts, feelings, and behavior and how these processes are effected by the environment, physical states, and mental states. How is crying defined? Demanding or requiring action or attention: as in ‘a crying need'. Abominable; reprehensible: as in ‘a crying shame'. Compelling immediate attention: burning, dire, emergent, exigent, imperative, instant, pressing, urgent. On the other hand what did I respond to: crying, as the process of shedding tears, the watery secretion of the lacrimal gland, which is located at the outer corner of the eye socket immediately above the eyeball. Tearing, or lacrimation, is a continuous and largely involuntary process stimulated by the autonomic nervous system. Fluid is secreted into the lacrimal lake, the area between the eyeball and the upper eyelid, and spread across the surface of the eye by blinking. Tears serve to bathe and lubricate the cornea, the sensitive outer covering of the eyeball. Typically, the fluid either evaporates or is drained off through tiny canals at the inner corner of the eye, but in times of excessive tearing the apparatus is overwhelmed and tears overflow the eyes. In the case at hand, once the ‘lacrimation' seemed to be abating, I felt we could get down to the business of working on understanding strengths and weakness in order to use the strengths to compensate or even by-pass the weakness and reach our goal of optimal functioning. This thought process, I guess defines not only the field of neuropsychology but also my ‘weltanschauung' (and probably the true answer to my question of The Tissue Box). As a developmental, rehabilitation, and medical psychologist, I work with people whose ‘differences' are obvious to the eye, or if not outwardly so, then obvious to Theodor Reik's ‘Third Ear' (listening with the third ear is to perceive what people really are trying to say). Using my poetic license, I am wont to say that neuropsychologists also diagnose seeing with the ‘Third Eye'. As I work with people with all kinds of ‘special abilities', most of them not obvious, my credo is ‘this is what IS, now lets get on with life'. So away with tissue boxes and maximize, Avodat Hashem, Gd's work, may we all live our lives to its fullest potential; L'Chaim ve L'Briut --to Life and Health. |
