The challenges facing a psychotherapist during a yearlong internship in a New York City public hospital.
Based on her own positive experience in psychoanalysis, Lockman pursued an education in the psychoanalytic tradition, which included supervised therapy with clients, one of whom she saw over a three-year period. She explains that this put her at odds with the mainstream of the profession today because of “the pernicious hostility toward the psychoanalytical way of working,” which often dismisses psychological problems as “nothing more than chemical occurrences in the brain.” She chronicles her initial frustration with her inability to put her education and skills to good use and her dawning understanding that the chaotic conditions at the hospital often made her skills irrelevant anyway. Her patients constantly struggled with the brutal conditions of inner-city life, job loss, random violence and more. The author eventually realized that the most important gift she could give them was her willingness to listen to their concerns and treat them with respect, while evaluating whether they should be released or sent to long-term care. Her internship included forensics (the determination of whether a prisoner was mentally fit to stand trial), different stages in the intake procedure, and consultations with doctors treating medical patients who seemed disturbed. Lockman remains convinced that along with the socioeconomic problems that place limitations on the treatment offered to mental patients in public hospitals, the medicalization of mental illness is also at fault.
Before returning to graduate school Lockman worked as a magazine journalist, a skill she puts to good use in this insider's look at the practice of psychiatry in a poorly funded, understaffed public institution.