Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Credulity and skepticism exist in a dynamic balance

Steven Reidbord, MD
Physician
November 3, 2015
Share
Tweet
Share

As we grow into adulthood, each of us develops a personal comfort zone located on the continuum between paranoia and gullibility.  A few of us are highly suspicious by nature, a few are unwitting dupes; most of us are in between.  Mental health professionals are no exception, and it shows in our work.  Is a request for tranquilizers or stimulants legitimate, or are we abetting a substance abuser? When told of horrific past abuse, do we believe every word, or do we allow for possible exaggeration or distortion?  Credulity and skepticism exist in dynamic balance: Too much of either impairs clinical work.

Our pride animates these assessments.  On the one hand, we see ourselves as sensitive and caring.  Empathy seems to require believing people’s stories, to be “on their side.”  On the other hand, we feel vulnerable and ashamed when fooled (as we sometimes are), and safer and proud of ourselves when we don’t fall for it.  Fueled by pride, proponents defend various points on the credulity continuum.  Some psychiatrists declare that they never prescribe tranquilizers because doing so invites manipulation by drug-seeking patients.  Conversely, some equally proud therapists never question the meaning of their clients’ cancelations, because doing so “lacks empathy.”

Like most doctors, I’m a critical thinker by nature.  This is a nice way of saying my comfort zone lies slightly closer to paranoid than gullible.  The perverse logic of the Freudian unconscious thus comes naturally to me.  Patients who claim complete marital satisfaction may be in denial, or at least recalling selectively.  Impassioned pronouncements of adoration may be “reaction formation,” telegraphing the exact opposite.  Dramatic hatred or disgust may hide a fascination, even an attraction.  The trick here, lest we treat our prejudice and not the real person in front of us, is to entertain such possibilities without becoming too attached to them.  It’s also important to distinguish empathy from blind agreement, belief, or endorsement.  I can empathize with a delusional person’s fear and panic without endorsing the delusions themselves.

A funny thing happened to me the other day.  A mental health professional in a remote land emailed me, seeking online psychotherapy for himself.  I was flattered that this colleague searched the world over and chose me.  He sought exactly the type of psychotherapy I like to conduct.  If not for distance — which would ultimately be a deal-breaker in any case, as I consider online therapy a poor substitute for the in-person kind — it seemed almost too good to be true.  Thus, wary of falling prey to my own pride and narcissism, I immediately suspected a scam.   After all, if something looks too good to be true, it probably is.  I imagined this email went to many therapists, and that it was a con, like those Nigerian emails that promise great riches and are now an Internet cliche.  This is precisely what con artists do so well: appeal to one’s greed or pride.  They hook you, then reel you in.  I wasn’t going to let that happen.

As a savvy Internet user, I knew just what to do.  I found the person online, and wrote him directly via his website.  I included the bogus email I received, to let this far-flung colleague know I wasn’t about to be taken in, and also that his identity was likely stolen for nefarious purposes.  I was rather proud of myself.

It turned out the original email was legitimate.  Adding injury to insult, I also violated the privacy of my correspondent, who doesn’t read his own website email.  I had unwittingly turned an earnest request into an awkward encounter by being too incredulous and self-protective.  In rushing to defend my pride against an imaginary threat, that very pride distanced me from someone who sought my help, and even hurt him.  It was an important and humbling lesson.

I sometimes share with patients that there is no disproving paranoia; it’s the safer stance at any moment.  Why ever let your guard down? Unfortunately this safety, which is sometimes only illusory in the end, comes at significant cost: isolation, viewing others as threats, constant fight-or-flight tension.  Sometimes this is the best self-protection we can muster in the aftermath of emotional abuse or betrayal.  However, it’s not the best we can do as human beings.  A degree of credulity, in contrast, brings vulnerability.  We can be hurt, humiliated, and diminished.  But it also allows relatedness, connection, and love.

In order for dynamic therapy to lead to change, psychotherapists must get caught up in our patients’ dynamics.  Not too much, such that we lose perspective and act like everyone else in the patient’s life.  Nor too little, such that no genuine connection or relatedness occurs.  Both parties ideally permit themselves enough credulity to be drawn into emotional engagement, while maintaining enough skepticism (or “observing ego”) to note what is happening.  Ideally, that is, for we therapists are the more obliged to maintain a watchful eye, and must balance credulity and critical thinking more carefully.

Logical argument is unlikely to convince the paranoid to be more credulous, nor the gullible to be more skeptical.  Our comfort zones are established early and unconsciously, based on emotion not logic.  The emotional power of dynamic psychotherapy and psychoanalysis, as well as close, healthy relationships in everyday life, can nudge our comfort zone in a direction that serves us better — and serves our patients better, if we happen to be psychotherapists ourselves.  Meanwhile, reflecting on prideful attachment to a particular stance on this continuum may offer us perspective and more flexibility.

Steven Reidbord is a psychiatrist who blogs at Reidbord’s Reflections.

Prev

5 ways radiologists can reduce unnecessary tests

November 2, 2015 Kevin 2
…
Next

The new mammogram guidelines emphasize that screening is a personal decision

November 3, 2015 Kevin 13
…

Tagged as: Psychiatry

Post navigation

< Previous Post
5 ways radiologists can reduce unnecessary tests
Next Post >
The new mammogram guidelines emphasize that screening is a personal decision

ADVERTISEMENT

More by Steven Reidbord, MD

  • Incurable psychiatric disorders: Should we offer palliative care or medical aid in dying?

    Steven Reidbord, MD
  • How drug prices are manipulated

    Steven Reidbord, MD
  • Which is better: Psychotherapy using video or in-person while wearing masks?

    Steven Reidbord, MD

Related Posts

  • How to balance confidence and humility online

    Brian A. Primack, MD, PhD
  • There’s no such thing as work-life balance

    Katie Fortenberry, PhD
  • A physician’s addiction to social media

    Amanda Xi, MD
  • Does work-life balance really exist for young mothers pursuing medical careers?

    Sheindel Ifrah
  • How my skepticism brought about a culture change in how our residency functions

    Michael Alpert, MD
  • The CVS-Aetna merger: millions of lives hang in the balance

    Niran S. Al-Agba, MD

More in Physician

  • Inside the heart of internal medicine: Why we stay

    Ryan Nadelson, MD
  • The quiet grief behind hospital walls

    Aaron Grubner, MD
  • a desk with keyboard and ipad with the kevinmd logo

    How to advance workforce development through research mentorship and evidence-based management

    Olumuyiwa Bamgbade, MD
  • The truth about perfection and identity in health care

    Ryan Nadelson, MD
  • Civil discourse as a leadership competency: the case for curiosity in medicine

    All Levels Leadership
  • When a medical office sublease turns into a legal nightmare

    Ralph Messo, DO
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Inside the heart of internal medicine: Why we stay

      Ryan Nadelson, MD | Physician
    • The quiet grief behind hospital walls

      Aaron Grubner, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

      AMA Committee on Economics and Quality in Medicine, Medical Student Section | Policy
    • How Project ECHO is fighting physician isolation and transforming medical education [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why clinical research is a powerful path for unmatched IMGs

      Dr. Khutaija Noor | Education

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Inside the heart of internal medicine: Why we stay

      Ryan Nadelson, MD | Physician
    • The quiet grief behind hospital walls

      Aaron Grubner, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

      AMA Committee on Economics and Quality in Medicine, Medical Student Section | Policy
    • How Project ECHO is fighting physician isolation and transforming medical education [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why clinical research is a powerful path for unmatched IMGs

      Dr. Khutaija Noor | Education

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Credulity and skepticism exist in a dynamic balance
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...