I recently came across a short “introspection” published in The American Journal of Psychiatry by Dr. Jonathan Benjamin describing the case of Mr. A, an unemployed alcoholic, during the time Dr. Benjamin was working as a consultation-liaison psychiatrist in a primary care setting. Mr. A. wanted to show his primary care physician that he was no longer drinking (a routine the physician and patient had been through many times in the past) by suggesting he could come into the clinic every other day so the doctor could smell his breath.
But Dr. Benjamin had another idea:
“Mr. A, I like the idea of your coming to the clinic every other day, but I do not like the idea of your reporting in disgrace. How about if you learned to bake a little? On every visit you could bring the team a cake or cookies you’d made.” (The clinic had about 15 staff members.)
“You could also do a little clean-up in the kitchenette, or sort some mail. That way we could all pretend you were volunteering, and not just on parole, as it were.”
The couple agreed to try, and I went back to a regular clinical and administrative job and forgot the incident. The other day, at a professional meeting, I ran into [the primary care physician who was Mr. A's doctor]. He told me enthusiastically that Mr. A had been sober for 8 months and had a new job. His wife was thrilled.
I felt a real rush of warmth. It is not every day we see a “quick cure” in psychiatry.
Dr. Benjamin then poses the question to the journal’s readers — what made this a seemingly successful intervention (if, as he noted, it even was the intervention that helped)? Was is the psychiatrist’s empathy for the patient, giving the patient Mr. A some renewed purpose and sense of self?
Or was it something else altogether? Post your thoughts below.
Reference:
Benjamin, J. (2009). The Importance of Cookies. Am J Psychiatry, 166, 1110.
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Links to This Article
Cookies or Empathy? | World of Psychology | Empath Intelligence Blog (10/15/2009)
8 Comments to
“Cookies or Empathy?”
Dear John,
Firstly thank you again for sharing such an inspiring “introspection”.
I would like to add that I feel it was more to do with the self worth and purpose in empowering Mr.A and the fact that Dr.Benjamin conveyed his trust and belief in
Mr. A that made this so successful.
And at the end of the day the proof is in the pudding so to speak and that‘s the way the cookie crumbled on this occasion.
Regards
Dawn Pugh
cookies are highly addictive. one addiction replaced another more malevolent one. did he experience weight gain?
Gratifying story. How the”intervention” This is how I perceive the process. multi-layered,integration of positive self mastery. During an internship as Addictions Counselor in a residential recovery setting I saw the intrinsic, deeply despairing belief in ones own lack of positive self value, instinct injury and dis-empowerment,along with debilitating, despair and narcissistic wounding. When a person is mirrored back with highest possible compassion, a true belief of a third potential identity,the positive”other”becomes the possible inner potential. Beyond the habitual identity of core wounding, shame,rage and dualistic double bind. Refusing the role of externalized authoritarian as “parole/judge-expert/invalidator”. Neither the inflated grandiose defensiveness of self protection, nor opposite side of shame and hopelessness filled with painful devaluation need happen. Dualistic double-binds are reconciled hen The unknown Third possibility presents itself as Intrinsic Value, worthwhile adult who’s inner intuition/self-mastery becomes enhanced and validated, A was invited to offer this third option of self-mastery in small positive increments. Mirrored by appropriate feedback and appreciation he could internalize.Appropriate humanistic Values and refusing the role of “authoritarian expert” worked better to empower A to occupy this role himself bypassing habitual identification with his usual conflict between his wounded/grandiose identities. Ones personal empowerment to choose self mastery emerges naturally with the unknown option. What follows is work in recognition of abuses of power and the original wound. Inner and outer power issues are no longer irreconcilable. Inner value, boundaries,Compassion and realistic self-acceptance become internalized self mastery, perhaps the first time.
Regretfully accidentally hit submit function before finished editing. Extremely sloppy, with glaring grammar and structure errors. Quite embarrassing. Nevertheless, I hope my premise rings true for interested readers. Regards A
Lie the story. It sounds as if: first,Dr. Benjamin treated Mr A. like a fellow human being, not so much as a “patient” and 2)helped him in what is always a awkward situation by giving concrete suggestions for positive actions, and 3)the acts had to do with service to others - which takes the focus off the self, is a unpressured social activity, and gave Mr. A something clear and real to feel good about.
Its been a while since I read it, but this reminded me of the book “Water Bears No Scars” about Morita therapy - with its emphasis on the therapeutic value of simple tasks (I’m no expert on it)
That said, I wonder if he made it long term? Alcoholism is such a beast, it usually doesn’t leave quietly or permanently…
“Was it the psychiatrist’s empathy for the patient, giving the patient Mr. A some renewed purpose and sense of self?” Yes.
One day I went to a psychiatrist that knew me for a few years. I told him that I studied a lot of material in his field and I might need his help because I was in a major depression. He told me, “You are just like a student out of medical school, inducing all kind of diseases!” I insisted that I had all the symptoms… He asked me to stay until he finished his work in his office and then to accept being hospitalized along with other 6 women that had the diagnosis that I offered! Until the end of his work day, I was invited to assist during his own hour of therapy, done with another colleague (someone that I knew too) probably to show me that they trusted me. I didn’t like the idea of being hospitalized but I would had liked less to be considered a non-serious person. Therefore I changed into the hospital attire and moved to the room. After 3 hours, I was cured! I left the hospital and thanked the doctor for his brilliant idea! 
I think what may have influenced Mr. A’s change of heart was the psychiatrist’s hinting at the fact that the world does not all center around Mr. A and his alcoholism, and his needs, and his failures, and his defeats.
In a way, that an alternative to trying to get rid of a problem, or rather than focusing on reducing/curing the bad may be to introduce the good, and positive, and this may by itself then make the bad take up less space? Kat
Gabriela, great story! Kat
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Last reviewed: By John M. Grohol, Psy.D. on 1 Oct 2009
