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.

Dr. John Grohol is the founder & CEO of Psych Central. He is an author, researcher and expert in mental health online, and has been writing about online behavior, mental health and psychology issues -- as well as the intersection of technology and human behavior -- since 1992. Dr. Grohol sits on the editorial board of the journal Cyberpsychology, Behavior and Social Networking and is a founding board member and treasurer of the Society for Participatory Medicine.

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    Last reviewed: By John M. Grohol, Psy.D. on 1 Oct 2009
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