San Diego Union-Tribune
Psychiatrist is a stand-up guy
By Fred Dickey5 a.m.May 12, 2014
Psychiatrists are not supposed to be funny. Patients are supposed to be funny — but not in a way we’re allowed to laugh at. But when we get Freudian, well, don’t be surprised at anything.
We’ve all heard the shrink jokes, but here’s a shrink that has jokes for us — some about himself and some about us, our heads and what might be hiding in them.
Howard Richmond, M.D., is a psychiatrist. He’s not a stare-over-the-top-of-the-glasses-in-a-suit-and-ugly-tie guy. He’s dressed casually and as relaxed as an end-of-shift bartender. At night, he sometimes can be found on stage at one of the comedy clubs or doing stand-up for a charity event. It might be because he’s good or because he’s free. It’s the only time you’ll see him at that price.
Richmond grew up around the world with a suitcase under his bed as the son of a foreign service officer. He has practiced medicine for 22 years. He and his wife live in Encinitas with two German shepherd rescues, and it’s also where he practices yoga and his 12-string guitar.
He’s tall, slim and dignified-handsome, the way a guy who’s 56 hopes to look. It’s apparent he loves the stage, standing there squeezing the mike with tie askew (comics have to have askew ties) and making people laugh. Yuks are harder to come by in his day job.
•••
Good evening, and welcome to a session with the Comic Shrink. Even though we only have 30 minutes, I still have to charge you for the full hour.
Before I go on, I have to dispel an old myth: Not all doctors think they’re God. I know, I’m part human.
Do you like me? You shouldn’t. That would be enabling.
•••
One thing people with mental illness rarely do is laugh. There’s not much funny going on in their lives — or their imagination. So, if he can get them to at least chuckle, Richmond figures that might be good therapy. “Humor is very healing, and it allows me to tap into my creativity.”
In his practice, Richmond uses medications, but also talk therapy. Now, for a psychiatrist, that’s kind of funny — different in itself. These days, psychiatrists use medications almost exclusively for treatment, and psychologists use talk, and rarely do the twain meet.
The reason is economic. Richmond says a psychiatrist can see four to six patients per hour for medication checks. That’s about the same amount of time a psychologist takes to consult with one patient.
“I say to my patients, ‘Medications won’t teach you anything. What they can do is quiet down your brain so then I can help you acquire tools that you need to have.’ If we don’t get out of the narrow vision that it’s either this (drugs) or that (therapy), we’re going to miss the whole picture.
“Psychiatry has tended to over-emphasize the biological or medication treatments and under-emphasize therapeutic measures.”
Have you seen cases of medications being over-prescribed?
“Oh, sure, yeah, especially if you’re seeing somebody for a short period of time. If you’re a psychiatrist who refers to a non-MD therapist, there (needs to be) good communication between the two of you. But in my practice, it’s one-stop shopping. If medications are needed, I can prescribe and then I do the therapy also.
“If somebody comes in and they’re emotionally hemorrhaging, they might need medication on the spot, and I will prescribe. Then (when they’re stabilized), we can do the therapy.”
•••
How many of you are from a dysfunctional family? Or two? … Some of you didn’t respond. You’re in denial. Denial is the first sign of being in a dysfunctional family.
•••
Richmond first employed humor as a deliberate therapy tool several years ago with a female patient whom he describes as a “psychiatric train wreck.”
“She had an eating disorder, anxiety, depression, etcetera. The traditional therapy wasn’t working. She would come in, eyes on the floor, and would hardly say anything. And if she did, it was full of tears and trauma. She just wanted to die.
“One day, when she was in that condition, I got up out of my chair and walked over to where she was sitting. I lay down on the floor and I looked up at her, and she cracked a smile. Psychiatrists aren’t supposed to get up off their chair, lie down on the floor and look up at patients.”
The ice cracked.
“The thickness of her negativity and pain, it just filled the room. Next session, I crawled into the leg-space of my desk, and I said, ‘Is this how you feel — all scrunched up like this?’ And she nodded and said, ‘Yes.’
“She started to become more animated. I began to use more humor in the treatment sessions. She was hospitalized 12 times in four years. She was 40, 5-foot-7 and weighed 85 pounds. She was on a very thin line between life and death.
“I was using my whole toolkit. I would see her in the hospital and the negativity was so dense. I would say, ‘Come on, let’s take a walk.’ We’d walk around the hospital grounds. I would run circles around her. ‘Is this what your mind is doing? Running in a circle?’”
Weren’t you worried someone would say, “He’s crazier than she is?”
“That thought crossed my mind, but I knew she could very well die if I didn’t do everything that I thought could help. Now, I wouldn’t do that with just everybody. This was a very specific case that really challenged me, and it broke open a door.
“I took her to the cafeteria. For an anorexic, the cafeteria is like going into Fallujah (Iraq); it was a battlefield for her. In (the food) line, I got two trays, and she is just mortified. There are some grapes there. I grabbed a grape. I toss it in the air. The gods were with me. It goes way up. I open my mouth — plunk. She laughed.”
Don’t try that twice.
“I did, and it worked twice. A doctor isn’t supposed to do this. I am throwing curveballs to her mind so she can’t hold on to her pain in that moment. Boom, it breaks it.”
What was the outcome?
“Good. She ended up good. She only sees me infrequently now.”
•••
I went to therapy and discovered I’m a “snag” — a Sensitive, New Age Guy.
And you know what that gets you with women?
Nothing. Nada. That’s what you women say you want, but you don’t really want that. You have gay friends for that.
•••
“The simple part (of life) is, we all want to be loved, accepted and to be happy. The complex part is, we muck it up, keep on doing the same things over and over. So much of our behavior is driven by judgments and emotions that are reflexive and automatic. I refer to this as our ‘auto-pilot’ mode. I remind people that auto-pilot is good in airplanes except with take-offs, landings or turbulence.”
Let’s go on to something else — guilt.
“OK, guilt. What I say to people is: Let’s distinguish guilt. Instead of an amorphous blob, let’s cleave it and let’s look at what healthy guilt is, and unhealthy guilt. Big difference, but nobody talks about that. If you’re feeling guilty of something that happened 20 years ago, it’s probably not healthy. Healthy guilt is if it keeps you from repeating behavior you know to be wrong. If a person has no ability to feel guilt, we call them a sociopath.”
Resentment?
“There’s a saying, ‘Resentment is the poison I drink hoping you will die.’ Every (resentful) person has a story: ‘He-she-it-they-them did something to me and I can prove it.’ That basically is the template for everybody’s resentment story, and that’s always a dead-end. Do we get better with that? No, it makes us sick, not well. What I teach is that it’s not about the story, it’s about the (attendant) emotions, the feelings of betrayal that have to be dealt with.”
•••
People that know me as a shrink can’t believe I’m a comic.
People that know me as a comic can’t believe I’m a comic.
Comic shrink is an oxymoron: Two words that don’t go together, like Korean missile, Microsoft Works, family function.
•••
Do people grow from pain?
“People don’t come to see me if they’re not in pain. I believe pain can be a teacher; we can learn from it and it makes us stronger.
“I think pain causes the reaction in our hard-wiring of, ‘Don’t touch that hot stove!’ so we withdraw from pain. On the other hand, if we can have a therapist or someone who can help us understand and accept it, and to have the courage to work through it, we can have tremendous growth.”
•••
My mother taught me that you can’t cry when you’re laughing. That’s what Richmond also believes. What a concept — a psychiatrist who might actually be as smart as mom.
Fred Dickey’s home page is freddickey.net. He believes every life is an adventure and welcomes ideas at [email protected].
© Copyright 2014 The San Diego Union-Tribune, LLC. An MLIM LLC Company. All rights reserved.
