Wednesday, April 23, 2008

Bringing the Doctor-Patient Relationship into the Bedroom

In Complaints and Disorders: The Sexual Politics of Sickness, Barbara Ehrenreich and Deirdre English describe the historical gendering of the doctor-patient relationship: the older, wiser, fatherly male doctor ministering gently but firmly to the hysterical female patient. This was not hugely different from the 19th- (and early 20th-) century ideal of marriage, in which the husband takes over for the father as caretaker and chaperone for the eternally childlike, hothouse-flower daughter/wife. Given this role overlap, it's hardly surprising that several works of literature created during this era feature husbands and wives who are also doctors and patients. I'm thinking particularly of Charlotte Perkins Gilman's "The Yellow Wallpaper" and F. Scott Fitzgerald's Tender Is The Night.

There never fails to be something sinister about such relationships, since the balance of power is so tremendously one-sided. Here's the protagonist of "The Yellow Wallpaper," introducing herself and her husband at the beginning of the story:

John laughs at me, of course, but one expects that in marriage.
John is practical in the extreme. He has no patience with faith, an intense horror of superstition, and he scoffs openly at any talk of things not to be felt and seen and put down in figures.
John is a physician, and perhaps--(I would not say it to a living soul, of course, but this is dead paper and a great relief to my mind)--perhaps that is one reason I do not get well faster.
You see he does not believe I am sick!
And what can one do?
If a physician of high standing, and one's own husband, assures friends and relatives that there is really nothing the matter with one but temporary nervous depression--a slight hysterical tendency-- what is one to do?
Personally, I disagree with their ideas.
Personally, I believe that congenial work, with excitement and change, would do me good.
But what is one to do?

You can see the extent to which her sense of herself and her own thoughts and opinions has already atrophied; we get so many words about John, what John thinks, what John says, and only a few slight glimpses of what she (the character is not even named!) thinks. When she does choose to express herself, it is alone, confiding in "dead paper" rather than fight with her husband over how much she should be taxing her poor fevered lady-brain. She's clearly worn down from having everything she says taken as proof of her wrongness and frailty. Paradoxically, she's utterly alone while her husband, sister and maid share a small summer cottage with her, and while her husband hovers over her, watching for signs of recovery.

I worry sometimes that this dynamic might be at work in my own relationship. He's older, more independent, NT (though he suspects himself of being a borderline Aspie), and robustly well-adjusted, while I struggle with severe depression. Because an aspect of my autism is a difficulty voicing my own needs and feelings (or even recognizing them!), it often happens that if I'm upset and don't know why (or can't articulate it), he will step into the gap and try to figure out what I need. By itself, that's fine --- people who love each other comfort each other when they're sad --- but he also tends to disregard what I say I want from him in those moments. It's almost like when I told him I couldn't decode my own emotions, I forfeited the right to have an opinion on them.

I showed him this passage from Tender Is The Night, which I thought illustrated the way that scenario normally plays out for us:

"This letter is deranged," he said. "I had no relations of any kind with that girl. I didn't even like her."
"Yes, I've tried thinking that," said Nicole.
"Surely you don't believe it?"
"I've been sitting here."
He sank his voice to a reproachful note and sat beside her.
"This is absurd. This is a letter from a mental patient."
"I was a mental patient."
He stood up and spoke more authoritatively.
"Suppose we don't have any more nonsense, Nicole."
"Listen to me --- this business about a girl is a delusion, do you understand that word?"
"It's always a delusion when I see what you don't want me to see."

He talks down to her, dismissing the evidence she presents of his infidelity as "deranged" and "absurd," and brings up her questionable sanity ("do you understand that word?"). My boyfriend recognized this as a more extreme version of a trend that can appear in our own interactions (though he heard my voice in Nicole a lot more than he heard his own in Dr. Diver), but he still tends to pathologize the things I say when upset. If I tell him to leave me alone, it's unhealthy and self-destructive, so he can ignore it and stick around, even if I really do feel smothered.

I wonder how prevalent this problem is among autistic women in relationships with NT men? We have very high rates of emotional problems, like depression and anxiety, which could lead a healthy person to dismiss what we say when sad or stressed-out as merely symptomatic (and thereby ignore the content of our complaints), and our autism puts us at a further disadvantage in trying to communicate with NTs --- both because we're less readily able to verbalize things, and because we know the NT is considered "right" by society. Indeed, autistic women get a double whammy of self-doubt: they're women, which I've indicated above has a long history of being pathologized (and still is, to read about the hormonal ravages of PMS and menopause), and their thoughts, feelings, needs and ways of communicating differ dramatically from what they've been taught is normal and healthy.

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