Adventures in telepsychiatry

“The doctor should be opaque to his patients and, like a mirror, should show them nothing but what is shown to him.¹“

A couple of days ago, I was doing a Skype session with someone and the video cut out suddenly, so we had to reconnect halfway through the session. As the connection was failing, we could each tell the other was talking and could see some disconnected video, but couldn’t really hear what the other was saying.

One thing I noticed about having the communication cut out on Skype was that, unlike the analogous problem with having the cellphone cut out halfway through a conversation, both of us knew right away that the other was probably not getting any good information, and we both stopped communicating anything important as soon as it was evident that Skype was cutting out on us.

This is the first session I had any trouble with Skype, and I realized that maybe Skype has one more advantage that I hadn’t thought of. I’m sure everyone who uses a cell phone has had the experience of delivering a monologue to someone else after the cell dropped, and realizing that he or she wasn’t talking to anyone at all! On a cell, we rely on little verbal cues like “uh-huh” and “OK,” but most people tend to take turns talking and a lot of times when a cell drops you don’t really know how much got through before the other person couldn’t hear you anymore. With Skype, even if people are fairly quiescent, there’s enough moment to moment activity like head movement and eye-blinks to know just about when the other person and you are probably disconnecting. I like that.

When I was walking home that evening, I had a flash of the quote that I started this blog entry with, and thought for a couple of minutes about whether Freud would have used Skype. I’m not a psychoanalyst, and certainly don’t have the “blank slate” approach of the television or movie psychiatrist, but I think that Freud certainly had a lot of good ideas (along with some big losers.)

Anyway, I read somewhere once that the reason Freud used a couch was because he didn’t like being stared at all day by patients. The Skype interruption made me think of the blank screen (here, a blank monitor screen) metaphor and I just can’t help wondering if Freud would have shared his video image with the patient or what it would be like for the patient to share video while the psychiatrist doesn’t.

Of course, there’s really no way to know, but  the title of this post is an interesting thought-experiment question. Would Freud have refused to share his Skype video?