I’m a retired psychiatrist living in Lincoln Ridge. It’s a quiet place. I like to read, remember, and imagine — I call it “daydreaming”. There’s a particularly lengthy daydream I wish to share. It’s a daydream that began with a parental-behavior query and shifted into some mental role-playing on the topic, and from there to a personal memory that, over time, led me not only to the answer but to an extra insight as well.

The universal shush

It began with my wondering why a parent holding a crying baby always makes shushing sounds. Was she taught that? Is she copying others? Did she read about it? I knew it wasn’t meant to be a gesture of mimicking familiar sound in the womb of blood pumping through arteries because grownups respond to “Shush!” and not because of their “inner child.” It’s a polite, “Stop the noise!” or “Get a hold of yourself!” I decided it’s an instinct, but I wasn’t sure.

I gave that daydream a test trial. I imagined myself encountering a stranger who is burned and screaming in agony and help hasn’t arrived. Chaos is everywhere. I move to comfort him and keep things from getting worse. I feel helpless and sense the beginnings of sick feelings. I try not to think of things getting further out of control, or that my repairing or fixing anything is out of the question, but how does one not think something? In my guts, that screaming fellow (in this imaginary scenario) and I are in this together and we both need to hang on (I get that). He needs to scream to mute his pain and I need him to stop screaming to mute my increasing alarm and helplessness and I need a distraction — and that was my insight. Shushing must be because you need something easy and immediately available for distracting yourself.

So far it made sense. Don’t kids whistle in the graveyard to overcome uneasiness? Didn’t Japanese soldiers on Guadalcanal, charging into American machine guns screaming “Banzai!” scream to override their fright? People do shush themselves. And then I remembered the time I instantly and dramatically shushed and didn’t know I was shushing. What I was hearing coming from myself was a silent shush.

The curious case of the psychiatrist who shushed himself while treating a patient who screamed

An open psychiatric hospital specializing in long-term residential treatment admitted a divorced woman in her thirties, hospitalized after years of unsuccessful outpatient treatments at other facilities for her chronic anger with emotional instability. Psychoanalytic psychotherapy four times weekly was to be her preferred treatment.

Her therapist was a senior-staff psychoanalytic psychiatrist. The initial focus of treatment was setting limits to her extremely loud and out-of-control screaming fits during every treatment session — sounds heard throughout the many floors of doctor’s offices. Investigating the triggers or motives was impossible. Simply having a conversation was impossible. Because those screams interfered with all other therapy sessions going on, colleagues were pleading with the treating psychiatrist to set better limits. After several months, and for the first time in this facility, a therapist quit the treatment. His senior-staff replacement lasted only weeks before he too called it quits.

The hospital director assigned the case to me. I was a new junior-staff psychiatrist. I was highly anxious about the assignment and feeling very insecure, exposed, and vulnerable. Foremost on my mind was pleasing my boss and calming his colleagues and not screwing up while repeatedly reminding myself of the failures of my superiors and telling myself over and over, “I have nothing to lose here.” I boldly asked for permission to use a small room in the basement as an office. It was approved. I introduced myself to my new patient in the waiting room, escorted her to this basement “office,” and explained to her she could scream as much as she wanted and as loud as she pleased. No one else would hear her. I also made it plain that I had no treatment to offer. I had no desire to study, analyze, or even advise her. There would be no “contracting for safety,” no talk of treatment goals. We would simply meet and thus did our meetings begin.

This woman kept every appointment and never screamed. We talked about whatever she wanted to talk about. Months passed. By the year’s end her funds had run out, so the hospital arranged to discharge her and, as was their custom, she’d continue her “therapy” with me and in this same “office,” only now as my “private” patient. She’d pay me, not the hospital. She approved. I refused. She complained to the director, who told me that it was expected and customary that staff continue treatment privately. I refused. She was discharged. I wished her well at her final appointment.

My patient relocated in a nearby city, took an apartment, and, within a short time, began sending me weekly letters. Her envelopes were thick with multiple pages with typed text. I never read them. I never opened them. Eventually the letters stopped coming. Years later, colleagues told me was she working for the city, had received promotions, and was totally self-supporting, all this without psychiatric treatment.

I remembered and thought about this at the close of my daydream but my thoughts weren’t about the lady’s diagnosis or recovery. It was about me and how I found the grit to take a road I’d never travelled.

Is shushing a mantra?

 I connected the final dot. Are we really any different from that “Little Engine that Could” who told himself, “I think i can, i think i can,” or Dory in the film “Finding Nemo” telling herself, “Just keep swimming, just keep swimming” when she became lost. Like traditional meditation or the mantra, isn’t the shush simply another way of quieting a part of ourselves? Wasn’t I simply tolerating distress via my distracting soundless shushing?

I concluded that shushing a baby is instinctive and DNA-driven while ensuring that the “parent,” the shusher, not only gets calmed, too, but feels it first.