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Parolles
It lies in you, my lord, to bring me in some grace,
for you did bring me out.
Lafew
Out upon thee, knave! Dost thou put upon me at once
both the office of God and the devil? One brings
thee in grace, and the other brings thee out.
Individuals may, for reasons both conscious and unconscious, reenact the internalized templates drawn from past experience, reinforcing expected dynamics of reassurance or rejection. In either case, the role of a mental health provider becomes particularly germane, especially in fast-paced settings which attempt to address a vast personal narrative within a rather limited time frame, guided to a greater or lesser degree by symptom constellation checklists. Such settings, interpersonally fragile by their very nature, lend themselves to the potential for reenactments, as pressures placed on both provider and patient to communicate in “time-efficient” ways funnel what and how communication occurs. The force of the bidirectional projective pressures may result in the psychiatrist/therapist stepping into a role which serves to reinforce that the patient must live in a damaging and misattuned world in which there is no choice but to be further broken by the traumatizing template.
The quick turnaround time seen on inpatient units and the “stonewall” approach emergency room physicians may feel pressured to apply to patients seeking entry by any means necessary, lead to fertile ground for such reinforcement. The reliability of specific diagnoses occurring in acute care settings has been queried in the literature (Lieberman and Baker, 1985), raising the question of how truly in touch we allow ourselves to be with the patient we are seeing, and how one's subjective lens can alter how a patient's presentation is conceptualized, even when using arguably objective (or at least somewhat standardized) diagnostic criteria. Taking a more holistic approach to patient care, including in the diagnost