Liam Farrell: The use and abuse of reverse psychology

We are come to the waning of the year, and a familiar refrain will echo across the land and through the surgeries.

Liam Farrell
Liam Farrell

Like the sound of wild geese honking triumphantly as they spiral down the wind over the Mourne Mountains to Carlingford Lough, wild wings from the northlands returning to the country of Finn and Oisin, landing in a rush and whirl of freezing spray, dawn's early light glinting coldly on their silver-grey feathers; the sound of what Chekhov described as a long and lustrous winter.

'My Auntie Josie got the flu jab, and she was sick for a month after,' said Pat defiantly, like generations before him; some traditions defy the years.

'Slow though I am to impugn the veracity of your Auntie Josie,' I said, 'even if it be the same Auntie Josie who claimed to have fought at the Alamo and been Davy Crockett's secret concubine, all the evidence suggests that the flu vaccine is both protective against the flu and very safe.'

'I still don't want it,' he insisted stoutly, which meant it was time for a bit of reverse psychology.

'That's great,' I said. 'It'll save us a fortune, the vaccine is very expensive, you know, which is why we only give it to selected individuals.

'Did I tell you I'm thinking of buying a new car? A big shiny car, with all the bells on, the make doesn't matter, so long as it's big and shiny.'

'Expensive, is it?' said Pat. 'So that's the reason you don't want me to have it.'

I played a little more, just for fun. 'Hey,' I said. 'Why so hostile? You're OK, I'm OK.'

'I want that jab,' he said.

'Oh alright, if you absolutely insist,' I said, whipping out a syringe and slipping it into his arm before he could have second thoughts.

'And can you guarantee that it's perfectly safe?' he asked, rubbing his arm gingerly.

This is a dilemma we must frequently confront. To treat our patients as mature adults we must share our reservations that no treatment is perfectly safe, nor is it guaranteed to work; in the real world, shit happens. Unfortunately, in doing this we lose the placebo effect and cede ground to the charlatans of complementary medicine. Hey, whatever, I say.

'If you want guarantees, go to a bank,' I replied, 'Not an Irish bank, of course.'


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