[A hospital room, walking in, chilling]
feeling like a lifetime visiting here, 4 years?
__________
[Door cracked Open]
B: Hi, Doc. How has it been?
Doc: That’s my line, B. But since you asked—same as always. People thinking they want answers when they really want permission to feel what they already know. And you?
B: Tired. But managing.
Doc: Managing—that’s therapist code for “I’m holding it together with duct tape and a prescription.” What’s up? Sleep, mood, meds?
B: All of the above. Sleep’s still trash. Mood’s… stable, but not really. Meds? I’m taking them, don’t worry.
Doc: Not worried, just tracking patterns. Your meds should be scaffolding, not a leash. You adjusting dosage or still running on the same?
B: Same dose. Thought about tweaking it, but I don’t want to mess with things unless I have to.
Doc: Sensible. Numb?
B: A little numb, but not in the “I’m a zombie” way. More like… it takes longer to feel things. Like there’s a delay.
Doc: That’s the SSRI buffering.
B: Yeah, yeah. You always say that.
Doc: And I always will, until you actually do it.
B: Fine. But I’m still doing better than last month.
_________
Worst nightmares
Doc: How does the Ambien work for you now?
B: Ambien? That’s what made me drunk all the time.
Doc: If there were no rules, I’d prescribe you more.
B: Rules don’t matter, Doc. I’m tapering it off… bit by bit.
Doc: Nightmares?
B: Don’t ask what you already know. Oh—right, you’ve got more patients.
Doc: So, what is it like?
B: Divorce. Divorce. Divorce.
Doc: That’s progress. You used to say “Marriage. Marriage. Marriage.”
B: I don’t see the difference.
Doc: You surrender to what you desire.
B: (laughs) You know what, Doc? The meaning of my partner’s name is “the one who is desired.”
Doc: Then he desires you.
B: I still run.
Doc: You’re just running slower… from those pains.
B: I still sweat. Difficult breathing. But some songs soothe me.
Doc: Progress. Let’s hang out.
[Long pause, like the air in the room is free.]
Doc: Can you wait? I’ve got four more patients.
B: Wait, I don’t drink anymore. You allowed me three weeks, so it was.
Doc: Who said you were the one drinking?
B: …Okay, I’ll take you home then.
_____________
Duality of being a Best Friend and a Patient
B: Hi, J.
J: Thought you would call me ‘Doc’.
[B Smoking, second breath, tossed the left]
B: J, why are you a psychiatrist?
J: Why aren’t you a therapist?
B: (smirks) You think I don’t play one every damn day?
J: You play, but you don’t stay. You listen, you fix, you disappear. Therapists don’t get to disappear.
B: You sound like you’re calling me out.
J: I am.
B: Then answer me. Why are you a psychiatrist?
J: Control.
B: Over what?
J: The chaos in people’s heads. The patterns. The spirals. The ones who talk like you.
B: (chuckles) So I’m a case study now?
J: No, you’re a walking dissertation.
B: Thesis still needs a conclusion, J.
J: That’s the problem. You’re writing yours in real-time.
B: So?
J: So you don’t know if it ends in a breakthrough or a breakdown.
B: And you? You’re the observer?
J: No, B. I’m just the one making sure you don’t turn in a blank page.
___________
Medicines or Drug, it depends
B: J, why do some people chase dopamine like it’s oxygen, but when they get oxytocin, they fucking RUN?
J: Because their neurochemistry wires them for pursuit, not connection. You read Behave, you know how this works. Dopamine is about anticipation, not satisfaction. It’s the chase, the reward prediction error, the endless “what’s next?” loop.
B: And oxytocin?
J: That’s the chemical of trust, of bonding. But for someone who’s been wired for dopamine—who’s been conditioned to seek more instead of enough—oxytocin feels like a threat. It signals vulnerability, interdependence.
B: (scoffs) You’re saying they get high on the chase, but the moment they land, their brain fights the very thing they were after?
J: Exactly. Because dopamine spikes on uncertainty, novelty, potential. Oxytocin is certainty. It’s here, now, stillness. And for someone addicted to the high of the unknown, stillness feels like withdrawal.
B: That’s why some people run the second they feel safe.
J: It’s not always conscious. The nucleus accumbens gets hyperactive from years of dopamine reinforcement—fast highs, fast rewards. When oxytocin comes in, it dampens the chase. Suddenly, the thrill is gone, replaced by something steady.
B: And they equate that to boredom.
J: Worse. To danger. Their nervous system reads stability as a loss of control. And control is the only thing keeping them from falling apart.
B: (laughs, shaking head) Fucking hell. So what—you’re saying they can’t love?
J: No, they can. But their brain makes love a battlefield instead of a home.
B: And me? Where do I fall in this chemical circus?
J: You’re oxytocin-dominant. That’s why you give and stay. It’s also why you burn when others pull away. Your nervous system doesn’t just want connection—it expects it. Losing it feels like losing a part of yourself.
B: But I still have dopamine in me. I still chase.
J: You chase truth. But you don’t run from love. That’s the difference.
B: So what do I do? Keep offering oxytocin to people who are wired to reject it?
J: No. You stop offering it like a drug. You let them build their own tolerance. You let them meet you halfway.
B: And if they can’t?
J: Then you walk. Not as punishment. Not as a test. Just as proof that your love isn’t something to be tolerated. It’s something to be chosen.
B: (quiet) That’s the hardest part, isn’t it?
J: It always is.
____________
J’s Confession
J: I need to smoke, you have any Cigg?
B: Fucking dopamine addict, huh?
J: (lighting up) You’re one to talk. You chase closure like it’s a goddamn fix.
B: (smirks) Yeah, but at least my withdrawals don’t come with lung cancer.
J: No, just existential crises and three-day benders of overanalysis.
B: (mock gasp) You wound me, doctor.
J: Please. You know I’m right. You’re wired to complete things, to understand them. That’s serotonin’s work—pattern recognition, making sense of chaos.
B: And dopamine’s work?
J: Keeping me from jumping off a bridge from sheer boredom. (exhales smoke) It’s drive, anticipation, momentum. Without it, people stagnate.
B: So what happens when someone has too much of it?
J: They never stop moving. They chase, they consume, they win—but they never arrive. The moment they do, the high’s gone, and they need another hit.
B: (leans back) And oxytocin?
J: That’s the real bitch, isn’t it?
[J looked at me] You are the real bitch here.
It slows you down. Grounds you. Makes you stay. And if you’re wired for the chase, staying feels like dying.
B: That’s why they self-sabotage. Because it’s easier to burn it all down than sit with the stillness.
J: (nods) It’s also why they run back. Because deep down, their nervous system wants the oxytocin. But their brain can’t handle it. It’s like trying to breathe underwater.
B: And me?
J: You’re different. You don’t fear the stillness. You are the stillness. And that terrifies people who’ve never known it.
B: (quiet) That’s why they call me crazy.
J: No. That’s why they come back.
B: (smirks) And that’s why I let them go.
J: And yet, here you are, asking.
B: (laughs) Fuck you, J.
J: (grins) That’s the oxytocin talking.
_______________
Just a Tired Psychiatrist
B: I strip it all down—lecturer, CEO, CTO, statistician, data scientist. Everything, except a husband.
J: (smirks) And that’s the one you can’t resign from, huh?
B: I don’t resign. I stay.
J: (lights another cigarette) You ever think about quitting all of it?
B: Every day. But then what? Start a farm? Meditate in the mountains? Open a café and call it ‘Existential Dread’?
J: (chuckles) Nah. You’d turn it into a multinational in six months.
B: Exactly. Some people are built to walk away. I build things. Even when I don’t want to.
J: (nods) That’s what I thought about psychiatry. Thought I could build something with people. But it’s all just… holding them together long enough for them to unravel again.
B: You sound like you already made your decision.
J: Maybe. Maybe I just need to hear it.
B: Then hear this: The world doesn’t need another tired psychiatrist. If you stay, stay because you want to. Not because you’re afraid of what happens if you leave.
J: And if I leave?
B: Then leave well. Burn the bridge. Don’t breadcrumb your way back.
J: You make it sound easy.
B: Nothing about endings is easy. But dragging something half-dead is worse.
J: (exhales) You really should’ve been a therapist.
B: And you should’ve been anything but.
J: (laughs).
B: So?
J: So I think I’m done.
B: Good. Now finish your fucking cigarette and let’s go.
______
End, enjoy your journey. J.
