Olfactory Oligarchy

She was a very nice lady, always deferential as true southern ladies are. She would come into my office, holding it together and trying not to cry about her life situation. She was on the downside of middle age, morbidly obese, unhappy, and feeling quite stuck. On the outside, she was always bright and shiny, dressed neatly and cleanly, makeup on, hair done perfectly, nails a bright fire engine red. Underneath it all, she felt used, abused, dirty, depressed, fat, and hopeless. It took her many months, years even, before she would even begin to let me in on those very well defended feelings.

And yet, the one thing that stands out very vividly in my mind about her, about each and every visit with her, was her smell. She used the old fashioned Ivory soap, the white bar, the classic stuff. How did I know? The smell was unmistakable, and for someone like me with a very sensitive system that is allergic to anything that looks at me sideways, it was a true irritant every time she came to see me. I would see her for thirty, forty, sometimes even sixty minutes, and in that time my breathing would change, my eyes would water, and I finally learned that before I went out to the waiting area to get her, I would open my office window just a crack, just enough to let clean outside air circulate and keep me from a coughing fit as she told me about her latest woes.

As we have talked about in previous posts, olfactory memories are extremely vivid ones.

I was reminded of that lady, a patient of mine from many, many years ago, today.

Now, a psychiatrist uses several senses many times each day as he goes about the business of treating patients. Sight is important, in that watching how a patient walks, looking for tremors or other abnormal involuntary movements, assessing dress, makeup, general level of grooming, affect and a myriad other variables is important from the very first moment of a visit. Listening is our stock-in-trade, so naturally a good sense of hearing and being able to truly listen to patients is of utmost importance. And of course we may use our sense of smell. You might not think about that as the most important arrow in a shrink’s quiver, but it is one of them.

There were many varied smells in my office today.

There was the clean, just-showered-for-the-doctor’s-appointment smell, the person who had prepped themselves, put on clean clothes and come to talk with me about the latest situations in their life.

There was the ubiquitous (at least in the mental health field) coffee and cigarette smoke smell. If you’ve ever smoked or spent much time around those who do, you know that the smell gets into everything and stays there, including in clothes and on the breath.

There was the acrid, pungent, unwashed-for-days-if-not-weeks smell that connotes a state of beyond dirty. One wonders sometimes if the folks who come to the doctor’s office dressed in clothes that could prop themselves in the corner at night, with a smell so offensive as to be almost unhealthy, are themselves immune to it. Some of them, of course, are simply so depressed or psychotic that all efforts at self-care simply stop. Others, I have come to believe, take on this aromatic mantle and wear it without a second thought.

Finally, there was today the over-perfumed, overpoweringly sweet smell of someone who is in the habit of drenching herself with Yves or Ralph or Gucci, the more the better. Unlike the nauseatingly acrid smell of the unwashed above, this person overwhelms with sweetness and fruitiness or whatever the smell of the season is. Not altogether unpleasant, this can still lead to stinging eyes and coughing fits if there is no circulating air in the small consulting room.

So, my clinic day today was, as it often is, a microcosm of life.

If I could not hear and could see but through a glass darkly, I could still get a wealth of information from my patients by simply paying attention to the smells they bring to my office.

The reasons behind each smell and the extent of it are myriad and fascinating. One must not only use his sense of smell, but must tie that data together with oral history, visual cues and other things that make each person unique as they present for mental health care.

One more reason that I love what I do.

We would do well to remember the words of the Bard penned in Romeo and Juliet.

“A rose by any other name would smell as sweet”.

4 thoughts on “Olfactory Oligarchy

  1. I have strong memories of the clouds of cigarette smoke at John Umstead, when I trained there. It was Hell on my asthma and I don’t know how I got through it. As I learned about the lives of the patients, many of whom were poor and severely mentally ill, it became the smell of desperation for some kind of happiness amid a life of absence. So many people expect psychiatric hospitals to be bursting with activity, movements, and noise. And certainly there are people in florid or agitated states. But mostly there was quiet absence and smoke. It was a very sad place in which I was honored to be trusted to learn and try to help.


  2. So many people I have taken care of for years start getting that unwashed smell as their fight starts winding down. Bathing, shaving and trimming nails just takes too much breath at some point. Hey,in reference to the past discussions about Robin Williams,the autopsy showed Lewy Body Dementia. The whole suicide thing makes sense now. All the resources in the world would have been for naught


  3. Your mention of Ivory soap triggered memories, meaning I’m either oh-so-sensitive or totally nuts. In either/both event, For me, Ivory soap is one smell that immediately translates to “hospital.” Don’t know if it’s the Soap of Choice for hospitals these days, but it was during the early 1970s and I had the gift (not being snarkastic) of spending six weeks in one, hooked up to an IV to deal with subacute bacterial endocarditis. Learned to love lots of stuff during that time (I was 20 years old). Not Ivory soap. Hate Ivory soap!


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