Note: this story uses fictitious names.
In the first year of my practice in St. Louis Park, I had a patient who was an attractive young woman who came late in the day for her sessions. At that point I was seeing patients for psychotherapy, as well as for medication issues. She was unhappy and anxious, talked vaguely about her social life, was frightened of men, and spent much of her time out of her chair and staring out the window. After several appointments she revealed that a close man sexually abused her. She showed me physical injuries on her arms and legs. She was very grateful for the treatment (she ended the abusive relationship and developed a healthier one), and, when we finished treatment, gave me a small painting as a gift. I started to learn about abuse.
A young woman came to my office, and said that my office was ugly. She was clearly manic, and I treated her with lithium. She discontinued appointments shortly after she improved. A few months later she called me late in the day and said she was depressed. We made an appointment for the following morning at 10:00 a.m. She did not show up, but was discovered by the police; she had hung herself to death. To this day I don’t think that I did anything wrong, but my hard lesson is that bipolar patients have high suicide rates. I also learned that whenever I receive telephone calls, I must respond to them, even if it is time to go home.
At St. Louis Park we had many female patients with a history of abuse, and the female psychiatrists were not very available. When an abused patient was seeing a female psychotherapist but need evaluation and/or treatment with medicine, they were often reluctant to see a male psychiatrist. But my staff members would encourage them to see me, and if necessary transfer them if they did not feel safe with me. Usually we had a very effective session, and she would inform her therapist that she felt safe with me and would continue to see me, despite my gender. I was one of the few men whom she trusted. We tried to teach women how to evaluate men: how to determine which ones were safe. I learned to be respectful, and to honestly answer every question: my approach, my concerns, my education.
I saw a young adult man named David. At that time, we scheduled either one full hour, or a half hour for each patient. He was divorced and suffered with schizophrenia; he had no social connections, no obvious feelings, and an extremely flat mood. He would say that he was fine, and had nothing else to say. Desperately, I tried to fill our time, and found that we could talk about the Minnesota Twins baseball team. He taught me to reduce the length of some sessions to 15 minutes, since there was little to say, and the only clear action was to refill his medicine. His health insurance changed, and he no longer continued having sessions with me. A few years later, in 1987, the receptionist told me that David was sitting in the waiting room, and wanted to see me briefly even though he did not have an appointment or insurance. I greeted him and walked back to my office. We happily talked about the Minnesota Twins’ World Series Championship. He then handed me a Twins baseball cap as celebration. I learned to be direct and superficial with him.
I saw another young man with schizophrenia every six weeks for 19 years. Before I saw him, he had been hospitalized three times by a psychiatrist whom his father did not trust. So, he brought him to see me instead of the other psychiatrist. Over time, his family moved to California, but he continued to live in a tiny room in Minneapolis. He would carefully set up transportation to his next appointment (usually three different busses). He would also write three original “jokes” between sessions, such as “Why did the orphan rub his toe?” He asked me to guess the answer, and over the years I only gave about five correct answers. I was able to avoid hospitalization for all those years, but when I moved to Vermont he had a six-month hospitalization, and was reportedly paranoid about me and psychotic. Referring him to a good colleague of mine did not prevent his collapse. The treating psychiatrist may be the only connection for a psychotic patient.
In my first year of practice following residency, I decided to run a weekly group therapy for teenagers. I had seen Susan as an outpatient, and at age 14 or 15 she joined the group. Her family treated her as an ignorant and weak person, and her father likely abused her. It was unclear whether she had the talent to complete high school, and her primary care doctor told me that I should convince her to get tubal ligation to prevent pregnancy. She was in the group for years, and after the group ended I treated her as an outpatient. We dealt with depression, abuse, low esteem, and hurt. She finished high school, got married, had two children, and worked. With time, her mood improved, she divorced her alcoholic and abusive husband, and eventually met and married a great guy, and continued work. When I left Minneapolis, she brought her husband and children to meet me and to say goodbye, and told them how much I had helped her. When she was age 50, she called me, when I lived in Vermont, and just wanted to let me know that she still was doing very well. She sounded great. Sometimes we become a good parent to an otherwise poorly raised person.
A male therapist in Minneapolis, whom I did not know, referred a woman to see me. He thought that she needed an antidepressant. She had previously been a Catholic nun, but at this point was leaving that role and wanted to be independent of the church. She was depressed and lonely, and was likely a good candidate for an antidepressant. She was vague when answering certain questions. During each appointment I not only asked about the depression and medicine, but I pushed her on other issues. She finally acknowledged that her therapist had started a sexual relationship with her. I referred her to one of our female therapists, Jane Thompson, while I covered issues related to medicine. Jane did a great job, and the patient stopped seeing her male therapist, and reported him to the State of Minnesota. He was forced, among other things, to pay for her therapy. With time she did very well with Jane, and she responded perfectly to an antidepressant. I learned how to listen carefully.