People come to see psychiatrists for all kinds of reasons. They may be going through a divorce or unemployment. They may have lost a parent or a child. They may be unhappy in their marriage or with their family of origin. No one comes to see a psychiatrist because they are happy or content with their life. Sometimes added to all the above woes are the everyday demons of poverty and need. Domestic abuse, unhappy marriages and other relationships or a general feeling of dissatisfaction with the way their lives are going, are some of the more common reasons for people to come to me.
Domestic abuse, unhappy marriages and other relationships or a general feeling of dissatisfaction with the way their lives are going — are some of the common reasons for people to visit psychiatrists
It remains up to me then to walk the fine line between offering what help I can but not encouraging grandiose fantasies of medicines and therapy to improve their lives beyond a certain point. Amazingly though, most people who come to see me become happy to know that I am simply there to listen to them and share their pain.
Jane (not her real name) comes to mind. I will always remember her because she was my first ‘therapy’ patient. She was a sad looking thirty-ish woman (she was 38, I later found out), and I first met her in the psychiatric emergency room of our large Houston Hospital after she came in, complaining of headache and thoughts of suicide. After a brief hospital stay, she once again showed up in the emergency room one day when I was on a call. I was in the first year of my ‘residency training’ and offered her weekly sessions which she accepted gratefully, even though she would have a hard time meeting the clinic sliding scale fee.
For the next 2 years, I saw her regularly once a week (barring holidays and vacation) until she moved to another town. I felt like an utter failure because nothing I tried seemed to help, not my well thought out “interpretations” or any medicine cocktails that I could dream up. She suffered from regular headache and would end up in the emergency room every other week or so for pain medication. I did manage to keep her out of the hospital for those two years and (as one of my supervisors once told me), just the fact that she kept coming back meant that I must have been offering her some help. She didn’t even miss appointments when her husband lost his job and the whole family had to move into a shelter for a few weeks. She had been abused sexually by her grandfather (it came out in therapy) and her mother had never believed her. Her sister had been abused as well and they had only shared it with each other. She had never been able to enjoy a normal sexual relationship with her husband and even though he understood (he had been through something similar), it was like a wall between them that neither could breach.
When we said goodbye after two years of therapy, I felt like an abject failure. Her husband had gotten a better paying job and they were moving to another city. She told me during our last session that she had dreamed about me the night before and in her dream, she was shaking my hand, saying goodbye. This was the extent of the intimacy that she could allow herself with a man, no more. We talked about the last two years, her hopes for the future and our sadness at parting. Our time was up. She stood up and extended her hand. I shook it and she left. The story might have ended there, except that I heard from her about 4 months later. She called the clinic and said she was visiting. She had simply called to say hello and to tell me that she was doing fine. I offered to meet her in the office and she agreed.
After the pleasantries, she mentioned that her teenage son (the fifteen year old; she had another who was nine) had recently died, cause unknown. They had found him dead in his room. While I was still digesting this and thinking of an appropriately empathic thing to say, she dropped her other bombshell. In a grateful tone, she said she wanted to thank me for all that I had done for her and wanted to let me know that it was the things I had said to her during her therapy and the things she had learned that had kept her going. I learned a valuable lesson that day — I didn’t necessarily have to do anything to help. Listening without judgment was sometimes all that was needed. I remind myself of that often and try to teach the same things to my students who struggle with helping people in pain.
Listen with a sympathetic ear and an open heart. Try and share the pain of a fellow human being. Your time and undivided attention are worth more than all the medicines in the world.
The writer is a psychiatrist practicing in Lahore. He taught and practiced Psychiatry in the United States for 16 years. He tweets @Ali_Madeeh
Published in Daily Times, July 12th , 2017.