When Your Patient Teaches You a Thing or Two About Living

The thing about clinical work is that each day you never know what’s coming. You can be working with a patient in the most clear-cut treatment plan with everything going textbook perfect and suddenly . . .

“Hi, Joe. Nice to see you.” And it was. Joe (not his real name) was a regular in my therapy room, but unlike some others, a willing and enthusiastic participant in his treatment program. He worked hard in session and practiced the suggested exercises in the times between visits. He was open, expressive and insightful — all elements of the “perfect patient.” We usually both felt good after a session.

That’s not to say that there weren’t painful struggles in his treatment program. Joe, like many of us, had his own demons to confront, his made more powerful and debilitating by his bipolar diagnosis. But he embraced the challenge, knowing that working through his “stuff” meant some pain for each gain.

Joe’s condition was stabilized by medication prescribed by his psychiatrist. My role was part two of his treatment plan — the talking cure — the “fun part” we called it.

With his more severe symptoms under control, Joe’s problems were not all that uncommon — relationships, work, stress, etc. We just had to approach them from his unique history and dysfunctional behavior patterns.

That fateful Friday started like any other session with Joe. He was calm and chatty and we exchanged some trivial dialogue before getting to the more serious work. I had tentatively penned in “communication skills” as a topic for the session, but only if Joe didn’t lead us down another path.

Joe turned pensive and quiet. I was just about to suggest the communication topic when he took a deep breath and said, “I think I want to go off my meds.”

I tried not to look surprised, but I was. While this is a typical reaction for many on psychiatric medication, it was unexpected from Joe. He had been faithfully following his medication regimen for almost five years. He had few side effects and had frequently expressed agreement that they normalized his behavior, for the better.

I was curious why he would say this now. Was he facing a crisis? Was he experiencing negative side effects? Did he Google his condition and become convinced he should try the latest wonder drug or fad? I even wondered if he was joking, trying to jump start a lagging session. And, to be honest, I was a little bit scared. Joe’s more serious symptoms had always been under control in my therapy room, courtesy of his effective medication. They made his problems seem normal and, more importantly, manageable. The full-blown symptoms of bipolar disorder were another matter altogether.

So I said what all therapists say when they don’t know what to say, “Well, Joe, tell me more about that.”

And thus began the most intense conversation I ever had with a patient in therapy.

He looked out the window, off into the distance and said, “It’s me. I’m losing me. I think the meds are taking away what it means to be me.”

“You’re losing the sick you.”

“That may be the only me there is.”

I let the silence get uncomfortable waiting for him to explain.

“You know, I’ve never really talked about it, but when I am manic I feel like I can fly! Like. I. Can. Fly. The world is mine.”

“I understand. But Joe, it’s not and you can’t.”

“Who says?”

“The healthy you knows this is true. We’ve talked about that.”

And then he focused his gaze directly on me and asked me questions that shook me to my core — my healthy, non-bipolar core. His voice was raised, but not in anger, with a deep and heart-felt passion for what he was saying.

“Have you ever felt anything that intense? Have you ever lived that fully? Have you ever felt that deeply?”

Taking a deep breath and donning my therapeutic persona again, I replied, knowing my argument would hardly stand up to such emotion.

“But you’re a danger to yourself when you’re in that state.”

“I’m a danger to the real me when I am so subdued. I get it. I get where you’re coming from. It’s not you. You don’t want to live that way. But how would YOU feel if everyone told you that you had to? Wouldn’t a little piece of you die inside?”

I knew I was defeated here. Arguing with him would just entrench him more deeply in his convictions. I couldn’t match his intensity in that moment. I needed to stop fighting him and accept him where he was.

“Joe, you know I cannot recommend that you do this.”

“I know,” he replied calmly.

“I don’t have the authority. I’m a psychologist, not a psychiatrist, so I cannot make judgements or decisions about your meds.”

“I know.”

“And since the course of action you have suggested could put you or others in danger, I need to call your psychiatrist right now. He’ll come and you can discuss the options with him.”

“Yes, I know.”

What we both knew, but didn’t say, was that he would be taken to the psychiatric ward for observation and consult.

The time between making the call to his psychiatrist and when the orderlies escorted him to the other ward, could have been awkward and tense. But Joe made it pleasant. We chatted about the trivial things that make up casual conversation — the weather, the Yankees.

Then, just as he was about to walk out the door, for the last time, Joe turned to me with one final piece of advice.

“Live a little, Donna. Just once do something that makes you feel like you can fly. Don’t always play it so safe.”

And while his words did not turn me into a risk taker they do come back to me from time to time when I stand on the brink of something I’m afraid of. And they make me just a little bit braver.

And sometimes . . . I believe I can fly. I believe I can touch the sky.