Clinical Psychiatrist at a Local

¶ … clinical psychiatrist at a local psychiatric facility, I am often presented with interesting situations and cases at odd times of the day. No exception to this was the case of Susan, who presented herself to me one morning as I came to work. I usually arrived by 8 am every morning, but this morning was particularly early, as I wanted to get some administrative work done. Nobody had arrived yet. My secretary Jenn, was usually at work by 7:30 - half an hour before I would usually arrive. On this Thursday morning, however, I had the dubious pleasure of arriving first, and finding Susan on our doorstep like an abandoned pet. She was not conscious when I found her. The night had been warm, so I did not fear that she had been the victim of exposure. A few shakes to her shoulder revealed that she had simply fallen asleep. I decided to offer her some coffee before trying to determine her reasons for being on our doorstep at this hour of the morning. The chances were equal that she was simply a homeless person looking for the nearest shelter or that she might be in serious need of psychological help. Being a government facility, all members of the public were welcome to seek our help. I sat her down in my office with a warm cup of coffee. Susan did not seem like an everyday homeless person; indeed, she appeared well-dressed and relatively clean in the light of spending the night on a doorstep. Her nails were manicured and her hair appeared to have recently been salon-cut. I was curious, but gave her time. She soon revealed her inner turmoil by bursting into tears soon after her coffee was finished.

When she seemed calmer, I asked Susan if she would like to confide her troubles. At this point she told her me her name and her reason for coming to the clinic. Susan is a secretary for a well-established law firm. Her position was fairly senior, and she made a good living organizing the appointments and other necessities of a number of high-profile lawyers in her firm. Things had been particularly busy during the last few months, and Susan had not had a vacation in more than half a year. In addition, Susan's boyfriend was becoming increasingly irritated with Susan's workload and was putting pressure on her to quit her job and find something less time-consuming. He was also becoming increasingly jealous and suspicious, questioning Susan's motives every time she left their home. Susan had been involved with this man for more than a year, but he had only recently begun to be suspicious and jealous. Susan told me that she had not given him any reason for such behavior. She had also tried to talk to him about it, but these occasions invariably degenerated into shouting matches to the point where the neighbors had started complaining. The result was an increasing sense of hopelessness. Susan was beginning to feel that the pressure both at work and at home was getting to her. She had recently been called to her boss's office because the quality of her work was beginning to diminish. She was increasingly making unintentional but serious mistakes with accounts and names, and her boss had placed her on two weeks of mandatory but paid leave. Susan's boss told her that she was a valued member of the workforce, but that he believed some rest would do her good. Regardless of such favorable comments, Susan felt like a failure as a result. At home, things were not getting any better. Susan became increasingly depressed and succumbed to drinking as a means of handling her stress. This only resulted in an increasing sense of hopelessness and depression. Susan's boyfriend also increased his emotional attacks on her, but refused to leave when she asked him to. Eventually, Susan had to enlist the help of the police to avoid being physically abused. This resulted in their final breakup. Susan spent almost 24 hours indulging in various forms of alcohol and drug abuse before ending up on my doorstep. She told me that she was afraid of doing something "irresponsible" to herself as a result of the depression and substance abuse.

A explained to Susan that I would be able to help her only if she was willing to accept such an attempt. I would write an official letter to her employer explaining that she would need a further fortnight of paid leave in order to help her through her emotional problems. During these two weeks, I would also commit Susan to our facility in order to monitor her response to medication and therapy. I decided to start Susan on a light dosage of Prozac, together with weekly sessions of individual therapy. After a month of this, and depending upon the outcome, I would start her on group therapy.

Susan was not interested in trying to mend the relationship with her boyfriend, who also seemed to be the victim of a mental breakdown. I therefore focused on helping her to heal herself. After I explained my plan, Susan told me that she was willing to be committed voluntarily for the prescribed time in order to ensure her own safety. She seemed fully aware that she was not entirely responsible for her actions, and might therefore succumb to her self-destructive urges if left to her own devices. This danger was exacerbated by the fact that she was now living alone after years of cohabitation with her former boyfriend.