I took on the inpatient care of an African-American woman in her later thirties after her previous psychiatrist was banished for misconduct and terrible judgement.
I was a resident just about her age and the small extra amount of money I got paid for adding her to my case load made a difference to me.
She was intensely suicidal, but without vegetative signs of a deep depression. She had more children than fingers on one hand. It was her avowed purpose to treat each one as if that child were an only child. She felt that it was her job to give each child everything that child might need or want. These requirements were absolute, as she saw them.
It was all too easy to see the shortcomings of such a model for practical child rearing policy. From the point of view of psychological economy and personal energy it was obviously not viable. A real effort to implement it could not help but leave a mother in a seriously depleted state.
This was a grandiose project that demanded a regime of self-oppression that was virtually unthinkable. It had no limits. Here she was wanting to end her life, refusing to make concessions to reality, as if any concession would be a source of boundless shame. The degree of harshness against herself, the all-or-nothing features of her thinking were striking.
She was beautiful and quite used to being envied because of it, not that she ever avowed either of these. Her beauty was striking. It was something it was literally impossible not to notice. She was intelligent. She was quiet, her rebellious inner states camouflaged as compliance. Everyone on the unit liked her and yet she remained elusive, a bit out of range.
She was serious about wanting to kill herself and had almost done so. What was disturbingly and compellingly contradictory was that, on the one hand, she wanted to give her children everything and on the other hand, she was quite prepared to make orphans out of them. It was as if she both loved and hated them but could not bring both intense affects onto the same screen at the same time. Her suicidality could even figure as a project for her liberation from being enslaved to her children.
I am white, Jewish, male. She was African-American, a light shade of brown,
born Christian but inclining to Islam, a woman for whom motherhood was a central value and challenge. I was worried that we would have a hard time constructing a bridge. I was worried that she would have been so disgusted with her previous psychiatrist that anything like trust would have been out of the question.
With me she was deferential but in a peculiarly non-committal way. We talked down in my office in the basement of the grand old hospital. I was respectful, quite well aware that her experience was a long way from mine. When I was respectful it was not a pose. It struck me as so odd that she had to be a patient and I had to be a doctor for us, with the protections of confidentiality, to talk more or less freely about matters that really matter, like the urge to suicide, the radical rejection of one’s own life.
We discovered quite by accident that we were both in Tanzania both looking for ourselves but in quite different ways in the sixties. We recognized some exotic places and names. Perhaps we had more in common than I thought. We might even have spent some time in Dar es Salaam together without ever encountering the other one.
She was involved in a terrible struggle, one that was relatively formless and didn’t easily give rise to words or communication. I could see it and feel it. I worried about her knowing that there was so much I did not know about her and in her, so much that she did not readily know of her. It had her instead of her having it.
One very hot summer’s day when my worry about her was already well above its normal high level, I received a call to the effect that she had run away from the hospital, something that, for all the conventions of locked door wards, was not that hard to do. I knew she was not safe and that she took what was most dangerous to her – her own self – with her wherever she went.
I spent the rest of the day in helpless dread. My considered opinion was that it was perfectly possible, if not likely, that she was off about the business of doing herself in. It was, as I have mentioned, a very hot day. I was unable to settle myself. When I left work I did something I had never done before nor have I ever done it since.
I drove the other direction from where I lived in the hope that I could find her somewhere. While I did this, I told myself that it was a foolish thing to do. I just could not bear not doing anything. I imagine that my chances of finding her were about zero. I suppose I had caught some of her anxiety that went beyond anxiety to become an unbearable restlessness.
Imagine my surprise when I saw her walking very slowly, almost abstractedly, by the side of a road that had no sidewalk. I was thrilled. I pulled up beside her, but even as I did so another fear entered my mind. When she noticed I was there, when I opened the door of my car, would she get in or would she bolt?
I took the risk and opened the door. She got quietly into the car and we drove back to the hospital without her saying much. It was strange, because it almost felt like a prearranged meeting. In therapy in the sessions that followed, she told me what she had done that day. She had wandered about, going from shop to shop, looking for something special that would remind her of each one of her children. This was what had postponed the project of suicide. In a very meaningful sense her children – or, more accurately, her love of her children – had saved her life.
I saw her in outpatient therapy for a few years after her hospitalization. One of the things that I learned about her was that one of her forbears was a Jewish man thrown up on the shores of the New World by the social and political turmoil of Old Europe.
The caretaking theme went on. When her mother started to become forgetful, she was the one of the children who stepped into the breach to provide care for her. I only hoped that the inner absolutism had moderated.