The training of a clinical psychologist is in many ways like that of an airline pilot. Beginning pilots, just learning how to fly a plane, must master many basic skills: how to take off, the use of complex avionics (the electronic technology of aviation) including long-distance navigation, flight-management computers, communication systems and how to safely land a plane which is racing through the air at hundreds of miles per hour. Having learned the basics of flying, pilots are next placed in extreme situations where a cool head is required: Engine failure, severe storms, and hijacking by terrorists.
The training of a clinical Psychologist (the term “clinical” means that the doctoral-level student is being trained in treating patients, as opposed to teaching or research) also entails the mastery of skills: how to interview patients, the use of psychological testing to detect the presence of clinical depression, or an undiagnosed learning disability like dyslexia, and the process of designing an individual treatment program which reflects the uniqueness of each patient, and is effective in helping them recover from their struggles with anxiety, depression or trauma.
Just like pilots, extreme situations requiring nerves of steel and a level head are also part of the training program. What are those extreme situations where life and death decisions are made? For clinical psychologists, the ability to detect the presence of the potential for suicide is the equivalent of the pilot whose instrument panel has just exploded into flashing red dials which scream out: Warning! Engine failure!
Today’s column is about a brilliant man, an artist and painter, who at 18 had already achieved recognition by having his paintings exhibited at prestigious art galleries. His name was Zack, and he was tall and rail thin. His high forehead hinted at great intelligence, and a well-groomed, small, black goatee suggested independence. But, as I was about to find out, the door which opened Zack’s heart would not be found in his intellect or creative talent. No, it would be in his laugh — a deep, belly-busting chuckle, but tinged with sorrow and sadness. It was this sadness I would attempt to grip, just like a doorknob, so that he could open up and allow me entry into his emotional core. Once that happened, the healing process would begin.
Zack’s mother had called my office stating that her son had once again exploded in a rage and had hurled — like hand grenades — horrific swear words at her. Zack began the meeting. “My mother made me come here, she believes I’m psycho. When you meet her, you will see who is really psycho.” Zack erupts into a series of deep chuckles, and because I was listening, I heard the sadness dripping off his words. “What is this sadness about?,” I asked. “I’m not sad,” Zack replied. “OK,” I said, “but when you said your mother forced you into treatment here, I heard your voice waiver, like you were upset.” Zack became quiet, unfolded his crossed arms, took a deep breath and as he exhaled, he sank back into his chair. I waited and waited.
“I’ve been sad all my life and I don’t know why. The more I achieve, the greater the sadness”. I then asked, “have you ever thought about or attempted to hurt yourself?” “Yes,” Zack said, “but no one knows this. It’s not like I kept it a secret, it’s just that no one ever asked me that question before.”
Zack’s treatment for a severe clinical depression (called major depressive disorder or MDD) was successful. Unfortunately, the same cannot be said for most people who have MDD. Here are some sobering facts (Stahl, p. 138):
1. Only one-third of those who suffer from MDD seek and receive treatment.
2. MDD is often missed by health care professionals.
3. MDD sufferers fear being told by their doctors that “there is nothing wrong with you, pull yourself up by your own bootstraps.”
4. 15% of patients with MDD commit suicide.
5. In the USA, 300,000 people attempt suicide, and 30,000 commit suicide each year.
Here is the lesson Zack can teach us: Never be afraid of asking a loved one, friend or family member if they have ever wanted or tried to end their life. This simple question has the power to save a life. The content of this article is for educational purposes only, not treatment. The characters in this story are not real. Names and details have been changed to protect confidentiality.
Source: “Essential Psychopharmacology,” Stahl, 2002.
Dr. Richard Elghammer contributes his column each week to the Journal Review.
