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The Dead Patient

Several years ago I saw a woman in therapy for awhile who was dead.  She had come in for attention because her few friends had grown tired of her claim that she was dead, when she seemed quite alive to them.  She was serious in maintaining that she was dead, and meant it literally.  A dead body needs no food, so she no longer ate.  She stopped going to work and to church.  Her acquaintances there had become disturbed by her delusion, and no one, even her minister, had been able to talk her out of it.  She sat alone and silent all day, or else spoke of her death (the smell of her body, the coldness of her breath) with whomever might listen.  Finally she was taken to the doctor, and thence to the mental health center where I worked.  She was told there that she was psychotic and given medication, but that hadn't helped.

She insisted to me also that she was dead, cared about nothing, and that there was little to say.  Still, with coaxing, she unfolded the following story in a cold, deathly way.

She had been born to a mother who was poor, bitter and crudely moralistic.  Her father disappeared before her birth.  A stepfather later took his place, but she always knew that she wasn't wanted by either parent.  She went through childhood listless and depressed, believing that she was stupid.  Some things she said I can see now were probably allusions to experiences of sexual abuse, but we weren't as alert to that then, and I didn't pry.  When she was 16, the first ray of light dawned in her life.   She met a man who had breezed into town and courted her passionately.  She fell deeply in love.  She became pregnant, but after a couple of months, the man breezed on off.  She was left abandoned, but still very happy with the beloved life growing within her.  When the baby was born, her parents literally cast her out.  She was disowned and shamed, and even the family's friends turned away from her.  She felt wretched and shameful, but found resolution for it by becoming more intensely devoted to her baby.  This baby would become a good person, she would make sure of it with constant effort, and this would make up for the bad person she was herself.  The beautiful little girl was born with a serious heart defect, and clung precariously to life.  She required lots of care, which the young mother provided.  With the baby her life now had dignity and purpose.  She picked up her education, worked hard at several jobs, each better than the last.  The girl grew and flowered, and became herself a beautiful 16 year old, with friends and good grades and a future.  Then the weak heart ripped in two, and she abruptly died.  My patient couldn't have it!  She screamed and raged and tried to pull up the casket as it was being lowered into the ground.  Then the death settled into her with dark finality, and she died too.

The story sank in for a while, and then I finally said, "Yes, I can see that you are dead."  My consent surprised her a bit, but there was also a little sigh of relief. 

At the next session, she recounted the same story.  This time halfway through her body tensed and shook and then a flood of tears burst forth.  She sobbed and gasped and wailed out her daughter's name.  This filled the hour.

The next week was the same story, with quicker tears and more deep sobs.

The following week, she same story was told but more quickly.  Her eyes were brighter.  Before she left, she mentioned that she had started to attend church again, and had picked up some sewing that she had put away. 

The next session was her last.  She had gone back to work, was visiting with friends, and had sent some kind notes to grieving friends of her daughter.  Alive.

Not all "talking cures" are as quick or simple.  But sometimes it is helpful just to affirm the reality of a person's plight, no matter how odd it seems.  To try to argue them toward "reality", or diagnose their "mental illness", will sometimes only serve to deepen their alienation and their conviction of defectiveness.  Moral:  take people seriously and they may come to life. 

James Carpenter, Ph.D.