Tales from the Couch

Seeing the patient from psychiatry’s perspective

The Prescription

Not your everyday Rx

Steve was a 52 year old successful executive who looked downtrodden entering my office. He’d come reluctantly, and only because his wife insisted he “see someone.” 

“She says I’m not living my life anymore,” he told me.

When asked what was going on, Steve said two years earlier, his dog of 14 years had died. His two kids were now out of the house, living on their own. His wife began teaching history at a community college, and he felt lonely, isolated, and demoralized. “I don’t look forward to much,” he said, and added, “And don’t even think of prescribing pills for me because I’m not a pill-taker.”

Steve talked about doctors being “pill pushers” saying, among other things, “You guys’re tied into the pharmaceutical industry. I know, everyone’s got to make a living, but I don’t want to be part of that whole pill dropping thing. Besides…I’m not depressed, I’m just unhappy.”

Steve was right about his condition. He didn’t fulfill the criteria for a clinical depression; he was simply miserable with the way his life was turning out. Though he was doing well at the office, he felt isolated and pushed aside with the kids gone and his wife now working. He’d reached a financially rewarding executive plateau, and felt there was little to look forward to in middle age

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By the third session he still complained about feeling empty. His wife was taken up with her career and the kids were doing well on their own. They rarely visited.

“So what do you have to offer?” he asked. “An anti-depressant? I won’t take it.”

“I’m not sure you need pills,” I said. “You really need something more in your life…”

“Are you suggesting I have an affair?” 

“Not at all. It sounds like you’ve been thinking of it.” 

“Maybe…but I’m sure it’ll cause more problems than it’ll solve.”

“You’re right about that,” I said. 

“So what can you do for me, other than prescribing a pill, which I won’t take?” he added, shaking his head. 

It seemed clear: Steve was challenging me to do something to help him.

“Well…I can prescribe something for you, but you would have to commit to the treatment.” 

“I told you, I don’t want any pills.”

I reached over to the side table and pulled out my prescription pad.

“Pills aren’t the answer,” Steve said. “Besides, what can you possibly prescribe for me so I won’t feel unneeded…just extraneous…even superfluous?” 

“I’m going to prescribe something. But you’ll have to make a commitment.”

“What kind of commitment?”

I wrote the prescription, ripped the sheet from the pad, and handed it to Steve.

Looking at the script in his hand, a huge smile erupted on his face. “You really think this will help?” he said, still grinning.

“Yes, I think that’s what you need…”

“Maybe…you could be right.”

“You’ve been in mourning long enough, Steve. It’s time.”

The prescription said, “Get a dog.” 

Mark Rubinstein, M.D., is a former professor of psychiatry at Cornell. His most recent book is the novel Mad Dog House.

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