A BETTER PSYCHIATRIST
Editor’s note: This essay won an “Honorable Mention” in our writer’s contest, in which readers were invited to write about that one single patient who made them a better psychiatrist. Dr. Schechter is an Assistant Clinical Professor of Psychiatry at the Yale University School of Medicine and the Chief of the Mental Health Outpatient Division at the Charles George VA Medical Center in Asheville, North Carolina.
I love my Whippets. Not the ones you inhale, but the ones you pet. My 3 “sons” are mid-sized greyhounds. All come from the same litter and are my new children now that the kids are on their own. We never expected to adopt all of the puppies at once, but there were 3 remaining from a litter of 7 and we could not split them up.
It was overwhelming at first. We did not anticipate the chaos that the dogs would introduce into our lives. Gradually, with the help of a professional trainer and countless hours of lessons, we were able to tame the herd. In the process, the dogs have made me a better person and a better psychiatrist. They have taught me about love, caring, and empathy.
Dog encounters have been a part of my practice for a long time. For months, I took one of my dogs to the office because he had separation anxiety. He hated being home alone and the patients loved his presence in the room. He would greet them and then settle down on the sofa during our session. Patients would pet him and snuggle with him. He always kept the material from the therapy confidential.
At one point, I had the privilege of working with a blind patient who came to our sessions with her guide dog. This was tricky, since the dog was a working dog and not a pet, so it is not appropriate to interact with the animal. For a dog lover, this takes willpower. The patient, however, knew I had an affinity for 4-legged friends and at the end of our sessions, she would occasionally give me permission to pet her dog.
I have also encouraged my patients never to leave their dogs in the car, especially in hot weather when it can be dangerous, even fatal. I do this not only to promote safety for the dogs, but also to have the chance to visit with them and to observe. The human-animal relationship can provide insight into the patient’s ability to connect, to interact, and to show care and empathy. My encounters have included Dachshunds, Beagles, Brittany Spaniels, French Bulldogs, German Short-Haired Pointers, Labs, Golden Retrievers, and countless mixed breeds.
I keep a small bag of kibble in my office for just such occasions. It is interesting and clinically useful to see how patients relate to their pets. The affection is palpable. I have often counseled patients dealing with grief after they lost their dogs. When an owner has to decide whether to put their pet “down,” their loss becomes even more complicated. Dogs do not have advance directives.
My most extraordinary encounter occurred on an ordinary day. I was scheduled to do an Independent Psychiatric Evaluation (IME) and did not expect the patient to come with a canine companion. A middle-aged woman, whom I will call “Mary,” was in for a PTSD assessment. She had a history of a brutal assault several years earlier. She needed medical treatment after the incident and continued to fear subsequent attacks by the same perpetrator. A protective order was in place. She came to my office with her emotional support dog, Mimi. The dog was a beautiful black Lab.
Both Mary and Mimi were apprehensive at first and I watched carefully as Mimi paced the room, checked the door, and listened for noises in the hallway. Mary told her story. She was genuine and direct and spoke eloquently about how a physical assault and ongoing fear had changed her life. It caused her to leave a promising career and resulted in ongoing anxiety and disability. Her life had dramatically changed from someone who was capable and in charge to a person who was scared, tentative, and restricted.
Mary had managed several hundred subordinates in the past and was now barely able to function alone in her home. She relied heavily on the support of her mother and struggled to remain engaged with her children. Her life had closed in around her and her support dog was one of the ways she was able to deal with her tension and withdrawal.
I tried hard to understand her plight and to develop an accurate narrative about her trauma. She appreciated my concern and at times became tearful. At one point, when she cried and apologized for doing so, I felt a gentle pressure on my lap. When I looked down, I saw Mimi's head softly and affectionately resting there. At first I was confused. This was an unusual gesture from a dog I barely knew. Was the dog concerned that I had upset her master and wanted me to stop? Was she bored? Then I realized she was responding to the emotion in the room. This lovely dog was thanking me for connecting with Mary and understanding her plight.
After 31 years of practice, I have received many notes of gratitude and words of kindness. I had never, however, been paid a thank you by a dog. This heartfelt expression of gratitude was one of the best gifts I have ever received.