Education Homelessness Lessons Medicine Observations

When I Grow Up…

When I grow up, I want to be a drunk.

I want to wake up feeling restless and uncomfortable. It’ll be neat to drag myself out of bed to open that first bottle of wine. I’ll drink all of it within an hour. Then I’ll go to the liquor store. The guy behind the counter will know that, everyday, I will buy a pint of vodka from him. He will look at me with stony eyes, which will make me feel even more restless and uncomfortable. What he doesn’t know is that I will also get two more bottles of wine and a case of beer from the grocery store before I return home. As an adult, I want my sole coping skill to consist of getting drunk.

When I grow up, I want to get fired from all of my jobs because I am frequently drunk. I can’t wait for my boss to call me into his office because my coworkers smell alcohol on my breath. It’ll be fun to make an a$$ of myself while working because I just can’t stop myself from drinking that bottle of wine in the morning.

When I grow up, I want strangers to see me doubled over a tree planter with vomit on my shirt. I look forward to police officers shouting at me to get the f-ck up and move along. I am eager to see the disdain and disgust of the firemen and paramedics when they realize that the 911 call was, yet again, for me. I can’t wait to hear the doctors and nurses in the emergency rooms say things like, “Oh, not him again. I’m so tired of seeing him. He’s taking up a bed that could be used for someone who is really having an emergency.”

When I grow up, I want to ruin all of my relationships because I am a drunk. I look forward to destroying property and scaring my girlfriends. I can’t wait for my wife to request a restraining order against me because I’ve threatened to kill her one too many times. It’ll be great when my parents and siblings never invite me over to their houses because they think my behavior is out of control. I can’t wait to achieve that level of isolation and notoriety.

When I grow up, I want to spend a lot of time in jail. I look forward to receiving charges of public intoxication, disorderly conduct, assault, and battery. I can’t wait to collect warrants because I was too drunk to show up for my court dates. It’ll be fun to bounce in and out of jail and frequently apologize to of all of my probation officers. It’ll be neat to lose my housing because I couldn’t pay my rent while I was in jail. Homelessness will be a delight!

When I grow up, I want people to judge me because of my alcohol problem. I look forward to people hating me because they believe that I choose to drink alcohol to the point that I can’t function. It’ll be exciting to realize that people believe I am useless and a waste of a human being.

When I grow up, I want to hate myself because I am a drunk. It’ll be fun to feel constant shame and complete lack of control over myself or anything else. I can’t wait to experience unending self-loathing and disappointment. And how thrilled I will feel when I realize that the only thing that makes me feel better in the moment is drinking more alcohol.

Fiction Lessons Observations



Her shouting is like a gas: It completely fills the space, regardless of the size of the container. The sound originates deep in her abdomen and bellows from her mouth before reverberating throughout the room.


Her wrinkled hands flecked with liver spots loosely hold a fashion magazine open. Long strands of her gray hair are falling into her dark eyes.


Spittle flies from her chapped lips as she roars. Her eyes are focused on the empty chair directly across from her.


A receptionist, a doctor, a nurse, and a dietician all stand around her in the waiting room. The shouting woman is waiting for her appointment. The staff are waiting either for her to calm down or for the last cue to escort her out.

Silence fills the room like a gas. The woman’s lips are stretched into an uncomfortable grimace.

Seated directly to her right is an older man. He still has not looked around the sheet of newsprint he is holding. He has not shifted position. The newspaper does not rustle.

Seated to her left is another man who is holding a small cell phone in his right hand. His right thumb periodically pushes a button on the phone and his eyes remain fixed on the small screen.

Two men and one woman are seated across the room. The woman continues to dip her crochet hook into the yarn; the hook has not stopped since the shouting began. One man has his arms crossed; his chin is tucked in and his eyes look closed. The other man rests his elbows on his knees, his fingertips lightly touching, and his eyes stare at the floor. If he has flinched, no one has noticed.


This story isn’t about her. It’s about the other people in the waiting room.

What happened in their lives that gave them the stoicism to completely ignore her?

They didn’t get up. They didn’t change seats. They didn’t stare with curiosity or fear. They didn’t look at each other with knowing eyes.

None of them had met her before, but they were already familiar with her behavior.

What happened to all of them?

Did their parents only scream at them? Was a shouting parent more comforting than silence, as that meant that at least a parent was present? Did they learn to tune out the shouting when they were incarcerated? Were they beaten as adolescents, such that shouting like this was a benign alternative? Did strangers only shout at them, making this situation nothing out of the ordinary?

How did they learn to cope like this? Who or what trained them to react like this, to react with nothing at all?

Homelessness Lessons Medicine Observations

Saying Good-Bye.

I originally wrote the post below over five years ago. It’s about a teenager I worked with for about six months at a residential treatment center. I still think about him from time to time; I hope that he was able to exit the mental health system.

A few months later, I learned that, less than 24 hours after we said good-bye, he injured himself while destroying property. He apparently threw chairs, punched walls, and tried to knock over bookcases and other pieces of furniture. There was no obvious trigger. It took four adults to subdue him. Staff commented that he had not behaved this way in over two years.

“That’s how he dealt with termination,” a staff psychiatrist murmured.

I’m still not sure if I agree with him.

I’m still not completely sure of the optimal way to proceed with termination.

Termination refers to the end of the therapeutic relationship between patient and physician (or, more specifically, psychiatrist). There are essentially three ways termination can occur:

  • Patient exits the relationship (patient stops attending appointments; physician fires patient; s/he dies)
  • Physician exits the relationship (s/he dies; patient fires the physician; physician disappears)
  • Patient and physician mutually agree on a final appointment date and time and complete the session

Ideally—for both parties—the last option occurs. This allows “closure”. And, no, I’m not entirely sure what comprises “closure”, but the lack of “closure” is why many break-ups suck. Think about it: Break-ups are uncommonly mutually agreed upon events; usually one party decides to unilaterally bail, resulting in negative emotions all around.

In therapy, we do not want to recreate break-ups; instead, we want to model and engage in the graceful end of effective and meaningful relationships. (Psychobabble.)

Saying good-bye is difficult. The white coat-wearing medical doctor within the psychiatrist bristles at the idea of termination; there is something about our medical training that promotes the idea (“virtue”?) of emotional distance and independence from our patients. So many things about our profession (both intentionally and unintentionally) facilitate this: Doctors wear white coats. Doctors wear gloves. Doctors ask a lot of questions, but rarely answer any. Doctors aim for objectivity and evidence.

So when we psychiatrists terminate with patients, the experience is weird and we are often surprised with how difficult it can be.

It’s never too early to initiate termination, so I had informed the adolescent male three months prior to our last appointment together that our time was drawing to a close. At the time, Andrew said nothing.

It’s not that he didn’t have anything to say about it; I had learned by this time that he heard practically everything I said, even though his behavior often purposely suggested that he was ignoring me.

A month prior to last our last appointment together, I reminded him again of my departure.

“Have you seen that Geico commercial? You know, the one with the little kid imitating a monster?” he replied.

As the days passed, he spontaneously mentioned the limited time we had together, though he tossed his remark within a smokescreen:

“I can’t believe that happened; it kinda makes me sad. You and I have three sessions left; we have to make the most of them. So I think I am going to try asking her again, maybe when she’s not so depressed, but it’s hard to tell….”

And that’s the way it had been the entire time we spent together; he would share bits of himself—often only a sentence here, another one there—at random intervals. Sometimes he would acquiesce if I asked a few questions to clarify his remark; most times, he simply changed the subject. One day, I called him on it.

“You’re really good at changing the subject when I ask you questions.”

“Yeah, I know,” he nonchalantly conceded, “I don’t like it when people care about me. It makes me feel weird.”

And when I tried to ask him more about that, he promptly commented on the weather. I smiled—sadly—at him.

The last time I saw him, he greeted me warmly.

We learn in the course of our training that therapeutic termination includes reviewing the time spent together and commenting on progress and goals attained. It’s like a summary statement, an opportunity to reflect upon how the patient has changed and how the patient can continue to effectively pursue his goals.

I already anticipated that, though he would hear my monologue of the above, he would not respond. My hypothesis bore true.

I commented on our very first meeting and what he stated were his goals at that time.

“Did I tell you the joke about the buffalo?”

I continued to commend him for the significant progress he had made in several spheres.

“What did the mother buffalo say to her kid as he left for school?”

I then reiterated his strengths—he had so many: he was so good with people; his integrity was admirable; he was intelligent and thoughtful; he was fiercely independent and more than capable of taking care of himself.


I expressed my hope to him that he would continue to pursue his dreams—I was (and still am) confident that he could reach all of them.

“How about the one about the cowboys?”

I looked at him, willing him to participate in the conversation—but I knew saying good-bye was not his strong suit. His parents had abandoned him when he was young; there was no such thing as a “healthy” good-bye in his experience.

“Because they are too heavy to carry! HA!”

“Take care of yourself,” I said, patting his shoulder. “Good-bye, Andrew.”

He had already started to walk away when he answered, “All right.”

I watched his lanky figure amble down the hallway. I then quickly turned to go.