A Place to Live

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As a resident in psychiatry, I believe in talk therapy. I've seen it help people make meaningful changes. I watched a recently retired woman who refused to part with her deceased parents' belongings realize that her hoarding was based on deep-seated feelings of guilt. She is now ready to donate their things to charity.

I like my job. But there's a tendency in this field to reduce patients to psychological constructs and diagnoses. So when "John," an elderly patient with whom I'd been working, told me he was about to lose his home, I felt stuck. Where was the underlying trauma, the irrational phobia? Sure, John suffered from chronic depression--that's why we'd been meeting. But what could theories of enactment and transference offer a man whose most basic need-- shelter--was about to go unmet? Here was a man on the brink of homelessness, and all I had to offer, it seemed, was psycho-jargon.

John did lose his house, and I was losing my confidence. It was then that I realized something: We could deal with his depression later, but first, we had to find him a place to live. When he came to our next session, I offered to use our time to call local social workers, non-profit housing groups, and community leaders. He was thrilled. I left messages all over town, and one of them eventually reached the head of the San Francisco Department of Homelessness, who helped find a permanent solution for my patient within a week.

Since moving into a studio he can call his own, John is happier than I've ever seen him. He's sleeping better, and he has the energy to dive back into his trove of Mozart recordings. We still meet to discuss his depression, and thanks in part to those psychological theories, John is making progress. But we could not have reached this point had I not realized that John is a person, not just a patient. Only when his most basic human needs were met could he make meaningful progress towards mental health.

With a Perspective, I'm Matthew Hirschtritt.


Matthew Hirschtritt is a fourth-year psychiatry resident at the University of California, San Francisco.