August 3, 2016

Adventures in Private Practice

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Stanley Kapuchinski, MD

Punta Gorda, Florida


It was one of those bleak, cold, gray-sky days that foretold of the New England winter to come. Inside, my office was warm and comfortable, and I looked forward to seeing my next patient, Brad, and finding out how he was doing.

Brad was a 19-year-old man who had just returned home, having withdrawn from the US Naval Academy in the first months of his first year. His depression had been so severe that he was unable to cope with the Academy’s demands.

Brad lived in a nearby town and had been pushed by his parents into seeing me about 3 months before he left for the Naval Academy. When I first met him, he looked the part of a good-looking young guy, casually dressed with short-cropped hair. He seemed like the all-American boy who was going off to college. But how he looked and how he felt were two different things. In the months before we met, he had become increasingly depressed. It was likely he’d been depressed a good part of his life. He couldn’t concentrate, avoided his friends, had no energy, and didn’t care about doing anything. Brad would have been content just to sit and stare at his bedroom wall. With his parents’ help, he had completed the Naval Academy paperwork and graduated high school. He was very sad all of the time.

As I spoke with Brad in the early weeks, I felt the emptiness, desolation, and dark absence of joy inside him. His sadness engulfed him and made every day cold and bleak.

“I didn’t want to come here, you know,” Brad told me at the first appointment. “I should be able to handle this on my own and not depend on anybody’s help.”

Neither psychotherapy nor antidepressants helped him prior to his leaving. But he was determined to go off to the Academy and succeed.

Now, after his return, we had been meeting again for a few weeks, with Brad very resistant to talking. As I walked with him back to my office, I noticed that Brad still wore his long coat. In the warm office, I wondered about it but went on to other thoughts. Brad sat facing me about 3 feet away, with his coat still on.

“How are you?” I asked. Silence.

“How are you feeling today?” Silence.

“Brad, how has it been going since you’ve returned?” Still no response.
The minutes passed.

He reached inside his coat, waited just a few seconds, and then slowly pulled out a gun and pointed it directly at me.

I was staring down the business end of a revolver 2 feet away, aimed directly at me.

James Bond I am not.

On reflex (and certainly not thought), I reached out to push the gun aside.

“Don’t do that,” Brad said, flatly.

I did what I was told and put my hand down.

I remember looking at the gun’s cylinder and trying to see if there were any bullets in it. But then I thought, “You idiot, he only needs one bullet in the chamber!”

Time passed. Whether it was a short amount of time or a long time, I don’t know. Brad sat across from me, still pointing the gun and staring at me, his face blank.

Then, he pulled the gun back and examined it. More time passed.

The gun moved again, but this time he was putting it back into his coat. As he did this, he said, “They sure make reproductions look real nowadays, don’t they?”

I have no recollection of what we talked about for the rest of the appointment. It ended. He left.

I know I tried to put on my best “professional” demeanor and think of the various psychodynamics in play. I know now I was just avoiding feeling how frightened I was.

How do you proceed with a patient who has pulled a gun on you? And then says, “Ha, ha. It was just a joke. It’s only a toy.”

How dangerous was he? Did he really want to kill me? Do I drop him as a patient? How can I be neutral after something like this occurs? What do you talk about, besides the elephant in the room, as time passes?

As a psychiatrist, I wanted to understand what was going on inside Brad. What drove him to do what he did? What really was going on in his mind (because how could he really want to kill me?)?

As a human being, apart from my professional side, I had felt incredibly powerless in those moments. Being scared was terrible, but feeling powerless was horrific. You cannot feel helpless without feeling angry. I tried to soften the anger, but it was still there. I replayed the scene over and over, asking myself if there was anything I could/should have done with a revolver pointed directly at me. In the days following the incident, I began thinking about taking a course in self-defense. Laughing at myself, I thought what a meager attempt this was to reassure myself that something like this could never happen again if only I were better prepared.

This event altered my side of the relationship. I wondered if I could go on to help Brad.

He did make another appointment to see me. As the day approached, I wondered how it would go.

When Brad arrived, I carefully noted whether he wore a coat and kept it on.
Once we sat down, I did have difficulty holding myself back from saying something like, “What the hell did you think you were doing?”

In time, however, Brad and I did discuss what happened. He admitted that he had become increasingly angry at being pushed into attending the Naval Academy, pushed to see me for treatment, and generally pushed into doing many things he didn’t want to do. He worried that if he didn’t do what his parents wanted, he would make them unhappy. He was very angry with himself for dropping out of the Naval Academy. My wanting to talk about his feelings (pushing him again) had made him angry with me too. Brad admitted that pulling the replica gun on me was his way of showing his anger at me for prying into how he was feeling. It was a lot easier to scare me than to face the emotional conflicts that were swarming inside of him. He was hoping that I would throw him out so that he could go off and be by himself.

I am pleased to say that Brad did improve. He eventually went off to a college that he wanted to attend. I hope he is happy … and doesn’t have a revolver.

I now live in Florida, where many people carry concealed weapons. This fact does not go unnoticed by me.

© Copyright 2016 Stanley Kapuchinski, MD.
Financial disclosure:Dr Kapuchinski had no relevant personal financial relationships to report. ​​

Category: Depression
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