I Only Came Here for a Prescription

You have already worked out how this is supposed to go. Twenty minutes. A few questions about sleep and appetite. A prescription. Out.

You are not shopping for a relationship. You want the thing that works.

I want to say plainly, before anything else, that this is a reasonable position. It is not avoidance and it is not a character flaw. If you had a fever you would want the antibiotic, not a conversation about what the fever means.

The young man who did not want to be in my office

He came because someone else decided he should. He wanted to see me two or three times, collect a prescription, and be finished.

What he got instead was questions. He told me later that the first visit made it worse. Question after question, all of it aimed at what he was feeling, which was the one subject he had no interest in discussing with a stranger.

He was not being difficult. He simply did not enjoy talking about himself, and I was asking him to do the thing he was worst at, in a room he had not wanted to enter.

What I understood before I said anything

His objection was to being examined, which is a very different thing from not wanting help.

Those are different, and the difference decided the treatment. If I had kept asking him how he felt, I would have lost him inside a month, and he would have gone off with a prescription and a conviction that psychiatry was a waste of an afternoon.

So I stopped asking. I gave him something to do instead.

The first assignment was to look people in the eye during a conversation. That was all. Not to feel differently about them. Not to understand why he avoided it. To do it.

Later, to say one true thing to his family.

Why a task and not a question

For a man who will not talk about himself, a task is the only currency he accepts. He can carry out an assignment without confessing anything. His pride stays intact. He is not being examined, he is being given work, and work is a thing he already knows how to do.

And then something happens that no amount of my asking could have produced. He comes back with evidence. He looked someone in the eye and the conversation went differently. That is his own data, gathered by him, and he cannot argue with it the way he would have argued with me.

The walls came down eventually. Not because I got past them. Because he stopped needing them up.

Wanting the pill and not the conversation is not a refusal to get better. In most of the men who say it to me, it is the last piece of the thing they still run themselves, and they are not wrong to guard it.

I am not against the medication

I prescribe. I have prescribed for fifty-five years, and I have written elsewhere that a great many people I meet are on too much of it rather than too little.

Here is the actual problem with the twenty minute version. The prescription treats the symptom you can already name. You came in able to say that you are not sleeping, or that you are flat, or that everything is an effort. Good. Those are treatable and I will treat them.

But whatever brought you to the point of making the appointment is almost never the thing you can name on the way in. If nobody ever asks, the medication works, the symptom quiets, and the machinery underneath goes on running exactly as it did.

That is how a person ends up medicated, functional, and no different.

Your resistance is the most useful thing you brought

I mean that literally, and not as a compliment designed to soften you up.

Silence of that kind is rarely new. It has usually been in place for years, it was built for a reason, and the reason is frequently more interesting than anything the man would have volunteered on his own.

I am not going to interpret it at you in the first hour. Most of what I notice early is never said, because saying it early would be accurate and useless at the same time. Timing is most of the job.

What the first session actually looks like

Longer than you expect, and far more questions than you are prepared for. Nearly everyone says so afterward.

You will not be asked to cry, to revisit your childhood, or to describe your feelings in any detail if that is not how you work. You will probably leave with something to do rather than something to think about.

And if what you need is the prescription, you will get the prescription. It will simply not be the only thing that happens.

An Invitation

If you have been putting this off because you did not want the whole production, you can say that to me in the first five minutes. I would rather know.

Come in wanting the medication. Bring the reluctance with you. It is welcome here, and it is more useful than you think.