Today’s column begins with a screaming match: “You just don’t get it! Our son, Mickey, tried to kill himself using your pills!” General Moore’s face throbs with anger. “Don’t yell at me!” Mrs. Moore, a petite woman, takes her husband’s hands and speaks softly: “I’m the one who is raising him. Ever since Andrew died, you’ve been buried in your job.” When she breaks down and sobs, he wraps massive arms around her.
Mickey, 17, has been transferred from ICU to a psychiatric unit, following a near-death drug overdose. He took a cocktail — prescription pills washed down with whiskey — and his mother, Jacqueline, found him, face down, unconscious upon his bedroom floor. His parents, vacationing in Spain, had returned one day earlier than planned. This single piece of luck was all that had stood between Mickey and his death.
As part of Mickey’s treatment team, I have been given the task of interviewing his parents. Like the excavation of an Egyptian tomb by an archeologist, I will be looking for the truth, using a three-pronged investigation: 1. Brush away the layers of mental debris obscuring the reasons why Mickey wanted to die. 2. Locate one frayed end of the threads of truth woven into the fabric of the family. 3. Pull the thread slowly to unravel the family’s mystery.
Mickey’s father, a marine General, looks like a pro-football lineman: 6 ft., 6 inches, 250 pounds, he is like a bull of a man. I’ve already been warned by the staff. He is a nasty piece of work who has bullied and intimidated them.
“General, I need to ask you questions about your son.”
His square head swivels, like a turret with two, 50 caliber machine guns, as he puts me in his sights. “Who the hell are you?”
“I’m Dr. Elghammer, I’ll be treating your son.”
“Doctor, Doctor of what?”
Feeling squished already, I speak louder. “I’m a clinical psychologist, sir.”
“No way, I demand a real doctor. Tell me, Dr. Humper, how many operations have you performed?
“None,” I say.
“Well, how many little, bitty pink babies have you delivered?”
“None,” I say. “See, you are not a real doctor.”
Refusing to be bullied, my eyes turned into steel daggers. “Steven (his first name), only intelligent people know that I am a real doctor. I need your help to save your son’s life. The next time he overdoses, he will die.”
I watch as he collapses inside of himself. The reality of his son’s near-death hits him. He answers all my questions and after two hours, I have what I believe to be a tight, clinical formulation.
Mickey is their only remaining child. An older brother, Andrew, died at age 3 from leukemia. General Moore never recovered from this loss; he still blames himself. This trauma has shaped the entire family. The father distanced himself from Mickey, and the mother over-compensated by giving her son way too much freedom. Mickey, feeling rejected by his father, became increasingly angry. His suicide attempt is a way to hurt his father.
Feeling successful, I get up to leave when Mrs. Moore takes my hand and, as she watches her husband leave -— he is going to get sandwiches — she sits me down and tells me a story.
“Don’t judge the General too harshly. He is only using his anger as a wet blanket to toss over the flames of fear: if Mickey had died, his father would be lost. He worships Mickey — even though he is emotionally disconnected — and has been deeply involved in Mickey’s life. He takes him to his violin lessons and for the past 12 years he has never missed a single concert.”
I’m stunned. If Mickey’s father is so devoted to his son, why did Mickey try to kill himself? My clinical formulation just exploded.
Interview with a 17- year-old drug addict: Mickey’s eyes shine bright; he is alert and eager to talk.
“Before you begin, you need to know I did not try to kill myself, OK?”
Confused, I ask, “What?”
“Since I was 11, I’ve been stealing my mother’s pills — she takes all kinds of prescription medicine — and I’ve been experimenting with drug combos. What happened was I had never mixed alcohol with pills, that’s why I passed out.”
I spent three hours with Mickey, as well as giving him a battery of psychological tests. After analyzing all the data, Mickey’s statements were validated. He had never tried to kill himself, but he did have a serious drug problem.
In summary, here is what Mickey taught me:
1. The “expert,” the one who lives and breathes with the child, is not the professional. If you listen carefully to the parents, they will guide you so you can understand how best to help their child.
2. Resist the urge to blame the parents for 100% of the child’s problem.
3. Drug use is hidden. Like buried treasure, you must dig to find the gold.
The content of this article is for educational purposes only, and should not be used as a substitute for treatment by a professional. The characters in this story are not real. Names and details have been changed to protect confidentiality.
Dr. Richard Elghammer contributes his column each week to the Journal Review.
