When a Therapy Patient Dies

She died last year. This lovely woman might be called a survivor, but her story deserves something more personal than slotting her in a category, no matter how fitting.

Call her Cassie. I met her in a psychiatric hospital. Not her first hospitalization, far from her last. A suicide attempt brought us together. The lady already owned a long and troubled history, one as middle-aged as she was. I’m talking about 35 years ago.

Once an amateur gymnast, as a youth she was fit, flexible, and energetic. Early photos captured an innocent Nordic beauty, as well. Just by her presence, Cassie must have been as fair and welcoming as the first birdsong in springtime.

Nothing in the woman I met suggested any of this. Like other sexual abuse victims, pounds became a bubble wrap to discourage those who might otherwise desire or terrorize her in search of chest-beating rapture and savage control. Now gray, her hair lacked its youthful golden hue, and the innocence remembered by the photos had been forgotten by her lined, questioning face.

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The hospital stay progressed. Apparent roots of her clinical depression extended to a male-dominated childhood, a bad marriage, and a ne’er do well, alcoholic adult son often in trouble. Cassie’s husband displayed passivity and incomprehension. Divorce followed.

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My efforts continued for a year before I received a call from a hysterical woman en route to murder her offspring within the hour.

Cassie didn’t sound like herself. Her voice turned unearthly; her tone transformed into that of an avenger of outsized energy and purpose, not the beaten-down creature I knew. My patient’s memories were disjointed, recent conversations erased. Cassie’s child, who’d been jailed for murder, had been released on a technicality.

Cassie intended personal correction of the law’s failure.

I talked her down, but the episode brought home a diagnosis everyone missed: Multiple Personality Disorder (MPD), today called Dissociative Identity Disorder (DID). I’d long recognized this woman to be dissociative, but here was a new facet. From that day, treatment inched its way toward goals she would achieve many years later: integrating her system of alter-personalities and reaching depression’s end.

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In homes such as this courageous individual inhabited, families create a loving self-image. Parents cloak themselves in the garb of religiosity.

Cassie’s father died not long after her updated diagnosis. The news came during another hospital stay. A breakthrough followed when Cassie began to have nightmares of never reported sexual abuse. The death of her abuser freed her from enough of the fear of more violence to allow her to remember and speak of it.

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The mother denied any mistreatment. In her daughter’s presence, she met with us and declared her upstanding husband incapable of it. Yet Cassie recalled her mother seeing a glimpse of her father’s molestation and watched her turn away and depart instead of intervening.

The trauma ended after her tenth birthday. The family relocated to a new home in another state. Upon moving in, she immediately asked which room was hers and found a key in the door. She grabbed and hid the key. The world changed.

During one of her hospital stays, I walked with Cassie off-unit, on the facility’s ground floor for a reason lost to time. Nor do I recall what distracted me. By then, however, I trusted her enough to sit in the lobby while I talked with someone at the front desk. My back turned, she disappeared within a minute.

Rushing through the doors, I spotted her about a half-block away, running toward the main street ahead. The chase began.

Knee surgery was not yet in my foreseeable future, and Cassie’s vanished prime gave her no help. Calls to her went unheeded, but I caught the laboring woman by the arm. She put up no fight.

I’d never read the word “racing” on a psychologist’s job description. I’ve become a more careful reader since.

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Cassie’s troubled life left her without medical insurance on another occasion. By then, she’d had many visits to the hospital where I met her. I spoke with the facility’s administrator upon her admission. He agreed to forgive all charges for her stay, no matter its length. God bless you, Phil.

For a significant period of my patient’s lengthy treatment, I also worked with an insurance company nurse. She became like a visiting angel, helping to craft the therapy to include multiple weekly sessions beyond the company’s normal policy. Her employer gave permission. This enabled Cassie’s life to escape some of the disruptions caused by her hospital stays.

Hat’s off to those good samaritans, as well.

At some point, Cassie raised the question of God’s role. Once a faithful Catholic, she now accused an all-powerful, all-knowing Deity who witnessed her father forcing himself on her and who permitted this outrage to continue.

I suggested she speak with a priest, a wise and sensitive soul of my acquaintance. He offered her tenderness and asked her to consider the possibility her rage at God could also be understood as an act of prayer. My patient solidified her religious connection and held it until the end of her life.

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Though he never again murdered anyone, Cassie’s son continued a mischievous, substance abuser’s life. His mom told him she would cease contact until he’d been sober for a year. Much time passed, but he accomplished this, found steady and honorable employment, married, and produced a family. Cassie embraced this change and welcomed them all into her life with much gratitude.

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Cassie’s road to health never included interest in finding new love. She did have many dear friends, modest professional success, sustained work, and several outside interests. She once said perhaps the only way she could share her life with a man would be if he were both uninterested in sex and unable to be sexual. Psychotherapy often has its limits.

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This woman was the only person in my practice with whom I maintained contact from the end of treatment almost to her life’s completion. She would send me a holiday card once a year, and I would telephone her soon after. We both enjoyed the reconnection. The last time we spoke her memory was failing with speed. She died a few months later.

My heart was full at the news. This woman was a kind and determined person, not without an edge, but with an unexpected tenacity not evident when we met. All the memories I offer here pushed themselves to the top of my consciousness. It was my great good luck to have known this lady and others like her.

Adieux, Cassie. Here’s hoping you reside in a heaven made for the most remarkable among us.

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The “Please Touch Gently” photo comes from Marduw Quigmire. The Paessaggio sculpture, “A Helping Hand,” was photographed by Safiyyah Scoggins –PVissions1111. Last are “Fungi Located on a Log Near the Forest Floor” by Mfoelk13. All were sourced from Wikimedia Commons.