Tillie

Practice Story, Tillie

Tillie was one of my first patients when I began what was at first a part time private practice.  She was 40 years old and had been seeing psychiatrists all of her adult life.  She was dressed in vividly contrasting colors. She was not attractive but she was engaging. Her speech was rapid, loud, and accompanied by frequent smiling.  She had never been married but had had many steady lovers over the years.  Most of them had been married salesmen who would phone her and arrange for a tryst when their jobs brought them to this area. She was a regular churchgoer. She loved her pastor and the congregation where she worshiped.

Tillie appeared to have lived her life in a continuous hypomanic state.  This had not impaired her ability to function at work.  Over the years she had advanced from being a telephone operator to that of a middle executive position in the phone company.  When the company was downsized her office was closed. Rather than move to a different city she took a job as a sales woman at the local Sears Roebuck store where she was also very successful.  Her main psychiatric symptoms, which on some occasions caused her to experience distress, were auditory hallucinations and delusional thoughts. 

Her previous psychiatrist had treated her with psychotherapy.  She had enjoyed her sessions with him and had even accepted the fact that these sessions in which her intimate thoughts were expressed had not led to what she thought would be a less professional but more personal and immediately satisfying intimacy at a local motel. It was my opinion that medication would be a better way to treat her symptoms.  She agreed to take an antipsychotic drug.  

At the end of this first interview I asked her if there was something more I should know that I had not asked her about in this first meeting.  I also asked her what her expectations were in terms of how I could best help her as her doctor.  After a pause she said the only thing more she would wish for would be for me to give her a hug.  I was unprepared for this request. I didn’t want to hurt her feelings by rejecting her but it was clear to me that a hug would not be appropriate or in the long run helpful to her. Somehow I was able to muster a quick reply, one I hoped she would find acceptable.  I told her that I never hugged my patients.  The only exception might be at a time when I knew treatment was being terminated.

Tillie continued to see me until the time I retired.  Medication did not totally eliminate her referential auditory hallucinations.  For example, once upon my return from a family trip she reported that while shopping at the local grocery store a voice was broadcast over the intercom that was clearly intended for her. The voice said, “You should get a different doctor.  The one you have now goes on too many vacations.”

The last time I saw Tillie, some 30 years since our first meeting, she was stable.  She was not hallucinating and was not describing delusional thoughts. She was tolerating her medication with no symptoms or signs of toxicity.  Based upon our previous discussion she had chosen a psychiatrist to take my place now that I was retiring.  When our appointment time was finished she got up from her chair and walked slowly toward the office door.  Half way there she stopped, turned to face me, held out her arms, smiled broadly, and said, “I’ll take that hug now.”