"I'm wondering if you want me to worry about you today?" I suggested Simon seemed unusually relaxed. This is a Skype patient who is usually hyper to the point of mania, always asking me when he’s going to be “fixed” and trying to force life tips out of me. He feels persecuted by the imagined and real criticisms of strangers, friends and family, and always assumes himself to be in the wrong and deserving of whatever punishment might be on offer. He talks breathlessly, pleading with big eyes. But not today. “I feel very calm,” he said. During the unprecedented two or three-minute silence that followed I began to wonder what earth-shattering revelation must be about to ensue. “I…” he began. Another very long pause. “It feels hard to articulate,” I offered. “No…” he said, his gaze drifting away. Another huge silence. “You feel quite detached from me today.” “Yes,” he agreed, 30 long seconds later. After 10 minutes of hearing his kitchen clock tick, I noticed that his eyes seemed to be closing and my anxiety began to mount. In normal sessions he complains about being tired, but the more tired he is the more wired he seems to become. This was different. When I spoke again he was startled out of reverie. “I’m wondering if you want me to worry about you today?” I suggested. “You can if you want,” he slurred. “I don’t care.” Now I was very worried indeed. “I don’t care about anything any more,” he said, slipping out of consciousness again. Had he overdosed on something? Was he drunk? Was he terribly ill? Or was I missing the countertransference? I tried to relax and think. But all I could think about was how I might get help to him. I know which company he works for so could I ask it to send an ambulance to his home? I know where his girlfriend works, I think, but I don’t know her surname. I remembered a psychoanalytic lecture I’d once heard where an analyst recounted the story of a patient having an asthma attack and how she’d wanted to call an ambulance but, in fact, staying calm and containing the patient’s panic ended the attack. I rolled my eyes inwardly. Yeah, well, my psychic powers were failing me. Or, rather, him. For the first time, I stepped out of therapeutic stance. We could interpret later. And, having taken this decision, I remembered. He’s diabetic. “Simon,” I said. “I am worried about you and I think you need to get some help. Could this be your diabetes? Is there someone else in the house who can help you?” He looked up at me, surprised. Another eternal pause. “I’m going to go now,” he said, getting up. “I’m staying here,” I said, not knowing what I might do. He was back in less than a minute. “Thank you,” he said. “I was low. I have eaten a bar of chocolate but it won’t kick in for 10 minutes or so.” “You already seem more lucid,” I said. “It’s the adrenaline. Fear,” he explained. We sat quietly until the end of the session. There will be a lot to process when we next meet—the suicidal aspect of letting it happen, his desire for me to see him like this, the unexpected direct access to his nihilistic unconscious, his enjoyment of the comatose state, and so on. But for me it was a terrifying crash course in when to stop interpreting and step in. And I’m sure I bungled it.
