Monday, July 14, 2014

Vignette 5: What Would You Do?

Annie, a suicidal student

Background: Annie is a sophomore with a psychiatric history dating to age 12. She has had multiple depressive episodes and was hospitalized at 16 after a suicide attempt by overdose. She has been in some form of treatment off and on since she started high school. Annie engages in cutting but that is a coping measure and not suicidal in intent, though she frequently thinks about suicide.

Scene: Annie answers questions in class which alarm her instructor and classmates.

Dr. Hokumba: So, can you recall an experience in your life which is evoked by your reading this week? Yes, Annie?

Annie: (Raising her hand) Well, when I was sixteen I was sent to a hospital after I tried to kill myself. Let me tell ya, it was exactly like what Kafka said.

(Other students quickly turn around to look at Annie.)

Dr. Hokumba: I see. In what way?

Annie: (Holding up both wrists, which reveal very red marks on the wrists.) See? People freak out over this but I went because I overdosed. The hospital was like a maze just like Kafka spoke about. I never did figure out what was supposed to happen or what I was supposed to do. It just seemed like whatever I did was the wrong thing, but when I tried to do what they wanted it just made it worse, ya know?

(There is obvious discomfort among the students.)

Dr. Hokumba: (nervously) Anyone else?

Annie: But I’m used to it. I still think the way I used to. After all, suicide would have solved Kafka’s problem. My shrink says I am stubborn that way.

Dr. Hokumba: Annie, let’s talk more about that after class, OK?

(After class, Annie approaches Dr. Hokumba.)

Suggestions: First, if you plan on having class exercises which involve personal history, creative projections of fantasy, or stream of consciousness thinking, you need to be prepared to field and respond to disturbing material.  This means being familiar with sources of support, referral, and immediate crisis response.  In this vignette the student reveals her thinking is current and not just in the past, and the fact that she is in treatment already.  Make sure others in your area are aware of your meeting and consider having your campus police nearby for support if needed.  In your discussion encourage her to continue in treatment and make every effort to refer her for follow up that same day, either to the campus counseling service or her current therapist if she is being seen off campus.  Either way the situation warrants timely follow up in order to determine her current level of distress.  If in doubt, ask your campus counseling service to send a counselor to your office in order to make a literal handoff to those services.  There may be many other considerations involved which cannot be covered here, so follow the recommendations of the counselor as they are provided during your discussions.