Dear C and Dr. B,
I am a therapist at a busy community health center and I am unsure how to think about one client who was in her 20’s. She told me she was going to commit suicide by contracting COVID. She said she would carry this out by not getting vaccinated and refusing to wear a mask. This puts me in a difficult position. I don’t believe I could have her committed for being suicidal because what she described would be very unlikely to actually kill her. She is more of a danger to others than she is to herself. I’m not sure how to handle it – her threat seemed more oppositional and childish than anything else.
– Mary Magda Lynn
Dr. B says:
You are most likely correct about your client’s behavior – what you describe is consistent with borderline personality disorder. Those with this disorder have difficulty understanding social rules and social reciprocity. These are people who tend to create chaos and suffering in others. They also tend to see the world as very black or white and see themselves being at the center of all things. “All people are bad to me…you destroyed my life…the world would be better off without me.“ Essentially they are arrested at age 12 to 14 forever. They think in terms of and react to things only in extremes. Jumping to suicide is a typical and acceptable solution to most problems for them as it is superficial, impulsive, and always the most extreme option. Such people have no capability for subtlety or patience; it’s the way they play the game of life.
Your client’s threat of suicide is an attempt to make COVID all about herself. Statistically, hospitalization doesn’t do a lot for personality disorders, nor does medication. Dialectical behavioral therapy (DBT) is a type of cognitive behavioral therapy which may produce better results. Motivational interviewing is another possible technique. Group therapy with a leader who is skilled in this area offers some promise as well.
Our culture at this point in time is very Me-oriented, which is similar in many ways to your client’s way of thinking. COVID is a communal and global problem, but many Americans focus instead on their personal right to freedom and choice. This is making it virtually impossible to fight this pandemic.
I’m probably not the person to ask for advice on this subject. As a member of the creative community, I have been exposed to far too many people with similar personalities and I’ve lost tolerance. At this point I believe that the best thing to do with such people is to ignore them. They are utterly incapable of change and will make you feel like you are going crazy if you even attempt to have a reasonable conversation with them. All they will do is keep turning the subject back to themselves.
Here’s how I suggest that you handle your client – foist her off on someone you dislike immensely. If you can’t do that, then wear invisible ear plugs and hum quietly to yourself whenever she starts speaking. Just make sure you can tell when she stops. She will throw a fit if she thinks you aren’t paying attention.
It’s too bad you can’t tell her that there are far more reliable ways to kill herself but I doubt if advice on effective suicide methods is approved by the medical board. I’d suggest you turn her in to the Stupid Police, but we’ve yet to establish that agency. Unfortunately, her crazed intentions are not reportable. Even though she’d endanger vulnerable citizens if she managed to catch COVID and spread it around, she’d have to be making threats against a specific person in order to merit criminal charges. You probably can’t violate her privacy by warning others to keep their distance, but make sure that you wear full protective gear if she ever enters your office.
– Cathren Housley
You can visit Dr. B’s blog at drbrilliantcliche.wordpress.com