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Case Studies

Language: English
Context: Ambulatory of family doctor
Title of document: Moses
Name of compiler: Sabrina Grigolo
Actors involved: doctor and patient
Description of the experience:
We should ask ourselves whether it is fair and to what extent we are allowed to cross that dark boundary line that separates our lives and, specifically, that even more invisible line, that “Gaza strip”, that exists between therapist and patient. Or we should ask ourselves whether it is more appropriate to act only as observers and limit our intervention strictly to the objective aspects of health care.
Some years ago, many years ago, in the waiting room I saw a "young man" of 32-34 years old. He was taller than the average man, slim, well-groomed, with very long hair falling gently on his shoulders. His style was casual - sporting and his clothes well-matched. But, on the one hand, he made a show of security, on the other, he had a worried look: it is the typical attitude of those asking for help. Then, I discovered he had a biblical name: Moses.
I welcomed him, he told me his story, a whole life summarized in a few minutes, a story that went back a long way: his father, a successful and wealthy man, had a short love story with his mother, a story that lasted just long enough to bring to life their son, but that did not grant any room to the newborn child. His "father" would never take care of him. Moses tried to get in touch with him, with a corresponding request for "actual responsibility takeover", but the attempt tragically failed; his father’s answer was "I have no intention to take care of you or help you in some way, go away and never come to see me any more". Basically, he had been asked only to provide very little help. Such an attempt was never made again.
His mother, a woman who had, to his say, great charm, but was also uninhibited and pleasure-seeking, started a new love affair, which lasted more, but, at the same time, she had other love stories; she gave birth to 5 children, but, she continued to prefer her multiple love stories to the role of "angel of the domestic hearth". She was not cut for being a mother.
In the meanwhile, Moses grew up but he lacked the presence of a father next to him: he continuously searched for a vicarious male figure and, at the same time, felt a utter contempt for the female sex, even if on a subconscious level (he still does not forgive his mother who has not loved him, nor brought him up or stood by him, the contempt he feels is therefore for the whole female universe). All this caused him a strong inability to engage in important love stories. From his past I can only gather he had a long relationship with a girl, which ended after some years and it just implied a long series of problems, because the girl started to suffer from anorexia.
Moses told me "when I really needed to be looked after, it was me who had to care for the others". In order to win a strong existential discomfort, he used to spend his life taking drugs and acids and working in discos at nigh as PR and boy image.

He is condemned to loneliness and to a life with nobody who loves him: not even his stepfather wanted to take charge of him. Right from the start, Moses had to learn to be independent, to survive, to look for a job, to deal with small and big daily problems. He seems schizophrenic: he needs company, but he is not good at relating and fears to communicate with others (he works hard, but he prefers jobs in which he is alone, for that reason all the times he began working in a factory he had to face several problems leading to the end of the work relation); he wants a girlfriend but he fails to imagine himself in that role. Sometimes he has manias of persecution (everybody is against him, everybody looks at him angrily), he manages to talk only with me, but our relation sometimes becomes turbulent: he calls for advice and tips, he tells me, but he cannot accept/follow my suggestions.
It was as if he had a mental block. I asked the support of an educator, a "female" colleague, and, initially, he did not want the new person to be present during sessions; he did not agree to follow a path with his psychologist since he was "too direct and too intrusive and puts his hands where he should not”. Moses became increasingly more uncertain and made very little progress.
Sessions take place weekly, every time a new piece of the puzzle is added, he sometimes disappears for a few months, then he reappears, he has a love/hate relationship with drugs (they help him but they bind him to doctors). He continues to talk and to confide in me.
Then, during a hot summer afternoon, a few years ago, he made me a revelation, thus confirming my strong suspicion: with watery eyes, he told me “but have you understood you represent for me the father I have never had?” It was a powerful moment. I knew what to do in situation like this one, but, when you find yourself into it, you feel as if you are engulfed in a strong whirlpool, in a black hole, and you do not know where it will drag you.

After a few years, his mother died; at that time, he started working in the cemetery in order to stay close to the only person who had given him a little love and a few bucks.

What remains today: 2 deaf stepbrothers, a partner-swapper sister who is deeply dependent on sex, another sister with a child, perhaps the result of an incest, a cat with which he has a close emotional relationship, no job, not even a penny, but a great empathy with his therapist, a relationship that could be interrupted at any moment, and many regrets for what it was his right to have and he has never had.
The only time he accepted one of my suggestions was when he decided to become a good computer expert, even if he had never used a computer until the age of 40 years old.
He is now successful, he has become an expert, but what is the point? He is in the condition of those people who have a lot of money but do not know how to spend it.
And above all: now, at 44 years old, what will become of him?
Objectives:
We should ask ourselves whether it is fair and to what extent we are allowed to cross that dark boundary line that separates our lives and, specifically, that even more invisible line, that “Gaza strip”, that exists between therapist and patient. Or we should ask ourselves whether it is more appropriate to act only as observers and limit our intervention strictly to the objective aspects of health care.
Means and Strategy:
Sessions take place weekly, every time a new piece of the puzzle is added, he sometimes disappears for a few months, then he reappears, he has a love/hate relationship with drugs (they help him but they bind him to doctors). He continues to talk and to confide in me.
Then, during a hot summer afternoon, a few years ago, he made me a revelation, thus confirming my strong suspicion: with watery eyes, he told me “but have you understood you represent for me the father I have never had?” It was a powerful moment. I knew what to do in situation like this one, but, when you find yourself into it, you feel as if you are engulfed in a strong whirlpool, in a black hole, and you do not know where it will drag you.
Conclusions:
The only time he accepted one of my suggestions was when he decided to become a good computer expert, even if he had never used a computer until the age of 40 years old.
He is now successful, he has become an expert, but what is the point? He is in the condition of those people who have a lot of money but do not know how to spend it.
And above all: now, at 44 years old, what will become of him?
Name of Institution: Gradenigo Hospital
Role: Project Manager

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