The Incredible Shrinking Patient and the Origins of a Research Program

Steve Saunders, phD.

The Incredible Shrinking Patient and the Origins of a Research Program

Stephen M. Saunders, Ph.D., Professor of Psychology

My research program can be traced to one of my first clients. Billy was 18 and living on his own, sometimes sleeping in his friend’s car and sometimes managing a few nights with his parents. He fascinated and frightened me. When I first met him, he was tall and stocky. He wore tight t-shirts that showed off his muscles, and he bragged about being able to “toss around thousand pound barrels” when helping at his uncle’s garage.

Billy stared and Billy smiled. When he was speaking, he would stare at me. When I was speaking, he would stare at me. He smiled nearly continuously, even when relating strange and painful experiences. The only time he stopped smiling was when thinking about something I said. Then he would tilt his head, gaze into the air above my head, and try to look pensive. Then he would look at me again, nod, smile, and stare.

I refer to Billy as “my incredible shrinking patient.”

With the help of a supervisor, over the weeks of meeting with Billy, I was able to gather my wits about me. She helped me realize that Billy was quite ill. The peculiar smiles, the odd presentation, the refusal to establish stable living—these were indications of a mind devolving into severe confusion. As this sunk in with me, Billy started to shrink. Turns out he was neither tall nor particularly muscular. He still smiled and talked about his incredible strength. But as I began to understand what his life was like and why he needed to impress others with his strength and confidence, he got smaller and less intimidating.

Billy no longer frightened me, but he increasingly fascinated me. I became fascinated that Billy came to see me. Just recently I had read the results of the Epidemiological Catchment Area (ECA) nationwide survey of the prevalence of mental illness. One in 5 persons in the U.S. experiences a diagnosable mental illness in any given year. But less than half of those persons get any treatment, and less than half of those half see a mental health professional (i.e., someone who actually knows how to help!). I knew many people needed mental health care. They were well-educated, knew others in therapy, and were ensconced in loving social networks, but they never sought it.

Billy had. He was 18, was sleeping in his friend’s car, had not graduated from high school, had neither friends nor family except an uncle prone to violence, and felt a need to flex his muscles when talking about the difficulties he faced. Yet Billy had made it into the mental health treatment system.

I wanted to know how he had done it. If we could know how Billy and others got the help they needed, perhaps we could convince others to do the same.

I’ve been doing research in the area of help-seeking ever since.

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