Vivian Owusu, a stunning twenty-one-year-old African woman who grew up in Ghana, was about to walk out of the university counseling center when I went to the waiting room to get her for our initial appointment. Her first psychiatric provider had retired a year after meeting her and her next one took a different job six months later, so I was her third psychiatrist in less than a year. Vivian had not shown for her first two appointments with me and now, due to a double-booking error that was my fault, I was thirty minutes late. I apologized and asked if she had time to stay and meet with me. I could see her anger and agitation. “I suppose.” Irritated but still poised, Vivian followed me down the hall to my office. What an unfortunate beginning, I thought, feeling harried. We had been short-staff ed for months and I had been squeezing patients in as best I could, feeling like I wasn’t doing my best work. Vivian settled herself upright on my couch and looked at me coolly. She had big dark eyes, flawless brown skin, beautifully braided hair, a button nose, and a hostile expression. In response to my questions, she told me she was a junior, pre-law. She hadn’t slept for three or four days. Depression had been plaguing her and she had been having thoughts of killing herself. Her expression of hostility briefly showed a trace of sadness. “I don’t trust people,” she said. “I take things personally and I get annoyed.” She often felt emotionally volatile and easily got upset with people if she felt they were rejecting her. I had skimmed her medical record prior to the appointment and saw that she had had multiple emergency contacts with our clinicians and two psychiatric hospitalizations, the second five months earlier. She said she wasn’t having suicidal thoughts currently and would call us if she did. What she wanted from me was a refill of medicines she was taking to help with the depression and anxiety.
