Jake Andrews had decided to come back to therapy, and Jennifer was surprised when he arrived. His hair was neatly cut and styled, and he was wearing khakis and a dress shirt. Jennifer didn’t say anything when he signed in; she was shocked by the sudden transformation. His demeanor had also changed.
He replaced his scowl with calmness. His skulking switched to a more confident appearance. He sat up straight and presented himself as a polite young man. What happened to the surly, unkempt, hoodlum? His angry personality had been replaced by what, exactly? And it had happened so quickly.
One thing was certain: he no longer fit into her rebellious fantasy world. When Dr. Prentice buzzed her, Jennifer informed Jake that Dr. Prentice was ready for him. She watched him cross the reception area, but he only offered her a smile.
Jake caught Dr. Aubrey Prentice off guard when he entered her office. He looked as if he had just come from Sunday school. The complete transformation was so dramatic that she began the session based on his appearance.
“Jake, have a seat. I have to ask, why are you dressed so nicely?”
“I have a date.”
“Really? That’s great news. Would you like to tell me about it? Who is she? Where did you meet her?”
“I met her on my delivery route, but I’d rather not tell you who she is, if that’s okay.”
“That’s fine, Jake. You can tell me what you’d like to and leave out what you want. I’m just so surprised about this change. You are talking to me like a respectful person. That’s great!”
Jake explained the change. “This girl I asked out is someone I liked in high school. She remembers me, but she knows me as the troubled kid who dropped out. But I didn’t drop out. I was removed from school because I’m bipolar and wouldn’t take my medication. My parents were afraid of me, so they had me committed to St. Joseph’s. Isn’t that where you went to college?
“Yes,” replied Aubrey. I’m so sorry that happened to you. I didn’t know.”
“Of course you didn’t, Dr. Prentice. I didn’t want you to know because I didn’t want to go back on my medication.** But I do now.”
“Because of the girl,” Dr. Prentice said. “That makes sense. But you know, Jake, bipolar isn’t something to fool around with. If I’m going to treat you, you have to stay with the medication and the therapy, or it won’t work.”
“I know,” Jake said. “So even if this girl doesn’t work out, then maybe another one will, and I can’t date with those kinds of mood swings.”
That was good news for Aubrey. A young man was treating his mental illness so he could score with a girl. That was definitely a chapter she could put in her book.
“So how was St. Joseph's?”
“It was terrible,” Jake said. “I couldn’t leave because I was underage, and my parents didn’t want me. They overmedicated me because I was always acting out, getting violent, so I went from being violent to becoming a vegetable. I wandered the hallways when I could.
Jake paused, remembering the painful time spent in the psych hospital at St. Joseph’s.
“I didn’t think it was that bad there, Jake. I interned there, and I didn’t see anything like that.”
“No,” he said quietly. “I was the problem. I didn’t do anything I was told. Then, after a few weeks, the staff began to talk about me like I wasn't there.
“He needs this,” they would say right in front of me, “or he needs that. And it’s for his own good.”
“You must have been a difficult case,” Dr. Prentice said. “Losing your parental support on top of everything else.”
“It was hard,” Jake admitted. “But I made it through.”
“Now you're out in the real world, Jake. “How are you making that work?”
“I’m doing okay,” he said. “I keep my head down and mind my own business. When I feel a mood swing something on, I realize it’s me, and I hold it all in.”
“That’s not healthy.”
“But that’s the way it is. But I figured that since we had this mental health service, I could get cured once and for all and be done with it.”
“That’s not quite how it works, Jake, but I admire the fact that you took the initiative.” Jake looked down at the floor. He looked uncomfortable.
Dr. Prentice changed the subject. “How did you get hired at Henshaw Industries?”
“I earned my G.E.D at St. Joseph’s, and they had a referral program. Henshaw Industries hires mental health patients as part of their charity work, and I was hired and have been there ever since.”
“So they know about your mental health issues?”
“Yes, and they're supportive. They have their own human resources department, and they referred me here. So here I am.”
“Then let me ask you this…” Dr. Prentice was treading lightly, “What happens when this girl finds out you are bipolar. I mean, what happens if you have an episode while you are out on a date in a public place and it catches her off guard?”
“That was one of the first things I told her,” said Jake. “I’m trying to man up here, and she didn’t have to know everything about me, but I figured that one was important. It came up naturally in conversation anyway.”
“How so?”
“She wanted to know why I left high school and what I’d been doing since then,” he said. “If I lied, she’d find out soon enough; best to get it out of the way first.”
Dr. Aubrey Prentice didn’t expect that answer. Here was a good-looking, younger guy who could lie his way out of anything to get laid, and yet he chose to be upfront about it. That would make another interesting chapter, “When a Man Decides to Tell the Truth: Beware or be thankful?”
Fortunately, Jake was truthful, and he was so damn sincere. What a lucky girl to find a devastatingly handsome man with an open mind when it came to getting the medical help he needed.
“Now back to your treatment,” Dr. Prentice said. “What kind of therapy did you receive at St. Joseph’s?”
“A lot of group therapy,” he said. “That’s when I figured that some guys had it a lot worse than I did, and I settled down. The individual therapy was mainly about my medications and some talks with my case worker. When I was better, I went to G.E.D classes and took classes to reconnect with the outer world once I was better.”
Dr. Prentice was curious. “Have you reconnected with your parents?”
“No, I haven’t. While I was at St. Joseph’s, they had moved without a forwarding address. I guess I’ll never reconnect, but they probably don’t care.”
“That’s too bad,” Dr. Prentice said. “Maybe we can help you find them and see if they want to reconnect.”
“Maybe,” Jake said, “but I’ll leave that for another day.”
“Yes, Jake,” she said, “why don’t we concentrate on the girl you like. So she knows about your bipolar episodes. What do you like about her?”
“She’s my age, and she’s pretty and smart,” he said. “And she has a high school diploma, as I do, so she’s not too smart. And she doesn’t know what to do with her life either, so that makes us two souls exploring the possibilities.”
“That’s sweet, Jake,” she said, but let’s talk about the reality. You know you’re working on your mental health, and at the same time, starting a new relationship. You can’t take this lightly.”
“But I’ve changed.”
“Have you?”
Jake continued. “Yes. Look, I know I didn’t take it seriously when they released me from St. Joseph’s. I thought the meds made me weak. I hated how slow they made me feel. So I stopped. And that’s when everything went downhill again.” He took a breath. “Henshaw Industries gave me a chance, and this time I don’t want to be that guy who makes trouble.”
“Thank you for telling me that, Jake. Your honesty will help us figure out the right treatment.”
“I just want to do it right this time.”
“Then we will.”
“I’ll do whatever you think I need to do. I’m not going back to how I was.”
“Good,” Aubrey said. “Because the person sitting in front of me now is someone who can build a future.”
While Jake was absorbing this new information, Aubrey made some more notes: Composed posture. Rehearsed behavior reflects what he thinks people want to see, but it isn’t permanent. Still unsure about his place in society. Fear of slipping, fear of being seen as the boy he used to be, fear of losing the girl who suddenly mattered.
She recognized that fear. She’d treated it before. This was easy since he was willing to take the medication.
Easier than treating Ian.
Not now, she warned herself.
But the comparison crept in anyway. Men like Ian had come to her father’s practice. Men whose charm, panic, or shame shifted constantly. Not because they were bipolar, but because they were full of themselves.
Men like Ian, with his apologies, his promises, his “I’ll do better, I swear.” Men who could say all the right things when they were afraid of losing control.
Aubreys topped herself. She hadn’t even seen Ian professionally yet, and she was already making assumptions.
Jake was here now, sitting in front of her with a new look and a new attitude on life.
This was how it was supposed to be. Treating someone who wanted to be helped.
Aubrey had to force herself to stay in the present. She was treating Jake now, not Ian. She couldn’t let Ian invade her thoughts with every trigger she encountered during the day. Like right now: Jake led to St. Joseph’s, which led to her father, which led to some of the dickhead male patients he had, which all led back to Ian.
This had to stop.
So, back to Jake. She observed him again clinically, making some notes, pushing her emotions about Ian aside:
Speech: normal rate
Affect: congruent, appropriate
Insight: present
Judgment: improved
Motivation: external, but not pathological
Risk of relapse: high
Jake watched her, anxious for approval, waiting for notes that would be positive and hopeful.
“You’re doing well,” she said, “and I appreciate how open you’re being. But I want to make sure you understand something important.”
“Okay.”
“You don’t need to be ‘the nice you’ for anyone else. Stability has to be your first goal. Otherwise, it never lasts.”
“I know. I do. I don’t want to mess this up.”
Aubrey agreed, but inside she felt the bitter edge of memory: the men who raged in her father’s office, telling him it wasn’t their fault that the people around them were the ones who needed an attitude adjustment.
But Jake wasn’t Ian. He wasn’t angry like her father’s patients were at St. Joseph’s.
“All right then, Jake,” Aubrey said as she wrote out a prescription. This should do you until you come back, and by then, I will know enough to treat you long-term.
“Thanks, Dr. Prentice.”
Jake looked at the prescription and left.
Aubrey watched him go, struck by the sudden clarity that he no longer belonged to the category of “dangerous fantasy” she had been drifting into.
He belonged to the category she had almost forgotten:
A patient who needed her.