Alexandre Vidal Porto - Sergio Y.

This allowed me to calmly recopy my notes after each session. This change made my work more consistent. I could play back the recordings as many times as I wished. I could hear the pauses, the silences. I could perceive changes in the breathing. I gained elements of analysis that the previous method of note-taking did not offer me.

Whenever my interest in a patient began to wane, I would try to discharge them as soon as possible. In such situations, my logic went something like this: I do not want to devote my time to this patient, therefore he does not need me. He will be better off with someone else.

There were times, though, when a case genuinely interested me and, for reasons beyond my control, I could not arouse the patient’s interest in being treated. When this happened, I was the one who was discharged.

When a patient left me, I would feel a deep sadness: infantile and unjustifiable. Something similar to the impotence a child feels when he discovers another child, younger than him, has broken his favorite toy, and that there is nothing that can be done about it.

Whenever I took interest in the case and the patient also showed interest in the therapy, at some point, I would invariably become obsessed. My obsession persisted for as long as the mystery lasted for me. It would last for as long as I could lose myself in the case in my attempts to understand it.

Some obsessions were easily overcome. Others, however, haunted me for years, even after the patient-therapist relationship had ended. I believe this is what happened with Sergio Y.

With him, I learned that some patients realize before the doctor when the optimal point in their treatment has been reached — when to stop, the moment when the returns start diminishing. It was with Sergio that I discovered the importance of humility.

I never did understand, however, in this story that I am about to tell, whether somebody in fact abandoned somebody else.

I want to make clear that, at this point in my life, I have no desire to lay bare the intimate details of a person who has entrusted his privacy to me. However, if I comment on this case and am somehow remiss with regard to my professional oath, my reasons for doing so have great merit.

It is true: I have not kept secret what my eyes have seen and my ears have heard. I know. But I do have principles. My intention in telling this story is not to do harm. I want to become a better doctor and a more principled human being. My intent is to learn.

The patient I will speak of came to my office recommended by his school principal, a friend of mine from college. In her e-mail, she said a seventeen-year-old student, “articulate, intelligent and confused,” would call. According to her, it was an “interesting case.”

I took note of that.

It was a very hot day in São Paulo. On the streets that morning people walked around hoping rain would come and cool things off. No one imagined, though, that it would grow dark so suddenly, or that so much water would fall from the sky. The hour and a half of rain was enough to disturb the entire flow of traffic in the city.

My office is on the twentieth floor of an office building. From my window, I can see the Marginal Pinheiros highway below. Sitting in my armchair, I could see the dark clouds move in and cover the sky and darken the entire horizon.

I turned the lights on at the front desk and walked to the pantry to make some coffee. I returned with my mug, resigned to the fact that the possible new patient would never make it to our first session. He would never make it on time, he would get stuck in traffic. Such was life in São Paulo.

Sitting under the office lights I expected at any moment to receive a phone call, the minimum courtesy under the circumstances, canceling the appointment. Meanwhile, so as not to waste time, I began to read the thesis of a student I was advising.

Sergio Y.’s appointment was the last item on my calendar that day, but since he could not make it, I would end my day early. I would stay in the office until the traffic eased up and then I would have an easy commute home.

I would not meet the intelligent and confused young man my college friend had referred to me, but I would have time to read Luciana Cossermelli’s thesis, something I needed to do anyway. At that moment, it made no difference whether I met a new patient or finished reading a dissertation on the methodology for establishing public mental health centers. It was all work, and it had to be done.

However, at 5 P.M. on the dot, the office doorbell rang. To my surprise he had arrived on time. I was impressed.

Since the receptionist had left early because of the rain, I opened the door myself. He wore jeans, sneakers and a white T-shirt with a picture of Mickey Mouse. Before greeting me with a handshake, he introduced himself: “I’m Sergio Y. Professor Heloísa Andrade from the Rousseau School referred me. How do you do?”

I recognized the last name and deduced whose son he was. I knew his father by name. At the time, however, I had no way of knowing he owed his straight dark hair to his mother.

In the office, he waited for me to invite him to sit. Then, looking straight at me, very confidently, he took the initiative, and began. He said he had asked the school principal to recommend a therapist because he “wanted to guarantee himself a future that was minimally happy.”

“I’m very pessimistic,” he said.

He was aware, objectively speaking, that he had everything necessary for a happy life. Good health. Material comforts. Looks. A school he liked. Parents who were good to him.

Despite all of this, he was sad most of the time. Once, he told me: “I’m depressed by nature. I always have been. I can’t escape it.” Today, in retrospect, it seems clear that it was his refusal to accept this unhappiness that led him to me.

For reasons he could not understand, his mood invariably reverted to a state of unhappiness, which, according to him, seemed a permanent fact of his reality: a sense of constant sorrow, which he could not stop feeling and whose origin he could not identify. His innermost nature was unhappy. The statement “I’m a sad person,” just like that, in quotation marks, is in my notes for our first session.

After he left — I remember it well — I needed to clean the office carpet, which his muddy shoes had soiled. While I erased his footprints, I thought that I liked the manner in which he had expressed his thoughts.

In our second session, Sergio Y. asked if he could move to the couch. There, he told me he did not have many friends, but that he did not feel isolated because of this. He spoke of recurring dreams involving his great-grandfather and Armenian ancestors whom he had never heard of and did not even identify with.

His way of expressing himself was unusual for a seventeen-year-old boy. He was loquacious without seeming anxious, and, most importantly, his tone did not irritate me, something that tends to happen with young patients who are referred to me.

It was in our next session that I decided that the case of Sergio Y. in fact interested me. I offered him the Wednesday, 5 to 6 P.M. slot.

He accepted.

I found Sergio Y.’s most appealing trait to be his integrity. He had all the necessary elements to lead a conventionally happy life. His family, the marketplace and society: everything pointed to a happy life. However, he refused to accept this self-delusion that life suggested to him.

My initial impression was that Sergio Y. tried to maintain a certain autonomy with regard to what family and people who knew him expected. By finding a psychotherapist at seventeen he had shown the courage to challenge the conventional wisdom that for him happiness was unavoidable. He was unhappy and was true to his feelings. For him that was enough.