Alternate Futures

Olivia Chen

I sit quietly at the long wooden table with the rest of the care team. The door opens, and a woman enters, long gray hair matted to the nape of her neck. She takes a seat gingerly at the head of the table, and even her baggy hospital clothes cannot conceal how thin she is, how she moves through space—timid and cautious, bones hollow, like those of a frightened bird.

We ask her about her goals for this week, for her stay here.

“To get better,” she says slowly, her voice low, face nearly expressionless. She looks down into her lap.

The room sinks into silence as we take her in, trying to make sense of the woman before us. I imagine her at home in her bedroom, unable to rise from bed. How could a person become so depressed that they remain in the same position for hours, then days, then months, until even passing a hairbrush through her hair becomes an immense, insurmountable task?

 Her partner later told us how she hid food in drawers, in her clothes, in the bedsheets. He would come home after long shifts as a mechanic and prepare meals for her. I picture his desperation as he pleaded with the woman he loved, who had dwindled to eighty-four pounds—the weight of an eleven-year-old girl. How one day, he discovered bread wedged between the furnace and the windowsill, and from then on would rifle through every drawer whenever her plate was cleared, driven by frustration and grief.

Now I sit across from her and watch as she peers at the screen, trying to decipher what we expect of her. What, I wonder, would it take to bring this woman back to who she was before everything collapsed? She raises her hand to her chin and leans on it. With a pang, I see in this gesture the uncertainty of someone navigating life for the first time.

Despite her gray hair and the lines of her face, I envision her as a teenager, going to the movies with friends and visiting her older boyfriend on weekends. She later told me she became pregnant with his child at eighteen, two years after dropping out of tenth grade. Could she have imagined that decades later she would be here, sitting in a cinder-block room locked for her own safety, holding her chin beneath the gaze of a psychiatrist, three social workers, and two medical students? There was something unexpectedly youthful in the way she straightened the paper before her as we barraged her with questions and sat in the silence that followed.

 And perhaps this is the art of psychiatry: to imagine not only the past lives but the possible futures of one’s patients. It is like watching a reel of film spool out—the past unfolding with a dread you cannot look away from, knowing exactly where it leads. Then comes the present, and the task is to piece together how it all came to this. Like gathering the fragments of a china vase shattered on the floor, one must attempt to mend what others have deemed irreparably broken, to envision how life might proceed from here.

Here the idea of an “alternate future” comes to mind—a psychiatrist must accept the trajectory that has brought someone to this point, yet still be able to envision a future self liberated from the weight of one’s past life. In this way, psychiatry becomes an act of resistance: it acknowledges that people are shaped by the forces around them, accepts the person who has emerged from these years of hardship and suffering for who they are, and yet still insists on a future grounded in agency, possibility, and freedom—through the mobilization of support systems and thoughtful use of medication, through the work of listening and interpretation, of giving language to experience. The very act of returning to this process, again and again, carries its own therapeutic power. It is the act of sitting across from an old woman and glimpsing the young girl still within her, imagining what might have been, and allowing that vision to ignite the search for a new path toward healing.

Olivia Chen is a third-year medical student at UMass Chan Medical School interested in psychiatry. Her writing explores the intersections of care and vulnerability, drawing from clinical encounters and personal reflection to uncover moments of quiet transformation within suffering and to examine what it means to be deeply human.