As a first-year resident in psychiatry at an unfamiliar hospital in Boston, Dr. Gary Small was nervous about putting his textbook knowledge into practice.
The then-27-year-old L.A. native was matched with a seemingly straightforward patient, a young housewife who became anxious when her husband traveled on business.
Initially, Small thought the woman’s angst originated from her loneliness and boredom at home.
Then she tried to get more personal with her therapist.
This story and other unusual cases are described and analyzed in Small’s newest book, “The Naked Lady who Stood on her Head.”
Co-written with his wife Gigi Vorgan, the book chronicles the UCLA psychiatry and biobehavioral sciences professor’s most interesting and bizarre psychiatric cases throughout his 30 years of practice.
In the scenario of the anxious woman, the patient started to wear increasingly more provocative clothing to her therapy sessions, and she began making suggestive comments. Her unusual behavior came to a head when she gave Small a Rolex watch, immediately running away after presenting it to him.
When Small attempted to return the gift, citing proper conduct rules for therapist-patient relations, the woman became angry.
She said he had seduced her and had had sex with her by looking into her eyes.
“She started inching toward me, and I started inching back,” Small said. “Then she slapped me.”
The woman was eventually diagnosed with borderline personality disorder, a condition between normal anxiety and psychosis, and was put on medications to calm her.
The cases are based on Small’s real-life experiences, he said, although details, names and even genders have been changed to protect the confidentiality of his patients.
But while the cases may be strange, they have everyday applications.
For instance, Small mentioned a case in which a young carpenter wanted to amputate his own hand. While this could be a sign of body dysmorphic disorder, a psychological illness in which patients are excessively preoccupied with their appearances, it also alludes to the common worry about self-presentation.
Though Small has published five other psychiatric self-help books, “The Naked Lady who Stood on her Head” is the first memoir of his career.
“It’s really a labor of love,” he said. “It’s been tremendous fun.”
Small and his wife collaborated on the book at home during evenings and weekends. While he was initially hesitant to write because he wanted to separate his work and personal life, he said they learned to work together.
“Just writing with a partner can be challenging,” said Vorgan, a former actress, screenwriter and producer. “I find Gary is the best partner I’ve had. He’s the person I know best in the world, and I can be myself.”
With a background in journalism and English, Vorgan started to co-write with Small for his book “The Memory Bible.” The collaboration worked so well that she became his co-author, which taught her more about science and him more about writing.
While working on the book, Vorgan said she helped her husband to verbalize his thoughts about the cases and pull out his feelings.
This process mirrors the emotional response of psychiatrists to their cases, Small said.
“Learning from our own reactions can help,” he said.
Dr. Jonathan Hiatt, chief of general surgery at the Ronald Reagan UCLA Medical Center, read through Small’s manuscript and said the book reflected his accomplishments.
“We’ve known each other for many years, and doctors always love to read about each other’s work,” he said. “(Small’s) on the fast track, very accomplished academically. It’s a talent to make science accessible to lay readers, and that’s a rare talent in doctors.”
Small said he hopes the book will incite interest in psychiatry, in addition to destigmatizing the experience of seeing a therapist.
“Psychiatrists are people with their own struggles,” he said.