Homesick, USA

“I am homesick for a place I have never actually been,” says the face on the screen in front of me, “like I have lost something I never actually had.”

The line strikes me as poetical and I wonder for a second if I have not heard it somewhere before, my reverie taking me to half-forgotten verse and dusty college library reading rooms a world away. It is at first an unconscious association but also part defense, for despite the genuine poetical nuance and the intellectual curiosity piqued, it is the emotion here, the feeling, that carries the most weight. Even over the digital divide it is very real to both of us. We honor it. We sit in it.

The face, my patient, is 3,600 miles away from me and yet I know exactly where he is—the off-white walls and dim light through scuffed windows offering glimpses down onto the ever-busy Cowgate are intimately familiar to me. I have sat in that space, maybe even the same room—the same chair?—the same dorm in the university student accommodation. We are the two of us displaced: he in the city of Edinburgh, Scotland, the place from which I emigrated to the USA over a decade ago; I in my office in the American Midwest, the part of the world my patient grew up in and for which he now painfully yearns.

Except that's not exactly true. It's not quite this place, this Midwest, for which my patient is “homesick” but rather an imagined world of support and comfort he has, by his own admission, never actually known but which must surely be better than the lonely torment of his current isolation. The child of an alcoholic mother and an absent father, he has known mostly indifference if not outright hostility from them throughout his life. This fantasized home of love and community exists only as preconscious echo in his mind, and yet he clings to it, fights for it through the pain of adjusting to more than just the dark Scottish winters. It is a lifeline, as is perhaps this call: a return to treatment after several months away. “I don't know wh