Daniel Sampaio is a retired professor of the Faculty of Medicine of the University of Lisbon, a psychiatrist, and a writer (I identify 28 works of his authorship). He is also the founder of various bodies and entities related to family therapy and mental health. He was Director of the Psychiatry Service at Santa Maria Hospital between 2014 and 2016. It is with great pleasure that he assumes himself as a “True Sporting Supporter”, having been Vice-President of the General Assembly of Sporting Clube de Portugal. The biography of Daniel Sampaio suggests that he is a man of a thousand trades, a thousand activities, a thousand deeds and accomplishments.

He is a strong advocate of humanistic culture. He believes that doctors, as health professionals, should cultivate the doctor-patient relationship. He defends that patients should be treated with tact, humanity, and that they are not just another number or a clinical prescription. During our interview, he reveals the love he feels for his family, as well as the constant and rigorous state of vigilance he has for his patients. It is with his hoarse voice, sweet eyes and kind gestures that he shares with us his experience, his beliefs and his total availability to help others.

 

Carrying out this interview aroused the weight of responsibility for all that he has accomplished in his 74 years of life and, at the same time, his family legacy. He is the brother of the former President of the Portuguese Republic, Jorge Sampaio, and the son of Fernanda Bensaúde Branco and Arnaldo Sampaio, a Portuguese physician who specialized in Public Health. He became famous for assuming the position of General Director of the General Directorate of Health in the early 70s. He was also the great promoter of the National Vaccination Plan and of the creation of Health Centres, as we know them today. Conclusion: it is impossible to reject his family legacy.

 

I was just talking about the weight of responsibility, not only for what Daniel Sampaio represents, but also because in March of this year, he went through a trial by fire in intensive care at Santa Maria Hospital with a severe infection caused by Covid-19. I wasn't sure he would be in the mood to talk about what had happened. The truth is that, as he later admitted, during his 50-day hospital stay, there was a moment when he gave up fighting for his life, such was the fatigue and isolation caused by the disease.

On the day of our interview, in the FMUL central services meeting room, I had a sheet with some questions written down and the recorder. I put everything down on the table. Noticing my A4 sheet, he says: “- I see you came prepared. Will I be able to answer all of this?”. I am afraid I have exceeded myself in the quantity and/or depth of the questions. Despite this, I confirm what I already suspected: I had before me a human being with an incredible capacity to give.

When I asked him to highlight his main characteristic, he replied "being participative". However, after knowing his stories and motivations, I realize that he gives himself totally to everything he does and to everything he loves that still keeps him active, not only in his practice office but in life. Even after having gone through hell in the Covid Unit, Daniel Sampaio remains faithful to his convictions: he writes, talks a lot with his grandchildren – for him the younger ones are a well of wisdom and potential. He respects the faith of people, but, like Voltaire, he just greets God.

 

Throughout your life, you have received several distinctions. You founded the Portuguese Society of Family Therapy in 1979, as well as several centres and projects to support mental health. You have written books, been Vice-President of the General Assembly of the SCP, etc.… amidst this panoply of deeds and achievements, who is the man behind the thousand jobs?

Daniel Sampaio: It's hard to answer this question, but I would say that what I've always tried to do is to be very participatory. Even when I was in high school, during Salazar's regime and student unions weren't allowed. I belonged to an association called the Pro-Association Committee of High Schools. We were involved in many colloquiums, many meetings and spoke with students from different high schools, in order to foster the associative spirit in the years preceding our entry to the Faculty. I think that was when my participation really started. Then, at the Faculty, I always worked at the Student Association. I was the students’ representative, something very important at the time, as I took on the responsibilities of organizing the exams and providing various forms of support to students. Later, I founded several associations: the most important was in 1979, the Portuguese Society for Family Therapy, something very innovative at the time. There was no family therapy in Portugal and, together with other colleagues, we founded the Portuguese Society for Family Therapy, which so many years later, in 2021, has more than 2,000 members and delegations in Lisbon, Porto and Coimbra. Over these years, we have trained many psychologists, psychiatrists, child psychiatrists and social workers. I was the one who laid the foundations for this association, which fortunately had many followers.

Throughout my career, I've always been dedicated to adolescence and families. Here, at Santa Maria Hospital, I created a service for young people at risk of suicide, a structure called the Suicide Studies Unit. Then, based on my training abroad, I became very interested in anorexia and bulimia nervosa, and created the Food Behaviour Diseases Centre. This last structure was not only a scientific association, but also a group of psychologists and psychiatrists committed to the treatment of these diseases in Lisbon, Porto and Coimbra.

In the 90s, there were psychologists and psychiatrists who treated these diseases, but they are very difficult to treat. This is why the creation of these centres has contributed to improving care in these main hospitals: São João do Porto, the University Hospital of Coimbra and here, Santa Maria. So I would say the two strongest characteristics for me is participation and persistence. Along this path, I struggled against many difficulties, and one of the tests was the creation of Espaço S, which now belongs to the Student Support Office. It was something very difficult to create in this Faculty, there was a lot of opposition.

 

And why was it so difficult to create Espaço S?

Daniel Sampaio: Because there was a completely wrong idea that medical students had no problems. It was believed that as they were very good students and had entered the Faculty of Medicine, they had no psychological problems. This is not true. There are many medical students with psychological difficulties, because the degree is demanding, many of them are displaced, their families are far away, they have to go to university residences or to rented rooms. At the time of its creation, in collaboration with the Student Association, the Faculty did not give us much support. This story is very interesting, because we started the consultations for young people at the University Stadium and only later, after admitting that they were important, did a change take place. Nowadays, we have 2 psychologists hired by the Faculty, we are on our way to having a 3rd one, which attests that this service is completely justified. I am very proud that I, together with the Presidents of the Student Association, for 2 years in a row, laid the foundations for what Espaço S is today. Currently, we have many requests from students and these psychologists have done an excellent job.

 

I know you have a very strong relationship with your family, especially your grandchildren. Is it due to living with them, as teenagers, that all the issues surrounding the growth and behaviour of young people are still so important to you?

Daniel Sampaio: No. This was a reason for specializing within psychiatry. When I was doing my training in psychiatry, I contacted a well-known child psychiatrist in the 80s, Dr João dos Santos. He liked me a lot, and insisted that I should follow an area where there was no specialization. This is because child psychiatrists cared for children and adult psychiatrists, there was a gap there between 15 and 21 years of age, where naturally there are already many psychological problems.

Dr João Santos challenged me: "Start developing this area. It's a good area for you". In fact, child psychiatrists found it difficult to deal with teenagers, they had no training, they looked after, above all, children. Psychiatrists dealt with adults. In the late 70s, when I became a specialist in psychiatry, I dedicated myself a lot to adolescence. I started making appointments, created an adolescence consultation in the psychiatry service, and started going to many health centres. Throughout my life, I went to many schools to talk to young people. Of course, the adolescence of my children and my grandchildren, particularly the adolescence of my grandchildren, was very important. At some point a person gets older and contacts are lost and my grandchildren update me on everyday issues. I have 7 grandchildren, aged between 10 and 21 years old, and I can conclude that adolescence is very different from when I started working with teenagers. The big difference, fundamentally, is the Internet, isn't it?

 

Are your grandchildren making you aware of these new topics?

Daniel Sampaio: Yes. They tell me what's going on in schools, how we stand on social media, what's new. Recently, about two years ago, they were the ones who explained

TikTok to me, which is a very important thing for my consultations...

 

How did they introduce you to TikTok?

Daniel Sampaio: There are many teenagers looking for me. And one of the questions that parents ask is precisely the time they should spend on their mobile phone, on social media and on the computer. So, I have to be very up to date on all these issues that have to do with social media and new technologies. My grandchildren update me a lot: they show me what Instagram is, what TikTok is, Twitter, how they work. It's something new they bring me and it allows me to update.

But do you use social media?

Daniel Sampaio: No. I think I have to have some reservations. I only use Facebook and not much. I' believe that if I want to continue to be able to talk about it, I can't get too involved personally. Despite everything, as I have a personal page where I have my biography, many people know about me, but I am not directly involved. Even with those who are in treatment with me, I always prefer face-to-face consultations. I do some online, but especially face-to-face consultations, and I don't use social media, because that would make my professional work more difficult.

 

Your father was one of the main mentors in the creation of the Health Centres and the National Vaccination Plan in Portugal. About the missions you embrace, are they ways to continue your father's legacy?

Daniel Sampaio: Yes, because my parents were very involved. My father was a Public Health doctor and he was always very involved. Examples include: the National Vaccination Plan, the fact of having been Director General of Health for many years, before and after the April 1974 Revolution. He was one of the few general directors that continued after the 25th of April. It was not even sacked, as many were. He was very concerned about Public Health, at a time when the subject was not talked about much. These days, we see Public Health every day on television, even in excess, in my opinion. At the time, not much was said. He had done his training in the United States, which at the time was unusual. He always told us about the Health Centres, and in 1973 it was he and a colleague, Gonçalves Ferreira, who proposed the creation of the Health Centres and the Vaccination Plan. For example, I remember my father doing the Polio vaccination campaign. At that time, in the 50s, I was still a child, there was a lot of polio in Portugal, and he started the vaccination. So this is a family trait. My mother was an English private tutor. She had a lot of students. We lived in Sintra until I was 15 years old and my mother was well known as the lady who gave English classes. As she was in England for 5 years, during her youth, her English was very good. My mother also spoke to a lot of people, so this is a characteristic that probably motivated my brother to go into politics, and in my case, my participation in many things.

 

How do you deal with someone who sees suicide as the only option, especially someone younger?

Daniel Sampaio: In my entire career, I've never met anyone who just wanted to commit suicide. When we have a person who talks to us about suicide, there is a part of that person that wants to live. We call this ambivalence. The serious suicide person wants to die, makes suicide attempts, thinks a lot about suicide and sometimes commits suicide, but there is always a small part of his conscience that wants to continue living. And we, the specialists, work a lot with this part. We draw attention to the positive aspects that the patient has in his life. We try to connect him to people, friends, and family members, because the person who is at risk of suicide has cut ties with others and is desperate. It requires a lot of availability on the part of professionals. For example, at school, where sometimes there are suicide attempts, I often say to teachers: "You don't need to treat these young people, because you are not psychologists or psychiatrists. What you have to do is, when you detect one of these situations, refer them to a Mental Health service", but they must be available, that is, be able to talk to them, boy or girl, make an appointment for the next day. It is crucial that they show interest in them, because when we bond with people who are at risk of suicide, we decrease the likelihood that that person will commit suicide. I'm not in the habit of giving my number to all patients, but since cell phones exist, I always give my number to those who are at risk of suicide. It gives the person a ray of hope. I usually say, "When you're thinking about committing suicide, call!" That's why the Suicide Prevention Phones, S.O.S Centre, Voz Amiga - the suicide support numbers - are so useful. We, specialists, call the moment of high lethality the precise moment when the risk of suicide is very high, because there is a high probability that the person will commit suicide in that minute and when we can hold the conversation with this patient, the lethality decreases. Most of the time, the patient postpones the suicide. Afterwards, it is very important to continue to monitor the patient with an appointment that will not take too long to take place.

Out of curiosity, I had a patient, who I treated for two years, who told me every consultation: "Suicide is not solved. I still think about killing myself. It's just postponed." For two years he told me this. At the end of these 2 years, he told me: "You can rest assured that I will no longer commit suicide. Now, it's solved”. However, it took 2 years for the treatment to work. We, psychologists and psychiatrists, must have a very important presence with people at risk of suicide.

 

Have you received many phone calls outside your working hours?

Daniel Sampaio:  Yes, and I've had patients who committed suicide. When there are colleagues who say that they have never lost a patient to suicide, I always say: "Either you are not telling the truth or you treated less seriously ill ones", because some seriously ill patients commit suicide, even when we do our best.

I remember a case when there were no cell phones and I had a beep. The patient contacted me through the beep. He once called at 4 am, I told him to come to my house, but I postponed the appointment, and a week later I got a phone call saying he had committed suicide. It did not go well. Of course, we can always say that there was a great desire to commit suicide, but as I told you a moment ago, there is always a part that we can work on. We have to be very available to these patients. Faced with a non-severe depressive situation or an anxiety situation, we can see these people from month to month. As for the person who is at risk of suicide, we have to see him every week. And there must be services, daily care: psychiatric emergencies or a specialized consultation without a prior appointment. These people cannot enter the bureaucratic appointment booking queues.

 

In your opinion, is the National Health Service prepared to support these people?

Daniel Sampaio: We have improved. One of the things I've always advocated is not yet created, that people who are at risk of suicide have a kind of "Direct Entry." These people must go directly to a consultation. The Emergency Department often is not enough, it is where they are seen to, but then there is a period when they are seen and, in many cases, medicated, and the appointment is scheduled. This period is sometimes very long. There must be a preferential channel in the Emergency Room for seeing suicidal persons. These patients must get ahead of others. This is an aspect that needs improvement. What is fundamental for treating suicide is the availability of specialists and speed of appointment.

 

Can I conclude that you have dealt with death many times?

Daniel Sampaio:  Many times... Not long ago I dealt with my own death. We will get there... (he smiles).

 

But how does one deal with death? (Pause) I suppose it causes a feeling of emptiness...

Daniel Sampaio: Death is irrational. We cannot rationalize death. I never met anyone who said they wanted to die quickly. I find people saying they want to die. In fact, there is a phrase often used in the study of suicide, belonging to a man named Stengel: "I want to die, do something for me". This sentence translates well the ambivalence I was talking about earlier. We shouldn't devalue a person who tells us he wants to die. We must take him seriously. But then there is another part of the person that wants us to do something for them. In general, psychiatry has advanced a lot in the treatment of depression, which is the main cause of suicide. If the person has the opportunity to be seen by a psychologist or a psychiatrist, or sometimes by both, the chance of not committing suicide is great. The drugs are effective and if the technician is available, the person is able to overcome the crisis. What we call a suicide crisis, that moment when there is high lethality and the person is very focused on suicide, is of short duration. If the person manages to overcome this crisis, more or less well, then there may be another crisis, but the intermediary work, between crises, is essential.

 

How does a professional overcome a patient who commits suicide?

Daniel Sampaio: Very badly, with great difficulty. Because the conscientious professional must question himself and must feel some feelings of guilt. The professional who has a patient who commits suicide, must questioned himself, must review his working method. We can always do better and that's what we must teach the youngest. They have to be available, they have to be attentive, they have to make a lot of consultations. It's not always easy, because there aren't many specialists in the services and there is a lot of demand. Waiting lists are long, but as I said earlier, we need to create preferred channels. When we work in a hospital and a patient shows the desire to commit suicide, despite having an appointment in a month, it is necessary to create the possibility for the patient to visit the doctor the next day. Sometimes a 10-minute consultation is enough for the person to get better.

 

Among the group of books you've already written, can you choose one, in particular, that has given you the greatest pleasure? Why?

Daniel Sampaio: I'll choose two. One deals with the topic of suicide, which is a book called: "Everything We Have Inside" and which had at its base a true story of a 17-year-old young man whose girlfriend committed suicide. It's a very beautiful story, I think it's very beautiful, maybe my best written book. It's a little romanticized, but it's very interesting, because it's about the difference in the way this guy was with his girlfriend, in a slightly superficial way. She was older and for him it was a discovery of sexuality, while she was completely in love. This difference was very marked in this case. I never met her, of course. I understood, from what he was saying, that he really liked being with friends, playing football, etc... and she had a car and was always looking for him, she felt very unloved. Of course, there were other reasons for her suicide, not just that. The book is a reflection on what love in adolescence is. Then there's another book, my last one, which I think is very important because it's about the father's role in the family. There is a lot of talk about the role of the mother, with the small baby, breastfeeding, the baby's early life, and today there is a lot of research that I report in this book on the importance of the father, even in the baby's first days of life. That's why I called it: "Hold my hand and take me". It is related to the idea of connecting the child to his father very early. It's very interesting, because when I was a father, in the 70s, the father was very unimportant and now the parents, in their 30s, both go to paediatric consultations, take their child to school, etc... This is a big change in the family.

 

I recall an interview with you, at the beginning of the pandemic in 2020, in the middle of the 1st lockdown: "The pandemic and its effects on human relationships", in which you very likely gave the first warning of the gradual tendency for the emotional consequences of isolation and fear of the disease. In a recent interview to Expresso, you reported your experience as a Covid-19 patient, admitted to the Gastro Unit, transformed into the Intensive Care Unit at HSM. What is the main difference between Daniel Sampaio from the 1st interview and Daniel Sampaio after the covid-19 infection?

Daniel Sampaio: Good question... There is a big difference. It's easy to talk like I did in the first interview. I've always been very concerned about Mental Health, I find the physical presence with each other, the kiss, the hug, even the handshake or a pat on the back fundamental in our socialization. I don't think we should live in isolation. The pandemic separated people from each other, particularly the elderly, the grandparents from children and grandchildren, people who lived in homes... The very expression "social distancing" should not be used. It should be: "physical distancing", but whether it is physical or social distancing, we became more distanced and I was very concerned about that. Accordingly, I talked a lot about it, in this and other interviews. In addition to the Public Health measures, which are fundamental, we must take care not to be far from others, particularly from our family and friends, taking the due precaution. This probably had an influence on the careless way in which I myself faced the virus and the possibility of being infected. I was unwise and I have said it several times. Me and my wife weren't careful. When she got sick, I didn't isolate myself from her and therefore, everything that happened at home was hell. Then, as the saying goes, I lived the situation from within. And the situation of serious Covid is devastating, both physically and psychologically. Physically, we feel very bad. I personally had no pain, but I was completely immobilized. The arms and legs don't work. We cannot get up, cannot stand up. It's a completely new experience for our body. Although the doctors, nurses and assistants are extraordinary - (by the way, my next book will be dedicated to the professionals here at Santa Maria Hospital, because they are the ones who saved my life), we feel that there is no specific treatment. What exists are cortisone derivatives and oxygen. Therefore, the hospital stay is prolonged. This for a medical patient is very frightening.

 

Do you feel more aware?

Daniel Sampaio: Yes. I knew what the blood tests and X-rays meant... I was always following up on my own illness, but at one point there was a great feeling of impunity. The disease lasts a long time, I was hospitalized for 50 days. I remember a time when I just said: "Don't do anything else, let me die here". First, I didn't contact anyone, I was in intensive care where there were no cell phones. Later, when I moved to the infirmary, I ended up fighting this idea with my family and friends, who helped me a lot through phone calls and messages. I imagine the case of a person who lives very isolated or who is elderly, and who has very few contacts, it must be a worse experience...

Will such person give up?

Daniel Sampaio: A person can give up. This message is very important: psychological resistance to illness is very important. It's a disease in which a person feels very lonely and therefore he has to get his energy reserves and convince himself that he has to survive, he has to keep going. This mindset was very important for my recovery.

 

Do you feel totally recovered?

Daniel Sampaio: No. My voice is different (he pauses to drink water). It's a little hoarse. I have already started the activity in my practice and my patients feel I have a different voice. I still get tired, I mean, if I walk too long, I have to stop. But the recovery is being excellent. I was discharged on 19 March and since then I have been recovering very well.

 

During hospitalization, was death your worst fear?

Daniel Sampaio: Yes, no doubt. Even because I was in the infirmary and witnessed the death of a... (He does not complete the sentence).

There were 4 of us. Interestingly, 3 were Sporting supporters and 1 was not, and that man died. We saw it all, his physical condition deteriorating. He was getting worse, we realized that. He ended up dying next to us in the infirmary. It is terrible to see it: doctors come to confirm the death, etc... We automatically think, "Well, this could happen to any of us". There was another very distressing episode when another patient fell. He was sitting in an armchair and at one point he wanted to move from the armchair to the bed and the moment he did, he lost his oxygen. He lay on the bed without oxygen. It was very distressing. Another colleague and I started ringing the bell. we thought he might die from lack of oxygen if the nurse didn't come quickly. He came relatively quickly, but we spent a very distressed minute there. However, we knew that there were people dying in the wards next door... Death is always very present.

 

Following your confrontation with death, how is your relationship with God? Do you, like Voltaire, just greet him when you meet him?

Daniel Sampaio: Just like Voltaire. Maybe it changed a little. You know, I was a strong believer until I was 15 years old. I went to Mass a lot, my grandmother was Jewish, she even thought I might become a Catholic priest, because I spoke very well and my grandmother said: "The boy is going to be a priest". But then, from the age of 15, I had a teacher of Religion and Ethics who was not good, in Pedro Nunes school, and I ended up moving away completely from the Catholic faith, until today. However, as I said in the Expresso interview, I have a lot of respect for the idea of God. I was very happy that so many people were praying for me. These people always said to me: "I know you don't believe, but we are praying for you". It was very comforting as I became sure I have many friends. Some people I haven't seen in 20 years. And the fact that there were people praying for me was very comforting. It gave me strength. I don't pray, but I have a lot of respect for those who do.

 

Still, you did not get closer?

Daniel Sampaio: No. I really believe in Science. I really believed in doctors. Some had been my students, who treated me respectfully as Professor Daniel. During hospitalization, I really believed that the doctors, allied to my personal strength, would overcome the disease with me.

 

The mind is a maze, don't you agree?

Daniel Sampaio: Yes. There is a lot that is not known. There has been more and more knowledge of the brain, but there are many things we don't know about. And, for example, a human characteristic that must be highlighted and that people often do not realise is the capacity to adapt to crisis. As I told you, there were times when I wanted to give up, but I looked at my colleagues in the ward and they were fighting back. Once a patient, who had taken off his mask, had forgotten to put it back on, and the nurse passed by and immediately told him: "Oh, if you do this you will not leave this place. You'll never go home again" and he replied: "Alive or dead, I will get out of here". I thought it was a great answer. There is always a part of us that thinks we might die, but there is also always a part of us that wants to live, just like in suicide. There is a resistance in us that we can increase, through our will and our connection with important people in our life.

 

The ambivalence you talked about earlier…

Daniel Sampaio: Exactly! I just want to leave a message to medical students regarding the cultural part. Medicine has developed immensely as a science, which means that they have a lot to study, in scientific terms, in biomedicine. This is very important. But there is a cultural dimension that needs to be improved in doctors, students and young professors that is fundamental for the doctor-patient relationship. Sometimes I get some complaints from my patients about doctors doing very quick consultations. They complain that doctors look at the computer a lot, order a lot of tests, but don't talk to them. And this ability to talk to a patient is a more artistic part, let's say, but it is fundamental. There are patients who get better with the same medication just because they change doctors, and the second doctor pays them more attention. Once, here at the Hospital, a lady came to me and said: "I want to be your patient!", I checked her records, and she was taking the correct medicine. I told her that there was no justification for the change. In fact, she was being followed very well, her doctor was very competent. "Why do you want to change?" I asked her. “Because he doesn't give me affection” (Pause). This conversation has been occupying my mind. We need to be affectionate and attentive to our patients, in addition to scientific knowledge. Medical students should be concerned about this. They should read, be interested in the important aspects for the doctor-patient relationship, which are very important for those who want to do clinical practice, of course. We must help students in this field.

 

 

Isabel Varela
Editorial Team