Tuesday, 15 July 2008

Nuisance

I've a lady who I've been seeing for a few years, she's now in her 70's. She has schizophrenia. She's been well for the most part, not needing either regular or frequent review, so we've kept meeting up haphazardly maybe once a year or so when she or her family or her friends or her GP reckon there's merit in doing so.

Last time we met up was a couple months ago, she was well, but wanted to talk about her medication. She was worried. She used to be on more, when she was a lot younger, did we need to increase it? She was well. She had no major problems with her mood, her motivation, her thinking, her memory, her disposition and personality or of her functioning (being motivated and able to do everything she wished to).

She's always been somewhat anxious, as reflected in her worry that she needed more drugs even though she felt all was well. She's sought reassaurance and not unreasonably so. She's had experiences of prolonged paternalistic health and social care so is accustomed to others taking responsibility and telling her how things are. Decades of this has resulted in a lady who, on talking with health or social care staff, is happy to share her 2p worth but then waits for the doctor to Tell Her How It Is.

Her anxiety has been worse of late. I wonder if her contact with me 2 months ago was because she had an awareness that things were changing and she needed more support. But, being a meek and mild and institutionalised wee thing, didn't have the voice to say so and my prejudice against over use of antipsychotics meant I tackled that issue and surveillance of significant symptomatology suggesting relapse but not her ghost of a notion that things weren't quite right.

Her anxiety means she calls her family for support. This is usually once a day and never through the night. Family are unhappy about this, but not so unhappy that they want to stop her 'phoning so much that they act on this. No, family say "she's a nuisance" and want her "sectioned, or something" to "put her away, for her own good."
For her own good. Methinks not.

Much badness.

4 comments:

marcella said...

are you SURE she's only phoning once a day? I know many (not, I hasten to add, my own family) who phone 20 times a morning and then 30 more times in the afternoon.

If she is only asking for reassurance occasionally then the family's perception of what is for her good needs to be challenged, but given that her history is one of top down intervention by medics, perhaps that's the family's expectation too. If in the past when they have said that she is becoming unwell she has been hospitalised, one can perhaps understand (particularly with all the bad press "care in the community" and the closure of inpatient wards gets) why they might think that this is what she needs now.

Xavier Emmanuelle said...

Hey Shrink! Have you read this?

Antipsychotics for people with dementia
John O'Brien
BMJ 2008;337:a602 (Published 9 July 2008)

I read it and thought of you immediately. I'd be interested to hear what you think of this man's opinion.

Oliver Smith said...

much badness indeed.

marcella said...

I keep coming back to this one as it's hit a nerve.

Maybe I'm just an example of extreme badness, but as the carer of an adult withing "the system" who really tries to be a good carer and do what I'm told by the professionals, but who rows with them periodically and has a sneaking suspicion that at least 1/2 of them blame me for my relatives illness, I can't help but sympathise with the relatives just a little bit.

When this lady was in her 50s I expect she was carted off to the local hospital at regular intervals. Professionals will have told her relatives that it was for her own good, and even if they were unsure they obeyed the professionals and let her go in. Now, just because fashions have changed in psychiatry, new, younger professionals are telling them that on no account should she go anywhere near a hospital and what's more are accusing them of badness for even suggesting it.

Maybe they are abrogating their responsibilities to care for their lonely relative because they are selfish @@@@s, but maybe they are tired, and getting older themselves, and don't understand what's going on with her care.