Friday 9 May 2008


I can't say someone's a drunk, or someone has "a drink problem." That could be a perjorative and unjust opinion. As a medic, pronouncing such a formulation or diagnosis has consequences (with driving, insurance, all sorts). As such, as with all good diagnosis, a combination of clinical acumen and a diagnostic framework guides formulation. The bottom line : I have to go by what our diagnostic bible, ICD-10, says.

This means that instead of "alcoholic" I end up with the less than catchy diagnosis of "F10.241 Mental and behavioural disorders due to use of alcohol, dependence syndrome, currently using the substance (active dependence), with physical features".

Or I can opt for "F10.1 Mental and behavioural disorders due to use of alcohol, harmful use." At least that's shorter to write.

Thus, it's not common for me to make such a diagnosis partly 'cause such folk go to drug and alcohol services and partly because the diagnostic framework means I've quite a high threshold before someone can attract such a diagnosis.

I was helping a gentleman who's almost 90. He was up before 7.00am today and went shopping at 8.00am. Does all the cooking, cleaning, washes all the crockery, pays all the bills, sorts all the post, does the laundry, vacuums and tidies up, does everything. He's knackered. At almost 90, although in decent physical health, he's unable to manage the volume and intensity of activity he's undertaking. It's not tenable over the long term.

He's not my patient, he's never been referred to me. It's his son, who's almost 70. His GP didn't think he was depressed but very sensible sought an opinion since it's all so grim, so he came to my corner. His son sits in bed most of the day, drinks vast amounts of alcohol and is dependent on his frail elderly father for everything. Not because he's physically unwell, or disabled, or has deficits. But because the son likes it this way, it means he can kick back and drink. Stress free, eschewing all life's responsibilities.

I really feel for his proud father, who's struggling but can't and won't thrust responsibility back to his son or accept social care/anyone doing things for them.

I can't cure this.


Anonymous said...

That really is a shame. How a 70 year old man can let his father of 90 do all that for's just wrong!

Dragonfly said...

That is hard..

Made by Mandy said...

It is sad to read but when we talk about personal responsibility there are issues around those who chose to take more than their fair share of responsiblity for others.

Over responsibility. Maybe it is parenting above and beyond the call of duty but it doesn't help the person not taking responsiblity for themselves.

It could be pride, it could be love, it could be wanting to make the other person better only it doesn't. The bulk of that is down to the other person.

Obviously, I don't know family histories and rarely are things black and white with one person being the saint and the other the sinner but I do think if people chose to take responsiblities taht are not theirs on, then that becomes part of the problem..or aggrevates it.

I must sound mean but nothing is without consequences and the father is going to die at some point and the son (who is still very dependant and coming across as a child in many ways) will struggle more. I don't have massive sympathy for him...all I am saying is that carrying people doesn't do them any favourts.

I say this as someone who doesn't always practise what I preach. Although have tried to support and encourage my daughter to have a life that is her own. A life beyond illness.

Made by Mandy said...

P.S. Dysfunctional family behaviour only becomes apparent when externally somebody else has to start dealing with it.

As in does anyone know what really goes on behind closed doors until they are opened?

Of am I going off on another tangent here?

Unknown said...

As a psychiatrist would you have questioned a War veteran in this manner who has PTSD and who has lost 300+ Falklands veterans to suicide?

Fiona Marcella said...

what's the poor old chap to do then? If he was a drugs and alcohol worker he could write to the patient and say that as he wasn't ready to change he was discharging him back to the care of his GP - but parents can't discharge their children however old they are.

Anonymous said...

Can't he just cut his son's allowance?

Or increase his rent?

And the old fella should spend the extra money on an escort service.

Made by Mandy said...

for Marcella

It is either a problem that the father wants to address or not. Does he actually see it as a problem or has the shrink identified it as a problem from the conversation they had?

I have no specific loyalty to the father or the son. It is not personal to me. I can see the dilemma and what shrink sees as the issues but is it an issue for shrink to be trying to help sort? If so, then perhaps the shrink can intervene...with some kind of referral service but that has to be done with consent of the father and, I assume, the son, although not sure on that.

From what I gather from the post, the son is not acknowledging that they have a problem and whilst the father provides funding then the status quo will continue.

Does that mean it will only become a real problem for the son when the father dies or that a physical problem arises that needs treatment? Does it mean that the father will be drained, financially and emotionally by the son? Most probably but ultimately until the father takes some kind of stand. Feels able to challenge their son then I can't see the problem being resolved.

And if outside services intervene will that do more damage than good? depends how things are handled and where people draw the line between personal decisions and intervention.

Fiona Marcella said...

Mandy - I agree, the father does have a responsibility to try something to help his son dig himself out of the pit he appears to be in. He does have SOME power in the sense of finance to do this. I guess my fear is that he or the Shrink might do this, get as far as getting the son to agree to a referral and then be very disappointed when he falls at the first hurdle, says it's too difficult to change, and gets discharged straight back from the services a slightly older and more bitter man who is able to say "they couldn't/wouldn't help me"

Made by Mandy said...

Such is part of the human condition.

Until someone acknowledges their own 'problem' and wants to deal with it then no one else can change their behaviour/thinking.

And I also understand that the father may feel duty to the son and that there is another negative but accepted behaviour cycle going on between the pair of them.

Bad habits are hard to break even if they started with the best intentions (and I mean that in relation to the father's funding of his son's alcohol use) as much as in regard's to what the son is doing.

No easy answer to this one but can see why Shrink is concerned. None of us can save people from themselves.

prin said...

it is really a shame, but it is their dynamic. maybe he does all that so he won't have time to think or to avoid an inevitable fight. drunks can be mean and very manipulative. i would take a guess that the son doesn't live much longer after the father goes, not long at all.

Lenin said...

This site is all about the Alcohol..
I can't say someone's a drunk, or someone has "a drink problem." That could be a perjorative and unjust opinion.
whatever it may be Iam not interest in alcohol..