What truth have you been told by a mentally ill person?
I will never forget one discussion I had with a young man suffering schizophrenia when I was a junior House Officer on overtime.
I had been called to 'settle him down,' which usually translated to 'quickly administer 10mg of vitamin H (Haloperidol) intramuscularly.' Given my own tendency to madness, I always liked to try and talk to people first….
Anyway, I approached this poor young bloke as gently as I could—he was huddled, half-crying and half-murmuring in the corner of the room.
I squatted down beside him (a couple of burly security guards stood intimidatingly behind me) and I asked him what was wrong.
I cant remember exactly what he said first, but it was something like 'Im just so sick of them. Im sick of it all.
I want it all to stop.' As I asked a few more questions it became apparent that he was describing intrusive auditory hallucinations, but he could also specify that he felt threatened by the staff in the psych ward.
As I explained to him that I was here to try and help him and that I wanted him to feel better he said something to me which has never left my memory:. 'But youre just one of Them, arent you?'.
'The ones that want to keep me prisoner and control me with drugs. Now, I have always thought of myself as a pretty empathetic person, but this exchange forced upon me a particular moment of clarity: of course he felt that way—he was right.
The fact that his psychosis had turned the world into a waking nightmare did not mean that he did not continue to assess, analyse, and respond to that clouded reality as best he could.
The poor man was terrified—his fears were being confirmed by the nature of our system. Saddened, I told him that although I didnt think of it quite that way I understood that it was reasonable for him to come to that conclusion.
I told him that I did, in fact, intend to give him medication and that it would make him sleepy but that I didnt want to force that on him because I knew I wouldnt want people to do that to me.
'Well, at least youre honest,' he said. 'Will it hurt?' I told him I didnt need to use a needle if he was willing to take a tablet.
Surprisingly, he said he would prefer the needle to 'get it over with.' I gave the haloperidol into the left buttock; he winced a little and then said, 'Was that it?' I said something like, 'Yes; you might want to go and lie down for a nap.' Then the most gracious thing happened: he thanked me, shook my hand gently and went to his bed.
The nurses remarked, 'Well that was lucky. Hes been violent before.'. The experience has stuck with me because all I could think was, 'Yeah, if I believed what he believed, I'd be violent too.
Two weeks later that young bloke went back to running his local record store, free of the tricks of the mind that were torturing him. Its wonderful to watch people get better.
When I went to say goodbye to him (I was incidentally present when he was being discharged) he had no memory of me, but he politely wished me well. Im not sure Ill ever forget him, though.
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