Fare thee well

I said goodbye to Jennifer a couple of weeks ago after making two quick trips out to see her in the space of a few days. On the first trip, I brought her a pretty floral dress picked up on sale that I thought would look good on her. She was delighted and said she would wear it to church that weekend.

To put an optimistic spin on whether she will do the Focused Listening program that I have been encouraging her to do, the answer is she has NOT been doing it, and my hope is that she will turn to it in future when she’s in a state of mind that will allow her to take more control of her health. To underscore this message, I typed out a letter for her that I slipped into the dress bag. I said that the only real gift I could give her was the music program.

On my final visit, I brought along a mutual friend who is keen on checking in with Jennifer from time to time. I’ve instructed my friend in the basics of the music therapy and she’s in charge of some money donated by our Club’s Board members that is earmarked for further equipment if there is a need.

Jennifer asked us if on our way home, we could to take her back to her old flat (15 kilometres away!) so she could get in her daily 3-hour walk back to the hospital. It was a blazing hot day. She doesn’t use sunblock. I noticed that Jennifer was back to wearing flimsy slippers, not the sturdy walking shoes she’d gladly accepted from me on a previous visit for exactly that purpose. I wince when I think of her walking all that way in the heat in those shoes. I’ve dealt with the same lack of follow through or understanding of protecting one’s health and comfort with Chris.

The difference between her and Chris? Chris lives with his parents and I’m constantly in his face about wearing sunblock, wearing the right shoes, and doing some useful exercises to improve his mental health. Jennifer’s care has been entrusted to the state. I’ll never figure out why so many parents spend so much of their energy trying to get the state to parent their grown children. I can well understand the impulse, but when you see that the state is an imperfect parent, and always will be, wouldn’t it make more sense to hunker down with your relative for far longer than you would care to parent, and focus, at the very least, on protecting one’s physical health?

Fare thee well, Jennifer. I hope that in time you will figure out what you need to get to a better place.

 

 

 

 

A “bad” situation isn’t always bad

Jennifer’s situation isn’t all bad, but I can’t tell her this if I’m hoping to gain her trust. She wants me on HER side and I’m afraid she’ll shut down if I tell her what I would do if I were her. Now that I think of it, I can be a little more forthright when she complains about the Haldol. I can agree with her that it’s an outdated med and the trembling it produces is unacceptable, but I can also slip in that the newer antipsychotics are terrible for weight gain, and I’ve heard they are harder to withdraw from. I don’t want to “tell” her she’s wrong about the Haldol, because she isn’t, but, at the same time, I want to encourage her to adopt a more “radical acceptance” attitude. She’s been involuntarily committed. Her attitude in future may keep her well and out of the hospital.

Maybe if she also changed her attitude about her state appointed guardian, she’d might get some doors to open. According to Jennifer, he’s an idiot out to get her, nothing he says can be trusted. Why should she play ball with him? etc. It’s obvious to ME that he holds the get out of jail free card, but this doesn’t seem obvious to Jennifer in her present state. I believe, and I may be wrong, that, in the past, by rebuffing all attempts by the state to encourage her to take sheltered training, the guardian decided she was a lost cause. She is no longer entitled to training. That’s my understanding of the situation, anyway.

My years of experience dealing with my own son tell me that Focused Listening may be her best chance to get off the drugs for good and become rational enough to hold down a job. I’m not sure how much, if at all, she’s doing what I feel she should be doing to achieve what she tells me she wants to achieve. (I’ll accept that the last sentence is a bit of a mind bender.) The only strategy I can think of to get her to do the Focused Listening is to be on her side. It’s a complicated dance we’re doing.

Radical acceptance – who practices it?

Recently, I’ve been thinking about the term “radical acceptance” after spending a couple of hours last week walking in the woods with “Jennifer” (see previous posts). “Radical acceptance” is a term coined by psychologist Marsha Linehan and it means “not resisting what you cannot or choose not to change” or words to that effect. I think of it as “playing the ball where it lies.”

I believe that radical acceptance isn’t just recommended as a coping mechanism for self acceptance, it also involves how outsiders interact with the individual. Outsiders are the family, the mental health system, the courts, etc. In a family situation, an example of radical acceptance could be accepting the fact that your relative doesn’t want to take medication or doesn’t want to do anything that you think they should do “for their own good”. And, you may be right about what they should or could do but wrong about how to change the situation for the better. Another way of thinking about radical acceptance could be “whose side are you on?” But, I haven’t cleared my understanding of the term with psychologists. I’m winging this one.

Radical acceptance is a tension pitting the individual against the care providers and it can feel quite “unfair” that one side has to do the acceptance while the other side appears seemingly oblivious to the need to constructively help herself.

Jennifer’s hospitalization happened after she took herself off the medication, Haldol, which she told me she hated because it made her hands tremble. (She did it responsibly by tapering slowly under professional guidance. In my book she gets points for that but I doubt that the mental health system sees this as a positive.)

Jennifer’s hands are once more shaking because the hospital put her right back on the medication that she doesn’t want to take. This seems totally contrary to the idea of achieving best outcomes by listening to the patient and taking her position into account. What are they thinking?

Her state appointed guardian wants to move her to a residence where her med intake can be supervised. It’s located in a small village half way up a mountain. Getting to her normal haunts will be that much more time consuming and expensive. Jennifer doesn’t want to move to the new place. She asked me to intervene. Without telling her I have done so, I wrote to the guardian asking if it is at all possible that they can find living accommodations closer to “civilization” (although I was more diplomatic in my choice of words). He is aware and sympathetic to the fact that she is isolated. At least, that’s what he told me. The public health system doesn’t have much leeway for these kinds of requests, but I’m nonetheless hoping he’ll prove me wrong.

To sum it up, Jennifer doesn’t want to shake, doesn’t want to take medication, and she doesn’t want to be isolated. Instead, she is being forced to shake on the same old med and she’s being moved to a remote location where she will have little social interaction. Many people say the definition of insanity is doing the same thing over and over but expecting a different outcome.

Who here is playing the ball where it lies?