Psychiatrist, Avenger & Me

Dean in the Underworld, Act 2

Yesterday found me back in the mental health system, sitting in a room with Dean and his Advocate waiting for the consultant psychiatrist. I am impatient and curious. How many of my stereotype boxes will he fit? 

At last, there he is, 10 minutes late. His first words were addressed to Dean: "you’re sitting in my chair."

I’m in observer mode today.

The doctor asks for introductions, he had not met me and Advocate before. He’s eyes linger on me for a few seconds. I can see that his curiosity has been peaked.  Dean had been immersed in the system since 1999 (which I didn't know until today) and his psychiatrist had never seen or heard of me before. Who am I? What is the nature of my relationship with Dean and/or his family? Why have I suddenly appeared after 14 years? The doc does not actually ask these questions but I can see them written on his forehead.

I offer the barest bones of information. All he needs to know is that I regard myself as an aunt of Dean’s (a very Caribbean tradition) and am now taking an active interest in his medical care and social arrangements as dictated by the system. I am here now because Dean asked for my support just a few weeks ago. I have a mental health qualification and have practised professionally.

An agenda is suggested for the conversation – housing, medication and laptop. The last item is easily dealt with, it’s simply a letter setting out the current situation and seeking a review of a previous decision (see Fuss and Frustration – 15/7). Doc took the letter. The issue of housing, the reason why Dean asked for my help in the first place, is easily resolved in the direction that he wanted. So that is a satisfactory outcome.

Now we come to the knotty issue: Dean’s medication. 

Now the laser beam comes out and focuses on the doc; I note and analyse every expression on his face, every inflection in his voice. The psychiatrist is a very mild-mannered man, obviously very comfortable in his own skin and has no need to use his power abusively. There are no veiled threats, no condescension. He remains very calm and patient when the automatic tape in Dean’s brain, the Victim/dark Avenger, switches on, heaping opprobrium on his head. The bottom line is that Dean wishes to stop taking his current medication and proposes something else. The doctor disagrees, the one Dean suggests he has had before is not as effective.

Dean turns to me for advice. Did I approve of him not turning up for his next scheduled injection or not? He wants me to tell him what to do. I ask Dean what happened last time he did that. There’s no answer. He turns to the doctor and the dark Avenger tape begins to roll again. He wants a second opinion because the system is stopping him having a life. The doctor tells him that is his right and actively encourages him to do so.

Doc then hands me and Dean an 8~page summary of Dean’s experience in the system. A quick scan tells me that all Dean’s problems emerge as soon as he stops taking medication and this has happened every time before he is sectioned. I am interested in a) the dosage levels b) why is it so difficult to acquire the medication for side effects. Reasonable responses are made to my concerns, but I am not totally satisfied. I am concerned about the some of the side effects that Dean complains about.  We will have to take this further. I am not satisfied that Dean has been tested for contra~indicators to Haldol, given his heart problems.

Meeting now over, outside Dean asks me again to tell him what to do; he really does not want to turn up next month for the scheduled shot. I remind him of choice and consequences. I say that if he was my son, I would advise him to a) get his accommodation settled and move into his new home; b) enrol on an ITC course; c) try and find a part-time job and live a steady life without drama for the next six months; d) try to get more physically fit.  In the meantime, we need to organise extensive medical tests, after which he will have the grounds for a second opinion on the medication and a formal review, getting a solicitor to represent him in a tribunal if necessary. The dark avenger pacified, Dean grins and nods his agreement with my proposal of how he should move forward. We head off for some lunch.

Any 'battle' with the underworld of psychiatry will take time and require solid evidence; and I was not sure that Dean had the patience. His warrior preferred to go head-to-head in the moment; that was not going to work in his favour because he had been well and truly tagged and documented.