Category Archives: Issues & Debates

Part II: Social, Peer & Exam Phobias

Anxiety Disorder, Clinical Case Studies, Issues & Debates, Treatment Approaches

Part I: Social, Peer & Exam Phobias

Few days later, I spoke to the mother again. They went to a Counselling centre in town. The patient opened up in the counselling session, saying that she was under great pressure and worried about various things especially her parents financial abilities.

She has always wanted to learn cooking and baking. So she’s chosen the school that she’s attending now, because this school has the course she wanted, and she can join it straightaway after Form 3, though it’s the most expensive course. The parents didn’t mind it, as they want their daughter to be happy.

The parents bought a new house earlier this year. They will be paying 3 times the house loan of what they’re currently paying. The parents are happy-go-lucky people, they know it’s going to be difficult but they were never too worried about it. Yet this eldest daughter of theirs is so concerned – whether they can afford paying for the new house and also for her expensive course. She still has younger siblings, she thinks, maybe she shouldn’t complete her Form 3 and go for such expensive course.

She also has a very traditional grandmother, who dislikes her furthering her study in cooking/baking. The grandmother always criticizes her mother in front of her, and scolding the mother for allowing her to study in this course which leads to a career that doesn’t earn money.

She listened to all these comments about her decision, is upset that her mother was scolded because of her. Somehow internally, she knows if she couldn’t pass her exams or doesn’t attend her exam she will not be able to proceed to the cooking course. And this is what she wants, or maybe not, but for her family.

We overlooked all these underlying concerns, worries and feelings. This is somehow true in psychiatric settings, especially outpatient settings. I’m not saying that medicine is not helping, obviously I’ve seen a lot of people benefit from it (especially when the condition is critical), but sometimes we easily overlook things that may not be solved by medication. Comparing to medication, in this particular case counselling and psychological treatment have shown a much better outcome.

Schizophrenia & Consent to Treatment

Clinical Case Studies, Issues & Debates, Schizophrenia & Psychotic Disorder

One day a mother of a 17-year-old patient called, said her relatives have been calling her, asking about her daughter. She posted several status on her Facebook (see? social media is what an important tool?!), saying she was going to kill her parents, and she has a plan about it (e.g. will chop father into how many pieces, then…). As patient has already blocked her parents on it, so they couldn’t see the status, but other relatives noticed it so they called mother.

This is a girl with Schizophrenia, having various kind of hallucinations about god, devils, aliens, thinking she is special, different from everyone else; isolating herself, easily agitated, bad tempered… She doesn’t sleep at night (well, most schizophrenic patients that I’ve come across don’t sleep at night). She has two younger brothers, she gets along ok with them. She thinks the youngest one is special like her, but he isn’t aware that he is special yet, at one point he will reach her stage.

Do you think someone like her will come for treatment, take medicine, go through treatment willingly?

If the answer were No, do you think we should then give up on her, and many people who aren’t well out there like her?

I guess many people understand the importance of consent to treatment (e.g. the surgeon is going to operate your brain, you or your family will have to sign a consent or else what if the surgeon is merely operating because s/he thinks this is the way s/he can earn the most?! Opps), but in the field of mental disorder this may not always be the case. It is not always possible to get the patient’s consent, the abovementioned is an example.

So maybe the parents can consult on behalf, then dispense medicine to the girl somehow… Till one point when the patient herself has the insight about her problem, she can then come for treatment personally!

There are some overly anxious parents or family members, who cannot accept “consult on behalf”- I’m not sick, why should I see the doctor?! Right, but your ill family isn’t coming either, how can we help her?