Nobody’s fault

Clinical Case Studies, Depression

The wife has requested to divorce earlier this year.

This is a husband who has no bad habits, and has not done anything guilty to the wife and their 3 daughters. He has supported the family financially and mentally from day one.

Why is the wife unhappy about the marriage? Frequent rows? Personality? Wife having affairs? Too boring?

They have their first daughter about 10 years ago. One year later the wife is pregnant again, and one day when she was already 8 months pregnant, the husband called the wife, and needed the wife to do something for work urgently. The wife did it as requested. And that was the day, the baby boy was born prematurely, … then passed away one day later.

In the next 5 years they have another two baby girls. But the wife couldn’t let go of it, the one and only baby boy. She blames it all on the husband, even after 8 years, can still never forgive him. She thinks the husband ruined her day and hence the water broke earlier. She thinks if the baby wasn’t born prematurely he wouldn’t have died.

She could be right. But is the husband not feeling guilty about it? Will the husband want his baby boy to die? If he knew that could happen, even on the slightest chance, will he still want the wife to do that?

OK well we can’t judge whether one’s guilty just by saying he has no motive to do so, because people do make mistake accidentally, just because you somehow kill this person accidentally, doesn’t make you guilt-free.

Now every day the wife is picking on the husband, moody, bad-tempered, and getting angry over little things. She tried to take some chinese herbs medicine, but the traditional chinese med doctor said her condition is getting so bad that she’d have to see a psychiatrist for a faster effect and action on her condition. The husband also tried to bring her to see Clinical Psychologists and went through a few sessions. But still, she couldn’t let go of the incident, and is putting the marriage and the family’s happiness at stake.

Nobody’s fault isn’t it? But when you step into her shoes you may understand why she’s feeling and behaving this way. Yet I feel so sorry for the husband and 3 daughters.

When traditional chinese medicine and psychotherapy (quit half-way) failed, will medicine help this family?

Guilt Feeling

Clinical Case Studies, Depression

She’s newly wed, just half a year ago. But she isn’t happy, as she’s involved with another man, after the proposal, before the wedding.

Few months after her wedding, the husband found out about the affair, by then she has already separated from the man. The husband also chose to forgive her about it.

This makes her feel worse. Within few weeks she was getting more and more depressed. She thinks she ruins their marriage, their lives. She would rather the husband being angry. She knew the husband loves her so much that he can forgive her about it and hopes that nothing like that will ever happen again.

But she feels so sorry, can’t get over with it and slowly develop depression, with agitation. The better the husband treats her, the worse she feels, and the worse she treats the husband back. The husband thinks he must have done something wrong, but doesn’t what to do to help with their relationship. Their marriage is at stake.

The root of the problem is her guilt feelings, that has to be spoken out, to a professional with the husband, that has to be solved, before any other problems it has caused can come to an end.

So speak out, when you feel sorry or guilty, depressed or sad, angry or agitated, you may not know what you’re doing, and may cause things to happen that make you regret for the rest of your life.

Be Positive

Basic & General

“Why not you try to find yourself some pleasurable activities, and go ahead to do it,  even when you don’t feel like doing it. You’ll be surprised at the end of it by how much better you may feel.”

“Can you give me an example of what I can do?”

“How about travelling? Going on a holiday?” (having known that this patient is financially capable)

“But there are so many disasters everywhere!”

“…”

A depressed man will only focus on negative aspects of things. He sees travelling as being involved in disasters or accidents and dying in other places, away from friends and family.

Just like myself – when I first started work, I remember so much of those family members or patients who were so grateful with their improvements after visiting us. Yesterday when I was discussing some cases with the doctor, I realized we’re now only focusing on the tricky bad cases, who don’t respond well to our treatments. We never really have time to even think about and appreciate the good ones.

This is how much we focus on the problems, and negative aspects of our lives. Once in a while we may realize how much we have in life (e.g. when you come across Nick Vijicic), but soon we forget about it and start to moan about life again.

This is probably so normal, as it is how we’re brought out up, and are taught to do. An engineer works in a factory will only focus on the machine that isn’t working and doesn’t realize there are 8 other machines that work completely fine and require no attention.

Of course, if they require no attention why do I pay attention on them? Of course, if my limbs are working fine why do I even think about them? Of course, if my tooth isn’t aching why will I realize how suffering it’s when it’s aching? Of course, if my mother washes all my clothes for me why will I still pay attention on it and remember to be thankful?

In fact if you think, it’s so damn easy to find something and feel grateful, happy about it. So, easy. But we only focus our attention on the bad, the negative, the downside. And when this happens in almost every aspect of your life, you’re most probably depressed.

So let’s try to do this when you’re disappointed, feeling a bit low, frustrated, unfairly treated, in pain, try to distract yourself from those negative feeling/thought, and think about something that make you feel grateful and positive, then focus on it/them!

Practice it often and hopefully we’ll all soon become happy people.

Schizophrenia Triggered by Relationship Problems

Clinical Case Studies, Schizophrenia & Psychotic Disorder

Do you think it’s possible? For one to suffer from schizophrenia triggered by relationship issues? (quite commonly triggered by drugs, trauma, stress, alcohol, adverse experience… But relationship problems?!)

They have been in a relationship for few years, after knowing each other since 7 or 8 years old in tuition centre. They also have a common childhood friend Ernest who attended the same schools with the guy Kenji. Sue knew Ernest had a crush on her when he was 12 or 13. But she didn’t think it was a problem, and didn’t take any action. She continued to maintain their friendships, spending a lot of time together, sometimes they could chat over the phone for hours. Sue didn’t hide any of this from her boyfriend Kenji, for the first few years, Kenji never (appear to) mind his girlfriend’s close relationship with another guy.

Till one day more recently, Kenji started to shout at and scold Sue, for still staying with Ernest despite knowing the latter admiring her. He said Ernest isn’t a good guy to befriend with, and he is kind enough to warn her about this. For the sake of her boyfriend, Sue decided to slowly keep her distance from Ernest. That didn’t help, Kenji started to hear voices, asking him to leave her, saying she wasn’t “the one” for him, he’d be better off without her. The voices were haunting him, day and night, especially when he was alone, so bad that Kenji started to stay away from Sue (which somehow relieves the symptoms).

Of course he still loves her. But he couldn’t bear the voices and hallucination. He didn’t feel better staying away from Sue, as he’s still thinking about her all the time, and fighting for her against the voices. He feels like he’s going crazy. He’s slowly losing his ability to function in other parts of his life.

Sue then decided to seek professional help for him. There wasn’t any apparent or direct family history of mental illness in Kenji’s family. It was in fact difficult to find the trigger. But Sue thinks it was all her fault, she is the cause and trigger of the psychotic symptoms in her boyfriend.

Is it possible?

When Schizophrenics Don’t Recognize Their Illness

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

Do you confront them? Do you “make” them realize their illness?

This couple came to consult the psychiatrist few months ago, but they paid only the consultation fees after seeing the doctor for almost an hour, without collecting any medicine.

The patient is their son, who is in his late teens. He’s currently attending a very famous top college in the town. He lives in hostel with two other roommates, only back to parents during term holidays. The son doesn’t think he has any problem.

But sometimes he sits on his own and laugh. He spends a lot of time thinking. His behaviour is purely “weird and strange”, as how his mother termed it. According to his roommates, he sometimes gets disappeared from college and hostel, for couple of nights, then came back and kept to himself, like nothing happened.

There isn’t much the parents can do about him, as he doesn’t live with them, they don’t even have the chance to put medicine for him (see case study 1 & case study 2 for why putting medicine without patient’s knowledge). They did try to confront him, they actually set up on him and made him to a general hospital where he was hospitalized for over 10 days, then put on medication for few months after discharge (he stopped medicine subsequently as it was causing drowsiness and disabling him from studying).

Since then he became more vigilant. The parents know it’s almost impossible to set him up again or force him to see a psychiatrist doctor again.

At some points counsellor from the college contacted the parents, they discussed about his strange behaviours. At one point the roommates even had to put tranquilliser or sleeping pill in his food or drink to make him stay in hostel and rest. Yet academically he was still not doing that bad (afterall he’s one of those top students… though the mother is sometime a bit doubtful whether being such a top student is a good thing for her son).

Few days ago he came back home for term and chinese new year break. The parents thought it was a good opportunity to help their son. However, after one night being home, the son couldn’t stand the confrontation and parents’ lecturing, he ran away from home, and hasn’t been home since. The mother has been trying to get in touch through phone, but when she spoke to him, she really isn’t sure what to say to bring him home.

Perhaps she hopes that the son get well without any medication and treatment? Perhaps she hopes that the college expel him so that he’d be home to get treatment? Perhaps.. she doesn’t know what to hope for.

So… back to my questions – how do we make them realize their illness? Or do we do this at all (let them be? confront them?)?

Asperger Syndrome

Clinical Case Studies, Developmental Disorder

Two of the tutors came to the mother today and said that they were unable to help the boy with his studies as his attention span is too short, he keeps get distracted.

This is a boy of 13 with Asperger Syndrome which was diagnosed when he was 6. With medication the boy still does not improve significantly after all the years. In school, he disturbs his classmates by walking around the classroom and talking to them while teachers are teaching. He also flips his books quickly (without reading them, but he likes creating that sound while flipping books), tears and folds books and papers. The teachers said he isn’t able to do any independent work, although he appears to have adequate intellectual abilities just like his classmates. Unfortunately he is never able to get seated down for a short test. The teachers don’t know what to do to help him, and he makes no friends in school due to his annoying behaviours.

Tutors were hired to assist him in school and to give tuition at home, but a few have left for the same reason as above – he’s too difficult to manage, to be helped. He can’t concentrate in studies or perhaps in “doing anything meaningful”, as how the mother termed it. He scratches himself badly, almost obsessed with this habit.

The parents are feeling helpless. If the medicine couldn’t touch him at all, what else would?