Wednesday, June 3, 2009

What If?

This was a post that I started a very long time ago, but for some reason just never got published. But then today I read a new blog called "Mel's Skim Cap" and she really got me thinking about it all over again. I'd definitely recommend that you jump on over and give Mel some bloggy love. She seems to have some really great things to say!

Sometimes I wonder if we in the 'helping professions' are really helping people. I worry that we are medicating children instead of actually meeting their individual needs. I worry that we are giving diagnoses instead of actually providing education and support. And sometimes I worry that we are pathologizing the things that make us individuals. So a kid is quirky and introverted - but we call it Aspergers' Syndrome. A little boy is uninterested in school work and isn't paying attention in class - we call it ADHD. A teenager is moody, argues all the time and breaks curfew - we call it Bi-Polar Disorder. But what if these are just the results of individual personalities on the farther ends of the normal developmental spectrum? Or the result of a poor fit between someone's temperment and their caregivers? And are we really helping by continually providing medications and therapy and telling them that they are 'disordered'?

And then there are the farther extremes - like the woman I met last weekend when I was on-call. Again, let me remind you that I don't have a lot of experience with adults unless they are the parents of the kids I see. Some of them do have mental health issues - but generally they are not too severe. But since I started doing on-call crisis work, I have been learning alot about dealing with the chronically mental ill adult population. It's very interesting and thought provoking for me - and it makes me work twice as hard to try to prevent the kids I see from the same fate.

Back to this woman - early 40's, African American - in the ER for taking 45 of her husband's narcotic pain relievers in an attempt to kill herself. It wasn't her first time either.

I came into the room and introduced myself and explained the process of evaluating her for hospitalization. She let me know that she'd been through this before. She'd been hospitalized 3 times in the past two years for suicide attempts. I asked her to tell me what had happened the night before. She explained that she'd been feeling more and more depressed for that past few weeks. Then she and her husband got into a fight and it culminated in her taking the pills and trying to run away from her husband so that he couldn't take her to the hospital. I asked her how long she'd been suffering from depression. She told me it had started not long after she'd been driving while intoxicated and got into a car accident - the accident killed her sister who was a passenger in the car. Makes the depression pretty understandable huh?

I proceeded to ask the rest of the questions down my list, all of which were unremarkable until I got to the questions about hallucinations and delusions.

Have you ever heard things or voices that no one else hears?
What do you hear?
I hear voices sometimes.
What do the voices say?
They tell me that I am worthless and that I should just kill myself. No one will miss me anyway.

Now, how do we know whether she is really 'hearing voices' or those are just her own thoughts and fears plaguing her? I continued on to my next question about visual hallucinations.

Do you ever see things that no one else sees?
What do you see?
I see my dead relatives - my dad, my auntie, and my grandfather.
When do you see them?
When I feel like hurting myself. They tell me that I am loved. They tell me not to hurt myself.

Now - I have to check off "Auditory and Visual Hallucinations" on my checklist. But as I left that day, I couldn't help but wonder about this situation. So, this woman is obviously tortured by the guilt of killing her sister years ago. Because of this, she 'hears voices' that tell her she is worthless and to hurt herself. But then she has 'visual hallucinations' of her dead relatives coming to tell her she is loved and offering her comfort. Chances are, she will now be given a diagnosis including the words "psychotic".

But what if it is not psychosis? What if we are ignoring the signs of the spiritual here on earth? Why do we not consider that those "voices" she hears may not be Satan's henchmen? Why do we not ponder the possibility that in response, God sends "visions" of a person's loved ones to offer comfort and encouragement? What if we are not dealing with screwed up brain chemistry and mis-firing neurons? What if we are dealing with the age-old battle between good and evil? And what if we are just medicating it all away?

What if?


  1. I have a lot of thoughts about this and think sometimes it can be very easy to judge what thoughts that an individual has may be valid and which aren't.
    I judge according to the amount of distress causes by what we may interpret as hallucinations. Often if there is a more spiritual or religious element, they can be a comfort and therefore there is no need for any medication or treatment.
    Treatment is something we would offer only where there are distressing visions/hallucinations/thoughts.

  2. I find this topic very interesting. I am a woman of faith and believe that we are in a battle between good and really leave something to ponder here. :)

  3. Excellent post!!! Oh yeah...what if....

  4. thanks so much for the shout out! I appreciated reading your thoughts on the topic. It can be a real challenge to bring the spiritual perspective into the workplace and still be respected as a professional. God bless you in your work and life.

  5. Interesting post. While I believe that there is meaning behind symptoms, especially psychotic symptoms, it's never passed my mind that it might be a Satan and God things. I guess it's just coming from different constructs.

    Ok, so what if it is? She's still in intense distress as evidenced by the suicide attempts. So what would you propose be done with her if it is indeed such a "spiritual" battle? Do you have any idea if she believes in God or not, or would it just be assumed that she did?

    Interesting stuff.


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