Wednesday, December 06, 2006

Other therapeutic interventions

Tonight I am writing this as I accompany Mr Man at a table tennis match, which is one of his many “therapies” that he engages in. This is one that helps him to interact with other people in a setting where the focus is on a sport which he loves rather than on the actual interaction with others, which helps to ease the pressure in that area. He has found this particular activity very difficult in the past and still does sometimes, but looking back it’s clear to see that there is vast improvement.

We refer to last season (Sep ‘05 – April ‘06) as Mr Mans first season back in the game, but actually his first season back was the year before (Sep ‘04 – April ‘05). He had been discharged from hospital 9 months earlier and felt that the time was right to get back into the game after about a 7 year break. He didn’t cope very well though and a bad back saved him from the embarrassment of having to admit the real reason for dropping out very early in the season. Still, I was proud of him for trying; he knew it was going to be difficult but at least he still gave it a go. Dropping out in no way meant that he had failed; he just wasn't quite ready yet, but he was already planning to try again at the start of the next season.

I think the determining factor in the success of this “therapy” is the fact that it was completely his own decision to play, and then not to play. With any type of “therapy” that is considered a person with Schizophrenia has to be willing to give it a try otherwise the results will be counter productive for two reasons: Firstly, a person with Schizophrenia shouldn’t really be forced to do anything against their will that will take them beyond their comfort zone and that they might not cope with, as this may cause a relapse of symptoms, and there’s a fine line between being encouraging and being pushy. Obviously this means there is a need for trust between the Schizophrenia sufferer and the "carer", and knowledge of how much the person can cope with. I’m sure some people with Schizophrenia would have the tendency to play on their anxieties as a way of getting out of doing something they don’t want to do, but I don’t find this to be the case with Mr Man, and I know him well enough to know when to push and when not to.

The second reason is that obviously for any person, not just people with Schizophrenia, their attitude towards the therapy will directly affect whether they benefit from it or not. An activity will not help the person if they are unwilling or unable to enjoy the experience and thus benefit from its therapeutic properties. That’s fair enough; we all have our own ideas of what could be enjoyable or not, and what will benefit us or not, that’s what makes us all individuals.

Sometimes I think the approach used by health care professionals is wrong. When Mr Man was discharged from hospital in November 2002 after his first admission, he began Art Therapy. This involved him having to draw something – anything – of his choice while a Psychologist sat and analysed his behaviour and mannerisms whilst he drew. This didn’t work for Mr Man for several reasons: It’s not exactly a relaxed setting, or even a natural setting, for someone to engage in something creative; the setting itself inhibits creativity. Also I wouldn’t have said that Mr Man was really the ideal candidate for such a therapy; he didn’t believe he was ill or in need of therapy for a start, and he felt that this kind of thing was for people who had “issues” which he didn’t have. Forcing him to engage in this form of therapy merely reinforced the belief that he was being observed all the time. Encouraging a patient to engage in arts within a group so that they are not singled out would be much more beneficial. The setting would be more relaxed and the patient doesn’t need to know that he or she is being observed. This is how Art Therapy is conducted on the ward, although I suspect that it is used mainly to give the patients something to do. I’m not knocking it; Mr Man seemed to enjoy it while he was on the ward and if patients are finding a measure of joy then that has to be a good thing.

Of course at the time of the referral Mr Man was still in hospital and under the care of a Psychiatrist whose abilities and even his motives were somewhat questionable to say the least. He refused to accept that Mr Man was suffering from Psychosis and seemed determined to prove that it was either all an act (which begs the question why he kept Mr Man on the ward for nearly 6 months) or that his problems were due to his upbringing and his “unnatural” attachment to his mother, his sister, and even me his wife. More likely is that the Psychiatric Consultant in question was out of his depth, and out of a job, as his contract finished just a week before Mr Man was discharged. One nurse on the ward openly admitted to me that he felt the Psychiatrist had lost interest and didn’t care about the patients as he knew he would be leaving soon. Anyway, I digress, but it would be interesting to know if Mr Man would still have been referred to see a Psychologist for Art Therapy if he had been under the care of someone who knew or even cared about what he/she was doing. Mr Man only attended about 3 sessions with the Psychologist and then just refused to go to anymore, but no one has ever mentioned it to him as if the whole event was inconsequential.

Last season (Sep ’05 – April ’06) was the first “proper” season back for Mr Man where he played for the whole season. I remember accompanying him to games at the start of the season and he would physically shake and sweat all over. How he won a single game in that state I’ll never know. The next day he would begin to feel anxious over the following weeks match, and this is how he went on, week after week. Still, he didn’t give up and I admire his courage. As his Community Psychiatric Nurse has said (and I do agree with him sometimes) there is more achievement in the fact that he continued to play despite his anxieties and symptoms. Before his break away from the game he used to play in the Premier division, but although he played in division 3 last season (the lowest division in this area) I can’t express how proud I felt as I watched him collect his trophies at the end of the season. They represented so much more than simply outplaying his opponents, and there is no question that he worked hard for them and definitely deserved them.

He had some setbacks this last summer, and of course being away from the game from April to September during the season break means starting again in lots of ways, but this season he is coping much better already. He paces the floor at home for about half an hour before we leave, but I suspect this might actually have more to do with the journey as I have mentioned before. Obviously he still has his good and bad days though. Some weeks he finds it very hard to concentrate on the game due to the voices being so intrusive, and he finds it hard to interact with other players. He speaks when he’s spoken to but he has a very intense look about him and seems oblivious to what is really going on around him and just goes through the motions. One week he accidentally hit the opposing player with the ball several times, but because he was so distracted by the voices he hadn’t even noticed and he didn’t apologise. He hasn’t told anyone in his club what his problems are so it must have seemed very rude to some, but of course I knew that it was because he wasn’t really “there”. It was quite embarrassing and when he came over to his seat I had to quietly remind him to say sorry when he hits people with the ball!

Tonight he coped fantastically well, interacting with other players from several teams. I noticed that he approached people himself to initiate conversation, and he had a laugh with some players. He seemed relaxed and he played very well. As I type these notes up he is sleeping on the sofa, exhausted from the evenings events.

By the way, he won all of his games.


shiva said...

It is really great that Mr.Man had won all the games....really great.I agree with you that TRUST is very essential between a Schizophrenic and a care giver...i also agree with you that no work/activity shd be thrusted to them against their will.
This,I am experiencing with my son now aged 32 years who was diagnosed as Schizophrenic in 2001.In the initial stages of his treatment I used to advise him not to sit idle at home and go for some DATA ENTRY WORK(this is the only job he was/is interested) and plead him that going for some job itself is a thrapy.He wd hesitate and reluctantly go for the job and giveup within a day or two;Or within a week or two.He wd return home with pale face and terrified look and tell some reasons such as "some of his coworkers are starring him at his back or they are waiting for chance to attack his back/neck/knees,or the working atmosphere is not well or noisy etc;"Any amount of counselling wd not convince him.After a break/rest of of one or two months he wd go for another job.Now he is comparatively better....he is able to go for a job continuosly atleast for abt 6 months.He is being paid poor salary.Whenever I point abt this he wd coolly reply"Appa! dont bother abt the salary....going for the job is important!" I am happy abt his change of his attitude.
Posted by shiva at 21:20 on Dec 6,2006

Mr Mans Wife said...

That's good news Shiva, I'm glad your son can now manage to go to work. I know that "pale face and terrified look" all too well.

Thank you for posting, and thank you for reading.