Discharge Conference – Part 2

The discharge conference was continued on Friday morning August 27. N. was being discharged – he could not stay at the hospital even if he wanted to, and was not going have a continuing relationship with this doctor. Medical psychiatry is focussed on sedating and housing people who act out and fit within a few diagnostic categories. Adolescent anger, dangerous life choices, addiction, even personality disorder are not issues that psychiatry claims to fix. How many psychiatrists does it take to change a light bulb? Only one if the bulb really wants to change. Psychiatrists don’t often acknowledge the limitations of their art, and when they run into an impossible situation, they can find lots of reasons why they can’t help. The dramatic trope that if only the patient had been diagnosed and treated sooner is familiar. The mental health professional tends to imply that she/he could have helped the child if the parents would have been different, or if other things in life had been different.
The resident who had been involved on Tuesday was there again. There was a second resident too. I think the conference was intended, from Dr. Perlov’s perspective, as a teaching conference for the residents. I went in understanding that he had encouraged Jan and me to tolerate some of n’s choices, to stay in touch and to support him emotionally. At the same time, he had been vague.
At his invitation I covered the events since Tuesday. N. got restless and Dr. Perlov interrupted me. He said I had a pedantic style and I was boring him. It was a power play. He had taken this conference to show that he had been involved in n’s care but it was becoming a waste of time for him. The good news for n. – he does not get identified as having a major disorder and all that comes with that. The bad news for Jan – no one is going to give n. the resources he wants and that she thinks he deserves. But he showed Jan and n. he was prepared to take n’s side. The take-away for me – n. has a hard time listening to me.

He told n. and me that I should wait for n.to call me and that I should not try to contact n. unless he contacted me first. He said that we might set up a routine that he could call me on certain days if he wanted. I didn’t try to argue with that. The take-away: N. didn’t want to hear from me unless he contacted me and asked for something. Maybe another point, but not clear, this was a warning – it would be risky for me to have too much more contact. I thought I had pretty well disengaged from n’s life before his recent hospitalization and that I had been trying to support n. in hospital and to respond to n’s calls to me – which started with a demand for smokes on the Saturday he was admitted. I thought he had taken my visits to n. in the hospital as evidence that I was pursuing n. He also I was going to feel that when n. called me, he was using me. He said that I should take the risk and let myself be used. He said that I should use my judgment and that there was a fine line between supporting n.’s emotional needs and enabling. Enabling refers to various interactions with an addicted person that support the addiction. It includes direct cash payments to buy drugs, indirect financial support for an addict’s life choices, and various emotional interactions that an addict can use, either in his own mine or objectively, the continued use of drugs. I pressed the doctor to explain whether I should pay for n’s apartment and food – the things n. had said he wanted even before he ran away last year. The doctor said that he would not give n. money and that n. should be trying to support himself but that we would help n. in emergencies. I asked about n.’s demands for money when he ran away to Edmonton. The doctor agreed that n. had broken trust by leaving the City. I asked about whether I was doing too much by helping n. to get a lawyer, taking him to court, and inviting him to the house to get his clothes. I said I had felt used because it sounded like n. had not been able to get out in the rain and deal with his needs, and he expected me to start supplying groceries.
N.got angry with me when I mentioned his call to me on Thursday, and n. asked if mom was going to get a chance to talk. The doctor had several comments. He agreed with n. that I was being annoying and passive-aggressive. He told me that I was showing contempt for n. and creating conflict. He told n. that he could not act out, and that I was asking good specific questions.
I said that I had also wanted to say that I was unsure of what to do when n. was asking for food for himself and his girlfriend and possibly the people he was staying with. I saw his concern for her as genuine but possessive. He would not care about those people if he could be there too, do drugs and make sure she was not fucking other boys.
Dr. Perlov asked Jan for comments. She was presented herself well – not the tearful, blaming presentation I have seen in private. She was presenting herself in a way that was calculated to avoid criticism and earn support from the doctors and to make n. think that her unwillingness to take him in was caused by my unwillingness or inability to support her career as a spiritual visionary.She said that she was limiting and controlling her contacts with n. She said she wants to support n but feels she does not want him to know her address because it is not her house etc.
I knew that she had been more involved with him through the last couple of months. He had been visiting him in the group home and had arranged for her parents and sister to visit n. That visit had taken place just before n. ran away from the group home on Garfield around August 10. I had generally not engaged with n. although I had left messages with the staff that he could call me.
Dr. Perlov asked if n. would accept the referral to the outpatient unit. Jan asked me if I would participate. I told her that her comment was not appropriate and that she was still locked into trying to blame me for n’s addiction. I asked a final question about whether it would be fair for me to ask n. about drug use. The doctor said it would communicate contempt. I asked if that would be harmful to n. by giving him a new rationalization to be angry and to keep abusing drugs. The residents nodded before the doctor could say anything. I don’t know if they agreed with me or they were signalling that Dr. P. had predicted that I was going to react this way
I was disappointed with Dr. Perlov’s advice. He was suggesting that n’s should not be told he was hurting other people because it would hurt his feelings.
I thought n. was finding too much support for his long-standing plan that I should pay for an apartment and food (now apparently for him and a girlfriend) and games and voice lessons and that I should take my rules and shove them. Jan is finding support for her idea that I caused n’s addiction and rebellion and the idea that n. will be all right if people will just support him in positive ways.


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