Today’s article, “What a young patient with schizophrenia taught me about limits,” is a lesson in humility, medical humbleness.
Dr Chong Siow Ann admits that some mental illnesses are simply beyond him. At his wit’s end, he even advised the parents of a young man suffering from schizophrenia to seek a second opinion.
The case came to him as one named “Mr L”. He was in his twenties, studying in an American university, when he suspected that his housemates were trying to murder him “by poisoning his drinking water.”
Many things happened in between, mainly concerning hallucinations and constant withdrawal, before events “culminated in an assault on housemates late one evening. Bloodied, they managed to escape and called the police.”
That was when Mr L was committed and diagnosed to have paranoid schizophrenia.
Mr L became Dr Chong’s patient. He went through a battery of treatment and medication, but none cured him. His symptoms varied from hallucinations and delusions to “profound loss of motivation, withdrawal and cognitive impairment such as difficulty in abstract thinking and concentration.”
A range of anti-psychotics and psychotherapy were tried on Mr L, including numerous hospitalisations and months of inpatient rehabilitation, but they did not bring “significant improvement.”
Dr Chong later admitted to “having run out of ideas as to what else (he) could do to improve Mr L’s symptoms and functioning.”
Although Dr Chong advised that they seek a second opinion, the family rather stick with him. “And so, together, we decided to just try to keep things on an even keel and to ensure that he stays as physically healthy as possible.”
Dr Chong observes: “He is still symptomatic and unable to work, but he is at least free of any side effects and has not been hospitalised for years. I continue to see him and family on a regular basis and assure them that if anything untoward crops up, we will deal with it together.”
Lesson? I like the way Dr Chong describes the multivaried causes of mental sickness. He wrote: -
“As with the rest of the medical specialities, the primary goal of psychiatry is to get our patients well and back on their feet, and on with their lives. But mental illnesses are intricately complex conditions with multiple causes interacting with one another in an unclear manner.
We have but rudimentary knowledge of the biological substrates of human thoughts and emotions. And we might never know all the murky secrets of childhood sexual and physical abuse, emotional neglect, parental losses, bullying and deprivation, and their terrible implications for mental health.”
Some of this mental illnesses can be so debilitating to the sufferers that Andrew Solomon, author of Far From The Tree, wrote, “an illness not of accrual but of replacement and deletion; rather than obscuring the previously known person, this disease to some degree eliminates the person".
Imagine that, a mental takeover so grave and aggressive that you not only lose your sanity, but your personality, a condition no less than self-oblivion.
Dr Chong cited a case of such a hostile personality takeover that resulted in tragedy.
“An article in the International Journal of Eating Disorders gave an account of a 30-year-old woman with chronic anorexia nervosa. After years of unsuccessful treatment, a clinical decision was made to forgo repeat hospitalisations, with their cycles of "forceful, intrusive, autonomy-depriving yet physical-life types of medical interventions" that she, the patient, experienced as personally unacceptable. She subsequently died - reportedly with the treatment team by her side.””
Every doctor worth his salt would be hard pressed to admit to reaching the tail end of his expertise. Most times, the struggles between competence and ego would drive a doctor to do all he can, even adopting draconian medical measures, in order to find a cure - staking his good reputation on it.
But according to Dr Chong, “such an urge can lead doctors to pursue aggressive treatment, with risks of causing more harm to the patient.”
The reality is, to finally come to a point whereby you have to admit that nothing can be done towards an effective cure, but you will just have to manage it for as long as it takes, is always a struggle of sizeable proportions.
The dearth or end of hope torments everyone, especially those who have the greatest emotional stake in a loved one’s recovery. Imagine the sufferer is your baby, your spouse or your beloved parent.
Promises, especially those based on religion, can be a double-edged sword when it comes to hope. No doubt it acts as a great motivation to never give up, to persevere towards the light, but for a handful of cases, never giving up can become an obsession, when hope turns into depression, faith into disillusion, and trust into betrayal.
Pastors do struggle deeply with cases that go beyond the laying of hands and the daily frantic utterance of scriptures. They are equally helpless when a case comes to them from loved ones desperate for some form of relief after seeking one help after another.
They know their limitation, and those honest and humble enough like Dr Chong, would openly and readily admit to it.
Yet, there are those who openly deny that nothing can be done. They actively resist it because to come to that point, one’s ego would have taken a severe beating. It is thus no longer about whether God can heal or deliver, but whether they will be seen by their congregant as less than creditable or reputable. When pride overtakes, the blame is sadly pushed back to the sufferer and this only hurl the victim into a vicious cycle of guilt, shame and pain.
Alas, bearing that in mind, we too have to admit that love never gives up. Possibilities do exist, over time. But love however overcomes in many ways. In the article, Dr Chong concludes with this: -
“I continue to see him (Mr L) and his family on a regular basis and assure them that if anything untoward crops up, we will deal with it together.
Medicine, with all its stupendous and dazzling advances, will continue to have its limits. But there is always room - indeed, a need - for concern, kindness and compassion for us to fall back on when that limit is reached.”
And if love is indeed patient, kind, compassionate and longsuffering, then by never ceasing to demonstrate its fruit through our actions and words, the face of God is never far from our loved ones because God is love.
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