No man is an island

The social worker next to me insists:

– It is advisable to work on your self-esteem and on your social skills. Your parents helped you as much as they could, despite your long and persistent disorder, so as to give you the best possible education and support. But you need to make continuous efforts to become more autonomous and learn to trust yourself.

The patient agrees. He will try to do his best. Just like his parents. The problem is that sometimes he can’t. And when he can’t, he either has bursts of physical violence, or he has suicidal attempts. But in general, when he’s not in the hospital, he’s ok. In fact, he is better when left alone or during his hospital times. He is at his worst when he lives with his parents.

The reunion ends and the patient and his family leave the room after a lengthy discussion.

I look at the social worker, a good negotiator and someone with an infinite patience, something I have less and less:

– The parents are not entirely reasonable. We should not blame the patient alone. He’s an emotional type, the parents are rational and pragmatic types. There is a problem of communication between them as well, as they can’t seem to find the common ground.

The social worker agrees. I continue:

– The patient is not the only one who should do psychotherapy… Maybe he should fix his self-esteem issues, but the parents should equally do some psychotherapy sessions so as to work more on their empathy and flexibility when dealing with predominantly emotional personalities. The patient is not the only one who has an issue.

The social worker argues that the parents had such a degree of psychological rigidity that there was a real risk of them leaving the room if challenged directly. They were already quite eager to fight for their perspective, namely that the patient is the only one in the room that needs to be cured. I agree. However, I emphasize:

– A patient, no matter who is and what his disorder is, shouldn’t be imagined alone, isolated, as some sort of meteor falling form the sky. He has roots, he has a background and a personal history that is intertwined with the history of his family. He is a part of a family system or structure, and if the family is dysfunctional, perhaps the patient can be considered as the symptom of the “diseased family”. He is not and he should not be taken as a separate element, but seen in his social context and as part of a wider interpersonal network. Psychotherapy, education, any similar intervention, should be preferably done at both ends: the patient and his family.

No man is an island.

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