Monday, February 24, 2014

What Happens At The Bottom?

There is one thing about Thomas' illness that I continue to get hung up on. Those delusions of his plague me constantly as I am promised time and again that he will get better. I have watched some things improve but what has remained firmly implanted are the delusions and I don't see where they will go anywhere anytime soon. I have asked doctors over and over again lately about them, I guess waiting for someone to say something that will make me feel better about their existence and when I have explained how long he has held them (since 8th grade--5 years+) they do what everyone else has done and their expression changes to something that looks like sadness and they cease to reassure me like I would like to be reassured. You see, the longer-standing the delusion is, the less likely he is to recover from them, that is what I have been told in the past anyway. I repeatedly ask about them because there must still be a part of me that thinks either that Thomas will get well completely and this will all have been a nightmare or that he will never get well again. Inside both of those thoughts lie a person who is still in denial about Thomas' course of "recovery" but somehow just accepting what is, isn't an option for me right now.

So, I wrote Dr. N. an email and asked him about Thomas' delusions yet again. I've got to hand it to Dr. N., he is very patient and kind with me and all of my emails. I'm trying to keep them to a minimum but because he always answers them with professionalism and compassion, I find myself turning to him time and again for his thoughts on things. The following is the email exchange we just had:
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My question:

Thomas had therapy yesterday too and in that session we discussed his self-esteem and tried yet again to help him to give himself positive affirmations every day so that he can find some self worth. His therapist questioned him further and discovered yet again that Thomas' sole source of self esteem comes from his delusions. Upon even further questioning we discovered that this delusion is with Thomas (according to Thomas) every hour of the day and it gives him a great feeling of power. Yet again it is evident to me (and to his therapist) that his delusions are well-entrenched and are not budging, in fact seem to be continuing to grow and solidify. It is (and I think I've said this before) those delusions that concern me a GREAT deal. I have been told several times from several different doctors and nurses that because his delusions were around long before we discovered them (they started in 8th grade) that they will be virtually impossible to treat. Even his own therapist can see that his efforts to change them are failing. Can you tell me what YOU see for his future concerning these delusions? It is my greatest fear that they will continue to worsen and he will get sicker and sicker. I have little hope for a decent recovery/remission for him because of that.

Dr. N.'s reply:

As for delusions that are very longstanding, there is possibility that they will get better, or that they will remain, it's too early to tell. In people who experience that kind of delusion, a typical course, if the medications start to work, is the person feeling gradually less consumed or preoccupied with them, even if they still believe them 100%, then slowly starting to wonder if they are not true, until they might even no longer believe them. However, there are some people who might continue believing them despite medications, but might "get over" them with time. For example, I had a patient with delusions who was sure there were people monitoring her every move, who, after being on the medications for quite a while started saying those people left her alone, while still believing the events happened in the past. She got to a point where she was no longer watching over her shoulder all the time. But it's too early to know how this will play out for Thomas.
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While he tries to give me some modicum of hope, it is evident in his email that we have a long road ahead of us. It is that long road that trips me up all of the time. Where a Band-Aid and some Neosporin with a kiss and hug used to help a painful fall and a teary-eyed child, we are now at a point where there are no longer quick fixes for things. Schizophrenia, and more specifically delusions, are going to be a fixture in our lives that will heal slowly....if at all...............

So, as always lately, I find myself swirling in a whirlpool with the debris of this illness rotating around me and bouncing off of me as we make our way down to the dark depths of the unknowns of schizophrenia. I know there is a bottom somewhere down here but the question remains, will we land in an exhausted heap at the bottom or will we find our footing, stand up and push back to the surface.

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