Another Rx Recovery Story
(Column: Ask the Therapist)
Rita Seiden, C.S.W., Ph.D., Executive Director, Park Slope Center for Mental Health
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Wilma (not her real name) was sent to me by her psychiatrist, a doctor who had been treating her since she was first diagnosed with schizophrenia 25 years ago. Wilma's mother had died, said the doc, and she needs someone to look after her. Wilma's older sister came to see me first. She was very concerned about getting her sister in to see me. Older sister came to the first appointment with Wilma. And, essentially left her in my care. For two years, Wilma and I talked about her daily life, her plans, her grief for her mother, and her sense of relief that she would not be regulating her life anymore. She continued to see her treating psychiatrist for renewal of her Trilafon.

We began to talk about imposing some order on her life and her thought processes. I had been recently introduced to the "miracle" of the new anti-psychotics and I wanted her to do a trial of one of these medications. She was unpersuaded. She explained that she tried all of the meds available, knew all the side effects, and had been the most stable for the longest on Trilafon, and didn't want to mess with new medications. We went back and forth over many months about the possibility that something new could be better. At one point she told me she would get angry if I kept pressuring her. I explained that I wouldn't pressure her, but I had an obligation to get her on the best medicine she could have.

Wilma may have been stable, but she was very far from being an ordinary citizen. She rambled, her thoughts were circumstantial and tangential, she had paranoid delusions, she heard the voices of her family members criticizing her or laughing at her. My efforts to get her to consider a new medication were subject to commentary by this hallucinatory Greek chorus. I approached her psychiatrist about a trial of Risperdal. I don't know if Wilma refused him or the doc did not want to do it, but it did not happen.

As we approached two years of psychotherapy, I asked Wilma to have a conference with me and one of Park Slope's psychiatrists, Dr. Graham, and allow herself to be informed about the process and the risks. This meeting was held in my office so that I, too, could hear the doctor's conversation and Wilma's hesitations. When the doctor explained that Wilma could continue her Trilafon while starting her Risperdal, Wilma agreed to a trial.

Within a few weeks, Wilma was able to report, and I was able to experience, substantial change. Wilma's thoughts and speech were more organized; the voices were at first diminished, and then they disappeared. Wilma became able to entertain some plans for her life and to understand how much trouble she was to herself and others without the Risperdal. She found a roommate. She was able to sell the house she had grown up in and find a lovely apartment for herself and her roommate. She was able to negotiate a relationship with her roommate of sharing and independence.

She has now been living in this apartment for 6 months. She is able to appreciate her roommate's good points and tolerate her difficulties. She buys herself new clothes, she takes care of her health, and her daily chores. Sometimes she even talks to me seriously about going to work. No, she is not transforming the world, or writing books, or likely to make a great contribution to the world. Her achievement and mine is that she is more like an ordinary citizen than she and I could have hoped for when she first came to my office.
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