freedom

I have written about this woman before, just over a year ago on January 28,2009. She is a fascinating mix of strengths and weaknesses. A mixture of psychological, neurological, traumatic, and also bureaucratic difficulties. She is very articulate, with a good sense of humor, but she gets disoriented very easily, is always anxious and in fear of harm, slightly paranoid, but from experience. She is also a hoarder, as bad as any of the cases you see on TV. (Boy, that is a sick, exploitive show, but that will be another post).

I received a call from a nurse who is part of her treatment team. They went to her house and realized that she is probably not taking her medication as prescribed because she can't find half the bottles that are lost in the mess. They also saw that she has three check-books she can't find, as well as several checks and money-orders that she has received. All lost in the piles.

They told me that they want to send in a visiting nurse, at least every other day to give her her meds, and also they would like to assign someone to be her payee who would manage her money, so her bills will get paid on time and her money will get put into a bank account.

This seemed reasonable, and probably helpful, so I brought it up to the woman at her next session. The idea made her very nervous, and she made me promise to tell them that she did not need, or want, those services.

As we discussed why, the reasons became clear, and reasonable. Although, in some ways she could see the benefit of them "helping" her that way, she really felt like they would be taking away her freedom to be who she is. They would clean up her place and make her throw away many things they viewed as trash, that she viewed as having useful potential, and/or things she was attached to. Yes, she attached to almost everything, but she felt strongly that everything had a purpose.

She felt the same about medication. She felt that if she took all the pills they gave her, she would be less anxious, but paradoxically, that would make her more anxious. She had a history of being abused by her mother, and then by a boyfriend, and finally by a husband who almost killed her --- see she does get very attached to things and people and can't let go. But from these experiences she feels that if she is not anxious she is much more vulnerable, She feels her anxiety protects her.

Also, she feels that on the medication, she would feel less anxious, but she would feel much less of everything, including, much less like being herself. And despite all of her flaws and hang-ups, she has come to enjoy being who she is. She feels hat she is a very nice person who happens to care too much about everything and everybody. She feels that the world would be better if more people were more like her. Instead there is a medical establishment that tries to make people, neat, clean, quiet and respectable. Zombies. She doesn't want that; she wants to stay alive.

So, I agreed to call them off.

ending treatment

I have been seeing Pauline for over three years. For almost two years she came every week, than it was every other week. Today we decided that we would meet once a month for the next three months, and that would be it.

She was a fascinating patient. She thought about things we said. She was a nurse, so she knew a lot about her own health and what to look for, and she wanted her life to get better.

Her problems were a combination of all the factors that affect how someone lives. She was a wound-up child who was crawling out of her crib at one-year old. Even then she hardly slept, and by the time she was three she was defiant.

Her father was over-bearing and tried to get her to behave by being loud and threatening. Her mother cried a lot. She married young and divorced early and was left raising two kids on her own. Along the way she developed an eating disorder and a drinking problem. By the time she reached me she had just bounced off the bottom of being frantic, drunk and suicidal. She had terrible panic attacks and had been isolated from the world. She had tried about eleven different medications, and an intensive group program. She is now on two medications that she agrees that she needs. They don't do wonders but without them she is awful.

During her time with me she got better, then got worse, and then slowly pulled herself together. And now we have reached a point when it seems to be enough for a while.

Her drinking has stopped. She is back working part-time. She had a terrible relationship with an older man, and now she is still sees him a lot, but they have learned how to deal with each other. Her being sober helps a lot and she is grateful that he stuck by her. He can still be selfish and irrational, but she has learned how to deal with him.

Her eating disorder lingers on. She won't go to a more intensive treatment program for it. She hardly even wants to talk about it. She finds ways to push it away sometimes, but it haunts her. I worry about how much it limits her, and so does she.

But over the last couple of months the tone of the sessions have changed and it is clear that we have reached a stable plateau, even if it isn't perfect. She is working, she has a relationship, she is out of debt, she is sober, and even enjoys herself once in a while.

She is a good example of how so many factors interact to make a life: genetics, family, environment, stress, health, other physiological factors, brain chemistry, as well as luck and random events.

We only have limited control of so many of these factors. We have to make the most of the leverage we have.