{"id":17624,"date":"2012-01-10T14:54:15","date_gmt":"2012-01-10T19:54:15","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=17624"},"modified":"2012-01-10T21:32:57","modified_gmt":"2012-01-11T02:32:57","slug":"thoughts-on-a-midwinter-evening","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/01\/10\/thoughts-on-a-midwinter-evening\/","title":{"rendered":"all it ever was…"},"content":{"rendered":"

1<\/h1>\n
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Terri’s approaching 50 now. Her psychiatric history reaches back into adolescence with suicide attempts, hospitalizations, drug abuse, jail-time. There were children taken away by the State along the way. I met her a couple of years ago in the clinic, brought by her husband, a disabled man who doted on her. The first time I saw her in the clinic, the diagnosis was easy – coma. She was so over medicated that I couldn’t interview her. All I knew was that she was on at least one [or more] drug from each class of psychiatric medications and spent her days in bed. I told her husband to bring her back next time I was in the clinic and hold off on all of her medications that morning. <\/div>\n

When she returned, she was awake. She had at least one or more symptoms from each category of psychiatric illness and spoke of herself in terms of diagnoses – "my bipolar" "my depression" etc. There was only one disorder she failed to mention – Schizophrenia – the disorder she actually had. Terri’s illness began in high school and from that time forward she’s on and off "heard voices" – primarily attacking her – "you’re no good" "you mess everything up" "you couldn’t be a mother" "you should just die" etc. She just didn’t tell people [including doctors] about the voices ["embarassing"]. She responded to Haldol, but felt like a "tree." She did better on Risperdal [3.0 mg\/day] and stayed hallucination free down to 1.5 mg\/day. It was funny. After the fact, I learned that the whole household had been ruled by her "voices." Whenever she was upset, they talked loud ["it helps her if we talk loud"]. The way they got her to sleep was to put a t.v. in her room and turn it up "real loud." When she got upset, she screamed at people – also "real loud." All of these things were apparently to "drown out" the voices.<\/p>\n

I wondered how I was going to get her off of all those other medicines, but it was not a problem. She stopped them on her own [including the Seroquel, which hadn’t stopped the hallucinations]. She retained the Xanax, the Trazodone, and the Risperdal. It’s a appalachian kind of story. Her husband went off to jail on a technical parole violation and she stayed with his mother. She was followed by a parole officer from Mental Health Court<\/em> [something invented for people in the community who need "seeing after"]. The only big snafu in the last several years was a time when the clinic failed to order her Risperdal. I was on a trip and came back to find her as I met her, trying to get better on "meth." Putting her back on medication resolved things fairly quickly. She’s taking care of the activities of daily living and now lives alone in a trailer across the road from her mother-in-law though she visits frequently [ironically, it was "too noisy over there"]. She’s looking forward to her husband getting out of jail soon. <\/p>\n

For those of you who’ve been in mental health, she’s like many Chronic Schizophrenic people – pleasant, with a number of preconscious automatisms [mannerisms]. Her emotions are flat. She’s very concrete, literal. When there’s emotional turmoil, she’s usually unclear where it’s coming from  until it is cleared up by someone else – invariably some fairly simple interpersonal conflict that needs talking through and clarifying. While she sometimes laughs and even teases, she lives in a mostly anhedonic [pleasureless] world. We helped her apply for SSI [disability] which she got on the first round [as she should’ve]. We’ll not be able to see her in our clinic now that she’s insured, and I have my fingers crossed that she won’t be over-medicated again in private care. I’ll miss seeing her…<\/p><\/div>\n

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\"JeanJean Piaget’s discipline is hard to define – education, psychology, epistomology – it was whatever he said it was. His beginnings came from his observations of his own children as they learned to know things. That lead to his theories [called genetic epistomology<\/em>]. He followed the development of his children’s reasoning skills – their increasing ability to know things as they matured. He schematized this sequence of their cognitive development as occurring in stages<\/em>: <\/div>\n
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    Sensorimotor<\/font><\/strong> [0-2]:<\/div>\n