Friday, July 24, 2009

Shit: biochemical or psychological?

Chris was packed off to the hospital with all his vitamin supplements. I left instructions with Dr. Stern to confer with Dr. X, the head of the unit, to make sure that Chris received them three times a day. I felt that all the progress that Chris had made would be quickly overturned if he was yanked off the supplements in favor of antipsychotics. Dr. Stern conferred with Dr. X about making this accommodation. He agreed, which was rather refreshing. Refreshing, yes, but suspicious. I sensed it would be a only matter of time before pressure mounted to get rid of the vitamins.

"I have such hate" said Chris glumly when I visited him a few days later. I bet he did and I was glad he admitted it, but I said nothing. Chris continued to urinate and defecate in his pants. The nurse informed me that the other young people were avoiding Chris and making fun of him, so they suspended his vitamin intake for a couple of days to see if this would stop the problem. I suggested to her that maybe his soiling his pants was a sign of anger and not a vitamin problem. For heaven's sake, we are in a psychiatric hospital - within these walls shouldn't shit be viewed as the deeply rooted psychological problem that it is? Instead, shit seems to be merely a biochemical end-product. What ever happened to Freud?

The French word for anger is "colère", in keeping with the words "cholera" and "melancholy", and is linked to the body's production of choler or black bile, one of the four ancient humours. Referring to black bile, Robert Burton, in The Anatomy of Melancholy, first published in 1621, observed that “there is no nook or cranny of the mind into which this ‘roving humour’ has not insinuated itself. It is ‘inbred in every one of us.’” He explained that he wrote of melancholy to avoid being melancholy. The famous schizophrenic "apathy, flat affect and lack of motivation" is this not depression and melancholy? If we all have it to some extent, cannot each of us find some resiliency in us to crawl our way out of it?

Chris was aware that he would miss out on interacting with others of he didn't clean up his act and he said so to me. He may have just been placating me, who knows? My opinion is that he would stop showing antisocial behavior when it was to his benefit to do so, not because the vitamins were temporarily discontinued.

Obviously, Chris's health was too important to leave to the discretion of the hospital staff, so I smuggled his packages of supplements into his room and encouraged him to take them every day.

At our next meeting, Dr. X announced to us that Chris's incontinence problem had cleared up, and so the decision to suspend the vitamin supplements had been the correct one. "Well, Dr. X", I interrupted him, "I am sorry to tell you this, but Chris has been taking the supplements all along. The vitamins have nothing to do with Chris's incontinence. Anger does." Dr. X flushed briefly, then regained his composure. "Then, I guess, under the circumstances, Chris may as well continue to take his supplements," said Dr. X, not unreasonably.

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