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Obum Mokeme
The Flip Side of Seriousness
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2. THE DISFUNCTIONAL FAMILY!
THE PRESENTING SCENARIO ON ADMISSION: Ann was admitted into an acute mental health ward. She had been sent to the hospital by the occupational health doctor at work. Her boss had observed a steady deterioration in her work. She was also not her usual ‘perky’ self. After a brief evaluation by the doctors at the local Accident & Emergency Department, she was referred to the ward for a full evaluation and treatment. BACKGROUND TO THE PROBLEMS PRESENTED: Ann has an older brother, one older sister and another younger sister. They all lived with their mother in a three bedroom council flat. Their mother brought them up as a single mother. The children were still quite young when their father abandoned his family. He went to work one day and did not return. Nobody had seen or heard from him ever since. His wife had exhausted her searches before she went to the police station to report him as a missing person. She had already been to see all his relatives as well as hers but nobody had seen or heard from him. The police reported that there was no trace of the husband and father and that the case has been closed. After several months of going to beg for money, food and toiletries from various family members, she was advised to go to the council offices for help. At first, she was too ashamed to approach the council for help. But relatives started turning her away when she came round again and again to ask for help. Some refused to see her while others told the children to say that they were not at home. The situation became increasingly difficult. She tried to ration the food and the snacks that she was able to find in order to stretch what little they had. But children do not understand such reasoning especially if they were used to a different standard of living before. Eventually, she had to swallow her pride and go to seek help from the council. She was directed to the social services department which dealt with issuance of benefits. After the usual information gathering; investigations; and confirmation that her case was genuine, funds were allocated to her and to her children. Things improved for the family. The first two children were neither in education nor were they interested in learning new skills to help them get into the job market. They had already been missing school as there was no money for transport to and from school. Now that they had some help from social services, the two older children still refused to return to school in spite of their mother’s efforts. The school took their mother to task about her failure to get her children to attend school but there was not much that she could do besides prompting them to return to school. Gradually, they dropped out from education one after the other as they reached the age of sixteen. The two oldest children, George and Susan both left school without any qualification. George appeared to be Susan’s role model. Whatever he did, she copied. They both also refused to attend the free skills acquisition classes run by the council. Ann was the third child. She seemed to be the sensible one. She asked her mother if she could be transferred to a school nearer their home so that she could walk to school as she would not need transport fares. Her mother was both surprised and delighted by Ann’s suggestion that she had both Ann and Robin, the youngest, transferred to the nearest primary school. Both children went on to complete secondary school education at a secondary school near their home. Ann left school with seven GCSC’s. She did so well that her teachers encouraged her to go on to study for Advanced levels in preparation for university but she declined to do so. She was in favour of finding a job so that she could help her family. Meanwhile, while she was still at secondary school, Ann worked at the local shops during weekends and school holidays. She also earned a small wage during work experiences which were organized by the school. She was able to contribute to family expenses out of the meagre wages that she earned. The difference that her contributions made to her family’s upkeep influenced her decision to get a job to help her family rather than going into further education. Although she passed her examinations with flying colours, she preferred to look for a job so she would be able to help her mother. Even though they now had some financial help from the council, it only met the basic needs and left nothing for emergencies or small luxuries like new clothes, shoes and family celebrations. Most of her clothes were handed down from her mother or her older sister while she did the same for her younger sister, Robin. Her brother George was not employable as he had no qualifications and he did not want to do any unskilled job, which he considered to below his status. He grumbled that nobody would employ him but at the same time, he refused to take up an unskilled job. He stayed at home all day and went out with his friends in the evening. George applied for unemployment benefits. When it was approved, he kept the money for his personal use. He spent it on cigarettes, clothes and drinks when he went out with his friends. Susan copied everything that George did. She too applied for unemployment benefits which like George she spent on herself. She was worse than George because she loved to stay in bed till late and then dress up in Ann’s best clothes while Ann was out working. She spent the money that she was paid as benefits on makeup at the salon. She had her hair and her nails done every week. She complained about everything but she would not lift a finger to help because she did not want to ruin her nicely manicured finger nails. They all sat at home while Ann went out to work. After work, she stopped at the shops to get some ingredients for dinner on her way home. When she came home, she cooked for the family. Ann hardly had friends as she was too busy at work and at home to create time to spend with friends. George also made a point of breaking up any friendships which Ann got into, especially if the friend in question was a man. He would become verbally aggressive towards any man that showed an interest in Ann and would go further into physically attacking them if verbal abuse was not enough to drive them away. After a while, Ann asked why nobody else was helping with the housework except their mother. Her question was met with a resounding silence. The situation remained unchanged week after week, month after month as the years rolled by. As they grew older, the months turned into years, but there was no change in the situation. The only visible difference was that they had grown into adults but they were all still living at home with their mother. Their mother did everything that needed doing while Ann was at work. She has been doing so since they were children, but she has continued doing so even as they grew into young adults. When her neighbour and friend asked her why she worked so hard while her children sat at home doing nothing, she responded that she felt that life has been quite tough on them since their father left. Her friend warned her that she was slowly working herself into an early grave which will turn her children into orphans. Her friend advised her to get the children to start helping a little at a time until they would able to take on more of the house hold chores, but she would not be talked out of habits she formed several years ago. She continued to over-compensate for their father’s absence even now that they were all adults. George was now a fully grown man, living at home with his mother and his three sisters. He had no job, no home of his own and no wife. He often stated that he would inherit the flat when their mother passed away and the others would have been married or moved away. Susan was not interested in anything. She turned up her nose at the idea of getting married or getting a job. She was gradually growing into an old maid, but she seemed quite oblivious of her situation. Their mother was growing older and less able to help Ann with the house work. Ann found it harder and harder to cope with both her job as well as doing all the house work at home. Robin, the youngest of the four has now completed secondary education. She was seeking admission into a school of nursing. Ann was delighted with her younger sister’s quest for further education. She encouraged Robin but at the same time was aware of how Robin’s interest would impact on her life. She was the only one who helped when Ann asked her to do one thing or the other. As time went by, the situation at the family’s home began to take its toll on Ann. Her health suffered under the weight of her work and her private life. She seemed to be working twenty-four hours a day, busy both at the bank where she worked, as well as at home. She seemed not to have a work-life balance. She was always so tired, she had no appetite, and she could not sleep well through what was left of the night, that she gradually began to be absent from work. Her boss noticed a gradual deterioration in the quality of her work. Her health appeared to be on a downward slope too. She began to take time off work on grounds of illness. Her manager referred her to the occupational health department. When she attended the appointment with occupational health, the doctor identified some symptoms of depression and sent her to a hospital for further assessment. The symptoms were confirmed at the hospital and she was eventually admitted into hospital for treatment. Her family were up in arms and demanded that she should be discharged immediately. Her brother, George was the loudest in demanding that she should be “released immediately” as there was nobody to do the shopping, the cooking and the housework. His behaviour was reported to the consultant. He was first seen by one of the junior ward doctors who thought that it would help to plan Ann’s care if the consultant interviewed George directly. The junior doctor invited George to a ward round to discuss his sister’s care. George was delighted at the chance to meet with the ward team as he believed that he could convince them to ‘release’ his sister from the hospital. At the ward round George was asked why he demanded that Ann should be ‘released’ from the hospital. He responded that there was nothing wrong with Ann and that there was nobody to look after the rest of the family while Ann was kept in hospital. He was asked what he did for a living. “Why are you asking what I do for a living? This is not about me, I am not the patient! I have only come to get my sister out of this hospital,” he answered angrily. Continuing with the assessment, the doctor said, “George, the point here is, that what you do for a living might be having an impact on your sister’s health.” “I don’t see what that has to do with my sister being here,” George retorted. “I am unemployed,” he added reluctantly. The doctor asked George where he lived. “Is this the Spanish inquisition?” George thundered as he stood up to leave. “Please sit down Sir,” said the doctor calmly. “You may not understand why these questions are being asked now, but by the end of our conversation, it will become clearer to you. Please answer the questions so that we can formulate your sister’s treatment plan.” “Alright,” George said. “We all live at home with our mother.” “How many are you and what sort of accommodation do you live in?” George stated that there are four of them and that their mother and they lived in a three bedroom flat. “How many of you work?” “Ann is the only person who goes out to work,” he replied. “Who does the shopping, the cooking and the housework?” the doctor went on. “Ann does the shopping on her way home from work.” “Who does the cooking?” “Our mother helps but she has to wait for Ann to come home from work because she brings the shopping home with her after she closes from work.” “Does Ann help with the cooking too?” “Yes, she does the cooking with our mother,” George replied. “It comes across as if Ann works, does the groceries shopping after work, comes home to cook and does the rest of the house work? What do the rest of you do?” “I already told you that I am unemployed. My sister Susan is also unemployed and Robin is now in college. So it is Ann that has a job and pays for things at home. Our mother also helps to pay the bills with some of the benefits that she receives.” He was asked again. “Please correct me if I am wrong,” the doctor said. “So Ann works, buys the food, comes home to cook for you all, and clears up afterwards. Is that why you are demanding for her ‘release’ from hospital?” “No, that’s not why,” George answered. “We just want her to come home.” “Alright,” said the Consultant. “The ward team will review the information that you have given to us in the light of Ann’s needs. It will help us to formulate a treatment plan for her. We shall let you know the outcome in due course. Thank you all for coming to the ward round.” George shouted, “Is that it! Are you not going to ‘release’ her today?” “No,” answered the consultant. “She needs to remain with us for a few days more. As he was not the patient, it would be rather out of place to suggest to George that he should look for a job and also try to help with some of the house-hold chores. George stormed out of the room grunting some obscenities under his breath. He was followed by his mother and his sister, Susan. After the family’s exit, the consultant said, “This case presents a microcosm of the wider society. George seems to believe that he has a right to the things that Ann does to help her family. Ann on the other hand believes that she is helping her mother with the burden of looking after the family, but she is in fact denying herself a normal life while at the same time allowing the rest to abuse her generosity. If each of them contributed a little bit, instead of putting pressure upon one person, things might work out better for all of them.” It had become quite clear to the ward team that pressure from the family was the principle cause of Ann’s illness. Although she was not on any psychoactive medication, she had improved significantly during the two weeks that she had been on the ward. While on the ward, she was simply encouraged to eat well at meal times, to participate in ward based activities and to try to sleep well during the night. She remained on the ward for a further week to allow the ward team time to plan her care in readiness for her discharge meeting the following week. Meanwhile, George came to the ward almost every day to find out when Ann would be “released” from the ward. TREATMENT PLAN:
RELAPSE PREVENTION: The following to be consider. The following ideas were suggested in humour. But in actual fact, they seem to be what Ann needed to do in order to break away from the strangle hold which her family had over her life.
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