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Dear Dr. Batya,
I have a child (age 25) who has been under psychiatric treatment for a number of years.
The child was doing better but stopped taking medications several months ago, started self-treating with St. John's Wart and garlic and now has regressed.
Anytime we, the parents, attempt to complain about the lack of medication, the child has been given a mantra - "I have to listen to Dr. X and not to you." We are becoming more desperate as the situation is becoming more difficult and has the potential to turn into a catastrophe. The doctor seems to be oblivious and ignores our input. The doctor feels his responsibility is to his patient and is relying solely on 45 minutes of input a week from his patient.
Is there any way I can intrude into the doctor/patient process to inject a dose of reality? The situation is quite scary and I feel a responsibility to the public at large to either get my child off the streets before something bad happens or get the child back on medication.
After treatment for almost two years, the doctor still has not come up with a diagnosis. Is this normal? I keep asking the doctor what he's treating if he has no diagnosis. - Desperate Parent
Dear Desperate Parent,
It sounds like you've had your hands full for quite some time. I hope that someone is able to hear your concerns. Your son has tuned you out and his doctor has not brought you into his treatment plan. He has also chosen not to listen to you and seems not to be available in any way to hear your concerns.
From your letter, it would appear that your concerns are quite serious. There is a fine line between being intrusive into an adult child's treatment and being a concerned parent. Clearly they seem not to want your input and no one has suggested a family session which, depending on the circumstances, might be appropriate if everyone were to agree. While you don't feel that you have a relationship with your son's doctor, I am wondering whether he has one and if so, is he happy with his psychiatrist and their relationship.
While the psychiatrist has a confidential relationship with your son and will therefore not be able to tell you anything unless your son agrees, perhaps you could set up an appointment with him to voice your concerns and ask general questions. This would at least make the psychiatrist aware of your grave concerns.
You have described your son as having regressed, not taking his prescribed medication and instead self-medicating. One question that must be asked is whether your son is indeed dangerous to himself or to others at this time? If so, your son's doctor must report this and you should definitely go to the police. You have said that your son is taking St. John's Wart, which is a homeopathic treatment for depression. I never take any medication lightly, whether prescribed or over the counter, as both have potential side effects and can cause difficulties in other areas of functioning.
Of concern to me is that while you say your son has been in treatment for almost two years, he does not yet have a diagnosis. The main reason one makes a diagnosis is so that in seeing an identifiable cluster of symptoms, one can then work with a patient to formulate and develop an adequate treatment plan. A diagnosis should not be given simply to label a patient. While in general I prefer short term solution focused therapy, there are some patients who indeed are in need of more intensive psychotherapy. Patients who are suffering from depression often fall into this category.
Two years of treatment is sufficiently long that one would like to see signs that treatment is indeed advancing. The amount of time in therapy is less of a concern to me than the lack of progress or even the regression you describe. In addition, if your son has no relationship with the therapist, then it sounds to me that it may definitely be time to move on. From a clinician's standpoint, if your son is really no better or worse at this time, than the psychiatrist must seriously examine why the current plan is not working and look to consider what needs to be changed.
Finally, you are concerned that the situation has the potential to turn catastrophic. Remember, at the end of the day, this is your child and you as a parent have a right to try and have your child's best interests looked after. It is never easy to deal with issues that our children present. He is fortunate in having you as his advocate.
The writer is a licensed clinical psychologist in Ra'anana. This column offers general psychological advice and is not intended to replace treatment by a mental health professional.
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