Monday, March 17, 2008

Creativity In Psychiatry, I

Partly, I went into psychiatry because it seemed like the most creative of the medical specialties. I enjoy employing my imagination, and my clients'. I like trying creative therapeutic "prescriptions".

One of my current clients had been on high doses of both a stimulant and a sedative, prescribed by his previous psychiatrist. He was confused, anxious, and having memory problems. Over the course of several months, I tapered down both medications, with positive results on his mental state. We got him off the sedative altogether, and got the stimulant down to just one dose first thing in the morning-- but he couldn't seem to give up that last pill. "I can't get out of bed without it", he said. "I leave it on my nightstand with a glass of water, and I take it when I wake up, and 15 minutes later I have enough energy to get out of bed. If I don't take it, I just roll around in bed, but I can't get up. I really need it to get going." I didn't argue with him. I said, "I absolutely agree that you that you can't get going without the stimulant. You need to have it. But you are wrong about being unable to get out of bed without it." He protested that in over a year he had never been able to get out of bed without taking the medication first. I said, "You've told me that you roll around in bed before you take the medication. To get out of bed, all you need to do is roll in one direction until you fall out of bed. It's possible that you can't stand up without the medication, but you can certainly get out of bed. So here's what I want you to do: Put the pill and your water on the floor near your bed, but just out of reach. When you wake up, roll till you fall out of bed onto the floor, then reach for the medication and take it. You won't have the energy to do anything else for 15 minutes until the medication kicks in. So just lie there on the floor until it does. Or if you get a little energy after a few minutes, you can get back in bed while you wait for the full effect, then get up. Until you try this, I can't believe what you're telling me about being unable to get out of bed."

He thought this was kind of crazy. He didn't like the idea of lying on the floor for a quarter of an hour in the morning, and put off implementing my "prescription" for almost a month. But eventually he tried it. He reported that on the first day he rolled over to fall out of bed, but it felt "silly", so he just stood up to reach his pill. While he was up he also went to the bathroom, then went back to bed to "wait for the pill to work". On the second day he did the same, but something distracted him while returning from the bathroom, and he didn't make it back to the bed. After the third day he stopped the pill altogether, and hasn't taken one since. (He was so unsure that he could survive without the stimulant that he took No-Doz for a few more days, but finding this gave him horrible jitters he quit that too.)

It was a good plan, I think. Coming later: Creativity II.


Blogger Graham said...

Good post!

3/18/08, 10:47 AM  
Blogger Ladyk73 said...

This made me laugh! And so true! :O)

3/18/08, 8:29 PM  
Blogger fibby said...

Brilliant! Absolutely brilliant.

3/22/08, 12:42 PM  

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