Alliance.

My daughter asked the hospital to send her a 'welcome pack'. I haven't seen it yet, she explained what it contained over the phone. To be honest it didn't seem to say very much. 

But one particular word used in the pack caught my attention.

Alliance...

Alliance is a noble aspiration, and something a set of people dedicated to caring for others shouldn't have too much difficulty in creating.

So what went wrong?
First thing, the psychiatrist we saw when we attended via the A+E drop-in, looked like a man who had been outside standing in the rain without a hat or umbrella for too long. That is how I summed him up at the time.

This was our first experience of 'how a psychiatrist talks' to a 'patient'.
Perhaps I categorized him as bored, annoyed, had enough...because of the way he spoke?
It must have contributed?

Anyway, a psychiatrist asks a person about recent events. The psychiatrist is interested in factual content. He is open to your phenomenological view....(your personal way of relating) but primarily the questioning - placed within a conversational tone of voice - is about time and dates and basically, are you able to provide a coherent narrative.

Of course, a person suffering a psychotic episode is full of fear and discomfort, and having someone ask for factual information about recent events can appear at first to be helpful, like the psychiatrist is interested in what has happened to you....but what has happened (your version of reality from your point of view) hasn't happened - you are psychotic (your account is a mess!) and the psychiatrist isn't interested in helping you to test reality to any depth greater than to see what happens when you are confronted with cold, hard logic.

It is more akin to provocation than anything else, 'lets see how the person reacts to being challenged'.

At this point, if not before, the charade of alliance goes out of the window.

If it had been me, I would have given Josh a letter for his GP requesting an MRI scan.
I would have held off the home visit team, created alliance by taking Josh's fears very seriously indeed, and definitely not have shouted at him (the psychiatrist and nurse were both shouting at him when, in despair or frustration he had zoned out of the interview - almost as if they were acting as if he had concussion and shouldn't be allowed to go to sleep!).

I would have asked if he would come back to see me when he had the scan, and we would talk about the result and decide to move forward only after the scan had been completed.

Josh was in distress because he believed he had a brain tumor or dementia.
He had suffered a catastrophic change...
Far from being mentally ill, he was anxious and the underlying problems causing that anxiety could not be addressed before he knew for sure he didn't have a brain problem.

Overall an MRI scan would have worked out cheaper for the hospital...
And saved the NHS a lot of money...how much does a night in ITU cost, surgery for fractured bones, a CT scan....
No need for the home team
No need for Citalopram...

I can't really believe how dumb this whole episode has been.
How tragic
How catastrophically awful...

All could have been avoided by an alliance?
By listening, by being rational, by avoiding treating my son as if his thinking was chaotic and meaningless?

Yes, actually!

Yes.