Question

You are a clinician in the psychiatric ward of the local hospital. A patient is refusing medication. Before medicating against his will, the likely next step, the actiing psychiatrist has asked that a therapist meet with the individual in a last ditch effort for them to take the medication voluntarily. You are that therapist and you are given the brief note found below before entering the room to speak with the patient. How might you address Mr. Johns?  

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Mr. Johns is a 34-year-old man diagnosed with paranoid schizophrenia. He was first diagnosed at age 19, and has been hospitalized several times over the past 15 years. In between hospitalizations, he has lived with his parents, who have supported him financially and provided for his basic needs. While he recognizes that he is unable to work and care for himself, he also feels that his parents are overly controlling and he desperately wants to be able to live independently.

Currently, Mr. Johns is enraged at being hospitalized against his will. As he sees it, he decided to move out of his parents’ home because his mother was trying to give him drugs in his food that would make him follow her wishes. In addition, he self-reported that whenever he fell asleep at home, his father would come into his room and read his mind, using his thoughts against him the next day. Naturally, he has been unable to sleep or eat under these conditions, and so decided to move out on his own. However, when his father saw him walking in the street, he began trying to force him into his car and bring him back home. When he refused to return, he called the police and had him admitted to the hospital.

Mr. Johns is adamant in his opinion that he has the right to decide how to live his life. If he wants to live on the streets or sleep on park benches, he says that is his right. He has been refusing to take medication because he knows that it only poisons his mind and keeps him from thinking clearly.

Answer 1

Since the patient is diagnosed with paranoid schizophrenia and having some delusions regarding the motives of his parents as a therapist I would first like to establish a trust with the patient by making him understand that I do believe in his delusions. Without making him this believe, any effort to give him medicine would add up onto his existing delusions and he might get sceptical regarding the psychiatrist's/ therapist's intention for giving him medication. After gaining his trust the patient can be asked if he has any physical issues which need to be addressed. Since he was already unable to eat and sleep preceding his hospitalization, the topic can be addressed by brought his attention to his sleep and appetite pattern which would definitely not up to the expectations what it should be. After getting even the slightest clue from the patient regarding his decreased appetite and insufficient sleep he might then be asked to have medications which would help him deal with these physical issues.