Thoughts About a Friend- part 1

By Lena U Carlsson. The text was written in November, 2000.

Picture above: L'eau dans Le Gaz, 1961, by Jean Dubuffet

In the column Solitary Beings I wrote about an art exhibition at Waldermarsudde that took place during the spring of 2000. Among the artists there were some who suffered from schizophrenia, and who created paintings before the introduction of antipsychotic medications. One of the psychic side effects with these medications is that the can inhibit the lust for life and creativity.

Large differences between departments
The exhibition at Waldermarsudde and the underlying story evoke some reflections about mental care of today. I got an insight into Swedish mental health services when a friend of mine got an acute psychosis some time ago. My friend, who not has been diagnosed as schizophrenic, was taken ill at two occasions following soon after each other. The first time she came to an emergency department where she stayed for a couple of weeks. The second time she stayed at a ward for long-term patients for about the same time. There was a striking difference in attitude towards the patients between the two departments. My friend has got artistic talents and she draws and paints a lot. She is also fond of singing. At the beginning of her psychosis her artistic sides blossomed out. At the emergency department she sang in the dining-room, and her song was much appreciated by the patients and the personnel. She was also allowed to go out for a walk with her relatives. At the ward for long-term patients, however, my friend was neither permitted to sing nor to go for walks, although she very much wanted to. The reason for the prohibition of singing was that it was unsuitable that my friend did things that she did not usually do! But she likes to sing even normally. The atmosphere at this ward was authoritarian, and the staff seemed to be organized in a strongly hierarchic way. After some weeks' stay in the psychiatric care my friend was discharged. She took antipsychotic medicine for a year. During that time she hardly fancied neither painting, singing nor reading any longer.

Suggestion on how to make use of creative needs
Should it not be possible to make better use of the creative needs and resources of the psychically ill? Why not create a special department in the basement of the hospitals, where the patients could get an outlet for their feelings without disturbing anyone. This idea was suggested a long time ago by a person within psychiatry. Musical instruments might be helpful, for instance large Japanese drums, which facilitate strong physical and emotional expressions.

Medication of psychotic patients
Of crucial importance in treating psychotic patients is the way medication is handled. The mental sideeffects of antipsychotic drugs have previously been underestimated by many doctors. Even today not every doctor seems to be fully aware of how the patients may experience these negative effects. According to the most modern view among psychiatrics, among others Tommie Lundberg at the hospital of Västerås, Sweden, antipsychotic medicines should be carefully tried during continuous assessments and talks with the patient. The aim is to attain a reasonable balance between symptomrelief and sideeffects. If the negative effects are too troublesome for the patient one should discuss and eventually try a lowering of the dose, a change of medicine, or an addition with another drug.

Sometimes psychotic symptoms may be tolerable, in exchange for fewer sideeffects. This issue should be determined in discussions with the patient. A person with a psychotic disturbance may be more or less aware of her illness. These circumstances influence the result of the dialogue and the consensus between the doctor and the patient. It is only in the case of compulsory institutional care that the doctor's opinion must sometimes be determinative, even if the patient has got a different view. Moreover, it is important that a patient gets the same competent treatment whereever the treatment occurs, Tommie Lundberg emphasizes.

Read the text "Thoughts about a friend- part 2"
Read about the art exhibition in the text "Solitary Beings"
Read more texts by the author in Lena U Carlsson´s Column