Blame Game
Posted by Dr. Vollmer on May 10, 2010
A year ago, Mitchell, https://shirahvollmermd.wordpress.com/2010/05/06/mental-illness-gratitude/ moved ninety minutes away. He still came once a month to see me, but recently, he had a setback. He stopped taking his medication and now he is massively depressed on top of his baseline of incoherent speech. He is not getting out of bed. He will not shower. He is eating too much food. Roxanna, his wife, is furious. She believes that Mitchell is deliberately making her life worse. Roxanna calls me to tell me “she is going to find a new doctor.” I respond “I can understand why you are upset, but changing doctors is a big decision. Maybe, I could see Mitchell and try to help him out. “No,” she says, “I think he needs a fresh look.” “I think a second opinion is helpful, but at the same time, I think I should see him because maybe I could help him get out of this crisis,” I respond. “No,” Roxanna replies, “we don’t need your help.”
I understand that without traffic, I am a ninety-minute drive, and now that Mitchell does not want to get out of bed, someone would have to drive him to my office. Since Roxanna works, she would have to take off a half a day. When Roxanna and Mitchell first moved, we discussed finding a doctor closer to their new home, but Mitchell insisted that he wanted to keep seeing me. When Mitchell is doing well, he enjoys the drive to my office; he enjoys seeing me. Now, the tides have turned, and Mitchell is no longer able to help himself. Roxanna has to take charge. Roxanna’s angry response is easy to understand. She is frustrated and confused by Mitchell’s situation. She would feel better if she could focus her anger. I am a temporary target.
Mental illness is a heavy burden for the individual and his family. How does one get angry at your loved one’s brain? How does one tease apart personal responsibility from a brain disease? How does one understand good medical care in the case of a challenging medical condition? How does one decide the importance of a longstanding physician-patient relationship versus the ease of proximity? Who does one turn to for advice? What about the shame? These waters are tough to navigate.
I worry about Mitchell. I call Roxanna and say “can I help you find a second opinion?” “No” she says abruptly. “OK, let me know if there is anything I can do. I would be happy to speak with another psychiatrist about Mitchell.” “OK” she responds hastily. We end our conversation on a rough note. I feel for Roxanna. She needs to decide how to help Mitchell. I wish she would call Mitchell’s mom, Sherry, but Roxanna does not respect her. I move from feeling Sherry’s gratitude to feeling Roxanna’s anger. Briefly, I feel the intensity of the ups and downs of Mitchell’s life.
Shirah Vollmer MD 
Shelly said
Of course Roxanne doesn’t blame you for Mitchell’s decline, she is just frustrated at the situation she feels herself in. Roxanne became, instead of a loving wife and partner, the caregiver of a mentally-ill spouse. This is not a role she ever imagined for herself. Sherry, being Mitchell’s mother, does not understand Roxanne’s situation and burdens; she focuses only on her son. As you mentioned in your previous blog, Roxanne bit off far more than she can chew–she married Mitchell without knowing his diagnosis, and instead of a partner, he became an adult child for her to take care of.
Do you feel that Roxanne is blaming you for Mitchell’s decline? A patient who goes of his meds makes his own decision, even if that decision is against his own interests. Speaking for Roxanne, she just feels overwhelmed and overburdened. I imagine that the best thing you can do for her is to convey understanding and empathy for her situation.
Dr. Vollmer said
Yes. You are right. Roxanna is really frustrated. I understand that. She is forced into the role of a caretaker. I feel for her. My point was that from Sherry’s point of view, I have been very helpful, whereas from Roxanna’s point of view, I am “too far.” If Mitchell did better, Roxanna would feel better about taking him to see me, but at the moment he is doing poorly, so she does not feel like it makes any sense to make an appointment with me. It seems to me that Roxanna’s frustration with Mitchell’s illness has spilled over into frustration with my work with Mitchell. I think the title “Blame Game” is misleading. I want to think about that some more.