Mary was 86 years old. This was her third trip to outpatient day treatment after a stint as an in-patient. Mary had been with us four days this time. She dressed well and used her make-up like a pro. She had shoulder length, curly gray hair. She was well-spoken, intelligent, and gregarious. The other patients in the psych hospital day treatment program liked her. Mary was always able to show her "good" side for four or five days.
Mary loved group. She was often insightful and always empathic - at first. Since she was the oldest patient in our program, many looked up to her like their mother or grandmother.
The same patients had been in treatment together for four days. Before group one day, Sue, a patient, asked me, "Mary seems fine. Why is she here?" I reminded her of confidentiality and suggested, "Why don't you ask her?"
About half way through our group time, Sue's courage kicked in,"Mary, pardon me, but can I ask you something?" Mary turned towards Sue, smiled and said, " Sure, honey. You can ask me anything." "Mary," Sue queried, "Why are you here? What happened?"
"Oh, dear me," Mary began. "Can I tell her, Donna?" She asked me. "It's up to you, Mary. You can share, or you can keep your reasons private. Whatever you decide." Mary, continued, "What about the stuff about the doctor?" I replied, "Mary, share whatever you want to share." "OK," Mary commented, "What the hell!" and laughed.
"Well," Mary started her story. "Ya'll all know young Doctor Sam. His office is in the building next to us. He's a real cutie. Well, after having a few appointments with him, I knew he had a thing for me." I surveyed the group and noticed several raised eyebrows. "I told him I wasn't interested, that I was too old for him. But he persisted."
"What do you mean?" asked Gladys. "Well, hon, that man started driving by my house." Mary continued. " I called the cops. They came once and then stopped coming when I'd call. You know doctors have their connections." Another survey of faces found half in the group with knitted brows of puzzlement and the other half with incredulous looks of "Huh!?".
"But the last straw - and I hate to tell you this," Mary's face scrunched. "The last straw was when he came in the middle of the night. I was in bed and I heard this chopping and sawing coming from the roof above me. As I turned on my bedside lamp, a saw tip poked through my ceiling. The hole got bigger and I saw him: “Doctor Sam”. I screamed. He jumped down on my bed. Oh, dear, do I tell the rest..." I repeated the ‘whatever you want’ advice" and Mary continued."
"I hate to say this, girls," Mary said quietly. "But he raped me. Then he left. I knew it wouldn't do any good to call the cops, so I called my daughter." Mary's daughter kept a close watch on her mother, in spite of her mother's constant criticism of her.
Unbelievably, Gladys asked Mary, "Did they arrest the doctor? Is he in jail? That's so terrible, Mary." Most group members looked at Gladys like she was crazy.
Sue asked Mary, "What's your diagnosis, Mary? Mine is Bipolar Disorder." We routinely, with permission, discussed patients' diagnoses and their agreement or disagreement with the label their psychiatrist had hung on them. "I forget. Donna, what's my diagnosis?" I asked, "You want me to share?" Mary quickly answered, "Sure, tell'em."
"Mary's diagnosis is Paranoid Personality Disorder," I told the group. "And your assignment for tomorrow is to look up info about this disorder. Also, to look up info about your diagnosis. We’ll all share tomorrow." Group time was up and I said silent "Phew!" to myself.
Mary's Paranoid Personality Disorder often resulted in her feeling serially victimized. Her latest perpetrator was poor Doctor Sam. In the past, Mary had accused her now ex-husband, her brother, her sister, her neighbors, her daughter. The cops in her small Mississippi town did know her, and would usually check with her daughter before sending "help". Mary's problem was a personality disorder, not, for example, clinical depression which results in chemicals in the brain doing too little or too much, among other things. There was/is no known effective prescription treatment, no anti-depressant or anti-anxiety medication, that would help. Some improvement can be derived from a close, trusting relationship with a therapist.
During Mary's time with us, we would see her gradually develop a "problem" with a staff member or fellow patient. Her paranoia would sprout and flourish. It was always a challenge to interact with Mary, to try to figure out ways to gain and keep her trust, and hope she'd let go of some of her paranoia. Mary, and folks like her, could never be very happy for very long, believing, as they do, that sooner or later, "somebody's gonna get me."
Miss Althea, have a good weekend.