(Not) Just Another Day at the Office (continued)

How pregnant his replies are! A happiness
That often madness hits on, which reason and sanity
Could not so prosperously be delivered of.

Polonius


A young fellow comes in, for a routine check-in after hospital discharge. He has been diagnosed with schizophrenia, although he disputes that (surprise). But he protests that what he really needs is not "pills," but rather housing and a job. "All you all ever talk about is pills...always more pills...what am I supposed to leave my kids, a bunch of pills?"

Good question. Fortunately his community support worker is sitting in with us; hopefully she has all kinds of great ideas for him. His last job was $7 an hour at Biscuitville, and with gas prices being what they were then, what was the point, really? The Obama campaign/transition team keeps sending me emails--what are they going to do for him?

Another guy, middle-aged this time. It sounds like he was quite successful, with a high-paying sales job and a family until he developed a severe psychotic disorder several years ago. Since then it has been steeply downhill, with several hospitalizations, disability, and divorce.

I had first met him a few weeks ago, when his family brought him in in a floridly psychotic state. At that time he was disheveled, paranoid, and exhibited thought-blocking. This time it is after his discharge and I barely recognize him. To be sure, his appearance is subtly off: a few hairs out of place, and a jacket that is a bit too long and too bright. But he is making an effort, and arrives early for his appointment.

He has been put on prodigious amounts of haloperidol, both oral and by long-acting injection, but he tolerates it without complaint. His chief concern seems to be a compound of loneliness and futility. He is heartbroken over not having seen his kids for months, and his ex-wife seems to have been able to deny him access. He wants to look into working and being productive again, like he used to be. Yet he sheepishly allows glimpses of persisting delusional systems. I don't think he could or should hold a regular job at this point. He lives alone, but does attend a church, and has some support from his family of origin. He has lost almost everything.

Why?