Alan stopped talking abruptly, tilted his head, nodded, and then finished his sentence. However, Alan wasn’t speaking to anyone that others could see. Alan was a patient at the Adult Day Care Center where my therapy dog Wendel and I work.
The diagnosis of Psychotic Disorder can be devastating, as I’ve observed in nearly thirty years working as a psychiatric nurse. Psychosis can take many forms and usually involves some type of hallucinations (auditory and visual being the most common, with smell and taste involved occasionally) – the patient responds to stimuli not actually present. In addition, delusions – false beliefs or opinions – are often present and interfere with normal activities. Deterioration in self-care abilities usually accompanies the disease and the person requires careful monitoring and medicating.
Diagnosed in his early twenties– a fairly common age for a first-time “break” — with schizophrenia, Alan’s functioning had continued to decline thereafter. Gone were outings with friends to the beach, his steady girlfriend and a college degree. Unable to keep a job and support himself, his family had abandoned him. His state-supported life-style was simple and routine – his “relatives” now had become his caretakers at the Board and Care home where he lived and the staff at the Day Care Center. Close friends consisted of other participants at the Center, many of whom had been attending for years.
This program hosts participants from five counties with low income, chronic illness and imminent risk of in-patient hospitalization being the criteria for admission. Transported in daily for groups, socialization and on-going assessments – the Center offers respite from lives ravaged by disability, crime and despair. So it is that Alan had joined Dr. Wendel’s list of patients. The doctor, as he’s commonly called (Wendel has advanced degrees in psychiatry and the elderly), has the right medicine in most cases. Reality orientation is part of Wendel’s amazing ability; reminding patients where they are and bringing them back to the present. Wendel is able to miraculously connect separate worlds, and as Alan’s monologue got louder, I cued Wendel. In addition to his scholarly accomplishments, Wendel always dresses in colorful outfits and is highly trick-trained. A little paw touched Alan’s leg.
“Oh, hello, Wendel – look how cute you are!” Alan exclaimed as he’s drawn out of his thoughts.
“Let’s get you some breakfast, Alan,” I said, as I brought the therapy session to a close.
This incident would play out numerous times during the morning, with frequent re-direction most helpful in Alan’s case. That is, until lunch time.
“I’m not hungry,” Alan stated emphatically. With gentle prompting, it turned out that Alan was convinced that the kitchen workers added arsenic as a seasoning.
“Would I let Wendel eat poison, Alan?”
“No, of course not,” Alan responded. And with that Wendel happily obliged for his now favorite patient and savored a mouthful of tuna salad. Alan carefully observed Wendel for any signs of adverse reactions, and satisfied that his meal was indeed arsenic free, dove in.
Alan’s suspicions gradually subsided over the next few weeks and then switched to a dread of pencils (“lead contamination”) – equally disruptive but not nearly as interesting to Wendel. Alan’s condition stabilized with a medication adjustment, however, Wendel kept a close eye on him for quite some time, especially when lunch was served.