Compel compliance what a good term to capture coercion. I have never liked the idea of compliance in medicine. I want to be invited not feel an imposition. Thank you for this post.
David,
Thanks for stopping by and sharing your idea of the link between compliance and coercion. Unfortunately the practices exist in all our institutions. The challenge seems to be how to expose them, and replace them with a more healing practice of empowerment.
Tom
Tom,
Healing would be great and neutral would even be fine but the negative element of forcing has such profound negative waves. So few leaders are skilled in "letting" rather than getting.
David
Letting, what a great idea, and simple. I think I need to just let things happen myself, if only I can "let go".
Thanks David.
Tom
The “gray-haired old fart”
Recently, I had occasion to be doing a psychiatric interview with a young man – around 18 years old – whom I had seen at monthly intervals about three times before.
He has a horrendous history of severe psychiatric disorders, and multiple hospitalizations for them throughout his teen years. He carries a diagnosis of “bipolar”, and has of course been recommended to take medication for that – to prevent mood swings, anger outbursts, depressions, etc. One of the most effective and most commonly prescribed medications for this condition is depakote.
He is very unhappy about the diagnosis of bipolar, and also is very unhappy about the recommendation to take depakote (which would be recommended for continuing treatment and maintenance for several years, if not for life.)
On the present occasion, he was once again very heated up in trying to persuade me that he did not have bipolar disorder. Unfortunately, his speech showed very clear evidence of what we call “pressure of speech”. This means that he was talking fast, and somewhat loudly, and was not open to any comments or interventions from me. He was very difficult to interrupt. Such pressure of speech is widely accepted as one of the indicators of a bipolar disorder (in its manic or hypomanic phase).
I was actually sympathetic to his wish to re-evaluate his diagnosis and his need for medication. But he was presenting his case with such pressure that I could not do much more than observe. I said, “I really want to understand what you are saying, but you are saying things so fast that I can’t take them in. Can you slow down?” This produced no change.
I also said other things, like, “You seem very eager to persuade me of some things.” These too produced no change in his pressured monologue.
So I said, “Look. I really don’t like to disagree with you about this, but you don’t seem to be able to slow down and stop talking like a manic person. So I am going to have to recommend that you resume taking depakote.” He continued with his pressured speech.
Finally, I said, “Look. There is something very interesting going on here. Why don’t you sit back, and let yourself relax, and just see what you notice about the interaction between you and me right here and now.”
Immediately, very coherently, he said, “Can I be blunt?”
I said, “Of course. Go ahead.”
He said, “Well, I really think that you are just a gray-haired old fart who just learned everything out of books a long time ago, and you have no idea how to relate to us young people.”
I listened, and invited him to go on. He made some elaboration of this thesis. As I listened further, I realized that his speech was no longer pressured. Without any further intervention on my part, he had slowed, had become much less loud, and was much more engaged with me.
I observed for a few minutes more, to be certain of the change. Then I said, “Look. You have slowed down. All that pressure that you had a few minutes ago has melted away, and now we are talking with each other much more normally. Your apparent mania has responded to an interpersonal interaction! So I don’t have to recommend depakote to you any more!”
Needless to say, he was pleased. Probably even more than I was!
Now, several months later, he has still shown no acute need for medications. One could make an argument that he really should be encouraged to take medication to protect him from further episodes of mania or depression or aggression, etc. One could also argue that the original diagnosis should have been “anger issues”, or something of the kind, instead of bipolar. But however that may be, I believe that the relationship that we have established, in which he can have some confidence in my listening to him and working WITH him, will lay some positive groundwork for better compliance with medications if an acute need arises.
(It seems to me that this is a clear example of the interplay of coercive power [of the medical/mental health “establishment”] vs. compassion and understanding. If anyone needs it to be further explicated, I would be happy to comply.)
Ralph Reeves
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