I'm a student nurse.. Currently, I am in a Psychiatric nursing rotation.. We just had our Christmas break, then we will resume again in January..
The essence of this message is that I would like to seek advice for my mentally-challenged client.. She's an old-adult with Paranoid Schizophrenia.. Will it be right for me to present her with reality or would it be a non-therapeutic approach because I would "challenge" her? I just thought that exploration or agreeing would just make her get indulged more with her delusions.. Another concern is that she told me that she did not like the previous student-nurses, she had nurse-patient interaction with, whom she said, "did not believe her (referring to her delusions).."
I'm just concerned with losing the established rapport with her.. We will still be meeting for 5 days for this coming January.. May I know what could be my possible approach or when will be the best time to start presenting her with reality?
The movie a Beautiful Mind inspired me that there's hope if the mentally-challenged client will be able to accept and realize the delusions on her own..
If it will be alright, encourage me to post her delusions if it will help with suggesting interventions.. If it would compromise privacy, I'll settle with "delusions.."
..to begin with, her main delusion was that she had a chip implanted in her brain so that these JFK followers (of bad CIA agents) can get information about her.. that was what the staff of the institution new, as well as my clinical instructor (since she did not personally interview clients, it was up to the students, she just knows the diagnoses).. Further nurse-patient interactions brought me to a continuation of the delusion that there was a neurosurgeon in the hospital she last worked at, whom she suspected to be the one who implanted the chip.. Then she told me that this person was the one being protected by the JFK followers and that this neurosurgeon stole money from her bank account..
..i tried to explore more by asking, "How much was taken?", "Were there money left?" She told me that only $5,000 dollars were taken.. I asked, "Can you recall an instance that you may have bought something?", and "Can you recall if you have lent your family members that money?" She continued to tell me that it was stolen.. Then, she refused to tell more because she said that it was a long story and that i should focus on the nursing care..
So I apply deductive reasoning to her situation:
I suspect this lady has experienced "voices" in her time - if not still. The experience of auditory hallucinations is most real. Think of an 'inner voice' - then give it a tone, pitch and volume.....
We don't know why or how this happens.
A chip in the brain - is often given as an explanation for all those unusual events we call 'schizophrenia' - where else would the voices come from?
JFK/CIA - Paranoia is a major theme (hence her diagnoses of paranoid delusions) - but then if someone was going around planting chips in people's heads - I'd be paranoid too! Who, of all the agencies, is likely to carry out mind-control?
Getting information about her - probably relates to all that information this chip in her head was telling her about herself. There's also a phenomenon called "thought insertion" where a person has thoughts but doesn't believe them to be their own. This might be a lesser version of the "voices".
Neurosurgeon - logical - who else had the skill to implant the device?
Then she adds it all up to it's natural conclusion ..... JFK and the CIA are protecting the neurosurgeon who put the chip in her head for the CIA to gather information and who are telling her things and putting thoughts in her head.
The $5,000 she lost - she probably has - some book balancing error - lost only in her memory but because her bank figures didn't add up one time - and since the CIA, JFK and the neurosurgeon are all in on this brain implant together.... that's where the money went too.
When we talk about 'entrenched delusions' - these are the ones that the person has simply come to believe and accept. They are bizarre explanations for a circumstance they find themselves in.
But, to paraphrase Sherlock Holmes on deductive reasoning - "When you rule out the logical, whatever remains, no matter how illogical must be true"
What's missing - what she doesn't have that we do - is 'insight' (which is another way of saying she can't tell reality from dysreality anymore - that the voices aren't 'normal' conversation) - we are aware that the cognitive events are not real - because we can't hear them.
But she can.... so she cannot simply say they aren't real - they are happening.
Tho if you could hear her voices too - would you say she was still deluded then - or just trying to reason what is going on? :)
Or if you were sat at home all alone and you became aware you could hear someone's voice.... but no one there .... how would you explain it to yourself?
..when i was interviewing her, she did not tell me that she can hear voices and she was very attentive during our conversation.. she told me that she was brought there for protection from the JFK followers/bad CIA.. the most i got to know was up to that $5,000 issue..
..with regards to her delusional family, i was not able to focus on it since she believed that they were real.. by computing for the ages she told me, i was able to verify that it was really a delusion.. the charts offered so little about the patients and we were not allowed to interview relatives..
It can be difficult - and sometimes it's simply not possible - to be sure about those parts of delusions that are partly reality-based and those that are embellishments of the truth - and those that are simply just delusional.
My comments above are certainly not a 100% explanation - but I like to apply that sort of thinking so it puts me in the context of 'understanding' a little better hopefully.
I also find it's also more intellectually stimulating than TV.
In relation to interventions on delusions - whether I would "reality orientate" or not depends on the impact of the delusion on the functioning of the person. If they're paranoid to the point that they assault people - then obviously I'd try to effect change. If they're distressed by the delusions then anything to ameliorate that distress is beneficial.
But if they're just 'off in their own little world' then I don't really see the need to upset that. Especially when it's not likely to last and the delusions might return or re-emerge in a different belief.
This is why I don't get into theological debates. What harm is it doing?
Her delusion was not good for those around her before she was brought to the institution.. She chased with a "bolo" those who brought her in.. That's why I wanted to remove her delusion about people who want to do bad things to her (as she perceived).. Or maybe just assure her that no harm will be done to her..
That's why I wanted to remove her delusion about people who want to do bad things to her (as she perceived).. Or maybe just assure her that no harm will be done to her..
Mr Ian
340 Posts
So I apply deductive reasoning to her situation:
I suspect this lady has experienced "voices" in her time - if not still. The experience of auditory hallucinations is most real. Think of an 'inner voice' - then give it a tone, pitch and volume.....
We don't know why or how this happens.
A chip in the brain - is often given as an explanation for all those unusual events we call 'schizophrenia' - where else would the voices come from?
JFK/CIA - Paranoia is a major theme (hence her diagnoses of paranoid delusions) - but then if someone was going around planting chips in people's heads - I'd be paranoid too! Who, of all the agencies, is likely to carry out mind-control?
Getting information about her - probably relates to all that information this chip in her head was telling her about herself. There's also a phenomenon called "thought insertion" where a person has thoughts but doesn't believe them to be their own. This might be a lesser version of the "voices".
Neurosurgeon - logical - who else had the skill to implant the device?
Then she adds it all up to it's natural conclusion ..... JFK and the CIA are protecting the neurosurgeon who put the chip in her head for the CIA to gather information and who are telling her things and putting thoughts in her head.
The $5,000 she lost - she probably has - some book balancing error - lost only in her memory but because her bank figures didn't add up one time - and since the CIA, JFK and the neurosurgeon are all in on this brain implant together.... that's where the money went too.
When we talk about 'entrenched delusions' - these are the ones that the person has simply come to believe and accept. They are bizarre explanations for a circumstance they find themselves in.
But, to paraphrase Sherlock Holmes on deductive reasoning - "When you rule out the logical, whatever remains, no matter how illogical must be true"
What's missing - what she doesn't have that we do - is 'insight' (which is another way of saying she can't tell reality from dysreality anymore - that the voices aren't 'normal' conversation) - we are aware that the cognitive events are not real - because we can't hear them.
But she can.... so she cannot simply say they aren't real - they are happening.
Tho if you could hear her voices too - would you say she was still deluded then - or just trying to reason what is going on? :)
Or if you were sat at home all alone and you became aware you could hear someone's voice.... but no one there .... how would you explain it to yourself?