WTF, or Transitory Irritation

So, Tim’s caseworker emails that she wants to have a family session by phone to talk about what happened the Wednesday before Thanksgiving.  I know, I’m repeating myself, but that’s where today’s freak out (on my part) starts.

I set up a time with her for tomorrow, and off-handledly mentioned in my email that they usually don’t go well, because Tim doesn’t like it when we talk about him when he’s there.  She said that Tim had said that as well (which I think is great insight for Tim).

Then she went on about how he needs to understand the different rules and expectations between “school” and home and how he can “behave” better at home, like he does at school.

I went bona fide ape shit on her, in email, which isn’t good.  But she’s Tim’s third caseworker in 18 months and I get freakin’ sick and tired of these 12 year old, just out of grad school, haven’t ever seen a kid with psychosis before numbskulls telling me that my kid is just fine there, he just acts out at home.

Here’s verbatim what I emailed.

Is he calmer there than at home?  Really?  I’m not sure that’s really the case.  I just got November’s report – 5 incidents where he needed to be restrained in November sounds exactly par for the course for November.  He has 21 last January, and Nov – February are his typical times of high agitation and psychosis.  Are the rules really different?  You experienced exactly what we do with his last blood draw. Refusal.  Irrationality about it (although, in the case of the blood draw, maybe not that irrational because the tech had stuck him in a nerve).  

What I don’t want is this to be a “why do you behave here and not at home?” talk.  Tim needs to learn better ways of coping with and expressing his anxiety.  He has anxiety about going to the dentist, not being home. This is no different than when he experiences anxiety there at ODTC.  What techniques are you working with him on to express and cope with anxiety?  What happens when he goes catatonic, or gets very agitated and violent there?  This is not a behavior at ODTC / behavior at home differentiation.  

About 6 months after Tim had been there, we got a call from Casey, Tim’s previous caseworker, because he’d seen Tim get very agitated, go catatonic for nearly an hour, and then rage.  He’d never seen it before.  It took a lot of restraint for me not to laugh, when I asked him, “why did you think Tim was there?”  Tim’s anxiety and fears are irrational.  They’re delusional.  HE’S GOT SCHIZOAFFECTIVE DISORDER.  

It’s not about behavior at home vs at ODTC.  I hate to keep harping on that, but it’s not.  He has the same anxieties and irrationalities and delusions there.  I want to know what you’re doing therapeutically to help him cope with them.  I’m tired of being blamed for the rules at home being different, or not parenting a certain way.  I’m sorry I’m being defensive, but you’re the third caseworker he’s had, and we go through this every time.  It’s like you guys have never seen a child with a psychotic disorder before.  
Some days, I feel like all we’re doing is warehousing him.  

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  • GB's Mom December 7, 2010 at 1:58 am

    I would put money on the fact the baby caseworker has never dealt with a psychotic break. I have dealt with an ER doctor who didn't recognize one when he saw it. It gets old fast.{{{{Hugs}}}}

  • Meg December 7, 2010 at 1:59 am

    I've sent many an email to many a person that look much like this. Don't feel bad. I can get really heated on this topic as well. My son does not have the level of psychosis yours does but nonetheless he was in the hospital once and they said they didn't understand why he couldn't control his emotions better. Hello (!?) That's why he's in the hospital (?!) What am I missing here??

  • Chrisa December 7, 2010 at 2:02 am

    Thanks, to both of you, and the friends that sent me comments on Facebook. Sometimes I really just need to hear that I'm not the only one losing my mind, or the only person who feels they're getting jerked around a bit. One friend did remind me that I have often had good things to say about ODTC, which is true. And they outnumber the bad. I don't know why it still shocks me when a licensed clinical social worker doesn't know what psychosis looks like. Guess I'll just need to school another one!

  • Anonymous December 7, 2010 at 3:53 am

    My favorite was when my psychotic brother, brought to ER catatonic, got a newbie doctor who told us his problem was that he had too many dominant women in his life — not enough male influence. Like a newbie doc had more "insight" than those treating his schizophrenia for the previous 10 yrs!!!

  • Templeton's fury December 7, 2010 at 12:08 pm

    Dear Chrisa,

    thanks so much for stopping by my blog…While i am not a parent, i do work in a RTC for adolescents. I could identify with your frustration regarding the case manager. You say u kinda feel like a bitch sending the email, however, those of us who are in the system and have loved ones receiving support services are all too aware that WE, oftentimes, are the voice for the child. The squeakest wheel gets the grease. It shouldn't be that way, but that's the current state of our mental health system. People (caseworkers, physicians, aids, etc…) are frequently unclear about the difference between psychotic children and oppositional children (and then all bets are off when u see both!) Behavior mod isnt going to work for the shizoaffective kids. The whole assumption is that they are incontrol of their moods/actions, which is NOT THE CASE!
    i could go on forever but i just wanted to tell you to keep you chin up, keep advocating for your son, and keep the best moments in the forefront of your memory. best wishes to you and your son

  • Anonymous December 7, 2010 at 12:08 pm

    Sorry to hear this Chrisa…It seems you have to be not only his mom but his counselor as well and yes to School these dimwits once again! Social workers are not the best to understand Psychiatric patients. That is not what they are trained for. Wonder why he doesn't have a Psychiatric RN as his case worker, seems a better fit. We as a nation have fallen down on the job of taking care of the Mentally ill with the closing down of so many treatment facilities in the past 20yrs or so. To many families are left on their own to figure out what to do, it's soo sad. You are doing the best you can Chrisa, just know that…Heike