oOur Experience in England 2003
Written by Ann Rosberg


In 2002, we started corresponding with a woman in England who located us on the website.  We exchanged letters frequently.  She told us about her sister who she said had a 20 year history of schizophrenia and she and the family had been looking for a source that might offer some understanding and direction towards treatment.  She had been part of the public system and her only form of treatment was medication and hospitalizations.  There was no direction and they, the family, felt a sense of frustration and had no understanding of other resources that might offer some help.  In the summer of 2002 Sara
came to California to visit some of her family and she made an appointment to see Jack and I in order to get some understanding of what might be done to help her sister, Jane.  We talked for quite a while and we made a tentative agreement to come to England for three months.  When Sara returned home, she discussed the situation with her parents and other members of the family and they agreed to our conditions and we then began making arrangements to come to England and work with her sister, Jane. 

In mid January, after a long flight from California we arrived in London and met Jane's mother who had come to the airport to pick us up.  We were happy to meet each other and it was a warm and friendly welcome that she gave us.  It was cold and blustery outside, but that didn't matter.  What mattered to us was that we were on another long journey to try and help another person with the diagnoses of this condition called schizophrenia.  After a drive to the suburbs of London, went to our flat and settled into life as it is in England.  We sat in our flat and had a pleasant talk with Jane's mother for some time over a cup of tea.

We contacted Jane's sister Sara to tell her of our arrival and asked her if she would introduce us to Jane in the next couple of days.  We needed some time to overcome the jet lag.

However, the very next day after talking to Sara, we were feeling much better and Jack thought that it might be a good idea to call Jane and invite her over for a cup of tea.  I called Jane and she was delighted to be in contact with us and gladly accepted our invitation to come for tea.  Her flat was just a short distance from our flat.  It had been arranged that we would not be too far apart, which would make it easier to work with Jane. 

In just a short while, she was at our door and I noticed as I opened the door, that she was a little nervous and also excited to see us.  After our introductions to each other, we offered her some tea and biscuits.  She was very nervous and as we sat down, she wanted to immediately talk to Jack about her troubles and some of her pathological symptoms.  Jack told her that he thought it would be a good idea to just sit down and get to know each other, first.  This was a good understanding and she seemed relieved by this.  I think that in the past, she had always related to a professional with her problems, immediately upon contact.

The next day was very different.  She came with her sister Sara and stayed for just an hour or so.  She became extremely anxious and perhaps overwhelmed with the thought that the four of us were going to have a lunch together.  She became acutely disturbed, she expressed a great deal of fear of Jack and it seemed almost delusional because she saw him as a dangerous person.  She said 'sorry I have to leave' she went towards the door and her sister and I tried to persuade her to change her mind and stay and made an effort to modify her fears.  Jane after a while said, almost in a scream, 'I can't, I'm schizophrenic, I'm schizophrenic.'  Since there was no way of stopping her or persuading her to stay, she managed to open the door and take off down the street with her sister by her side trying to change her mind.  Sara did not succeed.  Afterwards she, Jack and I sat and talked.  Sara was obviously quite disturbed about not being to stop her sister from leaving.  Sara left quite distraught.   

The next morning, Jane wrote us a note, put it through the mail slot at our front door.   In the note she told us that she could not see us anymore, because it would destroy her spirituality.  In this letter she apologized and felt that she had to discharge us from any further interaction with her.  It was interesting to us that she felt compelled to write us a note and drop it off.  If she really didn't want any further contact with us, it would have been better to just let it go.  There was obviously something there.
 
Jack called her father, who according to other members of the family has considerable influence over Jane.  He told her in no uncertain terms that she had to see us this was her last chance in terms of improving her condition and her relationship with her family.  It wasn't a request on his part, but an order because he cared about her. 

I called Jane and made arrangements to meet with her at her apartment and we would go to the town and have a cup of coffee and talk, she accepted this.  We met at her flat however, she would not let us enter, which we understood because of her fears.  She came outside and we walked to the café.  As we walked we talked about the previous day and how she had perceived us.  She was apologetic and when we accepted her apology  and she then felt that was enough explaining, she just stopped and said 'well, enough is enough'. 

We spent a long time in the café, it was cozy and warm.  We spoke together just the three of us for some time.  I should mention that Jane is a heavy smoker and she didn't even want to go out for a cigarette break, because we were sitting next to an English couple and I think it was they who started off with a conversation with us.  Jane was able to interact with the English couple sitting next to us in a jovial and congenial way.  We all had a good time.  We walked around the town a little with Jane as she wanted to show us her city.

It's very important to understand that the relationship with a person with any serious condition is critical.  If you don't have that, there is not much you can do to help that person overcome their conflicts and problems. 

Treatment conditions were far from being traditional.  Jane lived by herself.  There was no support system and we felt that in order for treatment to achieve some degree of success, we had to organize the family into a support system in order to affect a consistent treatment process. 

Jack, the father, the mother, and sisters were in contact many times over the phone.  We not only thought it was good to give some idea of treatment but as I said, to utilize them as a support system.  During our conversations with relatives, we never broke patient confidentiality.  But it's important to bear in mind that her family lived in different parts of England.  It's important to know that they had moved out of this lovely little city, so you see that Jane is all alone here.  She doesn't have any real friends, just acquaintances on the street.  She rarely goes into town on her own at this point.  She has many fears including the fear that people are talking about her.  Her flat has become a mini institution and in it she feels depressed, paranoid hears herself, she says, being talked about on the radio and being photographed through cracks in the ceiling.  This is a very lonely woman whose depression makes her create psychotic like symptoms. After a while, it became apparent to Jack, even though she expressed the symptoms that I mentioned that she was not a person with schizophrenia.  She was given to dramatics and hysteric expressions which fit what was happening, in the sense that she didn't want to cope with stressful situations.  She used these expressions to keep the world at arms length.  Jack found her to be more accurately diagnosed as a Histrionic Personality Disorder and as a secondary diagnosis, Severe Depression.  Her misdiagnosis as having schizophrenia led people to treat her as if she were some untouchable person like a leper in our society. 

Her family had very little contact with her because they regarded her with contempt for several reasons.  She was rude, insensitive and apparently self serving and her behavior was unacceptable.  The family saw her as being unmanageable they were convinced that she was very schizophrenic.  It was important for us in view of the fact that we needed them to support our efforts to redirect their perception of her into a healthier perspective.  We feel very strongly that she is a person and that there are parts to her that have been obscured by her illness.

Let me quote you a letter that Jack wrote to her father who he had been in contact with frequently.

Dear Ian:

Our experience with Jane has been quite interesting so far.  I want to inform you and I hope that this also gets through to the family that it's time for everyone to stop regarding Jane as some hopeless cripple, if in fact anyone does.  She has had a long history of a difficult condition, has not been exposed to treatment that was designed to do anything but mask and control some of her symptoms.  There was a sense of hopelessness about her that was perpetuated by the mental health system here, which is guilty of neglect and pessimism.  The stigma attached to mental illness perpetuates the condition it makes the person feel odd and unacceptable.  It makes a person look for certain strategies that will help them survive in a world that they feel is dangerous and also un-accepting.  When we look at Jane, we don't see that in her.  We see a person who has many good qualities, a person who has many healthy parts to her, a person who is lonely, a person who would like to have hope but has no reason to believe that she can live like the rest of the world.

I understand how people feel in the family after viewing her struggles, her symptoms and some of her inappropriate behavior.  In my opinion, as a seasoned professional who has seen many 'Jane's' in many parts of the world; I believe she can recover but there are responsibilities that she has to accept and I see that as gradually developing. 

Certainly Jane is capable of fooling us, but not completely.  However, the last several days she has been open in volunteering information about some of her problems.  There are two ways of looking at this, one, is to test us to see our reaction and the other is to get some relief and understanding from us so that we can offer her what she needs. 

She has been very responsive to Ann, as you know and it seems to be growing stronger.  When I talked to Sara yesterday, she was rather surprised when I told her that Jane was laughing and was very humorous, but she also told me that she had talked to Jane some days ago and thought that Jane's voice sounded different.  I have confronted her as I told her brother Edward I would, not in a harsh manner but in a way which told her that she could not control or manipulate us.  We are here to help her, we have made an arrangement with you and as a matter of fact, we told her we might even need to extend the time.  She did not object to that. 

Let me inform you of a simple idea of treatment.  If you listen to an individual who is also a patient, after a while they tell you what to do.  She is telling us now, not directly of course, but by her response and her mannerisms.  We know that the worse part of her day now is when she is home alone and especially at night.  When we are out together in the town or when she is here at our flat at this point in time, there are no visible symptoms. 

If any of you see me as being naïve I think that you need to understand that I am an optimistic person and at the risk of being immodest, I am a uniquely qualified person.  Ann makes a strong contribution to our efforts with Jane.  She by the way, this Friday has made an appointment with her social worker to go to the college and enroll for a course. 

We went shopping today and she bought herself a pair of shoes.  She was so pleased, that she did a dance in the isles!  She left, she was happy and I sense more optimism in her.  Of course we will have set backs from at times, that's the nature of life.  As I mentioned to you yesterday, who amongst all of us wants to change!  Why should Jane?  Even though her life has been unkind to her, it is familiar and without it, that is her condition, she doesn't know what to expect.  We have to help her find a way that she can see and touch and if the fear arises in her because of that, we have to help her overcome it. 

So, pulling her out of the dungeon of despair will be a gradual process.  She and we have agreed not to move too quickly because you 'can't grow all of a sudden'. 

I hope that the family will continue to be as supportive as they have been and also make contact with her, at least by telephone on a more frequent basis.  She needs all of you.  She believes she says, that you love her but you know actions are louder than words.  She needs contact consistently, she needs to feel wanted, she needs to feel like she is not some kind of freak in some side show.  I see more and more a good person who needs all of us.  We are determined!  I feel quite certain that given enough time, you will see the Jane that you knew many years ago. 

Cordially,
Jack

Each day we spend with her she seems to be more cheerful and more trusting of us.  It's important to have the trust of the person who we are trying to help because without that trust there is no treatment.  She told Jack before we left her flat that we had helped her already.  Jack asked her how and she told us 'by taking me out of my flat and the loneliness I felt there and when I thought the radio was talking to me I can now see that it really isn't true and that talking to you made me feel much better.'  We felt that her flat had become an institution to her.  In it she could act psychotic and I emphasize 'act' but when she left, and communicated with people, there were no symptoms to be seen. 

One of her strategies, when she feels threatened is to make an effort to arouse people's sympathies by saying, "I've been sick for so long" which is intended for them not to ask anything of her because there is only so much she can take at any given time.  That excuses she thinks, her hysterical behavior and pushes people away from her and allows her the right to be anti-social.  When I say anti-social, I mean just that, because she throws tantrums like a child.  She will make a face and pretend that she is going to cry   pleading in a whining voice.  She has also said, "Don't you feel sorry for me?"  

We have spent a great deal of time with her and she and I get along because she does not see me as a threat.  I think that she knows that Jack is strong in his beliefs and will not tolerate her anti-social and irrational behavior.

Another day, we met Jane in her flat and she had purchased two used sofas.  She didn't like the color of her sofas, so she went into town and bought some covers for them and also some curtains.  We felt that making changes of this sort was promising because it added some color to an otherwise Spartan institutional like area.  She had redecorated her flat and it was comparatively attractive.  We complimented her, which pleased her a great deal and then she decided that we should go to the center of town and look at some shops.  We did go to a bookstore and stayed for a while, then went to a small café where we had lunch.  She had made arrangements at the library to exhibit her artwork and while at the café she decided she wanted to advertise it and dictated an announcement to me.  The announcement was well done and remarkably so for someone who was diagnosed as being schizophrenic for so many years. 

She constantly complained that the medication had caused her a great deal of discomfort and she felt that she could not continue the injections she received every week.  She had been taking this particular medication for several years and according to her, it made her think in an unclear manner and made her sleep too much.  She decided that she would discontinue the injections.  Understand that she received treatment from the public sector.
So her alternative was not to show up for her injections.  She did this with a great deal of anxiety because she was afraid that they would come and hospitalize her against her will.  In England, a psychiatrist can 'section' a person and hospitalize them if they feel that the person represents a danger to themselves or to others.  I must state, that this was her idea, we did not encourage her, we were in fact concerned that if she did this that there would be many regressive symptoms as a function of the medication withdrawal.  She continued to avoid the injections and her initial reaction was one of increasing clarity and also she felt physically improved.  The 'whole world seems different to me now'.  She was more energetic. 

Interesting thing that I need to insert here was that she had been complaining about physical pains throughout all her body.  Head, back, legs, etc., and she attributed these pains to many years of medication.  I knew that some years ago in a fit she had cut off the tip of one of her fingers, tragic!  On the phone, she told me that she had resolved the pains in her body by binding her finger and putting her arm in a sling!  Sounds crazy doesn't it?  But not if you understand her flair for dramatics, which will be more clearly demonstrated shortly. 

We finished the lunch, which by the way, contrary to the experiences reported by her family, she ate slowly and carefully, obviously enjoying what she had chosen.  To clarify things, we were told that when she was with them she gulped down her food so rapidly that she was finished before the family members began while they were together in a social setting.

After lunch, we walked around for a while and without any apparent reason she said 'I have had enough for today, I can't take anymore, it's too much after all I have been isolated for so long I can't take all this pressure of being out.' The pressure of being out being in the world with all these people around and there were many people around, it was a Saturday and that's a market day and many people milling about, shopping.  She took off and both of us were upset with this, she was controlling, made decisions with no consultation or discussion with us and the more we thought about it, the more upset we became.  After she left, Jack thought that it was time to confront her with how she controls the world around her which helps her stay sick.  We didn't feel we could continue participating in this method of controlling us which she used so frequently with us and also other people as well.   

We went to her flat, she let us in, and I told her how I felt, that she had been rude and that this was not the way to treat people who were trying to help her.  Jack joined in and told her that she was dishonest and manipulating and controlling and in no way would we continue to tolerate that!  She denied this and they both began yelling at each other.  To change the direction of the confrontation, she showed Jack a book on medication being addictive.  However, Jack would not be taken in by that tactic and he told her that he resented her attitude and her treatment of us.  She said with emphasis, 'don't you feel sorry for me?  Have you no pity for me?  Can't you see I have been sick for a long time'? However, Jack continued confronting her that there was no excuse for her rude and disrespectful behavior.  She began to pretend that she was crying and then the tears she shed turned to laughter and she then tried to imitate Jack and nothing influenced Jack to change his direction.  After a while, not being able to control the situation, she got very angry with us and ordered us to leave her flat, which we did for that day.  

A quote from Jack:  "She plies on people's sympathies by saying, "I've been sick for so long" which is intended for people not to ask anything of her because of her illness, there is only so much she can take at any given time and of course that excuses her irrational behavior which pushes people away from her and in a way forces them to accept her anti-social behavior because 'she is so sick'.  This is a statement she uses with some frequency according to what we have heard and seen, 'don't you feel sorry for me'?  I'm schizophrenia, I'm schizophrenic'.  But she isn't, as I said, Jack has described her as a Histrionic Personality Disorder with Severe Depression with psychotic like symptoms.  There is no evidence of a thought disorder, she does not hallucinate and what she pretends as being a delusional system is a series of absurdities, which we believe she acquired during her hospitalizations.  It is not unusual for people who are hospitalized to acquire the symptoms expressed by other patients.

When we came home that very day after being dismissed from her flat, we thought that she had lost face in the confrontation by ordering us to leave.

I called her to discuss the announcement that I typed for her art exhibit.  She sounded very cheerful and was delighted to hear that I had followed through.  We decided to get together to finalize the draft of the announcement.  Doesn't that sound interesting in view of the confrontation wherein she ejected us from her flat? 

What I have said is a product of the first weeks with her and establishing that very important relationship.  We are faced with a woman, who is desperately clinging to her condition because it has become a survival mechanism and a lifestyle for her and she made it quite clear that she doesn't have to work.  She gets a pension from the government for being sick.  I am not critical of these kinds of pensions, especially in view of the fact, that treatment in this country, England and other countries throughout the world is so very bad!  Medication by itself only masks symptoms.  It does not help people overcome them.  It is one treatment tool, in a whole range of other treatment methods. 

I just received a phone call from her sister Sara.   She reported to Jack that she had talked to Jane's case manager and the time for her injection has passed and the case manager said that she was not going to go to Jane's flat to persuade her to take her shot.   She and the doctor conspired and plan to let Jane get worse and hospitalize her and start her on clozapine.  She is currently on a depot medication.  Jane wants to get off the medication or at least reduce the intake but the psychiatrist is not cooperative.  We believe that she should at least be given a chance.  After all, she is human and not a guinea pig and they should not experiment with someone's life.  Jane has been compliant with medication however at this time she feels that the medication harms her more than it helps her. 
In an emphatic conversation with Sara, Jack said that this is unethical this is unfair that they would develop a treatment scheme such as this rather than to work through her resistance.  It represents the worst possible practice of psychiatry and it is our opinion that how psychiatry is practiced today that it is like an assembly line without any understanding of the patient's needs.  She is sick (or very disturbed) this is obvious in many different ways to us.  But I repeat, she was misdiagnosed, she is not schizophrenic.  Also, there are times, when she might sound as if she were schizophrenic but there is no thought disorder and her auditory thoughts are just a product of being extraordinarily lonely.  There are times when she is very unpleasant and there are times when she is better and nice to be with. 

However, to rob her of her of her dignity to take away her humanity is sadistic and is a reflection of the stigma that many people in the field have towards the mentally ill.  Is this what represents treatment for the seriously mentally ill?  Is there no willingness to develop a system of support that allows people, like Jane, to feel accepted in this world  and respected?  Is there no one to take the time to listen to her?  We have seen this in many countries throughout the world and consider it to be cruel and unusual punishment.  Why do these people pretend to be healers, when in fact they are representatives or agents of the pharmaceutical companies. 

We are not against medication but medication by itself doesn't do it!  People need to be accepted they need to be understood and they need to be embraced by a sense of caring and warmth.  People with any condition related to mental illness are not stupid and pick up cues of how they are being treated, whether it's indifferent, or a sense of someone genuinely caring.  It's no wonder why Jane has spent so many years of her young life in and out of hospitals and visiting doctor's offices!  Tragic really tragic!

It would be interesting if she was able to weather the storm, so to speak.  But I don't think that Jane can do that, even as strong a person as she is, it's hard to get off of any medication after so many years.  We shall continue to work with her and be with her through any crisis. 

Last week for a few days, she was in such physical pain she was writhing all over in pain. Jane can be quite dramatic and 'acted' like Sara Bernhardt.  We still had to take her seriously.  She would double up and moan and tell us how much pain she was experiencing, in her back, her 'tummy' her head and her Parkinsonion like movements that she could not control.  Her muscles were tight and it 'felt like my muscles are pulling up on me' and she said she had no control over this, which made her leg shake up and down.  Now, as I said, this could have been an act, we didn't know.  In this field I want to believe the person we are dealing with, but sometimes they can act in a very convincing way in their efforts to keep the world at arms length. 

Jack asked her if she was taking the side effect medication to reduce any negative reactions to the medication.  Jane told him that she had some in the past but that she had thrown them away because she just didn't want to take any more medications.  So Jack suggested to her that she go to her General Practioner and get some of the side effect medication which might help her.   Next day, she saw her sister, Sara, who witnessed this terrible condition and she then called her GP and made an appointment for the next day.

Jane did see her GP the next day and she was able to receive a prescription for this medication, which she had filled immediately.  She took one pill in the morning and by the time we saw her about mid day, she was still in pain and just couldn't stop her shaking her legs and sometimes her arms.  Jack asked her if she felt any better, and her reply was not really, but she had more pills.  Jack read the material that was enclosed in the package and told her she must take another pill that evening.  She did this and told us that she was going to go to bed now and not to call her until next morning, which we did. 

When I called her the next morning, she sounded so happy and wonderful and full of life.  She told me that she felt so good 'last evening I painted my walls white and left the art work that was painted on my walls and it looks absolutely wonderful'.  She now had a nicely decorated flat and walls that used to be bright pink, green, olive green and blue.

We decided to meet at her flat and Jack talked to her for awhile and went over what she had felt the days before and how she felt physically now.  She said she felt wonderful, no pain, or aches in my head and was clearer than ever before.  She told us that she felt 'normal'.  She hadn't felt this good in a long time.  She was ecstatic, she wanted to go downtown and look at the market they have on Wednesdays and Saturdays.  We left her flat and Jack and I looked at each other amazed how quickly she responded which made us rather suspicious.  We began to understand that this woman was brilliant in the art of deception. 

As the three of us were walking, there was briskness to her walk, she was very cheerful and talked animatedly about so many different subjects.  This was a Jane that we were not used to.  She had been cheerful, sometimes in the past with us, but this was a different side to her altogether this was Jane without symptoms of an illness and seemed more real to us.  For the time being, she was free.

The next day we were to get together however, when I rang her up, she was almost ready to catch a train to go into London and attend a party with her friends!  I was shocked to say the least, but she was in a hurry and I told her that I wanted her to speak to Jack first, but to have a wonderful time.  Jack talked to her as well as I guess he wanted to hear how she sounded.  We both wondered if this was a crazy side of her or was just a normal impulse.  There were no signs of any sickness that we could detect over the phone in such a short period of time. 

When I rang her up on Sunday evening, she had just gotten home and was exhausted, but delighted and happy.  She had a wonderful time in London.  She took the 'tube' and got off in London proper and had a look around.  Then caught a train and then a bus to get to her destination where her friend's party was to take place.  She had a 'grand time, everyone was dancing and the group age was from 18 to 50.'  She stayed up all night to party. 

She was to have an art exhibit at the local library in town and had to get up quite early the next morning so I told her that I would ring her early.  This was agreeable.  Next morning I rang her and she was up already and almost ready to go out the door, she was excited and happy about showing her works. 

I must say that she did a splendid job in placing her art works on the wall and her art work was a delight to see.  Her father came to town to see her exhibit as well, picked us up at our flat and we came together to view her display.  Really a fine job, the father was very pleased with her and showed her some affection.

Today at the library, she was gregarious, friendly and warm towards both of us when we first arrived.  Jack asked her how she was feeling and she told us that she 'was feeling great and had never felt better, feeling better every day and that her head is getting clearer and clearer.  She also mentioned that she was seeing things more clearly, visually. 

She has been off the medication now for two weeks.  We approached her on the subject of the medication and thought it might be wiser for her to at least come off of it gradually.  However, she was determined to come off the medication 'cold turkey'.  She said that it probably wouldn't be any more than coming off of smoking or something of that sort.  She also told me that she was determined never to go back into the hospital.  At this point, time will tell.

Also, today, she wanted to share with me some of her writings that were in the form of a book that she had made up.  She didn't want to show Jack because it was quite personal about her sex life, her feelings about her life and also what had happened to her in the past.  I can certainly understand this I would feel exactly the same way.  She obviously wanted another woman's opinion.  I was happy to be able to tell her that I thought that her 'book' was extremely well written and her explanations of her life were wonderful, even though it was sad.  I said something to the effect that 'it was a very moving piece of work and I was very pleased that she shared this with me'. We now have a clearer picture of what happened to traumatize her and that's important.  Her writings are very clear for a person who was supposed to have schizophrenia, even though they were written under duress or under quite a lot of medication.

She was able to tell Jack that her thoughts were 'crystal clear' that her mind has never felt clearer, that I am not hearing any voices talking about her.  'I have never felt better for such a long time.  In the past, I felt heavy in the head and in my body with the medication.  I have felt horrible for years and years, always something.'

I hope that we are right in the assumption that she is very capable of coming off the medication because of her determination.  I don't want to become too optimistic at this time.  We have known her less than a month and it's presumptuous of me to come to any such conclusions.  Time will tell we have faith and confidence in her to do this one important thing in her life.  I hope that she is not disappointed nor I too optimistic!

She had a week to show her works and on another day, we actually arrived before Jane and her sister Sara with her daughter in hand.  Another friend came by as well.  We noticed that she is very competitive with her sister.  Jane is very protective of her relationships at this point with other people and sees Jack as a threat, not only to her illness but also to her relationships with other people.  Another friend came and Jane was very happy to see her as well.  People all week have been coming into see her work and we have watched her flourish in this light.  She is quite composed and happy at this writing. 

This week has been a superb example of the importance of her determination in the recovery process.  Jane has had a splendid week showing her art at the local library.  She has purpose, she interacted with many people including some of her relatives, has sold some of her interesting art and there is no sign of any symptom of mental illness or the side effects of the medication that is withdrawing from her system.  Bear in mind that this woman has had a 20 year history of what has been diagnosed as bi-polar disorder and then schizophrenia who has suffered agonizing symptoms that we have attributed to the unnecessary use of highly toxic medications.  What we see is a woman who suffered an outrageous assault on her physical being.  In the beginning, she was assaulted outside of the system and became extremely despondent because she had been given some illegal drugs on the street unknown to her.  She had walked around dazed.   After a while she became suicidal and fortunately as she poised herself on the third floor of a building, the police were able to take her into custody.  They then took her into the hospital, where she was misdiagnosed the first time and injected with a highly toxic antipsychotic drug.  Thus began her nightmare.  When she slept and when she was awake she felt like 'I was in a walking nightmare/dreamlike state'.  What developed as a product of her tragic experience in and outside of the system was the development of a personality disorder which was part of the feeling of hopelessness and her inability to do anything else in order to survive in the world that called her crazy. 

So that is what we are faced with now.  Not a psychotic, not a schizophrenic not a bi-polar disorder but she is a symptom of a corrupt and uncaring professional world that is dictated and directed by the pharmaceutical industry!  We hope that we can help her overcome this personality disorder and help her reshape her character so she can live a richer and more rewarding life. 

We came to the library early When she arrived she came up to us.  She would not say anything to Jack, but told me a little poem that ran through her head which was OK and then she walked down another isle.  Jack had the feeling that something was awry and asked me to go after her and talk with her.

Jane and I had a long talk while overlooking this lovely little city from the library.  While chatting, I brought up the subject of helping her get on with her life in a meaningful way. I am just going to give you the highlights of our talk.  She told me that Jack was too strong and she could not look at him.  To quote her 'there is just no way I can continue'.  I should be clear that this was the end of her exhibit a fine piece of work, which had given her a sense of purpose and meaning.  As this was coming to an end, there was an increased feeling of depression and a wish to avoid the important issues in her life that is to make behavioral changes. 

She told me that she was aware of her behavior indicating a fair amount of insight.  How she was able to manipulate people and even though she tries to overcome this, she can't. Which points out that insight doesn't necessarily lead to behavioral changes and that it's really the other way around.  Behavioral changes lead to a clearer understanding of the impact that she makes on the world around her.  She talked about being brought up by a mother who she said was a manipulating person herself this was her excuse for her behavior.  I told her that I didn't know about that but that I knew she had been manipulated and controlled by the professionals.  She added immediately that she had to develop coping mechanisms to deal with the professionals as well she said 'so you can see how I had to behave in order to survive'.  I told her to let Jack and I help her have a more peaceful life.  All we wanted to do is to help you reconstruct your life so that you can be happier.  With that she said and I am quoting her 'he's too strong, I can't look at him in the eyes he's just too strong'.  Ever since I thought he came onto me in my flat and I had to throw the two of you out, I have been ashamed and can't overcome that'.  She told me about some horrible experiences in the past and questioned my sensitivity about those issues.  I told her that I knew how destructive that had been to her but that happened a long time ago and that she still is fixed on that issue, which is not healthy.  She obviously uses that in a defensive way whenever she finds it convenient to resist any effort to help her make the necessary changes in her life.

Jack thinks that this is a crucial time and if she is allowed to avoid us, then the personality disorder will remain intact!  However, there are issues to be considered in her efforts to avoid treatment.  She could pretend regression when she sees her psychiatrist, or she might do something to hurt herself.  She gave me an excuse that she had forgotten her cigarettes, which we knew was not true and she left.  We waited for her and after a while, we realized that she wasn't coming back.  I called her on the phone and she told me that our conversation had disturbed her too much and she was unable to return.  I told her that I expected her to come to our flat on Monday at 11AM.  She said, 'OK, I'll be there'.

Jack wants to emphasize that if we can get through this period that treatment could be successful in overcoming her personality problems even in a relatively short time because of the fact that she is aware of her manipulating, controlling methods.  Jack has said many times 'remember that her character disorder houses the pathology' and it has become clearer to us that it represents the major issue.  She knows this and understands that Jack represents a threat to her pathological structure.   She will do what she can to keep him away and we believe that she will make every effort to retain her condition until it becomes clear to her that there is purpose in change and that she is competent and able to express herself in a way which will be rewarding to her.  However, we also believe that this could take a fair amount of time because we cannot forget her 20 year history of treatment that was more designed to meet the needs of the professionals that treated her than her needs.  Over the years it has become rather obvious to us that professionals, psychiatrists who are the primary treatment personnel because of the emphasis on medication are only human, they spend a very few minutes with a patient, they don't understand them well enough in many cases and they are also troubled, disinterested, bored and in many cases in need of help themselves.  Now this may seem rather harsh, but after our experience in 17 countries including the US, we have seen some good people and we have seen many who should be out of the profession because they really don't care and of course one can't forget the financial parts of this assembly line practice.  They also all have biases, I suppose all of us do, but do the biases have to exclude a sense of humanness.  The basis component of treatment is making contact that is the first step, without which there is no treatment and then forming a relationship where two people are trying very hard to overcome the problems at hand.  Can this be done in 10 minute interviews every fortnight or every two weeks?  We have heard from people throughout the world the failure of treatment.  We are all responsible for it!  Why are we afraid to come to grips with the severe mentally ill?  Is it because we live in such a sick world ourselves and are so concerned with our own needs that we lose sight of the people that we are supposed to help? 
 
Finally Jane was able to confide with Jack about her past and as she did, once again, she cried, cried real tears.  We know that she has said this, many times before and she feels genuine shame.  After she calmed down, Jack asked her an important question 'why have you held onto this for 21 years?'  She could not answer.  He was compassionate with her and she was able to unload a lot of material.  Hopefully she trusts Jack somewhat more and is not afraid of his 'strong personality'.  She saw in him a compassionate man with feelings for her.  I must say at this time we are not fooled by her.  After a while, we all went for a very long walk and she felt so much better.  We ended the day at her flat.
She is now starting to have some withdrawal symptoms however she is determined to withdrawal from her medications.  We hope that the withdrawal doesn't produce any significant symptoms.  Once again, she told us that being on the medication is more painful than whatever withdrawal symptoms she is having.  I think that it is important for me to tell you that we are not opposed to judicious use of medication providing it is connected with other treatment modalities like psychosocial rehabilitation and psychotherapy.  

The battle continues with her.  People in the field have talked about treatment resistant patients.  That comes as a function of some patients that do not respond to a given treatment method.  Other patients become treatment resistant because of the nature of treatment that has failed to meet the patient's needs, again and again.  Jane has learned from her experience, here is a classic case.  Jane wants to control the treatment program that we have been trying to develop with her and I want to emphasize the importance of patient empowerment.  I think that people need to have a say in how treatment is developed.  She has come to our flat or us to her flat on a regular basis.  Now she wants to come later, she 'must clean her flat and do things in the morning'.  We have told her that this is unacceptable and she must come to our flat on a regular basis at a given time.  There has to be some structure from both the individual in treatment and also the people who do the treatment.  In the beginning she only wanted to come to our flat for just a little while, three days a week.  She keeps finding ways to continue controlling us and according to her family that is characteristic of her treatment of them.  So in essence, she has to exercise control in the world around her.  This is apparently the only way she is able to deal with her anxieties.  This is a method she has developed over the years and doesn't understand how self-defeating this mechanism is for her.  Her denial is destructive and prevents her from living a better life.  

It is apparent that this woman is fighting in every possible way to hold on to a lifestyle that she developed over a 20 year period.  She is unwilling to cooperate at this point in time and has convinced herself that she is the only one who can help her out of the sick life that she has lead for so many years.  However, this should not be understood as an effort on her part to deal with her life in a more positive way.  This symbolizes, I believe her distrust of the world and her isolation and insulation is a way of keeping her safe, so she thinks.

One day, Jane was late in coming over.  We rang her up and she told us that she was just finishing a sandwich apologized and would be over in a couple of minutes.  Upon arrival, we noticed that she had bought another coat.  We greeted her at the door and she came in and sat down reluctantly.  Jack had a good conversation with her telling her once again what the arrangement was with her father so that she would understand just what was happening.  She has been confused on this issue and that is, Jack and I would stay for three months and if she showed signs of improvement, we would leave.  If she didn't her father wanted us to stay on for a few more months, this was all agreed upon.  Jack touched on other issues as well.  Also, it was obvious that she was uncomfortable, her eyes fluttered but she managed to stare at Jack and even said that she felt we had helped her, but she didn't know how we did it.  The conversation was brief and to the point where she was told that she had to show more respect to people around her and that she had to be more responsible and that she had to keep her appointment times (she said that she always had trouble keeping appointments).  All of a sudden she got up very fast, almost ran to the back door, told us in a hurried voice that she had to have a cigarette.  I went to the window and watched her pace up and down in the garden.  But when I looked out again, she had vanished.  I went out and looked around and called her name, no answer.  Jack then went out and looked and called but no answer.  All of a sudden she came out from behind a shed, skirted around Jack and ran into the house and said, 'sorry, I can't take any more' and ran down the street. 

The very next day, as I recall, we tried to call her but no answer.  We didn't know what to think.  Perhaps she has admitted herself into the hospital?  Where could she be?  Many thoughts went through our minds and I must admit that we did not have a good feeling. We called her again, no answer.  The father called us and told us that he tried to reach her, but she wasn't answering the phone.  We went to her apartment she did not answer the door.  I went around the back to see if there was anything wrong, apparently she was OK, her furniture was rearranged, she had obviously been there, her window was open but no visible signs of Jane.  Frustrating and terribly upsetting not knowing where she could be.  When we arrived home, there was a message on our answering machine.  It was Jane telling us that she was at the train station and was going to visit her friend in London.  She had taken her phone off the hook, when she had put the receiver back, someone called to remind her of her appointment with the clinic where she received her injections and she didn't want to make that appointment, shortly after she left her apartment.  She apologized for yesterday said that it was very painful for her and that she wanted to forget it and hoped that we could too.  She sounded very cheery and happy and asked us to meet her at the station, the idea being that we would go to London with her.  Of course it was too late.  We phoned her parents to tell them that she was OK. 

The next day, we received a call from Jane's mother after Jane left and were told that a message was left on her machine, by Jane and it was pretty much like ours.  This time, she told her mother that she knew that she had caused the family a lot of grief and that she was sorry.  Her voice sounded stronger and happier.

The next day, we went by Jane's flat and found her at home.  She greeted us at the door all smiles and happy.  She felt good and looked good, but tired as well.  She told us that she had gone to London.  She again repeated the story of the telephone call of someone reminding her of her appointment.  She laughed and told us that as soon as that happened, she got scared and left her flat immediately. 

In our long conversation with her after a couple days off, she is becoming increasingly more aware of herself and reality.  She is unhappy about her appearance, her hair is short and she 'looks like a boy'.  She wants to 'change her image and become more feminine'.  She wanted to change her clothes and when she looked into the mirror it wasn't what she wanted to see.  She saw someone who was not well dressed and wanted to grow her hair and wear a skirt.  She also told us that she 'cannot make changes overnight, it would have to be a slow and gradual process.  After all, hair doesn't grow in so quickly' she said with a laugh.  She wanted a new look, a new identity and to perhaps live elsewhere, perhaps in Bristol where she was happier, where she had gone to college.  She also stated that she knows that she had caused her family, all of them, over a period of time a lot of grief.  She needed to change her ways of treating them. 

She said her head hurt her and she would rather go through all these withdrawal symptoms rather than to go back to the terrible life of being on medication.  'I feel nervous but I am determined to go through this with your help.  I didn't have anyone to help me before.  I know that you are here and that the two of you can help me get through this terrible anguish'. 

She told me that from the very beginning that she was able to accept me and how we laughed and were able to relate to one another and she is now able to trust Jack more, even though not as much as she trusts me.

This was another indication from her that she was reaching out for help.  In the past, any statements that were made to that effect, was primarily lip service, this time, the pain of her withdrawal and the anxiety and the discontent of how she looks and how she is seemed to make her realize that she can't go it alone anymore.  As always, we are cautiously optimistic.  We believe that she can be helped we hope that her attachment to us allows us to resolve some of the pain she is enduring.  But one can also speculate that once this current crisis is resolved, that she could close up again and retreat from treatment.

I must tell you at this writing how important loneliness and depression is in this condition and other conditions like Jane's and people with schizophrenia and other related disorders.  She has been so alone 'the nights are the worst part of any day'.  She had said this before about the nights and I certainly believe her.  I also believe that the days in the past have been a very lonely time for her as well. 

I am happy to say that Jane came to our flat today, in good spirits.  She is going through the withdrawal, I think, with a sense of determination and dignity.  No more complaining, you might say she has a sense of loss at this time, of the years gone by.  She felt a sense of shame that she had treated her family so badly over the years and wanted to write a letter to all of them and 'get back on the right path with them'.  She is coming to grips as to what to do in the future with herself.  She 'needs to get a new bunch of friends, perhaps in another city.  But for now I must fix my flat because I don't know what happened to it!  It looks terrible, the floor, the walls' as she shakes her head in wonderment.  (Interesting comment from her, almost as if there was a real lapse in time).  'In a month's time I plan to write to my psychiatrist telling him that I have been treated by a famous psychologist and I am feeling so clear in my head.  Then I will add a P.S. I'm moving away so you can't catch me'.  We had a good laugh at that, as did she.

As Jack says, 'we must be careful now some people take flight into health to avoid any further treatment'.

The main part of her problem at this point is obviously her character flaws.  It's true that she has had problems with depression and psychotic like symptoms, that she had responded badly to medication and her life has been in the hands of professionals who didn't care about her well being.  Jack told her directly what he thought about the whole range of behavior that I described above.  He demanded that she assume the responsibilities of a person 'in recovery'.  He demanded that she meet the needs of our treatment structure.  She tried to redirect this confrontation by claiming that she had been mistreated by the world and Jack angrily told her that she was mistreating herself even though it was true that she had a difficult time in the past.  She had made a commitment to treatment that had to be met and that there was no compromise. 

It's important to understand that Jack was trying to force his way through her character armor, which is the worst part of her illness.  She agreed to accept the structure of treatment and promised to be at out apartment the next day.  However, it is not yet certain that the battle is won; she could act out to strike back at Jack who she sees as an over powering figure and he told her that he was determined to do his work well, no matter how long it took.  We shall see if she meets her obligations.  If not, Jack will continue his attack on her resistance.  But when Jack pointed out her resistance to her she said that she was simply frightened and felt she could help herself.  Jack pointed out how destructive she had been to herself. 
As you can see the treatment is not an easy one.  We keep pursuing and putting pressure on her to make corrective behavioral changes.  We have a time limit. 

When Jane came over, she put up a few barriers.  We managed to overcome this by Jack setting forth his plan to overcome the obstacles that she has been putting before us and that she needed to have more structure in her life.  Jack told her that in order to overcome these barriers, she must sit still and let's talk about whatever is really bothering her, if she's uncomfortable, be uncomfortable for a while so that we can rid your feelings of being miserable most of the time in your life.  Jack told her that 'this is your life we are dealing with and you have had a difficult life, but it can be overcome.   Let's explore it with you and help you overcome the difficulties of the past'. 

With this a lot of material was exposed.  There was so much anger and resentment in her and a sense of remorse about the past.  She began to talk about her angers, her feeling of resentment, remorse and also feeling like she was of no value to anyone.  She became much more real after talking about this subject that has been for so long held inside of her. 

That's the sadness of any condition related to mental illness.  People have a stigma attached to them and not only with the lay public, but in the professional world as well.  Professionals just don't want to deal with this population, sadly enough.
 
We hope with this particular day and our time remaining that she can emerge through the darkness and have a life of whatever happiness that can come her way.  Time will tell.

In conclusion:

When we left England Jane was in recovery.  We felt confident that her recovery could continue with some regressive episodes because we had helped develop that very important support system that every person who goes through such a difficult condition needs, but so very rarely has.  Her family, all of them, parents, sisters and brother are determined to do everything to insure her progress.  They are sensitive, loving, and strong and are willing to deal with her in a meaningful way.

I don't mean to say that she has recovered, but to quote her she is recovering.  I expect that there will be some difficult periods but we hope it will be overcome.