The untreatable patient
I am happy in my chosen field that the vast majority of my patients can be successfully treated –most people get substantially better with treatment even if it doesn’t leave them totally without symptoms.
There are, however, some patients who are not helped by treatment and here are ten of the most common reasons why:
1. A refusal to listen to advice.
Many people come in for help but believe they have all the answers. You might ask why a person like this would seek treatment in the first place – and that is a good question. Sometimes these individuals will see a psychiatrist in order to please someone else or under duress of some sort. Others are curious about what a psychiatrist might say, but are not really willing to accept the opinion rendered. Still others enjoy discussing their condition but seem more interested in demonstrating their own superior knowledge than getting advice or treatment.
2. Fixed ideas about treatment.
Some people claim to want help but have a very specific idea in mind about what constitutes appropriate treatment and are not willing to try anything else. This can take many forms, but the most common example is the person who refuses all medication. Many problems can be treated without medication, but there are some disorders that simply will not yield to anything else and will certainly do much better with medication in addition to whatever other therapy might be offered.
3. Refusal to give up illicit or inappropriate drug use.
Sometimes these individuals are addicted, but sometimes they simply refuse to accept that their drug use is part of their problem.
4. Unwillingness to leave dysfunctional living situations.
Quite often people have problems related to dysfunctional situations including bad marriages, bad jobs or dependent relationships with parents or others. These people get into a rut and cannot be persuaded to get out. Sometimes this is due to fear of change, but it may be simply that they are having too many needs met to risk the insecurity of change.
Those who are paranoid believe the doctor is part of the conspiracy rather than the solution. Paranoia varies in severity from individuals who simply can’t trust anyone to those who are truly psychotic.
Those who are too disorganized to keep appointments or follow treatment advice cannot be treated effectively. These people tend to miss so many appointments that eventually every doctor stops seeing them.
When a person is in extreme poverty, practical problems tend to become so overwhelming that no type of psychological therapy or medication can really make much of a difference.
8. Symptoms making it impossible to seek treatment.
Some people are so ill they cannot leave their homes – either because of extreme phobia or lack of motivation and fatigue. For those who have never experienced these symptoms, it is hard to imagine, but there really are people who are that disabled by their mental illness.
9. Adaptive behaviour.
When people have been sick for a long time their entire lives may become so adapted to their role of being ill that they know nothing else and no one around them expects anything else. In these instances, equilibrium has been established between the individual and his or her social system and it is difficult to break.
10. Finally, there are a very small number of people who do everything recommended, attend all appointments faithfully and participate in the process but simply do not respond to treatment.
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