Saturday, October 11, 2008

translation trial

“Behaviour is not – and cannot be – a disease, except in psychiatry. Controlling behaviour, with or without a person's consent is not
– and cannot be – a treatment, except in psychiatry.
And faking illness is not – and cannot be – an illness, except in psychiatry.”

Thomas Szasz[1] 2001

I once had this boy Tommy who developed a limp on his right foot. This prevented him from participating in sporting activities at school, much to the school’s annoyance. It upset their rules. He then refused school, complaining of severe pain in both legs. He was admitted by my consultant for observation. I was at the time Senior Registrar. He was about eleven. His mother suffered from Multiple Sclerosis and it was not difficult to see that the limping was from observing his mother’s gradual deterioration. She was by then in a wheelchair and yet still pleasant and cheerful. Tommy was a very well brought up boy. I felt at the time he was expressing his fear that he would one day be like mum and if he presented his symptoms early we might be able to do something. Others felt it was more a kind of sympathy pain given mum was now unable to walk. He was in fact a very good table tennis player and represented his school until recently (hence the school’s annoyance). One day I was having a game with him after lunch and noticed that he was limping on the wrong foot. So before my next serve, I said to him: Tommy, wrong foot. He saluted me and said thanks and went back to limping on his right foot again.
It was an encounter that I remember with some fondness for how I dealt with it and how he took it. From then on we had a great therapeutic alliance and he eventually made good “recovery” and is now a swimming instructor at a local public pool. His mother has since passed away. Whenever I see him at the pool he would start limping for old time’s sake.

1. Dou really want me to believe that my child will fake illness, and lie and do all those things? It is up to you of course, but if you watch House, M.D., do you remember the episode where the mother said she had no secret from her daughter? It turned out she was not even her mother.
2. Even some doctors and psychiatrists are not very good in sorting out the fakes, so do not be too hard on yourself. There is also the consolation that your child is only faking illness and not really suffering from any formal psychiatric disorder, and therefore can be helped without medication.
3. Some children may be on medication unnecessarily if the doctors cannot tell the fakes.

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