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Ask the Doctor: What If My Family Member Refuses Help?

QUESTION:
A relative of mine clearly needs psychiatric help, but he refuses to see a doctor about this. What should I do?

ANSWER:
Unfortunately, this is a very common problem. Sometimes people who are clearly suffering from psychiatric illness don’t themselves recognize that they are having problems, even when this is readily apparent to their families. In other instances, the person may feel ashamed to acknowledge that there is a problem, or feel afraid of what treatment might entail (including fearing possible hospitalization), or feel concerned about being stigmatized because of obtaining mental health treatment. There are many instances when people really know they need help, and may even want it, but can’t or won’t get it without guidance and encouragement from others.

If you have a close relationship with this person, the first thing to do is to try to discuss with him your concerns, gently giving examples of what he has said or done which have made you alarmed. Try to do this in a calm, supportive, and non-accusatory manner, and suggest that he see a psychiatrist or other appropriate mental health professional for an evaluation. Try and convey that you are only suggesting this because you care about him, and be reassuring that the professionals he sees will be knowledgeable and compassionate people genuinely trying to help.

If speaking individually with him doesn’t help the situation, or seems unfeasible, another approach would be to have several close family members or friends meet together with your relative to similarly express their concerns and suggest the need for evaluation and treatment. Sometimes it is helpful to offer to take the person to see a mental health professional, or to accompany him.

If you fear that your relative might be thinking of suicide, or might be violent, clearly there is much more urgency to his getting professional help. In these situations, or whenever serious psychiatric illness is suspected, one option is for you, perhaps accompanied by one or two others, to simply drive the person directly to an emergency room (where psychiatric evaluation is typically available). If you can’t do this, or you fear your relative wouldn’t cooperate, another option is to call the police. In Maryland and many other states, the police are legally obligated to take people with suspected mental illness who seem endangered or dangerous to a nearby emergency room so that a medical and psychiatric evaluation can be performed, and appropriate medical care can be provided.

Another option available in Maryland is to go to a district court and fill out a form called an Emergency Petition. Once this form is filled out, it is given to a judge or magistrate, and a hearing is held in which the judge may ask you some questions about your family member. If the judge/magistrate becomes convinced that your relative might have a mental illness, and might be in danger of immediately impending self-harm or violence, the court official can compel the police to take him to an emergency room for a medical and psychiatric evaluation.

Sometimes, when it seems very hard to know the best way to get help for a family member, it can be extremely helpful to make an appointment with a psychiatrist (without the relative being present), explain the situation, and receive professional guidance about how best to proceed.

Going the extra mile to get a relative needed help is an expression of great concern and love; frequently, at some point the family member realizes this, and ends up feeling extremely grateful.

Ask the Doctor: How can I help a “hoarder”?

QUESTION:
I have a 34 year old daughter who neglects her home and it has come to the point of hoarding items. She never cleans her home and there are piles of stuff all over her home. When I try to condense things for her, she makes excuses as to why they should be kept. To make things worse, her father has been diagnosed with paranoid schizophrenia. Also, her husband seems to put up with it.

Please help me make the right decision to help her and her hubby. They have 2 minor children in the home.

ANSWER:
The most important thing about this question is that your daughter needs a good psychiatric evaluation. Rather than focusing on what might be wrong with her, instead its important to focus on getting her evaluated by someone who has the expertise and experience to determine whether she has a treatable psychiatric problem, and how to approach her about that treatment. In light of the family history, and some of the hoarding behavior that you describe, it certainly seems likely that she may well have one of a few possible treatable conditions. So, how to approach her?

First you might wish to let her (and her husband) know that, like heart problems, psychiatric problems can run in families, based on genetic and other factors. There is certainly some family history of a disorder there, and that makes both your daughter AND her children at higher risk.

Second, you can tell her that psychiatric disorders are actually more treatable than most heart problems.

Third, you might want to let her know that untreated psychiatric problems in parents can take a significant toll on their children in terms of the childrens’ mental health, social adjustment, and academic performance. So, getting an evaluation would be a big favor to her children.

Fourth, you might want to do some homework before this conversation and identify a psychiatrist in advance who would be willing to see her. You could speak with your daughter’s family doctor about your concerns and get a recommendation from that doctor (as well as have him support the idea of a consultation directly in a conversation with your daughter). You can even speak with the identified psychiatrist in advance of talking to your daughter about this–either by phone or through an appointment with that psychiatrist yourself. It is actually quite appropriate for family members to consult a psychiatrist about their troubled loved one, and get some guidance from the psychiatrist about how to bring them into treatment, preparing the way in the most welcoming fashion.

You might want to include her husband in any or all of the above discussions, even before you approach your daughter. Getting him on board with the idea of at least a one-time consultation, might be easier to do first, before approaching her.

Ask the Doctor: Concerned when a friend does not reply?

QUESTION:
A questioner asked what to do when a friend who lives in another town who she suspects is having emotional difficulties, and who has attempted suicide in the past, doesn’t answer phone calls, e-mails, or other attempts at communication.

ANSWER:
The first thing to do is to try to establish communication with your friend. It sounds as though you have already done this, but what might help is for you to send e-mails and voicemail messages telling her that you are very concerned and worried about her, that it frightens you to not hear from her, and that you beg her to at least send an e-mail or preferably call you to let you know how she is doing.

A second suggestion: If you ever believe there is a clear emergency, call the police in the local area where your friend lives and give them all the information you have, and they can try to help your friend or make sure she is OK.

The Building of a Sanctuary Receives Media Award

The American Association of State and Local History (AASLH) has given a Certificate of Commendation to the documentary film The Building of a Sanctuary. Executive Producer and Foundation member Carol Allen will travel to St.Louis, MO to accept the award.

The AASLH Awards Program not only honors significant achievement in the field of local history, but also brings public recognition to small and large organizations, institutions, and programs that contribute to this arena. By publicly recognizing excellent achievements, the Association strives to inspire others.

Made by Historic Towson, Inc., the film is about the last built and best designed of the early private psychiatric hospitals in the United States, The Sheppard and Enoch Pratt Hospital.  Its founders drew on lessons learned from other institutions and from Europe to provide moral treatment in a homelike setting and to turn 400-acres into an intimate campus of Victorian buildings with beautifully landscaped grounds.

Honorary Director Riva L. Novey, M.D., Aged 90, Obituary

Riva Novey, M.D. a prominent member of the psychiatric community in Baltimore died on May 27, 2005, age 90, at the Wesley Home in Mount Washington. Dr. Novey’s career in the mental health field spanned a period of 58 years from her graduation from the School of Social Work at Smith College in 1938 until her retirement from the practice of psychiatry and psychoanalysis in 1996. During her career she was active in the teaching of psychiatric residents at the Johns Hopkins, University of Maryland, and Sheppard and Enoch Pratt Hospitals. Additionally, she was a supervising and training analyst in the Washington Psychoanalytic Institute. She was a member of the Maryland Psychiatric Society beginning in 1958 and was chosen a Distinguished Fellow of the American Psychiatric Association in 1966. She was given Distinguished Life Fellowship in 1985.

She was born Riva London in Selma, Alabama, January 15, 1915 and moved with her parents to Baltimore as an infant. After graduation from Forrest Park High School in 1932 she attended Goucher College in Baltimore earning an A.B. degree in 1936. She was elected to Phi Beta Kappa Honor Society while there. She earned a Master’s Degree in Social Work from Smith College in1938 and did social case work in family and children’s agencies and the University of Maryland Psychiatric Clinic 1938-1948, and was the chief psychiatric social worker for the University of Maryland Psychiatric Clinic 1946-1948. Because she wanted to become a psychiatrist, she entered the University Of Maryland School Of Medicine in 1949 and graduated with her M.D. degree in 1954. She interned at the Union Memorial Hospital 1954-55. Her residency in psychiatry was at the Sheppard and Enoch Pratt Hospital 1955-57, and she served as staff psychiatrist at the Springfield State Hospital 1957-1959. She began her psychoanalytic studies at the Washington Psychoanalytic Institute in 1957 and graduated in 1962. She was a Diplomat of the American Board of Psychiatry, certified in Psychiatry in 1965.

Dr. Novey held many teaching positions in the mental health field. She was a supervisor of social work students from the University of Maryland, Catholic University, and Smith College during her years as a social worker. She instructed medical and nursing students at the University of Maryland. She had been a supervisor of psychiatric residents at the University of Maryland, Sheppard Pratt, and Johns Hopkins Hospitals in their experience of learning psychotherapy. In this capacity she was respected and was sought out because of her experience and expertise. The Washington Psychoanalytic Institute recognized her skill and dedication by making her a supervising and training analyst in 1968.

Dr. Novey was married in the late 1930’s to Samuel Novey, M.D. a prominent Baltimore psychiatrist and psychoanalyst. After his death in 1967, several years later she married a local artist, Jacob Glushakow who died in 2000.

All who knew her admired her cheerful outlook on life, her understanding of people, their conflicts, and their strengths, her interests in the cultural life of the community and society, and her willingness to share her ideas and expertise. She was an excellent cook, a harpsichordist, and shared with her late husband a lively interest in art. Her wisdom and guidance will be missed by everyone who benefited from knowing her.

She is survived by a sister, Ms. Debbie London-Hoffman of Owning Mills, Maryland, a brother, Coleman London, of Southbury, Connecticut, a step daughter, Ms. Jane Glushakow of Baltimore, and nephews, Michael Novey of Baltimore and Larry Novey of Washington.

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