Pamela P.

Abstract

Getting the diagnosis right, as early as possible, was even more important for Pamela than for Gary. To go along with her previous diagnosis of a psychotic illness would not have helped to explain the course of her life previously or thereafter; worse, it would have led to issues in treatment that would have only confused both her and her treatment team. To realize that she suffered from an extreme version of a personality style, on the other hand, helped clarify what she had been struggling with in the past and how she would be likely to deal with ongoing and future issues in her life. Support from the art therapist was crucial in confirming this diagnosis, and again shows the importance of individual team members’ skills and experience. The other generic issue was how the psychiatrist needed to be aware continually of when to access outside help, which will come up again in several succeeding narratives (Victor, Richard, Alex), because in each of these cases there was a need to manage a significant and complex general medical condition. The need to access outside medical help in all four of these cases provides further examples of the need for integrated care. Pamela’s personal goal was to make a quiet, satisfactory life for herself, bettering it as she went along, in the face of considerable disappointment and loss. To help her, it was necessary to adapt to her unique style, an effort which culminated in the psychiatrist’s absorption of her idiosyncratic way of addressing herself.