Bernardo H.

Abstract

The generic issue here is the limit and complexity of the “harm-reduction” model, which directly challenges the psychiatrist’s paternalism, particularly, when the substance abuse significantly exacerbates an increasingly serious general health risk. It raises the question of how far to go in challenging a patient’s explicitly stated preference not to address his alcohol abuse. The life issue is this man’s effort to hold onto his pride, as he struggles to maintain the vestiges of a modest but satisfactory lifestyle in the face of multiple threats. Initially, the psychiatrist tries to support this effort by responding to the patient’s requests for additional resources he can no longer obtain for himself. Later, when both recognize the danger that is emerging, the psychiatrist tries to defuse their confrontation, offering up instead a collaborative exercise that he has found helpful in similarly challenging situations. But it comes too late. All he can do is to encourage his patient’s belated efforts to confront his alcohol abuse. The effort to know him better does not stop even with the patient’s death.