Seth S.

Abstract

This man in his mid-50s had long since identified himself as having schizophrenia, and over time he had developed successful self-management guidelines. These included structuring his time with constructive and meaningful activities, staying physically active and healthy, and maintaining continuity with previous treating psychiatrists to maintain continuity. Thus, the generic issues involved the psychiatrist’s fitting into the patient’s established routines and being prepared to follow his lead in developing the new ones that events demanded. These included managing his type II diabetes more effectively and learning to interact with house-mates to resolve conflicts, which required more intensive socialization than he had been used to. All along, he made an effort to reach out to me, in order to make his needs and requests clear. His energy, pluck, and intellectual curiosity enabled him to make continually necessary adaptations. When our agency introduced a new policy promoting discharge from ACT services, he accepted the need to move on. His positive attachment to the agency, rather than to me, as ultimately responsible for his care, allowed for a smooth parting.