Saturday, 20 March 2010

Daisy's Story: Part 2

The hostel where Daisy had lived for over 15 years decided that they could no longer manage her and gave her notice to quit while she was in hospital. In the event, this was to Daisy’s advantage, as being a vulnerable and potentially homeless person, she was allocated a nice flat away from a hostel environment. When she was recovered, she moved into her new flat, with some community support. She was content. For about 5 years she remained well, although her physical health did not improve. Through her continued obesity, she developed Type II diabetes, and her liking for sweet and fatty foods made it difficult to control. Her legs had become ulcerated, probably because of her poor control of her diabetes. But her mental state remained so stable that the CMHT reduced its involvement to little more than periodic medical reviews with the team psychiatrist and weekly support with practical things such as shopping.

Then her father died. She was understandably upset, but this also served to destabilise her. Over a period of a few months, her manic symptoms returned. By now, her daughter was an adult and frequently visited her in her flat.

One Friday, her daughter came to the CMHT to tell us that she had visited Daisy and had found her mother washing her cups and plates in the washing machine. When she tried to challenge her about this, she explained to her that a Shaman had told her this was the best way to do it, as it would bode well for the future. Daisy had also phoned the RSPCA to report the presence of a five inch diameter spider in her bath (she was very exact about this), and had also reported to the police an attempt to burgle her flat from below (it was a groundfloor flat). She was again spending lots of money on food, and her fridge was crammed with smoked salmon, pate de fois gras, roast partridge, oysters, and champagne. Her daughter had also found her prescription of lithium, with evidence that few had been taken in the last couple of weeks.

Daisy happened to have an appointment with the psychiatrist that afternoon, so I stood by to find out the outcome of this. The psychiatrist popped her head round my door. “I think you’d better come in,” she said.

Daisy was sitting regally in the psychiatrist’s room.

“Oh, hello,” Daisy said when she saw me. “Have you come to section me? I’m not going to hospital, because I will die of a heart attack if I step foot in a hospital. They’re bad places. People are always dying in hospitals. Best to avoid them completely. A Shaman has foretold this. So it will come to pass.”

She continued in this vein for some minutes, despite attempts to ask her questions and discuss the situation with her. Her GP and her daughter joined us, and got no further with her than we had. It was becoming clear that Daisy needed to go to hospital again.

I took her daughter to one side.

“Your mother needs to go into hospital, I’m afraid. She’s clearly not going to agree to an informal admission this time. Since we know her diagnosis and we know she needs treatment, we’re planning to use Sec.3 of the Mental Health Act. As her Nearest Relative under the Act, I need to know if you have any objection to this.”

“Actually, I do,” she told me. “There’s a friend of hers coming this weekend, and mother would be very disappointed if she missed him.”

Her daughter would not be swayed in this. So we could not proceed with an admission under Sec.3 at that point.

We cobbled together a plan for the weekend. Her daughter would try to get her medication into her, and her care co-ordinator would review her on Monday and we would take it from there. The ward were alerted to the possible imminent need of an admission and a bed was reserved

As it happened, things did not go well over the weekend. Daisy would not take her medication, she became so excited by the prospect of her friend visiting that she did not sleep at all, and her mood continued to spiral out of control. Somehow or other, her daughter managed to persuade her to go into hospital, and on Monday she was making her presence felt on the ward.

She remained as an informal patient for about month. Then I received a request to assess her for detention under Sec.3. Although Daisy was showing no signs of wishing to leave the ward, she was also not taking her medication. In addition, she resisted attempts to stabilise her diabetes by refusing to have blood glucose tests or take her diabetic medication.

“Oh, it’s you again, is it?” she said, when I went into her room, accompanied by a female social work student as a chaperone. She was sitting in a chair beside her bed. Her legs had recently been rebandaged, but she seemed intent on loosening the bandages.

“You like me, don’t you? I know you do. That’s why you keep coming to see me. You are undressing me with your eyes. You want to get in my knickers, don’t you? Would you like to see my knickers?”

I was suddenly very glad I was not on my own.

“Daisy,” I said. “I am here, again, to see whether or not you need to be detained in hospital for treatment.

“Treatment? Treatment? I don’t need any treatment. There’s nothing wrong with me.”

“You are mentally unwell at present. And you’re also physically unwell. You’re not letting the staff help you manage your diabetes. You keep interfering with your bandages on your legs.”

“I don’t need any help with my diabetes. I’ve been taught by a Shaman how to control my diabetes with my will alone. In any case, diabetes does not really exist. It’s only a shortage of sugar in the diet that creates the illusion of diabetes. Everything’s an illusion. These bandages are an illusion. They’re not really there at all.”

“Well, it they’re not really there, perhaps you could leave them alone,” I said, becoming slightly irritated.

“Are you being sarcastic? Because if you are, I shall have to ask you to leave.”

Our conversation continued in this vein for some minutes. It was clear that she was manic, that she was delusional, that she would not accept the treatment she needed, and that her mental illness was also affecting her physical health. She did need to be detained.

But her inpatient stay dragged on and on this time. Her mental state did not seem to improve. In some ways, it seemed to deteriorate.

The hospital gave her a brain scan. The results weren’t good. There was evidence of atrophy in her frontal lobes. She was developing dementia in addition to her mental illness. This would explain her disinhibition.

But there was no treatment for this. And she would continue to deteriorate.

Daisy was eventually placed under Guardianship (Sec.7 MHA) and transferred to a nursing home. Five years on she is still there. She seems to enjoy it there, but still protests that she wants to return to her flat in Charwood, where she would be able to make her diabetes fade away using only the power of her will and a regular supply of doughnuts.


  1. This is sad. Interesting but sad. Still dealing with the early years of BP.And also applying to study social work in the hope of becoming AMHP one day I find your blog very good. But please tell us some stories that have happy endings. There must be some. Everytime I think of throwing my meds away I will think of Daisy and how sad things can go.

  2. Some of my stories do have happy endings. Daisy is not necessarily a typical example of someone with bipolar disorder -- her condition was complicated by early onset dementia. Working in a community mental health team, I see many people with bipolar disorder who never need detaining under the MHA or even need to go to hospital. There are as many manifestations of bipolar disorder as there are people with bipolar disorder. No two are the same. Many manage their disorders very well indeed, and in fact may excel in their lives and fields of work. But it is important to recognise you do have the disorder (if you do), to learn the early warning signs, and to learn to live with it, rather than fighting against it.

  3. Another great post. It is sad when another disease falls upon a person and can have such effects.

  4. La-reve, as the Masked AMHP says, this is not necessarily typical of bipolar disorder.
    I wanted to encourage you though, in your quest to learn to manage your disorder and study social work- as I have and am doing both, and very successfully!
    Keep fighting the urge to stop your meds and learn how to use non-medication means to manage symptoms too, and you will most likely achieve your ambitions!

  5. Are you sure her medication did not contribute to obesity and to the brain atrophy? It probably did.