When Service Users Seek To Deceive Part IV

The Masked AMHP assessing "nature or degree" in the hit Edinburgh Fringe play "How to Survive a Mental Health Tribunal -- Missus"

The following account may contain triggers for self harm.

It’s nearly 10 years since I last had any contact with Eunice, but I still think about her from time to time.

Eunice was, and still is a mystery. I don’t think I ever really did get to the bottom of what was happening with her. I don’t suppose I ever will.

Eunice was in her 50’s. She was married to a man somewhat older than her. He was a bank manager. When he retired, they moved to Charwood, and bought a large house on an upmarket estate.

Her consultant psychiatrist from the area where she had lived wrote a letter of referral to the CMHT. It described her as a “pleasant, polite and deferential lady” with a long history of depression. More unusually, she had consistently recounted a long history of having been physically and emotionally abused by her husband. More than that, she also described a history of having been the victim of systematic physical and sexual abuse by a group of men, including her husband, who would come to her house and abuse her in various unspeakable ritualistic ways. The psychiatrist had never been able to corroborate these stories. He had once invited her husband to come to an appointment, but the husband had not attended.

I conducted an initial assessment with a female member of the team. Eunice was a tiny, birdlike woman who had very poor eye contact. She frequently trembled during the assessment, and often appeared to be in great distress. She recounted a history of childhood emotional and sexual abuse at the hands of her father. She was an intelligent woman who went to university and obtained a degree in English Literature, then met and married her husband and became a housewife and mother to her son and only child.

It was noticeable that her arms were covered with a silvery criss-cross of scarring consistent with many years of self harming with a sharp object. However, when I asked her about the scarring, she denied that she had ever deliberately self harmed, claiming instead that these were inflicted by her husband and others during their abuse of her.

When I came to write up my assessment, I concluded that “Eunice's overall presentation is consistent with a history of chronic sexual, physical and emotional abuse as a child, and her accounts of this abuse, and her beliefs and reactions revealed when discussing it, ring entirely true. However, her accounts of the sadistic abuse over many years by what appears to be an organised ring is necessarily very hard to believe. This is not a description of conventional, if that is the word, "satanic" or "ritual" abuse.”

Despite my reservations, my approach with people who reported childhood abuse has always been to believe them unless I had evidence to the contrary.

I worked with Eunice for over 5 years in total. Initially, I attempted on a number of occasions to persuade her to allow me to report her allegations to the police and the Adult Protection Team. She would never allow me to do that. I explored with her as gently as possible the nature of the abuse. Some of it involved reports of her husband deliberately inflicting pain on her, an example being when he allegedly burned her with an electric iron. She showed me the burn on that occasion.

There were in fact several times when I saw injuries on her, including what appeared to be rope burns on her wrists and ankles. On one occasion she told me that she had been taken by car, with a hood on her head, to somewhere in the countryside, where she had been tied up and then subjected to a range of appalling ordeals. But she would never let me intervene.

I continued to persevere with her, trying to improve her self esteem and assertiveness to the extent that she would permit me to take action over this apparent abuse.

In one review I noted:

The injuries I have seen on Eunice are consistent with systematic and organised abuse. However, these injuries could as easily have been self inflicted as caused by others. There are three possible explanations for the reported abuse:
1. She is the victim of an organised ring of sadists of whom her husband is a member.
2. She has a longstanding and consistent, but untrue delusion that she is the victim of this abuse, caused by a psychotic state.
3. The accounts of the abuse as an adult are hysterical inventions and all the injuries are self inflicted and consistent with Munchausen's Syndrome, possibly arising as expressions of genuine childhood abuse.

 

She will not give me permission to speak to her husband, and has refused offers to help her leave him and go to a safe place, saying she is afraid not so much of what they might do to her, but that they might harm her adult son.

After a couple of years of working with Eunice, her husband unexpectedly and suddenly died of a heart attack.

Although Eunice expressed considerable grief, I also saw this as a possible new start for her. Now her husband was dead, she might be able to forge a new life for herself, free of abuse.

I enlisted the help of a female support worker from the team, and together we helped her to clear her house of her husband’s effects. I had secretly hoped to find some corroborating evidence relating to her husband’s double life, but there was none.

The support worker began to work with Eunice, and over several months Eunice’s mood appeared to improve. I even caught her smiling occasionally during my sessions with her.

Then she began to tell us that she was again receiving visits from the men.

She reported to us that one of them had left an obscene message on her answering machine. Unfortunately, she had erased it.

On another occasion, she told us that a video had been posted through her letter box containing compromising scenes involving her husband and herself, and a threat to send it to her son. However, the “visitors” then took it back.

Still working on the basis that what she told us was true, in spite of some misgivings (why did she always dispose of the objective evidence), I encouraged her to increase her security, including having a spyhole installed in her front door, installing a chain, and also ensuring that her other doors and windows were secure. I even suggested that we have a CCTV camera installed, but she would not agree to this.

Then one day, when I visited her, I found her in a state of intense distress. She said that the previous afternoon there had been a ring on her doorbell. She said that when she opened the door, one of the men was there. She eventually revealed, over a long period interspersed with tears and trembling, that he had forced his way in, and had then dragged her upstairs where he had tied her up and abused her.

She showed me what looked like fresh rope marks on her wrists and ankles.

I told her that this could not be allowed to continue, and that I would have to report it to the police.

I arranged for a female police officer to interview Eunice in the presence of the support worker. She was told that, for a formal investigation to take place, she would have to make a formal complaint and have a medical examination. She said that she could not tolerate submitting to a physical examination, as it would remind her too much of her abuse.

Stalemate.

Eunice continued to give periodic reports of visits from the men, and accounts of their continuing abuse of her. Sometimes she would show us injuries – rope burns, bruises.

After a few more months of this, I discussed the case with a female officer from the local Adult Protection Unit without telling Eunice. She said she would make some discreet enquiries prior to any further action. I assumed she meant that she would do some background police checks on Eunice’s husband. She came back to me, saying that they would not be able to do anything further without interviewing her.

Eunice reluctantly agreed to this.

I was pleased about this – the Adult Protection Officer was extremely experienced and might just be able to get somewhere with Eunice.

She interviewed Eunice on her own, at her home, coincidentally the day after Eunice had reported yet another “visit” and with accompanying rope marks on her wrists.

The Officer reported back to me afterwards. She did not consider that Eunice was being abused in the way she described. This was on the basis of the content of Eunice’s account, her body language during the interview, and exaggerated and incongruous reactions to touch, etc. She also based her conclusions on her experience of interviewing rape victims as well as people known to have made false allegations.

I decided that I should change focus with Eunice. I reviewed her Care Plan with her, pointing out that it appeared she would prefer me to sit and listen rather than try to impose change on her that she feels unable to achieve. She gave me a list of concerns which I tried to address, some practical, some emotional. One thing was her car wing mirror, which was hanging off. I looked at it for her, and was able to fix it easily and quickly. Eunice appeared delighted in a childlike way by this, even smiling spontaneously.

For the next few sessions, I became a handyman, replacing light bulbs that she could not reach, fixing a latch on her back gate, fixing a leaking tap. While I did this, she sat and talked to me about her mixed feelings of grief and relief over the death of her husband. I did not mention the “visitors” and neither did she.

Then one day she abruptly announced that she was moving. Her son, who lived in another county, was arranging for her to live in a bungalow nearby to where he lived. He was taking over her house and was going to let it out.

Within a month, she was packed and gone.

I confess to a sense of relief. She was no longer my problem.

A few months later, however, I received a letter from her. She said that she did not know what to do, as the “visitors” appeared to have tracked her down, and were again entering her house at will and abusing her in various terrible ways.

I wrote back, telling her that she had to report it to the police, and should also let her son know.

I never heard from her again.

When Service Users Seek to Deceive Part III

For about 15 years, from the early 1980’s to the late 1990’s, I used to do sessions on the Social Services Standby Team. You would cover nights and weekends, as well as doing your fulltime day job.

It always seemed to be that the oddest and most perplexing cases turned up outside normal working hours. Nigel was certainly one of those.

One Saturday afternoon, I received a call from the Charwood Samaritans. They needed the help of a social worker. However, it was not the sort of problem that the Samaritans usually dealt with.

Nigel had turned up at their offices out of the blue in some distress. It had taken them a while to coax the story out of him. They eventually gathered that Nigel had been living in some sort of residential facility in a county about 150 miles from Charwood. They thought he probably had learning difficulties. He told them that one of the staff had shouted at him, so he had decided to leave. He had packed a few belongings in a bag and had left.

He had then gone to the local coach station and had got on a random coach, which had eventually dropped him off at Charwood bus station. Lost and upset, he had found the first place that seemed to offer help.

My first step was to try and find out more about him. If he had left a residential care home, then he would have been reported as missing. I rang the standby social worker for the area he had apparently come from to see if they had an alert out on him. Unfortunately, he was unable to tell me one way or the other.

I decided I would have to see Nigel, and make an assessment of the situation. If he appeared to be a vulnerable person, I would then need either to arrange bed and breakfast for him through the local housing authority, or if necessary, try and find an emergency residential placement for him until we could return him to his home area.

When I arrived, one of the Samaritan volunteers took me through to a side room where Nigel was ensconced with a cup of tea, three sugars, and a sandwich.

Nigel appeared to be in his forties. He was wearing an anorak zipped up to his neck and had a round face and rosy cheeks.

“Hello,” I said to him gently, and told him my name. He peered up at me through the thick lenses of his glasses. “I Nigel, thank you” he replied.

I attempted to find out from him his full name, his address, and a contact phone number. He told me the place he had come from, but was unable to give me names of carers or a phone number.

“The bad man shouted at me,” he said. “I didn’t like it. So I wanted to leave. So I got a coach. I got off here. Here I am, thank you.”

I asked him if he had any sort of identification. He shook his head. I asked him if he had any medication with him. He took a bottle of pills out of his duffel bag and showed them to me. They were anticonvulsant tablets. They came from a pharmacy in the town where he said he had run away from.

It was apparent to me that Social Services would have to look after him until he could be returned to his home county. He seemed far too vulnerable just to arrange bed and breakfast.

Being many years before cheap mobile phones were available, I was reliant on the Samaritans to let me use their phone. They were kind and accommodating. One of them showed me into a small cubicle which contained a small desk, a phone, and a chair. It was one of the cubicles the volunteers used when they were manning the Samaritans’ helpline.

I started to make calls to the social services residential homes that specialised in learning difficulties. I then had to wait while staff talked to managers and managers talked to staff.

After a wait, one of the care homes rang me to confirm that they could accommodate Nigel on an emergency basis over the weekend, until further enquiries could be made.

I went to see Nigel and explained to him what was happening. He seemed a bit apprehensive.

“They won’t hurt me? They won’t hurt me? I don’t like it when they hurt me!”

He suddenly stood up and picked up his duffel bag.

“I go to the bus station. I get a bus, thank you.”

“It’s OK, Nigel, nothing’s going to happen. You’ll be safe.”

He eventually calmed down and allowed me to take him to the care home.

The next day being Sunday, I rang the next social worker on duty and explained the situation to them. They would chase up the local authority where he came from and get some more information, and hopefully arrange for his safe return. And that was the end of my involvement.

I happened to see my standby colleague a week or two later.

“Remember Nigel?” he said. “I got through to his local authority. I managed to speak to someone who knew him. They knew him all right. He’s not from any of their care homes – but they did accommodate him in one a few weeks ago when he turned up on their patch one weekend saying that he’d run off from somewhere in another county a long way away. That is, until they made their own enquiries – and got the same story. Then they sent him on his way! Once we found this out, we confronted him with it and he left, rather quickly. I wonder where he is now?”

There is a postscript to this story.

I was speaking to a social worker in a neighbouring county a couple of years later. I told him the story of Nigel. He immediately recognised him.

“We put Nigel up in one of our mental health care homes for about 6 months,” he said. “Then we had a full psychological assessment done, and it turned out that he had a completely normal IQ and everything. Then he mysteriously disappeared.”

From time to time I think of Nigel, traveling the country, turning up in distress, like a lost person with learning difficulties, in need of care and shelter, being taken in and looked after, at least until the truth about him was found out, then moving on again. What drives someone to live their life like that?

He’s not the only one who does it. I knew of another case which happened in our county, of a young girl, apparently in her early teens, who presented herself one day, wearing a nightie and clutching a teddy bear, claiming to have been abandoned. She was placed with foster carers for several months, until it was discovered that she was actually 25 and had the tenancy of a flat in another part of the country.

Does it constitute a mental disorder, or is it simply a means to an end, a way of being looked after without any responsibilities? How many are there like Nigel and the “little lost girl”? And how many are so successful that they’re never found out?

When Service Users Seek to Deceive Part II

Borrowed from the excellent Little People Blog

 

Warning: this post may contain triggers for abuse.

 

During the more than 20 years that I have been based in a CMHT, I have worked with literally hundreds of women and men who have been the victims of childhood sexual abuse, rape and domestic violence.

 

One of the greatest fears that abuse survivors have when they disclose their abuse is that they will not be believed. That is one of the reasons why, as a matter of basic practice, I always believe what service users tell me. After all, I often tell them, why would anyone want to make up those sorts of stories?

 

I also often say to those people that out of the hundreds whose stories I have heard, there has only ever been one who did not tell the truth.

 

Trudy was 25 years old when I first met her. She already had a considerable psychiatric history, including depression, anxiety, and bulimia, and had recently had a spell as an inpatient. She also had dependency problems with amphetamines and other drugs. As a result of all this, she had split up from her husband, and he had got custody of their two children.

 

When I assessed her, she told me, without going into any detail, that at the age of 16 she had gone to live with an older man whom she described as a gangster. While she lived with him, she was terrorised by him, and had to endure nameless sadistic practices, until she had eventually managed to escape his clutches and move to another part of the country.

 

Through copious tears, she described a range of symptoms of post traumatic stress disorder, including nightmares, flashbacks and intrusive thoughts and memories.

 

She decided that she needed to disclose the details of the abuse she had suffered at the hands of this man.

 

However, she was very avoidant. She would cancel appointments, or forget to come, or find other reasons why she could not attend. This pattern continued for over two years, with far more cancellations and DNA’s than actual sessions.

 

When we actually did have a session, she would frequently become so distressed and tearful that she was unable to speak.

 

Eventually, we devised a plan in which Trudy would write about specific incidents at home, and she would then bring the printed account to the session. I would then read it through, and it became possible for her to begin to debrief these events. His abuse of her, according to these exceptionally graphic and lurid accounts, was almost unimaginably sadistic. It was not surprising that she had been traumatised by this relationship, and that she now found it so hard to deal with it.

 

However, she reported that things were gradually improving as a result of these sessions. The trouble was, we would have one or two good sessions, then there would be a series of cancellations or no shows.

 

During this time Trudy had a number of acute psychiatric admissions. Various sorts of medication were tried, with little success. At the time, the CMHT did not have a clinical psychologist, but a psychologist from another team showed me how to practice EMDR (Eye Movement Desensitisation and Reprocessing), a technique in which the subject recalls a traumatic event while the therapist moves a pen or other object from left to right in front of their eyes. The technique is supposed to disconnect the emotion from the event, and hence to reduce the traumatic recall.

 

I tried this technique with Trudy, with quite remarkable results. She reported an improvement in her emotional response immediately. We therefore did several sessions, and the improvement continued.

 

Trudy worked hard to regain control over her life. She stopped abusing amphetamines. She started to do volunteer work, she went on a diving course, she began to address her weight problem, and on our last session she told me she was planning to take an HGV course. She was discharged from the CMHT.

 

It was very gratifying to see the change in Trudy, and to feel that I had in some way helped her.

 

Then a few months later, she unexpectedly turned up at the CMHT asking to see me urgently.

 

I took her into an interview room. She presented in a way I had never seen her before. She seemed agitated, but also almost elated.

 

“Masked AMHP,” she said to me, “There’s something I need to tell you. You know all that stuff I told you about, about that relationship? None of it was true. I made it all up. None of it happened. And when I went into hospital? I just pretended to have those symptoms.”

 

I didn’t know quite how to respond. I didn’t know quite how I felt. How could she have deceived me so well? And not just me – how could she have pulled the wool over the eyes of all the inpatient nursing staff and psychiatrists?

 

“Why do you think I did that?” she asked me imploringly. “Why did I make all that stuff up?” She seemed desperately eager for my response.

 

"Well,” I said at last. “There is a mental disorder called Munchausen’s Syndrome. That is when someone pretends to have an illness, and feigns the symptoms, and often convinces medics that they are really ill. It’s more usually about physical illness. Such people often end up having many operations and courses of treatment.”

 

“I see,” she said, as if this was a remarkable revelation. “That sounds like me, doesn’t it?”

 

“Then there’s Munchausen by proxy, where a parent pretends their child is ill, or even feeds them poison to make them ill, and then seeks medical help.”

 

Her eyes lit up.

 

“But I used to do that!”

 

“What?” I said.

 

“I pretended that my son was having epileptic fits. He had all sorts of tests, he was even admitted to hospital for a while. He was on medication. Of course, there was nothing really wrong with him.”

 

These revelations were even more difficult to process. Although her children were no longer in her custody, I knew I would have to report what she had told me to Children’s Services.

 

“You need to help me,” she continued. “I need help. You see, even though the other stuff wasn’t true, what is true is that my Dad sexually abused me when I was a little girl.”

 

“What was the nature of the abuse?” I asked her.

 

“I can’t actually remember anything. But I know he abused me, and I need help.” But her presentation was incongruent with what she was saying. Her eyes were wide. They glittered. She was excited.

 

“We can’t do any more today,” I told her. “You were discharged from us months ago. You’ll have to get your GP to refer you again.”

 

However, she moved out of the area shortly afterwards. I never saw her again.