Discharge Conference - Part 2
The discharge conference was continued on Friday morning August 27. The resident who had been involved on Tuesday was there again. There was a second resident too. I think the conference was intended, from Dr. Perlov's perspective, as a teaching conference for the residents.
I went in understanding that he had encouraged Jan and me to tolerate some of Dave's choices, to stay in touch and to support him emotionally. At the same time, he had been very vague and his vagueness supported inconsistency in our dealings with Dave and getting drawn in to supporting his risky and unhealthy behaviour.
At his invitation - which was a trap - I covered the events since Tuesday. Dave got restless and Dr. Perlov interrupted and attacked me. He said I had a pedantic style and I was boring him. I got two things out of that. First, he was establishing to Dave that he was prepared to take Dave's side and attack me. Second, he may have been trying to help me to see why Dave has a hard time listening to me.
He told Dave and me that I should wait for Dave to call me and that I should not try to contact Dave unless he contacted me first. He said that we might set up a routine that he could call me on certain days if he wanted. I didn't try to argue with that. I thought I had pretty well disengaged from Dave's life before his recent hospitalization and that I had been trying to support Dave in hospital and to respond to Dave's calls to me - which started with a demand for smokes on the Saturday he was admitted. I thought he had taken my visits to Dave in the hospital as evidence that I was pursuing Dave. However I didn't disagree with the advice.
He also I was going to feel that when Dave called me, he was using me. He said that I should take the risk and let myself be used. He said that I should use my judgment and that there was a fine line between supporting Dave's emotional needs and simply enabling. Enabling, for those of you who haven't heard the term, refers to various interactions with an addicted person that serve to support the addiction. It includes direct cash payments to buy drugs, indirect financial support for an addict's life choices, and various emotional interactions that an addict can use, either in his own mine or objectively, the continued use of drugs.
I can understand that this might be good spiritual advice for me, but I wasn't sure that Dave (and Jan) saw this as anything but a prescription to give Dave what he wants. I pressed the doctor to explain whether I should pay for Dave's apartment and food - the things Dave had said he wanted even before he ran away last year. The doctor said that he would not give Dave money and that Dave should be trying to support himself but that we would help Dave in emergencies. I asked about Dave's demands for money when he ran away to Edmonton. The doctor agreed that Dave had broken trust by leaving the City. I asked about whether I was doing too much by helping Dave to get a lawyer, taking him to court, and inviting him to the house to get his clothes. I said I had felt used because it sounded like Dave had not been able to get out in the rain and deal with his needs, and he expected me to start supplying groceries.
Dave got angry with me when I mentioned his call to me on Thursday, and Dave asked if mom was going to get a chance to talk. The doctor had several comments. He agreed with Dave that I was being annoying and passive-aggressive. He told me that I was showing contempt for Dave and creating conflict. He told Dave that he could not act out, and that I was asking good specific questions.
I said that I had also wanted to say that I was unsure of what to do when Dave was asking for food for himself and his girlfriend and possibly the people he was staying with. I saw his concern for her as genuine although I felt I was being dragged along with his plans and priorities.
Dr. Perlov asked Jan for comments. She was presented herself well - not the tearful, blaming presentation I have seen in private. She said that she was limiting and controlling her contacts with Dave, which I thought was a half-truth. She said she wants to support Dave but feels she does not want him to know her address because it is not her house etc. I realized that this was pretty standard behaviour for her. She was presenting herself in a way that was calculated to avoid criticism and earn support from the doctors and to make Dave think that her unwillingness to take him in was caused by my unwillingness or inability to support her career as a spiritual visionary.
I knew that she had been more involved with him through the last couple of months. He had been visiting him in the group home and had arranged for her parents and sister to visit Dave. That visit had taken place just before Dave ran away from the group home on Garfield around August 10. I had generally not engaged with Dave although I had left messages with the staff that he could call me.
Dr. Perlov asked if Dave would accept the referral to the outpatient unit. Jan asked me if I would participate. I told her that her comment was not appropriate and that she was still locked into trying to blame me for Dave's addiction. I asked a final question about whether it would be fair for me to ask Dave about drug use. The doctor said it would communicate contempt. I asked if that would be harmful to Dave by giving him a new rationalization to be angry and to keep abusing drugs. The residents nodded before the doctor could say anything.
I was disappointed with Perlov's advice, and with how Dave and Jan received it. I thought that the doctor had not informed himself about the history and was too focused on Dave's conflict with me. He was overlooking Dave's conflicts with teachers when he was in school, his conflicts with his social worker and his conflicts with the staff at Garfield. Dave doesn't like anyone who tries to impose any limits or rules, and he rationalizes his addiction, rebellion and misconduct as a fair response to an unfair world. He was taking a child-centered approach which addressed Dave's feelings without looking at his addiction and his conduct as objectively wrong.
I thought Dave was finding too much support for his long-standing plan that I should pay for an apartment and food (now apparently for him and a girlfriend) and games and voice lessons and that I should take my rules and shove them. Jan is finding support for her idea that I caused Dave's addiction and rebellion and the idea that Dave will be all right if people will just support him in positive ways - which is a romantic belief that Dave had always manipulated.
