Lessons from Amy
CMAJ 1997;157:13
See response by: S. Cameron
See also:
I congratulate Dr. Cameron for having the courage and honesty to share with us in all faith such an interesting patient as Amy. I have discussed this paper and this patient with members of our psychogeriatric team and must confess that our opinions and our conclusions were far different from those reached in this paper.
There is no doubt that the patient's rights, such as refusing treatment, must be respected. Nevertheless, one should look into this refusal and its meaning, especially if, as seemed to be the case with Amy, the patient's illness could have been "arrested." Our members felt this person was not really listened to by her physicians. She was an intelligent, articulate person who talked in an apparently logical way and was listened to in a similar logical way, but she was certainly not listened to with the "third ear."
For instance, how can one explain the discrepancy between what this patient was saying, her wish to die and the flood of SOS letters she sent to so many people? Why did she return to see her hematologist 3 times in spite of her apparent refusal of any treatment? Someone who does not want help does not go through all that pain and trouble. Could it be that her sadness, her loneliness and finally her fear of dying were not taken into account, explored and presented to her as having much to do with her refusal of treatment and wish to commit suicide?
In psychiatric terms, this woman was showing signs of grandiosity: she was called the "Queen" in her neighbourhood and she would not let nature or fate or destiny or God take her life. Instead, she would be the one who decided when to live and when to die, and in a way she would act like God. This, to me, is manic denial. Unfortunately, one cannot see her action as anything affirmative!
The problem with Amy was not whether she was mentally ill. Here was an extremely sad woman who had no one to really listen to the expression of her emotions; we only listened to the physical expression of her symptoms. She gave gifts to her physicians and to the coroner and no doubt would have hoped that someone would have given her the gift of listening and trying to understand what her problem really was.
While reading and thinking about Amy, who was indeed a good teacher, I could not help remembering Balint's book, The Doctor, His Patient and the Illness.1
Laurent Gervais, MD
Hôpital du Sacré-Coeur de Montréal
Montreal, Que.
Reference
- Balint M. The doctor, his patient and the illness. New York: International United Press; 1957.
 |
Send a letter to the editor responding to this letter
Envoyez une lettre à la rédaction au sujet de cette lettre |
Letters