Sunday, November 24, 2013

Is your boyfriend good enough for you?

I have a patient who is bat-shit crazy.  Violent.  Sudden mood swings.  Talks to herself non-stop.  Long history of hospitalizations.  Resistant to taking most medications.  Currently on a monthly injectable.  Alienated her children.  She's so unrealistic and violent that most of the other patients know to stay away from her.

The strange thing is that she has a lovely male friend who faithfully visits her every weekend.  He seems learning disabled.  He is kind, polite, and patient.  He takes a few buses to get to the hospital.  He brings her goodies to eat and personal grooming products.  She was nice and happy when he was around.  She had reality-based, pleasant conversations with the staff.

A few weeks ago, she became more sexually preoccupied than usual, with some remarks directed at me, that I wanted her boyfriend and was to stay away from him or she would kill me.  I reported this change to her psychiatrist.  For my own understanding, I asked him why she was involving me in her sexual preoccupation.  I did not think that I was attracted to her boyfriend and figured that she was misinterpreting my politeness towards him as sexually charged.

The psychiatrist provided me with great insight into the patient's behavior as well as other women who have made similar claims.  The patient thinks that her boyfriend is a loser and she needs to prove to herself that he is not.

How did we get here?  The steps:

1.  Girlfriend is with boyfriend.
2.  Girlfriend thinks boyfriend is a loser.  Beneath her.  Not worthy of her.  She does not want this to be true.
3.  Girlfriend accuses another female of perceived higher status of being attracted to her boyfriend.  Promulgates this delusion by yelling at other female to stay away from him.
4.  Girlfriend now thinks that boyfriend is worthy of her because another female who is better than both of them wants the boyfriend.

The patient sees me as a far more desirable romantic interest than herself, so if I find her boyfriend desirable, then he is good enough for her.

This explanation has helped me so much.  It often takes a patient's raw, intensified emotions and behavior to clarify such patterns in non-institutionalized people.

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