Post by Shy Ted
Not a Convid post! I never studied or practised child and adolescent mental health but used to watch from afar as colleagues tortured themselves over diagnoses, causes, contributing factors and such as to why little Johnny or Suzie was a bit weird or just an a***hole. They were very big on societal causes, broken homes, discrimination and every other buzzword and very, very small on problems during pregnancy, parenting, head injuries and such. Then they would agonise some more about what to do before Johnny and Suzie didn’t come to appointments.
But just occasionally I’d have no choice but to listen to a parent telling the life story of their child and on just a few of those occasions I’d hear “he was fine until he had the MMR vaccine and after that he was a different child”.
This is the story of quite one of the weirdest cases I became involved in.
I’d taken a contract at a quaint country area, just a bit too far out from the city to be desirable but a big contributor to the economy. Contracts pay better and are easier than permanent employment because you have an end date in sight but there’s a reason why clinical positions become available – they’ve got no clinicians. I’d watched mental health disintegrate from a focused mental illness service staffed by doctors and nurses into a wishy washy, feel good, do nothing blob, staffed by well meaning people with dubious qualifications and job descriptions. And no clinicians to do the actual assessments.
First thing in the morning we meet to discuss new referrals and assessments and I couldn’t believe what I was hearing. “A man goes to the local show and the next day believes he’s caught syphilis from a toilet seat and you think it’s OK to reassure him that he hasn’t and that’s it? I want to see him this afternoon”. Another case seen by the only person with real qualifications – “he’s got Aspergers. I’ve got a nephew with Aspergers and he’s just like him”.
“Can I see the paperwork?” A referral from the GP, “Could you see this family? Father has Alzheimers, mum finding it difficult to cope and the son with profound mental retardation. I’m not quite sure what they want or what we can do”.
It’s like this everywhere outside the city now. Amateurs trying to do things beyond their ken and missing the point.
First things first, first chap, afternoon assessment. Syphilis chap – psychotic depression, very serious, next appointment with psychiatrist. Untreated, 60% of sufferers will complete suicide. Into treatment, I lay out the treatment plan which nobody understands because they aren’t clinicians.
Family – plough through medical records of all three. Have we got enough info to respond to GP’ letter? No, not even nearly. Tentatively ring mum, not keen on seeing us again because we “didn’t do anything last time”.
Nice lady, ex-nurse, worn out, ageing. Husband clearly has had Alzheimers for several years but no behavioural problems and happy with him at home. “I know almost nothing about Michael, mid-forties, other than a note from his childhood which said profound mental retardation diagnosed aged 3. Could you give me his life story?”
Reluctantly, resignedly, she did. Normal pregnancy, birth, milestones. MMR vaccine, a week of severe fever and seizures and never the same again. Assessed by the paediatrician and put in an institution for life. We visited him every month but he never spoke or interacted with us. When he was in his 20s he just came home one day. He said “they say I don’t have to stay any more so I’ve come home” and he’s been with us for 20 years. He’s no problem at all so I don’t know why the GP referred him”.
“Sorry to interrupt you but people with profound MR can’t talk and certainly can’t form sentences. They can’t usually be toilet trained and they have no comprehension of danger such as crossing a road.”
“That’s what I thought too. He just stopped communicating with us and every so often he’d just do something really weird like running into traffic so they institutionalised him. My only child.” Tears.
“And you have conversations with Michael now?”
“When there’s something that interests him on the news we talk about it but mostly he likes to watch the weather report and give his own take on where it will rain. You can try but he won’t talk to you”.
“If I’m home he won’t prepare any food but if I’m out he’ll make a sandwich but not return his plate or wash up”. Very strange.
He was an odd-looking chap with crossed eyes and no features of emotion who seemed to take everything in but didn’t react. He didn’t seem to be watching the TV or looking through the window. That’s how he was, all day, every day. It didn’t make sense. But I had heard the magic word “seizures” and that’s where I would start. Mum appreciated me pulling out one of my favourite old texts “Neurology for Nurses” and we went through the various unusual epilepsies, lost since reclassification. Neuropsychiatry had become my thing long ago. Rare in the city, common in the country. “Yes, he does that. And that. Yep, something like that”. We looked at each other knowingly.
“Should I write to your GP and suggest a trial of anticonvulsants for Michael?”
Bursting into tears she replied, “no. I can’t take any more. Things are OK as they are. I couldn’t bear any more hurt”.
“Sure, I respect that but I have to write to your GP anyway so I’ll just leave it open as an option”.
And that was that. Letter written. A few weeks later, just before the end of my contract I saw Michael in the main street of the main town, window-shopping, carrying a bag from one of the local shops. I called out. He turned, saw me and strolled on in his previous manner. People with profound mental retardation don’t do this. I went into the shop and asked about the transaction, knowing the shopkeeper. “He never talks to us. Comes in, strolls around, if he wants something he’ll point to it, pay by card and leave. Most times he never buys anything. Never acknowledges us. He bought a sandwich maker today”.
I never saw Michael again but it’s one of those cases where you wonder what happened. Mum wouldn’t live forever. Did he have epilepsy? Don’t know. Autism? Don’t know. Mental retardation? Certainly not to any degree.
The purpose of this post. Having met a few mums with such stories along the way I read lots of what I could understand. I read Wakefield’ research but it’s complex beyond my ken. There’s lots of articles out there about MMR and adverse effects such as autism. Do other vaccines cause autism, epilepsy or other conditions? They can and they do in my humble opinion. Sometimes. Why? Don’t know.
Shy Ted considers himself a bit of (not a lot of) a veteran of rural and remote life, mostly, but not always, nursing. Most of what you might read about in the media, other than the superficial headline such as doctor shortages, is nonsense. It’s interesting, challenging and rewarding and not for the faint-hearted or ideologues.