Of course Anna does not always smile. Suddenly she is angry and frightened – very difficult to find out why or what. Any help you give her is a threat – so that she rejects it all. ‘I can do it myself.’ But she can’t do anything.
It is a dilemma, when you think someone is disturbed, you know they are, but you want still to respect their autonomy. Anna used to have quite a benign hallucination, that she was carrying one of the cats. She would clasp her arms round her bosom and seem very content and totally convinced by this. It did not seem necessary or helpful to say, there is no cat there, it made no sense to her.
But what if she wakes in the night, scared, pointing wildly in a sudden terror? You try to reassure, say there is nothing there. But this makes no sense to her, also.
I remember my first wife, Judy, who was manic depressive. She has some wild ideas – if you wanted her to keep talking to you, you had to listen and with sympathy to what she was saying.
The rules are different at home than they are in a consulting room – but there is the same need to hold a line, when it seems that reality is under threat.
The response is immediate. ‘You hate me’.
I make reassuring noises, less and less convincing with each repetition. ‘You’re mad’, she says. Or: ‘You think I’m mad.’ Whichever, it is a recognition that we are in different worlds at the moment.
I am surprisingly calm, too calm. It is over six years since the diagnosis. I used to get more upset than this. Every change in Anna felt like there was a step missing and we were falling into hell. Worst were the psychological tests that recorded clinically her loss of spacial awareness, her losing the ability to recognise objects. But I am not shocked any more by the deterioration in her condition.
I despair at the way time is drained from each day, as we sit and stand, stand and sit, circle restlessly.
It may be she has an infection. It would be good if there is something we can do to help.