August 31, 2015
Mr. Chad Ramirez is a 26-year-old male bilingual in Spanish and English. He presents himself as clean shaven and appropriately dressed. He has been hospitalized 3 times in the last 90 days. He comes to our out-patient clinic after a referral from Middle Tennessee Mental Health Institute. He currently lives in a group home run by Dr. Simmons Pd.D. with five other men. Dr. Hammond has diagnosed him with acute schizoaffective disorder bipolar type while in MTMHI.
Chad believes he can talk to angels and demons. He is knowledgeable about current events and watches the news whenever he has a chance. The angels tell him who to believe when he hears about current affairs. The demons try to disagree with the angels, but Chad reports that he tries not to listen to them.
Only after Chad starts to trust his doctors and therapists does he share the subject of these “conversations”. Chad is well versed in the Bible and loves to tell people about stories from the Bible.
So far no medications have quieted the voices that Chad hears regularly. In fact, Chad does not believe that anything is wrong with his reality that he converses with angels and demons. Non-compliance with medication is a major problem for Chad after he is released from the hospital. When not taking his medication his care takers at the group home report that he suffers from insomnia and paranoia.
After three 50 minute conversations with Chad, I question his diagnosis of schizoaffective disorder bipolar type. While he certainly presents with behavior and beliefs that point to that diagnosis, none of these profoundly affect how he interacts with others in the so called real world. Perhaps Chad does in truth have a gift that we simply do not understand as doctors and social workers. The more spiritually inclined may go so far to say that he is “blessed”.
I suggest that for Chad we try a non-conventional treatment to see how Chad reacts when he is completely undedicated. In addition, I recommend he seek treatment with a spiritual advisor like a pastor that can discuss freely with Chad his personal belief system in a language that he can understand. As scientifically trained providers we may not have adequate tools to help Chad. However, it is our responsibility to attempt to find the best possible treatment for Chad, taking into account his own personal preferences and beliefs.
Progress Note: September 7, 2015
One week since Chad has had any medication. Chad reports no insomnia or hypersomnia, no paranoia or suicidal ideation. When asked about his “conversations”, Chad reports that only the angels have been talking to him. According to Chad he is “getting along better” with his roommates and staff members.
Chad met with his new therapist, Reverend Michaels on September 5, 2015 and says: “He is a Godly man.” Reverend Michaels reports that he and Chad had an in depth conversation on the book of Jonah. Chad has told me in the past that this is one of his favorite stories. Chad has agreed to continue working with Reverend Michaels once a week for the next month.
Progress Note October 6, 2015
After five sessions with Reverend Michaels, Chad reports that the demons no longer talk to him. Reverend Michaels reports that Chad has shared that he is “one of my favorite people.” Without a doubt this treatment plan has been an unequivocal success. Clearly, Chad does not need any medication at this time. He has agreed to continue to see Reverend Michaels on a weekly basis. However, he will also continue to see me once a month to insure that he has no relapse of symptoms.
Progress Note November 5, 2015
Chad continues to recover with the help of Reverend Michaels. Also, Dr. Simmons Pd.D. from the recovery home reports that Chad is getting along with his roommates for the first time ever and has not suffered from insomnia for at least two months.
At Reverend Michaels suggestion, Chad has started to attend church services on Sunday morning and Wednesday night at The Church of the Holy Comforter: a Lutheran church down the street from his group home. He has met several friends there his own age. This fact is a very good sign in Chad’s recovery. He has never had friends outside of his roommates or Our Place Peer Support Center: a day program he attends Monday though Thursday.