Benign Neglect or Can Deception Ever Be Therapeutic?
The rather brief podcast linked below suggests a novel approach for addressing the problem experienced by a German retirement home where residents suffering from dementia tended to wander off campus and become lost in the community. Irrespective of how closely the focus of this piece may parallel your professional work, there is an inherent ethical question associated with the proffered solution: Is it okay to intentionally deceive individuals, in a rather elaborate and premeditated way, when the result of the deception is a reduction in the likelihood of the demented individual experiencing harm?
Related to this is a story from my clinical experience over 30 years ago. While directing a clinical staffing in an in-patient addiction treatment program, the program’s consulting psychiatrist related the story of an elderly woman suffering from dementia who was living with her daughter. Each morning this woman would get up, happy as the proverbial clam, fix herself tea and toast, and then proceed to sit in the front-room of her daughter’s home for several hours “watching her friends as they would do their acrobatic tricks out front of the house.” Now, the friends were little people who used the telephone wires strung between the poles out-front of the house to practice their routine. As you have no doubt surmised there were no “little people” doing “acrobatic tricks” in the telephone wires in front of the house; this was the woman’s delusion.
The woman’s daughter became concerned about her mother’s hallucinations and her increasing fascination with them...in short, they because the highlight of her day and all she would talk about through the day. The psychiatrist interviewed to elderly woman, made a diagnosis, prescribed medication and in relatively short order the delusions ceased. The psychiatrist was satisfied with the result, the daughter was ecstatic with her mother’s return to sanity...and the elderly woman became severely depressed. The depression progressed to a point where the elderly woman became lethargic, inattentive to such things as eating and personal hygiene, and uncommunicative. The daughter again contacted the psychiatrist, outlined the new symptoms and her concerns for her mother after which the physician agreed to reexamine the elderly woman. He diagnosed her condition as related to the “loss of her friends” and the depression observed the result of the grieving associated with this loss.
His recommendation? Take the elderly woman off the medication and engage the daughter in supportive “talk therapy” so that she might better cope with her mother’s condition. With in a relatively short time, the elderly woman’s friends returned, she now was the one who was ecstatic and returned to her previously outlined daily routine. The daughter agreed to the therapy and as the result, was able to better cope with her embarrassment related to the stigma she perceived being associated with her mother’s “mental illness”; the case was closed.
My point in sharing this latter story is to approach the question mentioned initially above from a different perspective: Is the intentional deception of a client resulting in harm reduction or the intentional withholding of treatment that can effectively alleviate symptoms of pathology albeit with iatrogenic effect (1) justified, and if so (2) is it ethical?
What do you think?
Check out the referenced podcast on iTunes: http://ax.itunes.apple.com/us/podcast/wnycs-radiolab/id152249110 (#13, “The Bus Stop” episode)
Best regards,
Dr. Robert
Related to this is a story from my clinical experience over 30 years ago. While directing a clinical staffing in an in-patient addiction treatment program, the program’s consulting psychiatrist related the story of an elderly woman suffering from dementia who was living with her daughter. Each morning this woman would get up, happy as the proverbial clam, fix herself tea and toast, and then proceed to sit in the front-room of her daughter’s home for several hours “watching her friends as they would do their acrobatic tricks out front of the house.” Now, the friends were little people who used the telephone wires strung between the poles out-front of the house to practice their routine. As you have no doubt surmised there were no “little people” doing “acrobatic tricks” in the telephone wires in front of the house; this was the woman’s delusion.
The woman’s daughter became concerned about her mother’s hallucinations and her increasing fascination with them...in short, they because the highlight of her day and all she would talk about through the day. The psychiatrist interviewed to elderly woman, made a diagnosis, prescribed medication and in relatively short order the delusions ceased. The psychiatrist was satisfied with the result, the daughter was ecstatic with her mother’s return to sanity...and the elderly woman became severely depressed. The depression progressed to a point where the elderly woman became lethargic, inattentive to such things as eating and personal hygiene, and uncommunicative. The daughter again contacted the psychiatrist, outlined the new symptoms and her concerns for her mother after which the physician agreed to reexamine the elderly woman. He diagnosed her condition as related to the “loss of her friends” and the depression observed the result of the grieving associated with this loss.
His recommendation? Take the elderly woman off the medication and engage the daughter in supportive “talk therapy” so that she might better cope with her mother’s condition. With in a relatively short time, the elderly woman’s friends returned, she now was the one who was ecstatic and returned to her previously outlined daily routine. The daughter agreed to the therapy and as the result, was able to better cope with her embarrassment related to the stigma she perceived being associated with her mother’s “mental illness”; the case was closed.
My point in sharing this latter story is to approach the question mentioned initially above from a different perspective: Is the intentional deception of a client resulting in harm reduction or the intentional withholding of treatment that can effectively alleviate symptoms of pathology albeit with iatrogenic effect (1) justified, and if so (2) is it ethical?
What do you think?
Check out the referenced podcast on iTunes: http://ax.itunes.apple.com/us/podcast/wnycs-radiolab/id152249110 (#13, “The Bus Stop” episode)
Best regards,
Dr. Robert
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