KEEPING SECRETS

The patient is a young man in his 20s admitted to the hospital for increasingly disorganized and bizarre behavior. His halfway house is rapidly nearing the limits of its patience with him because of his disruptive lying and stealing; the patient may also be jeopardizing his part-time job by similar antisocial behavior. As the assessment proceeds, the treatment team is struck by the lack of information on this patient, especially concerning his parents and other members of the family. Although the parents live in the same city, they have allegedly cut all ties with the patient and want little to do with him. Similarly, he presents himself as having separated fully from them, and, by inference, the treatment team believes that this again has to do with their reaction to his inappropriate and unmanageable behavior.

After a period of time, a different, deeper perception emerges. It becomes clear that the patient misses his family a great deal, but attempts in a certain sense to “protect” the family from treatment team members by keeping them separated. He almost seems more concerned with their well-being than with himself. It becomes apparent that his recent decompensation is in part caused by the parents' alleged move to a nearby state and his sister's enrollment in a school on the West Coast.