Sunday, October 12, 2008

Hiccup Boy: A Reflection

In The Cockroach Catcher, in a Chapter called Hiccup Boy:

"Johnny was referred by his GP to me because he had been having non-stop hiccups for the better part of six months. It was unusual for the problem to have gone on for this length of time before being referred to me. His doctor was one of those who seldom referred anyone. He tended to believe that there must be a physical reason, especially for a condition like hiccups. The boy had even been to the National Hospital for Nervous Diseases at Queen Square and Great Ormond Street. Both sent him back to the GP saying that his problem was probably psychological and perhaps the local psychiatric clinic might be of help.”

In one session, I managed to get the boy to stop his hiccup.Bullying has to be recognized early and yet many parents fail to grasp how nasty other children could be.Schools do not want to acknowledge the existence of bullying either as that could be bad for the name of the school. Also, recognition requires action: action on bullying.

In the case of the “hiccup boy”, it is clear that the victim did not help himself. He was fat (like his mother) and he probably lacked in social skills. Not all intervention in our work needs hours and hours of therapy or talking treatment.

I reflected in the book:

“Child psychiatry is not about asking questions, but about feeling the answers. It is a discipline where empathy rules. It is important that you know within ten minutes or so what is wrong.”

“So within the first few minutes, I knew what to do.”I sent everybody away including my junior, Dr Zola.

“Dr Zola, would you mind taking mother to the other room to get some history?”

Training rules as dictated by managers nowadays would mean that I might be subject to disciplinary action for not allowing my junior to observe what I did. But then my plan required me to be alone with the boy. No matter. Modern management has no heart.

I had to save his face, I needed authority and he needed to believe that I could deliver. Imagine the modern day doctor desperately “Googling” for a NICE guideline in front of everybody and still failing to come up with anything other then: “We will try and do another MRI, have a conference and perhaps ask the psychologist to look into him and then meet with school.”
Meetings and conferences later, the boy could still be hiccupping.No, my intervention took less than 5 minutes and the whole session less than 40 minutes, including the time taken to pacify the junior so that she would not complain.

The Hiccup was cured. The boy was saved from further bullying. Work that followed included dietary advice, weight reduction for the obese mother and boy pair, and then, of course special educational arrangements.It was not difficult to pacify my junior doctor, as she trusted me and liked my style. We put up with some bad tempered teachers in our medical school days because these professors were good at what they did, and here I was not even bad tempered.

Further thoughts:

They say it is a tough world and kids need to learn early on. Maybe! But this boy was hiccupping for 6 months for a good reason. It was his defence and in a way it worked for him. He was not killed, nor did he commit suicide.

Could mum have done anything different? Sure, don’t indulge the boy in the wrong foods and drinks. But we all know it is easier said than done.

What about his family doctor? Here his belief that the hiccup had an organic origin led to six months of no progress, although I doubt if my intervention would have been as dramatic if he had only been hiccupping for a day or two. Most parents prefer a non-psychological diagnosis.

“It is often better though if you can somehow get the parents to do the magic cure.”

Indeed it should be the aim of most intervention in the specialty of Child Psychiatry. It is of course the principle of psychoanalysis that a patient should be able to gain insight without being told; unfortunately the patient could wait a life time for that to happen.

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