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Charles

Age at interview: 61
Brief Outline: Charles’s elder son became depressed and started self-harming aged 16. He is being treated by CAMHS and private psychologists. Charles finds his mood swings very worrying and difficult to deal with.
Background: Charles, 61, is a retired company director, married with three children aged 17, 14 and 12. Ethnic background: White British.

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Charles’s son Henry [not his real name] became depressed before taking his GCSEs. He moved to a different school where he seemed happier, but then said he couldn’t face school anymore and tried to harm himself by tying ligatures round his neck. Their GP, without consulting Charles and his wife, referred him to the CAMHS (Child and Adolescent Mental Health Service) Crisis Team. They saw several different members of the Crisis team, who recommended that Henry should not return to school. Charles and his wife couldn’t understand what the problems with school were, and were anxious that Henry did not fall behind with his school work. Nevertheless, Charles took Henry away to their holiday home abroad for a week. He tried to talk to Henry about coping with depression but Henry became angry, cut himself with a knife and tied a belt round his neck, leaving the door open so that his father could find him. They returned to England and again saw a succession of different clinicians, including a psychiatrist who considered admitting Henry to an inpatient unit. Henry wanted to go with the family on holiday, so persuaded the clinician that he did not need hospitalisation. There was one incident on holiday when Henry put a dressing gown cord round his neck following an argument with his brother. Henry is now back at school part time and is seen weekly by a private clinical psychologist who uses CBT (cognitive behaviour therapy), and is also seen regularly by the main CAMHS service. He is taking antidepressants.

Charles finds it difficult to cope with Henry’s sudden rages and the worry that he might damage himself or other people in an argument. Charles’s two younger children have been deeply affected by their brother’s volatile behaviour. His daughter has to control her reactions to him to avoid causing an outburst of temper, and Charles thinks that she is more grumpy and bad tempered as a result of this stress. Charles’s other son is relieved to be at boarding school, away from the tension at home. Charles says that the strain for him and his wife is huge, ‘like walking on glass’. Their efforts to comfort Henry sometimes make things worse – the clinicians have advised them to ‘give him space’. They feel powerless and constantly dread triggering more violent behaviour. Charles’s wife thinks much of Henry’s behaviour is related to teenage hormones and the normal difficulties of adolescence. They sometimes suspect that Henry is manipulating them, using his illness as an excuse not to go to school and to get his own way.

Charles has lived abroad for much of his life and is not used to the National Health Service. He is very satisfied with the private practitioners he has used, especially with the convenience of making appointments and being included in treatment. The Crisis team made him feel disempowered: he says his views, feelings and perspective were completely ignored. He is confused about the relationship between the Crisis team and the main CAMHS service, but is much happier with the consultant NHS psychiatrist and case worker who are now looking after Henry. Charles thinks that he is more trusting of the professionals’ opinions than his wife, who feels ignored and excluded from Henry’s treatment. They would like the opportunity to discuss the situation with the clinicians without Henry present, and think family therapy would be beneficial, especially for their daughter so she could express her feelings, but there is a long NHS waiting list. 

The school has been very supportive, but Charles worries about how long staff will put up with Henry’s poor attendance. He is anxious about the effect on Henry’s future if he misses too much of his school work. Charles used the internet to learn about teenage depression, and at one point thought Henry’s mood swings might be due to bipolar disorder, but was reassured by the private consultant that this was not the case. 

There is no family history of mental health problems, though Charles’s great-uncle killed himself over a love affair after the First World War.

Charles describes Henry as a charming lovely boy for most of the time. He worries about Henry’s lack of confidence and low self-esteem, but hopes that the combination of medication and therapy will enable him to live a normal life. He would like to hear how other parents have coped with similar situations. His advice to clinicians is to involve the parents as much as possible, so they have a better understanding of what is going on and how best to help their child.
 

Charles says his wife thinks a lot of their son’s behaviour is down to teenage hormones.

Charles says his wife thinks a lot of their son’s behaviour is down to teenage hormones.

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My wife, for example, would still say that a lot of his behaviour can be attributed to teenage hormones and growing up, and the normal difficulties of adolescence. But because [our son] has had all these psychiatrists and people dancing round him, telling him he’s suffering from a depressive disorder and all the rest of it, he now uses that as an excuse. And, in fact, jokingly, I mean when he’s not angry, he’s said once or twice, “Well, if I don’t,” with a smile, he’s said, “Well, if you don’t give me some nice presents for Christmas, I don’t know what’s going to happen.” 

[laughs] 

And this kind of thing. So she feels that if from that first day we hadn’t involved the medical services, I mean initially the GP, who then brought in the CAMHS, the crisis people, who then brought in the CAMHS, other people. If we hadn’t done that [my son] my son might be less prone to using his illness as an excuse not to go to school, not to do homework and not to eat the food which is put in front of him or whatever. Something which he doesn’t feel like doing, says, “Oh, you can’t make me do that. I’m depressed or I’ll get worse or I’ll have an episode.”
 

Charles would have liked advice on practical ways of minimising risk.

Charles would have liked advice on practical ways of minimising risk.

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Is there anything else that you think is important that you’d like to talk about?

I probably should know more about the practicalities, just the practicalities. I mean when one’s child goes thumping upstairs in a fury and one worries that he’s going to harm himself, what can one do? And it’s ludicrous to say, oh well, in fact, we do do it, we look for belts and ties and stuff and try and hide them but they’re always there - probably wouldn’t take him five minutes to find where they’re hidden. And there are always going to be sharp objects, scissors, geometry sets, which he’s used, or any number of implements. I mean well, glasses, bottles, tins, goodness knows what. One can’t, other than locking him up in a padded cell, are there practical ways of minimising risk? I don’t know.
 

Charles pleaded with his 12 year old daughter to avoid annoying her brother.

Charles pleaded with his 12 year old daughter to avoid annoying her brother.

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Can you say a bit about the impact that this has had on the family sort of both emotionally and practically and socially?

The first point I’d make is it has been explained to me how completely selfish people are in this sort of mental state that the patient has absolutely no apparent concern for the effect his behaviour has on his younger siblings, who are at a very impressionable age, fourteen and twelve. And there has been a very deep effect. I mean it is particularly, well, on both of them, the twelve year old says things like, “Well.” We try to say to them, “Please don’t, try not to annoy him because we don’t know what’s happened. He suffers from something called depression and anything might happen.” And so this poor girl has to bite her tongue and feels very constrained about what she can say or do with her brother and so it’s a great worry for her, and I think possibly she’s more grumpy and bad tempered than perhaps a twelve year old girl would normally be as a result of this stress. 
 

The tension for Charles and his wife was ‘like walking on glass’.

The tension for Charles and his wife was ‘like walking on glass’.

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So I think for my wife and myself, the tension has been huge. It’s like walking on glass. You just wait for and dread the telephone call from school saying, “Can you come and take your son home?” Or you dread, you’re constantly trying to monitor his mood and sometimes, to be quite frank, it’s probably ninety five per cent of the time, he’s normal and lovely.

Yes.

But it’s for that five or three per cent of the time, when something triggers this sort of fury and anger, that’s the time, one is just constantly dreading and one feels fairly powerless. 
 

Charles would have liked the Crisis Team to help get his son back to school.

Charles would have liked the Crisis Team to help get his son back to school.

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Since we came back from France, we managed to get out of the grip of the crisis centre. I can see their role seemed to be to do anything to keep this boy calm. They had no obvious consideration about getting him back to school or the bigger picture or treatment for that matter. It was purely a sort of, “We’re on the end of a telephone. We’ll come and see you. How are things?” You know, “Come on, [son], cheer up.” Just taking an interest and so on. I mean that seemed to be, what to us, that seemed to be what the crisis people were concerned about. Subsequently, he was discharged by them when we left for three or four weeks holiday overseas because, obviously, they can have no role, and since coming back things have settled into a much better routine.
 

Charles tried to encourage his son by telling him how common depression is.

Charles tried to encourage his son by telling him how common depression is.

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I said something to him, trying to encourage him, saying that depression was a very common condition and even, I said, even when I was thirteen or fourteen, I got very cross with something at school and even went so far as swallowing I think two, possibly three aspirins before giving up. And I mentioned this in a sort of humorous encouraging way, saying you can get over these things and lots of people like Stephen Fry and Winston Churchill and God knows who, many people manage to overcome depression and so on. 

And he got angry about this and left the room and I found him again having found a kitchen knife or something, no actually, it was an eating knife, which he had attempted to disinfect with a flame thrower thing. I thought it was rather amusing. “If you’re going to try to kill yourself, you should disinfect the blade”, but any rate, he’d made a number of marks and left all the evidence all laid out, the knife and the gas lighter and everything all laid. And then I found him sitting again with a belt round his neck but clearly in a room with the door open so that I would find him and I tried to comfort him and calm him, which I think succeeded, and the next day in fact he was as right as rain.
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