He was pleasant, in his fifties, graying at the temples, articulate,and pretty much burned out on the symptoms of an alleged schizo-affective disorder. Like many of the people I treat he had been involved with the Hollywood entertainment establishment years previously. Now he lived in a residence suitable for his situation, and told me there was nobody he could talk to; he hated it. He even produced a lovingly-constructed list of names of people who had been important to him in the past. He did not know where they were, had no intention of finding them, so it served no ostensible purpose, except maybe to help him live in the past, because he had no interest in his dull and frustrating present. He said he simply could not relate to anyone in the residence where he was. They had no words, in many cases were illiterate, and were of no interest to him because they would not converse. He said he was depressed, but it was clear this was not the kind of depression you medicate.

I called for his case manager, who told me he had been offered another placement where it was expected there would be more conversation;  not once, but twice. He had declined. The complaints I heard from him had been going on for years. I asked him what was going on. He told me, again quite articulate.

“I can’t decide. I’m like someone who stays in a marriage, even if they don’t love the other person. They just can’t change. I have tried, and I don’t think I can. Maybe people like you should leave me alone and stop trying to help me. I don’t think even a smart lady like you can do a good job of treating somebody who can’t make decisions.” Read more on Decisions, Decisions!…