A very low-functioning schizophrenic patient with diabetes and other problems that have seen him hospitalized for "cheating' on his diet recently reports another incident of doubling up on dessert.
I tell him that the doctor has been very clear about what is at stake and that it sounds like it doesn't matter to him if he lives or he dies. He is silent.
I decide that his affect block, which sees him talk mechanically about things he should do, local sports teams or video games, won't let me go very far with him as the subject.
I ask him what his parents will feel like if he is dead.
He replies that he doesn't know.
I ask him if they think it'll be good or bad.
He says bad.
I ask him to say more.
He says bad.
I say "bad as sad you are gone, or bad as guilty or responsible for your death"
He says that they would feel responsible.
I say "you are living on your own in a big scary world and they don't take care of you"
He corrects me and says that it's his mom, and she doesn't make time for him.
I add that he is angry and he is punishing her, and that she will see what happens to him.
I ask what she would say if he told her how alone he felt and tell her he needs her.
He says that she'll probably just ignore him like she's always done.
I ask him if he thinks I can help him find new words so that she will hear him and know its serious.
He says he doesn't know.
I ask if it will hurt if he reaches out and she ignores him.
He confirms and says it'll hurt a lot.