Patient Y said something to me, back at our first meeting, which I haven't forgotten.
At first, I thought he was playing with me, but the more I think of it - I just don't know. Day one, we hadn't done appropriate introductions yet, and the first thing he says is something to the effect of him having the ability to get prescribed according to how he wanted. I wasn't sure at that time if he was speaking of wanting to have a role in determining how he would be medicated, if it were deemed necessary, or if he was initiating mind games straight from the beginning. I determined, at the moment, that he was lacking in social skills and although he most likely meant that he intended to have an active role in prescribing his medications, I can't help but wonder now if he was initiating playful intellectual sparring.
Now hear me out. One of the extremely few things I knew going into this one was some considerable history of mental illness dating back 25+ years, none of which had ever "really worked," except his latest efforts with another program, but he had a long list of doctors spanning all this time, and he had taken near every combination of psych drugs at one time or another. Time after time, failure after failure...
He very reasonably could have studied what would cause what medication to be prescribed in what condition. I remember hearing stories from years back of patients who would share stories and opinions of what their different meds were like and recommend them to each other.
But if this patient had plans to manipulate me either as part of a game or to get certain medications from me, why would he open the conversation with telling me that was his plan? It could have been a personal game of egotism he played only for himself. It could have been to prove something, then or now. What I believe that I have discovered as the truth far outreaches those possibilities: He was telling me, from the start, that his nature was to manipulate. Avoiding the time spent building trust, becoming more comfortable, the disconnection of not having yet built a relationship, he started right in with what he believed he had discovered as an issue I'd be able to fix. I don't know. But if this were true, why? What advantage was there to doing it this way? I'll continue on this later, for certain!