Madness Around the Care of a Difficult Patient in the Hospital: Who Makes Who Ill?

Abstract

Miss S.G. is now 22 years old. Rejected by her entourage and by several foster home and adolescent institutions because of her hetero-aggressiveness, her death threats since she was 13 years old and her various suicide attempts, she was hospitalised in our service for adults in 2006 in order to no longer be able to leave. at the hospital, this young woman of slightly limited intellectually and a history of abandonment became a first-class aggressor, creating upheaval throughout the service.

Initially, she became aggressive towards patients at the slightest frustration and despite the reinforcement present, finally proceeded to attacking caregivers and the service's referring doctor. Her long stay in the service allowed her to divide the team. the escalation of her violent behaviour and the attack on the doctor finally led us to direct her to the specialised service for difficult patients, but at what price?!

The event and the exhausting care of this difficult patient provoked a deep institutional conflict that we have resolved with difficulty. We will present our thoughts on the limits of our role as carers in the care of border-line violent subjects who do not accept the care protocols. We esteem that the collaboration with other educational structures other than psychiatry is important for the management of these difficult clinical cases.

The departure of the patient to the specialised service allowed us to take a step back to obtain better cohesion and change her care protocol on her return.