(I love having blog inspiration at six in the morning when most sane people are getting UP, and I’ve not yet gone to sleep. I really do. /Sarcasm)
One of the things a case manager assesses when working with a client is their ADLs- activities of daily living. Many of my clients have atrocious ADLs. They do not bathe on a regular basis, or use deodorant, or do anything related to their teeth (if they still have some and they haven’t all rotted out,) or wash their clothes, or clean their apartments… I’ve noticed that people with schizophrenia in particular are terrified of water, especially running water from a tap or shower. One of my clients has this aversion, and the voices tell him that he’ll drown, fall, or be scalded, so he avoids the shower until he simply has no choice. He, at least, sponge-bathes the important bits daily and wears deodorant. He has trouble keeping up with his dishes, because he is afraid of being scalded. No amount of “no, seriously, it’s ok to wash dishes in cold water, so long as you’re using soap” seems to really help, but standing there with him and talking him through it works. We’ll upgrade that to standing outside of the bathroom and coaxing him through a whole shower soon, once we have the manpower to see him three times a week instead of the paltry one we currently are able to manage. This fear is remarkably common and I often wonder if it’s been studied, but as most of the good articles are paywalled and I am not presently a student, I can’t do too much research on the subject.
Another client I’ve had in the past had bipolar disorder or schizoaffective disorder based on the diagnosing clinician (I still lean towards bipolar, and I saw her daily, so I’m pretty sure of anyone, I had the best handle on it,) once commented to me, “You know, it’s ridiculous. I *know* I should shower and brush my teeth and all those things daily. But I just… can’t. I can’t force myself to do it, not all of it, and it’s so stupid, but there’s a block there.”
I totally get it.
It’s particularly bad when I’m already late heading to bed, because I am mentally ticking down the hours until I have to be up again, but skipping part of my nightly routine and not being freshly washed when I get into bed results in a LOT more tossing and turning then normal. I lie there and think about how I didn’t shower, or skipped brushing my teeth, and finally get up after I start to panic about it and get it over with. I feel better and usually fall right to sleep, but now it’s been an extra hour agonizing over something that takes fifteen, twenty minutes TOPS. I’m really bad on the weekends when I should be sleeping at a normal hour but totally don’t, so at some point my brain stops responding and I’m honestly worried I can’t shower because I really *will* fall over, due to how tired I am. I skip brushing my teeth sometimes and lie there and think about tooth decay and gum disease for an hour rather than just taking the four minutes it takes to complete my whole dental routine. I can’t seem to juggle ALL of my routine maintenance, as it were, and haven’t been to the dentist in ages, or optometrist, though I know my prescription needs adjustment. I am religious about my therapist and psychiatrist, but the others slide, because I am just tired of so many appointments. It gets old, fast…
Does anyone else struggle with this? It’s so simple, going through your daily routine. But as soon as I slip up and stay up too late, the battle begins.