term. Margaret could be helped to see herself in a few years; time, when both children are at school, when both parents are employed, when the debt will have been repaid, and they will be able to pour the fruits of their labor into making a better family life for themselves and their children. The reality is that they are both healthy and young, and they can make a good life for their family in the city. They also have the alternative of possibly settling in the country and working in the city like so many people do. The point is to give Margaret the ability to have a more realistic perspective of the future rather than the present perspective, which is one of hopelessness.
JM summarized that these were the two dimensions of therapy; the first dimension is her internal dynamic and the expectations that she has of herself (as shaped by the abusive parenting of which she was subjected) and others, and the second dynamic is to develop a more realistic and more long‐term perspective of her future. For further study on effect of physical abuse on parenting see (Buist, 1998a; Buist, 1998b; Lang et al., 2010).
The doctor then added the dimension of parenting skills. Margaret sometimes hits her children physically and then feels remorseful about this. She feels unhappy that she is repeating the pattern with which she was brought up and is keen to give her children a different family experience. The doctor pointed out that although she wants to give her children a different family experience, when she is distressed and angry, she acts impulsively and hits them. JM responded to the doctor's added dimension by inviting her to focus on the reasons why her son was misbehaving. The doctor suggested that her son may be feeling jealous that much more attention was being given to his infant sister. JM suggested that it would be helpful to find out more about how her 3‐year‐old son developed the troubling behavior that he has and what is the feeling that drives this behavior. More particularly, the exploration needs to be directed to whether these parents give direction and proper attention to their son or whether they are neglectful of him because they are absorbed in other activities, some of them necessary, such as the care of their infant daughter, and some unnecessary, like the husband's online gambling. JM invited the doctor to explore the role of the father with his son and, in particular, whether the father actually spends a reasonable amount of time in some enjoyable or creative activity with him.
JM suggested that the possibility that the boy is misbehaving because he is neglected by his parents and, particularly, by his father should be explored more fully. JM pointed out that the overall impression is one of a mother who is overinvolved with her own sense that she should be responsible for the welfare of everyone and a father who is underinvolved and rather self‐indulgent in gambling and perhaps not carrying his share of weight for the family. This family dynamic needs to be more balanced if the children are to be more content and exhibit less disturbing behavior.
JM concluded the session by repeating that Margaret and her husband are two young people who are physically healthy and have the potential to work and provide for their family and shape a better future for themselves. This is the baseline from which they can both be given some realistic hope for their future and such hope would motivate them to channel their energies in a more creative way.
References
1 Buist, A. (1998a). Childhood abuse, parenting and postpartum depression. The Australian and New Zealand Journal of Psychiatry, 32(4), 479–487.
2 Buist, A. (1998b). Childhood abuse, postpartum depression and parenting difficulties: A literature review of associations. The Australian and New Zealand Journal of Psychiatry, 32(3), 370–378.
3 Lang, A. J., Gartstein, M. A., Rodgers, C. S., & Lebeck, M. M. (2010). The impact of maternal childhood abuse on parenting and infant temperament. Journal of Child and Adolescent Psychiatric Nursing, 23(2), 100–110.
3 Bipolar Affective Disorder
Miss C
Introduction
Miss C, is a 21‐year‐old woman suffering from Bipolar Affective Disorder.
History of present illness
Miss C was noted since July 2017 to be showing increasingly irritable and labile mood when she was taking her evening school examinations. She scolded her mother and sister on trivial matters. She had recently joined an insurance course and planned on taking the qualifying exam. She spent about US$1,000 this month on clothes and handbags and was spending more on dining. She mentioned that she needed to be someone “with class.” She mentioned that she will get rich and be the breadwinner of the family. She tended to lock herself in a room at night and listen to music, experiencing decreased sleep as well. She absconded from home 2 weeks before admission and stayed at her classmate's home for 5 days. She enjoyed her time there, chatting with the family, but they found her unmanageable and asked her aunt to take her home. She had an outburst of anger t a week before admission when she was nagging to have a portion of her sisters' food and her mother confronted her. She handed a glass bottle to her mother and asked her mother to kill her. Her mother smashed the bottle and pointed it to herself said she would kill herself instead. Miss C eventually locked herself in the toilet and splashed water on her face. She was seen at the outpatient department in August 2017 and a compulsory admission was arranged by F123 of the Mental Health Act due to manic relapse.
Personal history
Miss C is an evening school Form 6 student and part‐time waitress; she lives with mother and elder sister in a private flat.
Miss C was born in the city. Her birth and developmental history were unremarkable. She was raised by her parents and maternal grandparents. She is quite fond of her maternal grandfather who is gentle with her. Her maternal grandmother was deaf and had frequent conflicts with patient.
Her father came from a family associated with a criminal society. However, her father was not involved in any criminal activity, and he ran a cigarette and alcohol business. Her father was an alcoholic who tended to drink after 3 p.m.; he would scold her but would not hit her. Her mother and her mother's younger sister employed frequent physical punishment when Miss C was rebellious and would hit her with sticks.
Miss C's parents divorced when she was 9 years old and she was raised by her mother since that time. After her parents divorced, her mother worked as a waitress to support them. Her parents got back together later but never remarried. Miss C enjoyed a good relationship with both her parents. She respects her mother for the hardship that she endured in sustaining the family. She has good memories with father about their shared interest in movies and food.
Miss C had good academic results before Form 2 when her father died. She was always in the advanced class of the year. She described herself as “a shy kid” but enjoyed a good relationship with her classmates; she has five close and supportive friends with whom she's still in contact.
She has had one courtship from Primary 6 to Form 2 (ages 10–13), which she described as “puppy love.” When she was in Form 3, she was bullied by a classmate. That classmate would throw a basketball at her and would also threaten to beat her. Miss C gave up day school in Form 4 because of repeated hospital admissions as well as sedation resulting from psychiatric medication. She stayed at home and played computer games most of the time after quitting day school but later joined evening school. She worked as waitress on a short‐term basis to earn money.
Her maternal grandfather died in 2014 from pneumonia, and she was discharged from the hospital just in time to see him before he passed. She resents psychiatrists for depriving her time to accompany her maternal grandfather in his last days and for delaying her academic progression. She plans to get a university degree and work in an office. She said
