A follow-up psychiatric consultation: a father, Mr Yang, consults a psychiatrist regarding his sixteen-year-old son’s sudden withdrawal from school, reversed sleep patterns, refusal to leave his bed, irritability, and past suicide threats, exploring whether the symptoms indicate adolescent depression rather than schizophrenia.
- Psychiatrist · turn 1
Well, on the last two or three occasions that we’ve met, we’ve talked about your son staying in bed all day. In fact, last time you said you thought he might have developed schizophrenia. Has anything changed since then?
好的，在我們過去見面的兩三次會面中，我們談到您兒子整天賴在床上不起床的情況。事實上，上次您說您認為他可能患上了思覺失調症（精神分裂症）。自那以後情況有甚麼變化嗎？
- Mr Yang · turn 2
沒有甚麼改善。其實我之前也跟您提過，最困難的就是每天早上叫他起床上學。每次我叫他起來，他都會說：「再睡十分鐘，就十分鐘。」然後轉眼又睡著了。他睡得特別沉，怎麼叫都叫不醒。當然，現在已經沒有這個問題了，因為他已經退學，不再去學校了。
There hasn't been much improvement. Actually, as I mentioned to you before, the hardest part was waking him up for school every morning. Every time I tried to wake him, he'd say, 'Just ten more minutes, just ten minutes,' and then fall back asleep in the blink of an eye. He slept so deeply that nothing could wake him. Of course, that problem doesn't exist anymore, because he has dropped out of school and no longer goes.
- Psychiatrist · turn 3
I see. Obviously dropping out of school is concerning, but difficulty getting up in the morning, or having to be called several times before getting out of bed, is quite common among teenagers. In fact, plenty of adults have the same problem. What makes you perceive this as an illness rather than typical teenage behaviour?
我明白了。退學固然令人擔憂，但早上難以起床，或者需要被叫好幾次才肯起床，這在青少年當中相當普遍。事實上，很多成年人也有同樣的毛病。是甚麼讓您覺得這是一種疾病，而不僅僅是典型的青少年行為？
- Mr Yang · turn 4
我覺得這就是病。他退學了，卻根本不去找工作，而是成天躺在自己房間的床上。他媽媽每天晚上八點左右下班回家，可那個時候他還是在床上，連晚飯也不吃。然後通常到了半夜十二點，他才起來找點東西吃。有時候我們早上起床，才發現他整個晚上都沒有睡。
I feel this is an illness. He dropped out of school, but he doesn't look for work at all; instead, he lies in bed in his room all day long. His mother comes home from work around 8 o'clock every evening, but he's still in bed at that time and won't even eat dinner. Then usually around midnight, he gets up to find something to eat. Sometimes when we get up in the morning, we find out he hasn't slept the entire night.
- Psychiatrist · turn 5
That certainly doesn’t sound like a healthy routine, although it’s still not entirely unusual. Some young people become quite inactive when they’re not attending school or working, particularly if they spend a lot of time playing computer games or staying up late. Apart from his sleeping pattern, what other changes have you noticed?
這聽起來確實不是健康的生活作息，儘管這也並非完全罕見。有些年輕人在不上學或不工作時會變得很消極被動，尤其是如果他們花大量時間玩電腦遊戲或熬夜的話。除了作息規律之外，您還注意到他有甚麼其他變化嗎？
- Mr Yang · turn 6
他現在已經完全不分白天黑夜了。每當我讓他幫忙洗碗、收拾房間甚麼的，他就是賴在床上，盯著天花板看，就好像甚麼都沒聽到一樣。他很少跟我們說話，一張嘴不是發脾氣就是罵人。有時候我問他到底怎麼了，他就把門鎖起來，誰也不理。
He completely confuses day and night now. Whenever I ask him to help wash the dishes or tidy up the room, he just lies on the bed staring at the ceiling, as if he hasn't heard anything. He rarely talks to us, and whenever he opens his mouth, it's either throwing a tantrum or swearing. Sometimes when I ask him what on earth is wrong, he locks the door and ignores everyone.
- Psychiatrist · turn 7
I understand. I don’t want to dismiss your concerns, but some of what you’ve described can occur as part of typical rebellious behaviour during adolescence. What would concern me more would be a sudden and significant change from his previous behaviour — particularly behaviour that is noticeably unusual or completely out of character. Has that happened?
我理解。我並不是想輕視您的擔憂，但您剛才描述的某些情況，確實可能屬於青春期典型叛逆行為的一部分。更讓我關切的，是他是否出現了與以往行為截然不同的突發性顯著變化——尤其是明顯反常或完全脫離其性格特徵的行為。有發生過這樣的情況嗎？
- Mr Yang · turn 8
對不起，我最近腦子不太好使，剛才就想告訴您這件事。他的確是突然變成這樣的，大概是從半年前開始吧。在那之前，他在學校的表現一直很好，成績也不錯，對我們的態度從來沒有這麼極端。後來他突然變得很消沉，也不願意去學校。我們一開始以為他只是青春期叛逆，所以逼他繼續上學。可是有一次他威脅我們說，如果不讓他退學，他就去死。我們當時嚇壞了，也沒有甚麼辦法，只好先讓他退學。
I'm sorry, my memory hasn't been working well lately; that was exactly what I wanted to tell you just now. He indeed changed like this very suddenly, about six months ago. Before that, his performance at school was always very good, his grades were decent, and his attitude toward us was never this extreme. Then he suddenly became very despondent and refused to go to school. At first we thought he was just being rebellious, so we forced him to keep going. But on one occasion, he threatened us saying that if we didn't let him drop out, he would kill himself. We were terrified and had no other choice, so we had to let him withdraw from school first.
- Psychiatrist · turn 9
That’s very important information. When someone threatens suicide, particularly in combination with a significant change in mood and behaviour, we need to take it seriously. Did he ever tell you how he intended to harm himself, or did he make an actual suicide attempt?
這是非常重要的資訊。當有人以自殺相威脅，特別是伴隨著情緒和行為的顯著改變時，我們必須高度重視。他有沒有向您透露過打算如何傷害自己，或者他是否有過實際的自殺嘗試？
- Mr Yang · turn 10
沒有，他沒有說過具體要怎麼做，我們也沒有發現他真的試過自殺。不過自從他說過那句話之後，我太太一直很擔心。她晚上有時候會起來看看他，怕他真的做傻事。
No, he didn't specify how he would do it, and we haven't found that he ever actually attempted suicide. But ever since he said those words, my wife has been constantly worried. She sometimes gets up at night to check on him, terrified that he might do something foolish.
- Psychiatrist · turn 11
All right. Has he ever behaved as though he was hearing or seeing things that other people couldn’t? For example, has he mentioned hearing voices, or has he developed any unusual beliefs, such as believing that someone is following him or trying to harm him?
好的。他的言行中是否曾表現出聽到或看到別人看不到的東西？例如，他是否曾提起聽到某些聲音，或者產生了任何不尋常的信念，比如認為有人在跟蹤他或試圖傷害他？
- Mr Yang · turn 12
這個倒沒有。他從來沒有跟我們說過他聽到甚麼聲音，也沒有說有人要害他。所以我也不知道是不是精神分裂症。我只是看到他整個人變得跟以前完全不一樣，才會往這方面想。
Not that. He has never told us that he heard voices, nor has he said that someone was out to harm him. So I don't know whether it's schizophrenia either. It's just that seeing him completely transformed from who he used to be made me think in that direction.
- Psychiatrist · turn 13
That distinction is useful. Hallucinations and delusions can occur in psychosis and schizophrenia, although their absence doesn’t necessarily rule out a psychiatric condition. Based on what you’ve told me so far, however, I wouldn’t jump to the conclusion that he has schizophrenia. Does he have any close friends? Or perhaps a girlfriend? What was his social life like before all of this started? Also, are you aware of whether he had any behavioural problems while he was at school?
這個區分很有價值。幻覺和妄想常出現在思覺失調與精神分裂症中，儘管沒有這些症狀並不代表能徹底排除精神疾病。然而，根據您迄今為止的陳述，我不會草率地下結論說他患有精神分裂症。他有要好的朋友嗎？或者有沒有女朋友？在這一切發生之前，他的社交生活是怎樣的？另外，您是否了解他在學校期間是否有任何行為問題？
- Mr Yang · turn 14
我覺得他有幾個比較要好的朋友。以前他經常跟他們一起出去玩，有時候週末整天都不在家，但是現在完全不跟他們聯絡了。他也沒有女朋友。現在他就是整天把自己關在房間裡，躺在床上，我覺得他的精神已經完全垮了。至於他心裡到底在想甚麼，他從來不跟別人說。以前他也不太願意告訴我們學校裡發生的事情。現在回想起來，我一直在想，會不會是他在學校遭到了霸凌，只是一直瞞著我們？
I think he had a few quite close friends. In the past, he often went out with them, sometimes spending entire weekends away from home, but now he has completely cut off contact with them. He doesn't have a girlfriend either. Now he just shuts himself in his room all day, lying on the bed—I feel his spirit has completely collapsed. As for what he's actually thinking, he never tells anyone. Previously he wasn't very willing to share what happened at school either. Looking back now, I keep wondering whether he was bullied at school and just kept it from us all along?
- Psychiatrist · turn 15
That’s certainly one possibility. There must be something that triggered such a sudden behavioural change, and bullying, problems with friends, academic pressure or another stressful event could all contribute. From what you’ve described, I wouldn’t say that he has developed schizophrenia. However, the loss of interest in his usual activities, withdrawing from friends and family, disrupted sleep, staying in bed for most of the day and talking about suicide can all be associated with depression.
這確實是一種可能性。必然存在某種誘因引發了如此突發的行為轉變，霸凌、與朋友之間的糾紛、學業壓力或其他壓力事件都有可能誘發。根據您的描述，我不會認為他患上了精神分裂症。然而，對以往活動喪失興趣、疏離朋友和家人、作息紊亂、終日臥床以及提及自殺，這些都與抑鬱症（憂鬱症）密切相關。
- Mr Yang · turn 16
可是他才十六歲啊。這麼小的孩子也會得抑鬱症嗎？我們家裡也沒有甚麼大問題，他想要甚麼，我們基本上都會盡量滿足他。我實在想不明白他有甚麼好抑鬱的。
But he's only sixteen years old. Can a child this young really get depression? There aren't any major problems in our family either; whatever he wants, we basically try our best to provide for him. I really can't fathom what he has to be depressed about.
- Psychiatrist · turn 17
Depression can affect teenagers as well as adults. It isn’t simply a matter of having a difficult life or having nothing to be happy about. There can be psychological, social and biological factors involved. At this stage, though, I don’t want to diagnose him without assessing him directly. I recommend that you try to talk with him calmly and find out whether something specific happened around the time his behaviour changed. Try not to interrogate him or immediately dismiss what he tells you.
抑鬱症既可以影響成年人，也可以影響青少年。這並不僅僅取決於生活是否艱難，或者是否缺乏值得高興的事。它涉及心理、社會和生理等多重因素。不過現階段，在沒有親自對他進行評估之前，我不希望直接下診斷。我建議您嘗試心平氣和地與他交談，了解在他行為發生轉變的前後是否發生了甚麼具體事件。盡量不要審訊式地質問他，也不要立刻否定他所說的話。
- Mr Yang · turn 18
問題就是他根本不願意跟我們說。我一問，他就嫌我煩，說我們甚麼都不懂。有時候我太太想安慰他，他還會叫她出去，把門關上。
The problem is that he simply refuses to talk to us. As soon as I ask, he complains that I'm annoying and says we don't understand anything. Sometimes when my wife tries to comfort him, he even tells her to get out and slams the door.
- Psychiatrist · turn 19
In that case, please encourage him to come and see me. I’d like to speak with him directly and conduct a proper psychiatric assessment. We can look at his mood, sleep, appetite, concentration and social functioning, and assess whether there is any risk of self-harm or suicide. If necessary, we can then discuss appropriate treatment, which might include counselling or psychological therapy. Medication is another option in some cases, but we wouldn’t make that decision until he has been properly assessed.
既然如此，請您鼓勵他前來與我面談。我很希望能直接與他交談並進行一次正規的精神科評估。我們可以評估他的情緒、睡眠、食慾、注意力以及社交功能，並評估是否存在自殘或自殺的風險。如有必要，我們隨後可以討論合適的治療方案，其中可能包括輔導或心理治療。在某些情況下藥物治療也是一種選擇，但在對他進行全面評估之前，我們不會輕易做出決定。
- Mr Yang · turn 20
如果他就是不肯來呢？他現在連家門都不太願意出。我怕我一提精神科醫生，他就覺得我們把他當成精神病人，更加不肯配合。
What if he simply refuses to come? He's barely willing to step out of the front door right now. I'm afraid that as soon as I mention a psychiatrist, he'll think we treat him as a mental patient and become even less willing to cooperate.
- Psychiatrist · turn 21
Unfortunately, there can still be considerable stigma surrounding mental health treatment. You might explain that seeing a psychiatrist doesn’t mean that he is “crazy” or that he has schizophrenia. It simply gives him an opportunity to speak confidentially with someone who can assess what he’s going through. Most importantly, because he has previously threatened suicide, if he talks about killing himself again, develops a plan to harm himself, or you believe there is an immediate risk to his safety, don’t wait for another appointment. Seek urgent help straight away.
遺憾的是，圍繞心理健康治療的污名化現象依然相當普遍。您可以向他解釋，看精神科醫生並不意味著他「瘋了」，也不代表他患有精神分裂症。這只是給他一個機會，在保密的環境中與專業人員交談，讓對方了解並評估他正在經歷甚麼。最重要的是，鑑於他此前曾威脅過要自殺，如果他再次提起自殺、制定了自殘計劃，或者您認為他的安全面臨迫在眉睫的危險，請切勿等待常規預約，務必立即尋求緊急援助。
- Mr Yang · turn 22
好吧，我回去再試著跟他談談，也會叫他媽媽不要一直逼問他。希望他願意過來見您。他這個孩子總是出狀況，可是我到現在還是不能理解，為甚麼這種事情偏偏要發生在我們身上。
All right, I'll go back and try to talk with him again, and I'll also tell his mother not to keep interrogating him. I hope he'll be willing to come and see you. This boy is always running into trouble, but even now I still can't understand why something like this had to happen to our family of all people.
- Psychiatrist · turn 23
I can understand that this has been difficult for the whole family. For now, the most useful thing is to focus on finding out what your son is experiencing rather than blaming yourselves or him. Once I’ve had an opportunity to speak with him directly, we’ll have a much clearer idea of what support he needs.
我完全能夠理解，這對整個家庭來說都是一段艱難的時期。眼下，最有幫助的做法是專注於了解您兒子究竟在經歷甚麼，而不是責怪您自己或指責他。一旦我有機會直接與他交談，我們就會對他需要甚麼樣的支援有一個清晰得多的概念。
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