Patrick had completed mainstream schooling despite having mildly autistic traits. Now, after his A-levels, he seemed to have sunk into a pervasive depression. He presented as flat and apathetic; he told me he spent his days and nights shut in his room, surfing the internet. When I tried to find out what his hopes for the future were, all he could think of was travelling to Australia to see a girl he had met on social media. But he couldn’t even do that, because he didn’t have any money. And he didn’t believe he’d ever be able to get a job to allow him to earn any.
All this was puzzlingly at odds with the reasonably bright young man in front of me, who I thought could easily find employment. I tried some motivational interviewing and problem-solving, but nothing helped him break out of his torpor. He wondered if pills might be the answer. I prescribed an antidepressant, but it was no surprise when he returned to report that it had made little difference.
Before his next appointment, I got a call from his father, Steve. He wanted to know what was going on, and became belligerent when I explained that, because Patrick was 19, I couldn’t talk to him without his son’s consent. “Don’t you understand he’s autistic?” Steve shouted down the phone. “I manage all his affairs, and I need medical information to put on his benefits forms.”
When Patrick returned for follow-up, I asked whether he wanted me to speak to his dad. He shrugged, eyes downcast, and made no comment. I probed further, and gradually began to assemble the true picture.
Steve, unemployed, had survived for a number of years on an intricate array of benefits designed to help parents with disabled children. Now that Patrick had left full-time education, Steve was converting this to a package of allowances intended to support disabled adults and their carers. All the money went into Steve’s account; Patrick rarely saw a penny. If he asked for any money, the volatility of the reaction depended on how much his father had been drinking. Steve’s livelihood relied on having a disabled son. He had too much vested in this to allow Patrick to find his own way in the world.
There proved to be more. Patrick’s parents had divorced many years previously and his mother had subsequently died. The house that father and son occupied was jointly owned by Patrick’s mother’s estate and a maternal uncle. Her will specified that, once Patrick reached 21, the house was to be sold and he would inherit his share. At that stage, Steve could find himself with nowhere to live, and a son with independent means – but only if Patrick were allowed to assume control of his own affairs.
I’d learned enough. Patrick was subject to an unhealthy degree of control from his father. His depression reflected his disempowerment: he was unable to see how to break free. With his consent, I arranged to talk to Steve. It was a prickly consultation. Steve had a firmly held set of beliefs – Patrick was incapable of living independently (he couldn’t even make toast for himself!) – that justified his role in managing his son’s life. All my suggestions as to how to help Patrick acquire skills and independence were met with aggressive scorn.
Fortunately, the notion that some adults can be as vulnerable as children to abuse is now well established. Patrick agreed to a confidential referral to the safeguarding team. There followed a series of meetings to define his goals: to assume independence while, if at all possible, preserving his relationship with his one surviving parent. Over the ensuing year, the safeguarding team worked patiently to support Patrick in extricating himself from the enmeshment. Despite resistance on Steve’s part, they managed to retain his co-operation.
The crunch point was always going to be the house sale, but sadly Steve’s alcoholism caught up with him before then. Patrick is now free, and is making his own way in the world, albeit as the orphan he had never wished to be.
This article appears in the 01 Mar 2017 issue of the New Statesman, The far right rises again