Violent cycle broken at last

Case notes

Practitioner: Lee Thompson, social worker.

Field: Older people’s services.

Location: Wakefield, west Yorkshire.

Client: Michael and Lynne Doyle are both in their late seventies, have been married for more than 50 years and live in their own home. About four years ago, Michael had a stroke that left him immobile and which also had a life-changing effect on his and Lynne’s lifestyles. They have three married sons with families who all live locally.

Case history: Lynne became Michael’s main informal carer following his stroke. A care package included two carers visiting three times a day to support Michael. In 2001, Michael told his carers that Lynne had hit him over the head with a coal shovel. The carers referred the allegation to the social work team and an investigation took place in line with the local authority’s adult protection procedure. Michael, despite telling the carers and members of his family, would not disclose anything during a more formal investigation. It was clear that the couple had had a volatile relationship all their lives and Michael, a controlling man, was perhaps the victim of revenge.

Dilemma: Although Michael disclosed the physical attacks to others he would not do so formally to social services and continued to protect Lynne.

Risk factor: With Lynne using physical violence as possible revenge, Michael might sustain a serious injury if not worse.

Outcome: Following a diagnosis of dementia Lynne has moved into residential care, while Michael continues to live at home.

Michael and Lynne Doyle have spent a lifetime together. They have been married more than 50 years and have brought up three sons, all married and living locally.

Yet Michael and Lynne’s relationship was always volatile. Michael was a controlling figure with fixed ideas about a woman’s role in society. It was easy to believe the volatility had erupted into domestic violence.

And then Michael suffered a stroke that left him so paralysed that he can now only be moved by two carers visiting three times a day. Suddenly the powerful man is powerless. Were the tables now turned?

This is certainly the scenario suspected in November 2001 by social worker Lee Thompson following an allegation that Lynne had struck Michael over the head with a coal shovel.

“Lynne often touched upon how Michael had been in the past. It was plain to see that he had been controlling. If I suggested something he didn’t like he would shout at the top of his voice and really put you in your place. So, you could get a picture of what he had been like for a number of years,” says Thompson.

However, he adds that he was also concerned about Lynne: “We recognised almost immediately that although she could be physically harming Michael she was under a lot of stress as a carer. She was very defensive and wary of social services: she didn’t want to speak about anything and denied everything. And there were signs of cognitive decline.”

Although Michael did not want to take things further, it was decided that the home carers and Thompson should continue to monitor the situation. For the next six months or so, apart from minor incidents, things progressed on an even keel.

“In April we observed bruising on Michael’s face – it was in the final stages of colouring, a pale yellow. He disclosed to a family member that Lynne had thrown a chair at him,” says Thompson, who again tried to investigate the incident. But again Michael proved less than forthcoming. “He said that he had leaned forward and had banged his eye on the lounge door which opened out towards his chair – and which could have happened.”

However, more attention was focused on Lynne. “She was constantly unaware of her husband’s frustrations and difficulties, and lacked insight into his physical disability. The carers were daily witnessing Lynne getting angry, aggressive and abusive – and were frightened about what they might walk into one day,” says Thompson.

Despite Michael’s reluctance to disclose anything formally, it was decided that a case conference should be called under the adult protection procedure.

A cognitive functioning assessment of Lynne was requested but she refused to engage with the community psychiatric nurse. The home carers were required to be extra vigilant and the district nurses, who were visiting three times a week to dress Lynne’s ulcerated leg, were also called upon to play a monitoring role.

“We needed to get the family on board as we felt that they had colluded and perhaps knew much more than they were letting on,” says Thompson.

As part of the protection plan, Michael knew that he could talk anytime to Thompson, or if he wanted to leave home an emergency placement would be found. He was offered respite care and day care but consistently refused both.

The district nurses became increasingly concerned as Lynne was refusing to comply with treatment to her leg – which was now in a very poor state. Lynne was finally diagnosed with dementia and placed in a specialist residential care home.

“With Lynne gone, the family dynamics became clearer and the sons started talking about how she had been previously,” says Thompson.

“As children, they were kept isolated and weren’t allowed to play with peers. Perhaps Lynne had a personality disorder that had not been diagnosed or acknowledged. We believed it was Michael who was the controlling one but the sons began to talk about how it was their mother whom they feared.”

Michael remains at home, still refusing day or respite care. A lot of his aggression has reduced and his carers, who now visit four times a day, report a good working relationship. He chooses not to visit Lynne.

Arguments against risk

• Although not disclosing information during the official investigation it must have been clear that Lynne, whether through revenge, stress or, as it turned out, her deteriorating mental health, was assaulting a defenceless man. The home carers were aware of her aggression and fearful of what they might find each time they visited.
• If Michael was so controlling why was he colluding with Lynne’s behaviour? As Thompson says: “There was an acknowledgement of his fear in terms of the way he wouldn’t disclose anything. I think, perhaps, deep down he was frightened of the potential consequences.”
• Were the family initially unhelpful because any placement would require the sale of their parents’ house to fund it, leading to them losing out financially?
• Why were the family as a whole wary of social services? Had something in the past or within one of the sons’ families caused this negative outlook?

BOXTEXT: Arguments for risk

• Despite informally disclosing that he had been assaulted by Lynne, Michael did not tell the adult protection investigation.
• They had been together for 50 years – maybe that is how they just were. “One of things I struggled with,” says Thompson, “is I’d come along and implement our procedures to protect people around risk but for them the issues that we were concerned about were probably normal to the couple.”
• With home carers visiting daily, the district nurses regularly and the social worker also keeping in touch, it meant that strong monitoring was taking place.
• lt was clear that, whether or not Lynne was exerting revenge over her seemingly controlling husband, she was under immense pressure as the main informal carer. With the family’s help and additional support this pressure could be alleviated, which might lead to things become quieter.   

Independent comment

Politicians who criticise social services for being interfering, meddling or worse should be made to read this case history, writes Jef Smith. Some dysfunctional families do manage to go on functioning against all the odds, their members having come to accept as normal the sort of violent relationships and bizarre behaviour that most people would find intolerable. The Doyles were together, more or less unhappily, for 50 years, which seems strange to those of us with calmer partners. And even a highly perceptive social worker admits to be still learning about the family’s dynamics after many months of working with them.

Hitting a severely disabled man with a shovel is certainly not to be approved, but that is far from saying that such an incident, or stream of incidents, gives a statutory authority the right to separate people who for their own reasons want to remain together. There is nothing to suggest that Michael was incapable of deciding for himself what was for the best, and being fairly seriously abused was for him preferable to leaving his own home. That was his right.

The offers of help, however, remained on the table. The couple’s sons were drawn in. The availability of the social worker and the visits of home care workers and district nurses meant that the situation was monitored and could be reviewed at any time. In due course Michael and Lynne were separated, but at a time and in circumstances that were not forced on them.

Jef Smith is a writer, trainer and consultant in care for older people.