Maintenance · call recap
When a steady dose stops holding
1 June 202512 attendedHeld by Benedikt
Three members arrived with the same thing: a dose that had held them steady for a year or more had stopped doing so, over a couple of months, without any change they could point at. This is one of the more frightening things that happens in maintenance and there is very little written about it, so we took the whole hour and were careful about the difference between what people had experienced and what any of us could explain.
Where the room started
Frightened, and quietly ashamed, which is the combination I most want to interrupt in this circle. Two of the three had waited weeks before telling anybody, including their prescribers. One had been keeping a diary and could see it clearly and had still assumed she was imagining it.
The shame is worth naming because it is doing the harm. If you believe a change in either direction is a moral event, you will hide it, and hiding it is the only part of this that actually costs you something.
What came up
All three had gone to their prescribers eventually, and all three had had a different conversation. One went up a step. One stayed where she was and was asked to come back in three months. One had a set of bloods that found something unrelated and useful. There is no pattern in that and I said so rather than inventing one.
What the room could offer was better than a pattern. Ida described how she had documented it — a fortnightly two-line note over four months — which turned a vague sense into something a clinician could act on in nine minutes. Two people are copying that.
Where we left it
With the plainest thing I know. A dose that stops holding is a clinical question, not a character question, and it belongs in front of the person who prescribes it. The circle's job is to make sure nobody sits on it for eight weeks first because they are ashamed.