We haven't written about involuntary psychiatric treatment on Shrink Rap for a while because it gets our readers really stirred up. Now I'm going to try to stir you up.
ClinkShrink and I are talking about writing a book on the different perspectives of involuntary hospitalization -- we'd like to put both sides of the argument on the page and look at issues related to patients' rights as well as families, members of the law enforcement and legal systems, and the doctors, nurses and hospital staff. Roy is involved in his techy projects and won't be in on this, though we will continue to get his input and to eat pizza and crabcakes with him.
We're at the point where we need a "sample" chapter to illustrate what it is we are trying to write. This isn't going to be a real chapter in the book (I don't think), but just "here's the idea." Because the actual chapters will entail a great deal of interviewing and reviewing medical records and speaking with people and their families, I'm looking for an easier way to begin the process, and truthfully, the idea was inspired by our Shrink Rap readers who have written in over the years with stories about how they were damaged by what occurred during their involuntary hospital stays. It got us thinking that there have to be better ways, while at the same time, it seems that it's shameful that our society leaves terribly psychotic people living on the streets and eating from the garbage because there is no way to treat them. Maybe if treatment were nicer?
So I need your help. I need someone with a really good, detailed story to be the subject of my sample chapter. Will you tell us your story in the comment section, or email it to us at Shrinkrapblog at g mail dot com? The comment section might be nice because it would allow for others to dialogue. We don't need your name, but please don't write as Anonymous because I won't be able to the stories straight, a nickname is fine, and you can sign in to Google as "anonymous" as long as you sign the entry with some name that distinguishes you from the others. Also, I might want to speak with you later, so if that's not acceptable, then maybe you don't want to participate.
For the sake of the sample chapter, I would like to hear from people who feel they've been treated badly. The "so glad they committed me, it saved my life" is for another chapter. If you're a psychiatrist and you have a patient who feels they've been unduly traumatized by an inpatient admission, please see if they want to participate, and the same goes for family members. Obviously, books are about stories, and the stories need to be compelling.
Years ago, we did a poll, and I was struck by the fact that two-thirds of those who had been involuntarily hospitalized said they would not want to be hospitalized again, even if they were a danger to themselves or others.
In advance, thank you so much.
Thank you in advance.
There was a time – it was a long time ago, maybe 40 years ago – when I could think whatever I wanted to think. I could use a jillion models – be doctor medical model at 8AM, psychoanalytic at 9AM, cognitive behavioral before lunch, and throw in a little existentialism in the afternoon. It was like a toolbox filled with a lot of wonderful ways to think about the problems before me and my job was to bring whatever I could find to help until I found what really mattered – some shared way of understanding that my patient and I could use to make some headway. And in conferences we’d argue back and forth, the various different kinds of us, about what was right and wrong, which was all in fun because there wasn’t any right or wrong just different cameras on the same set, then we’d all go to the pub and be human together. It was an exciting time for me. I miss it – always have.
Then in the 1980s, that all changed. Because I was a psychiatrist, I was supposed to be a biologist. Well, I am a biologist, but that’s just a piece of what I am and what patients needed from me. And because I was a psychoanalyst, I was supposed to be … psychoanalytic, but that’s just a piece of what I am too and what patients needed from me. And so on and so on through the toolbox. And worse, I wasn’t supposed to meander from tool to tool until I found the one[s] that fit that patient on that day, I was supposed to have some consistent evidence-based position that could be validated by some third party to prove I wasn’t a charlatan or a I-don’t-know-what-but-it-was-a-bad-thing. I wasn’t up to it. I’d spent a long time refining my skills at doing it the other way which was some hard work, so I went off on my own and did what I’d learned to do until I retired. I’m so glad I did that.
Now it’s coming full circle. The psychologists are saying that the medical model psychiatrists are off the deep end. The biologists are at war with each other over which biology is the correct biology. The humanists are after the robots. The analysts have learned to be quiet, but you can bet they’re thinking their thoughts. I’m sure all the existentialists in France and elsewhere are off being existential together. I know a lot of very talented and competent mental health types who come from a wide variety of backgrounds but they are unified by a few simple things – a deeply ingrained practice ethic, a suitable awe for the marvelous and monstrous variability in human beings, a genuine curiosity, broad training and life experience, and humility. If they can’t help you, they’ll at least be able to help you find someone who can.
When I think back on things, the most helpful piece of my training in mental health was becoming a hard science Internist first. The reason is that I knew a secret my psychiatric colleagues didn’t know. The hard science medicine I left was no more precise and assured than the loosy-goosy psychiatry I went to. Sure there were more tests, more precise diagnoses, more drugs. But there was the wall of physical disease beyond which you couldn’t go. Once you found it, that was the end of the road. With mental illness, there’s no wall. Even with the worst cases of our most devastating illnesses, there’s still something that can be done, even if it is only a small thing. You may not find it, but it’s not because it’s not there.
So in one way, it makes me sad to read all these battles flying back and forth precipitated by the release of the DSM-5. On the other hand, it reminds me of those days long ago when we fought with each other to learn from each other. I’ve missed that more than I knew. And it makes me feel hopeful that what’s up ahead will be a toxic environment for the know-it-all psychiatric KOLs that have so contaminated our world [and detracted from the contributions of biologists with good sense], and their pharmaceutical marketing colleagues, and the opportunistic Managed Care types whose job it has been to keep us from doing ours. Right now, I hope right thinking psychiatrists of all flavors, psychologists of all flavors, social workers, counselors, etc. can brace themselves for a long-needed realignment that is consistent with our shared task. It won’t happen any time soon. We’ve been lost in the wilderness too long for that. But the wind blowing in the trees is at least encouraging to this old man…