My pager went off at about 7 p.m. I had already finished rounding at the hospital, gone home, showered off the day, and sat down with a cup of tea. It was my senior resident. We had admitted a psychotic young woman to the hospital, and her parents were trying to sign her out against medical advice.
The young woman had been acting more and more strangely over the past several months. When her parents finally brought her to the hospital after being unable to help her at home, she was completely disconnected from reality. She was hearing voices, screaming, picking at her clothes and skin, unwashed, and unable to have any coherent interaction with others. The staff psychiatrist had been by and had confirmed the diagnosis of acute psychosis due to newly diagnosed schizophrenia.
Her parents were clearly worried and frightened. They had watched their daughter descend into madness with increasing sadness and helplessness. Finally, as many do, they turned to their church…the Church of Scientology. And this is where the sad problem of a young, psychotic woman took a perverse turn. They were assured that through the applied philosophies of the church, their daughter could begin the return to sanity. In no uncertain terms, they were told that medical psychiatry would destroy any chance they had of recovering their child’s mind. This, the terrified and hopeless parents latched onto tightly.
Psychiatrists had told the parents that they could expect a lifetime of illness, hospitalizations, maybe a job, maybe a life in a group home, and, if there was some luck, a somewhat normal life. Maybe. The church assured them that, through their healing programs, their child would return to normalcy. The demons haunting her would be purged, and she could have the life of a normal, young woman. For a price…
So, as we medicated the patient, in an attempt to reduce her fear and hallucinations, the parents came to the hospital enraged, sure that psychiatry was designed to destroy their child. Also, as parents, they felt it was within their rights to take their child, fly her to California, and enroll her in a Scientology treatment program. But the patient was 18. Without her explicit consent, they had no right to take her out of the hospital until she was stabilized. As any parent would, they had trouble understanding this. I spent hours on the phone and at the bedside with them. Since the parents could not serve as legitimate surrogates for the patient, it was necessary to file papers for involuntary psychiatric commitment. And from there arose the next problem.
My residents contacted the staff psychiatrist. He refused to certify the patient. They paged me. I called the chair of the department. He was at first quite vague, then he explained that Scientologists sue psychiatrists…a lot. But what of your duty, I asked him. He was clearly nervous about the entire case, and told me the rest was up to me.
So, after being told that psychiatry really couldn’t help the patient, I went back to the hospital to do the commitment papers myself. I explained to the parents that they would be better off staying involved, since they had little recourse, and that after her commitment, they could investigate their options further. But I don’t think any of us was satisfied.
Modern psychiatry, while making enormous breakthroughs in treating diseases of the mind, has been economically pressed to treat patients only medically…psychotherapy is not reimbursed well. Psychiatrists are already pressed when it comes to trying to provide the best care for their patients. To add to that the concern about being sued by cultists, well, that serves no one. The patient, at her greatest time of need, is caught in a perverse struggle, not only within her mind, but by powers outside her. Of course, she told us there were those out to get her. If she only knew the truth, how much greater might her fear be?
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