Editor’s note: the author has chosen to write under a pseudonym, due to concerns about the impact her suicide attempt could have on her career as an artist.
For weeks I had been trying to get released from the psychiatric ward of a private hospital in NYC, and none of my arguments, compliance, or attempted air of normality had made an impression on the barely-visible ward psychiatrist who had 2pc’d me. I had, I was told, made a very serious suicide attempt and this was a predictor of future attempts. They would let me know when they thought I was sufficiently remorseful and stabilized to be released.
I did want to process my attempt, which had been terribly frightening. It scared me to think that I was capable of such a thing. But there was no psychotherapist on the ward, and no private room where such therapy could take place. There were, of course, drugs – that is, “medications” – on the ward, from which I had been attempting rather frantically to detox. But I was duly warned by others on the ward that to refuse to take those meds (selected without my input) was to delay my release. So I complied. The most therapeutic element of the ward was my fellow inmates who counseled me and commiserated with me and kept me somewhat sane.
Although I am an adult, I was infantilized and dragged back to an earlier century in the ward, away from my job, my computer and the internet. So my mom was my advocate. After meeting with the resident psychiatrist and social worker, my mother was dismayed. They had told her that my stay was indeterminate and that no, there were no criteria upon which to base the release; just their judgment. Weeks did not fly by but rather crawled, leaving me tense and irritable and immensely bored. Finally my mother called the head psychiatrist, Dr. L, asking once again why I was not being released – what more was necessary, what could we do? Dr. L responded that if we were so intent on release, why weren’t we going to court?
Court? Yes, there was a poster by the nurses’ station saying that there were legal services available, but I had been told by others that they were basically inaccessible and ineffective. I hadn’t mentioned it to my mom.
My mother stuttered, confused, “But we’d need expert witnesses, a lawyer, it would take so much time, money. I don’t know where to begin.”
Dr. L, purportedly my doctor, advised her that all of that business was not necessary. “There is a free legal service here, Mental Hygiene Legal Services, and you don’t need experts. You don’t even have to go yourself.”
Excellent advice. My mom asked him how often he was successful at arguing against release in court. “Oh, about 95% of the time,” he said. He later entered my room (he seemed to be able to find it) and announced that I would lose in court. I was where I belonged, he said. My mother nonetheless hired a social worker to testify for me, and googled mental health courts to learn more. Under that label she found a scattering of information about forensic mental health courts (for those accused of a crime but deemed mentally ill), and she found lawyers who offered to help commit your family member, as well as some descriptions of non-forensic courts/panels in the UK, but nothing written about the courts in the US.
I had called Legal Services earlier, but they never returned my calls. After my encounter with Dr. L, I was very upset. I made one more attempt, leaving in my message that I wanted to go to court. Those must have been the magic words because the phone call was returned the same day. A meeting was set up for the next day, with the court hearing six days after that – plenty of time for preparation, we were assured.
My mother and I met with the Legal Services lawyer who was wearing shabby clothes, indicating to me that she was dedicated but not well paid. We met in the coat room of ward interns who occasionally popped in to collect their jackets. My attorney was overjoyed to hear that we had hired a social worker to review my files and testify in court. Wow. This was rare for her. She smiled and said that with an expert witness and family support we were in good shape. She was also pleased that I agreed that I had a mental illness and needed treatment. “They like to see that a person has insight,” she told me. Just like a parole board. Going against us was not only the fact that the psychiatrist won 95% of the time, but also that the judge was up for re-election the next year. “No one wants to release someone who goes on and kills herself,” the lawyer explained. I nodded. Of course not.
* * * * *
On the day of the trial, an ambulance brings me and a few others to a court housed upstairs at Bellevue hospital, still grand in appearance and scary in reputation.
We arrive at 10am sharp. Dr. L, whose time is decidedly more valuable, makes his appearance at 1 pm, shortly before the trials are to start. Finally we are called. I wait my turn to testify, appropriately in the waiting room, watched carefully by several guards lest I try to escape.
While I am waiting, Dr. L and then our social worker testify. Dr. L states that I am not only bipolar but have borderline personality disorder, and thus am able to manipulate my family into siding with me and trying to manipulate the court (frankly his diagnosis seemed manipulative to me). Our social worker testifies that she reviewed my files and there was no such diagnosis given, only reiterations about how well I was doing. Good for her. Dr. L will be more careful with his notations in the future.
Then I am called. It is daunting to go up before a crowd of people and sit in a witness box defending my sanity. The attorney for the hospital begins asking me general questions, pressing me to admit that I have a mental disease, which I did, and to recognize that I need treatment, which I do. It is so absurd. I imagine a patient hospitalized with a badly broken leg trying to go home against doctor’s advice and having to go to court first. The judge asks, “Do you admit that you have a broken leg? Do you recognize that you cannot walk normally yet?” The patient nods. The judge says, “Do you have remorse for having been running so carelessly before you fell?” The patient mumbles a little about uneven broken pavement, but no one cares. The judge says, “Past carelessness is a predictor of future carelessness. Why should we trust you now?” The patient looks remorseful. I remove my thoughts from these imaginings and pay attention again.
The attorney asks if I am compliant with my doctor’s orders. I nod. “Absolutely,” I say.
“Why then,” he says, moving in for the kill, “do you persist in wanting to leave the hospital against the unanimous advice of a team of doctors and specialists?”
I can see my mother’s face scrunch up in alarm. But it is unnecessary. I might be ill, but I’m not stupid. I can answer this. I say, “I’ve always worked with my doctor to come up with plans and make choices. I’ve been on medications for about seven years.”
“But,” I continue, “these doctors here on the ward are not my doctors. I haven’t met with Dr. L since I was first admitted, or should I say committed. How could he be my doctor? In what way? The resident stops by every day to ask me how the meds are and if I am feeling suicidal. In what way have Dr. L or the resident been doctors to me?”
Then my mother is called up to the witness stand. She looks very composed. My attorney asks her why she wants to see me released rather than kept longer on the ward. She says, “I think that the doctors on the ward have done a very good job stabilizing her. She is much better now.” I am not sure why she said that, but it may have been her attempt to seem sober and moderate, not a rebel, like she is.
Then she goes in for the kill. “In fact, Serafina is ready for therapy now; she needs it. But there is no therapy for her on the ward while she is waiting to be released. To keep her from being healed is so damaging to her, so counter to psychiatry as I know it.” She shakes her head in dismay.
Then she continues, sitting up very straight, “And we’ve set up a crisis management team for our daughter when she is released. She’ll be safe.” She goes on, “My daughter has gone through so much to overcome her debilitating depression – she worked terribly hard to save herself, but even her doctor had come to the end of his rope. Her suicide attempt came out of desperation, not because she wanted to die. When she woke up from the coma, she felt hopeful again. But instead of treatment that feeds that hope, she has been locked up for weeks. She is stabilized, but she needs more. She is seeking recovery, but each day that she remains locked up, she feels worse. Her hope declines.” She pauses and goes on again, “What she has gone through, I don’t think I could have done. She is a hero; we should honor her and help her to heal, not lock her up and tell her to be remorseful.”
There is no cross-examination from the opposing attorney. The judge looks sympathetic and suggests to me, “Well, couldn’t it be arranged that your outside therapist comes to visit you in the hospital? Then you will be under supervision and still get your therapy. A good solution.” The judge turns happily to Dr. L, sitting in the audience, and asks, “Could you provide a room where Serafina could meet her therapist within the ward?” Dr. L nods enthusiastically. They are all happy. Problem solved.
This is a terrible solution. But our attorney is on it. She turns to me and asks, “What happened to you just a few days ago?”
I describe how I warned the staff that my roommate was increasingly agitated and then I was attacked by her with her walker (in the middle of the night) while I slept.
The judge asks, “After your alleged attack, did the hospital not take any action?”
I agree that my roommate was removed.
Our attorney continues, “Do you feel safe now?”
“No. There is no protection. Anyone can come in my room.” This information might be shocking to an outsider, but the judge nods without apparent interest. Alleged attacks do not phase her. It’s just part of ward life.
Our attorney presses on. “And do you get sunlight and exercise on the ward?”
“No, and it’s very hard for me. It’s depressing. I’ve been in there for more than five weeks. I need to feel safe, to have sunlight. To go out among people so I can start healing from all this. I’ll be fine with my mother,” I say.
I can feel the judge becoming less and less interested. She liked my mother’s impassioned plea. It was a bit of distraction from the usual. But now it is sinking back to the old routine of patients claiming that they suffer on the wards. The court and the hospital do not seem to be interested in possible trauma within their walls. They are worried about possible suicide attempts of patients who are released. This is the drama that makes the newspapers, not the quiet trauma of everyday life on the wards.
But our side is not finished. Our attorney, who is quite excellent, gets up to cross-examine Dr. L. She asks, “It says in the files that you will release Serafina to an unlocked facility when they have space for her. She can leave it at any time. Yet you will not release her to her parents’ care on a temporary basis? Why not?”
Dr. L responds that he does not understand the question. Odd. It seems clear to me that it is all an issue of liability, for the hospital, for the judge, for the doctors. Amongst all this, the health of a person is not in consideration.
It reminds me of what psychiatrist Loren Mosher wrote, that when he encountered, early in his practice, the dehumanizing conditions of psychiatric wards – the perpetuation of powerlessness, dependency, and prioritizing of institutional needs – he suffered a personal existential crisis. His colleague Richard Warner wrote: “In the general mental health culture of the United States we take our most frightened, most alienated, and most confused [people] … and place them in environments that increase fear, alienation, and confusion.”
And then we offer them a court system that is a mockery of justice.
The judge looks over at the audience and says, “I will announce my decision at the end of today’s session.”
We sit in the waiting room and wait.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.