Posted by: Kate | January 23, 2008

Intense and Anguished

I’d like to write about the crisis assessment I did last night.  I’d like to write out some of the intensity and the creepiness of it all, but I can’t.  Not the way I want to.
Partly, it’s out of respect for this man’s privacy.  Normally I alter non-crucial details of my encounters with patients so that I can get my basic point across without threatening their confidentiality.  In this case, I can’t decide which details are non-crucial.  It was so fundamentally odd, so unsettling, on so many levels, that I don’t feel I can paint an adequate picture without stepping closer to unethical behavior than I’m willing to get.

Partly, it’s because it really requires a physical demonstration.  I don’t have the right words to convey just how intense and unblinking his eyes are, and how very quickly a normal-looking guy can start to seem dangerously weird.  I tried to show Willem last night, after I got home, and after a very quick and watered-down example, he asked me, in all serious, to stop because I was freaking him out.  The difference is, I could stop.  The patient could not.

And partly, it’s because I’m unhappy with the outcome, stymied by the laws of the Live Free or Die state.  In New Hampshire, the only ways in which I, or anyone else, can impose mental health treatment on someone who doesn’t want it is if that person is actively suicidal, homicidal, or so acutely ill that they can’t conduct the basic functions of daily life (bathing, eating, staying warm).  This means that I can watch another human being teeter at the edge of a severe schizophrenic break, his first acute psychotic experience but likely not his last, and I have to accept his refusal to consider hospitalization or even outpatient treatment.  I have to go home with the knowledge that this man is very likely to cause serious anguish and possibly even physical harm to himself or those around him, but without an explicit threat I can’t intervene.

I watched madness wash over this man, in small but ever-advancing waves, and was unable to help.  I think he knew, though he was unable or unwilling to talk to me, that something is very wrong and it’s not getting better on its own.  In between behavior that was frankly creepy, there was a sadness in him, an anguish that no one could seem to soothe.  I’m left hoping that he gets sick enough to allow someone else to step in, or reaches sufficient awareness of his own illness to agree to accept help on his own terms, before damage is done.

It was the first time, in my year and a half at this job, that I asked the security officer to walk me to my car at the end of the night.



  1. This is where I have issues with the rights of the mentally ill. It sounds very scary.


  2. How scary — for you, for society, and above all, for him. My hubby worked as a Psych Tech fresh out of college and used to come home with stories (and physical demonstrations) that I simply could not fathom.

    I’m just glad there are people like you out there helping people like this guy.

  3. Eeeesh. No, there are only hard decisions at those edges of freedom vs. social health. Sorry you were on that front line so hard.

  4. I used to work for a social service agency that dealt with foster children. Even though I was the Executive Secretary to the two owners, I would sometimes get nabbed to type up a psych eval. Oh, how I wish I could scrub my brain clean even to this very day (and it’s been more than a decade ago).

    Sadist that I am, I still sit on the Human Rights Committee for the same company.

  5. Hugs, I am sorry that you are having such a hard time with this one, and that you felt that you needed security to walk you to the car. I hope that man gets the help he needs, with having to have it forced upon him, and soon.

  6. Scary stuff indeed, on so many levels…

  7. I have a vivid picture in my head of the look you only somewhate described. The one I’m picturing I’ve seen in my mothers eyes at times… in her mother(my grandmother)’s eyes often, and in my one Uncle’s eyes every time I saw him… which was why I inevitable stopped visiting him.

    It is scary.

    I want to feel sorry for them… but, often fear and just being creeped out over-power that.

    I’m thankful there are “professionals” like yourself that are at least trying to help… even when it seems there is nothing that will help.


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