Posted by: Kate | August 17, 2008

Insanity Does Not Invalidate Asshattery

My phone rang while I was heading home for lunch.  “Hi, Kate, it’s WoefullyUndertrainedAndProneToPanic at the reception desk… We just got a call from Joe, who is a client already but says he doesn’t want to talk to his case manager.  He says he’s very unhappy.  What should I do?”

Now, if you were my husband, or amongst the lucky few who have witnessed my tantrum after such a phone call, you would know the answer to this question: call his case manager anyway, or call the case manager’s supervisor.  The rule is unambiguous: If someone is already a client and calls during business hours, then they should be referred to a member of their treatment team.  It’s not because those of us in Emergency Services are lazy or work-averse, it’s because, presumably, the treatment teams have a philosophy and a purpose behind their treatment, and Emergency Services is intended for crisis response.  We can’t know the philosophy behind every client’s treatment plans, so it’s best to keep the coninuity as long as the team is available.  Or something.

Anyway.  “You should call the treatment team anyway, WUAPTP.  Not wanting to talk to the treatment team doesn’t invalidate protocol.”

“Oh.  OK.  Right.”

Ten minutes later: “Hi, Kate, it’s WUAPTP again.  We couldn’t reach his case manager or the supervisor, and Joe just called back.  Now he says he took a bottle of Seroquel.  What should I do?”

“Well, WUAPTP, taking a bottle of Seroquel kind of takes this out of the realm of needing someone to chat with.  He needs an ambulance.  Can you call 911, or do you want to give me his address and I’ll do it?”

“Oh!  Right!  It says that right here on our protocol sheet!  Call 911!  Right!  I’ll do it!  How exciting!”

Really?  Whatever.

Hours later, then, I got the call that Joe was medically clear and ready for his mental health assessment.  He may, indeed, have taken a whole bottle of Seroquel, but given the fact that he was alert and coherent, I would bet good money that the whole bottle didn’t contain more than five or ten pills.  Regardless, he needed a conversation with a mental health professional – some days, that would be me – before getting the all-clear to go home.

Over the course of the next two hours, I listened to him explain why he thought he should be the one to restructue our entire agency to suit his preferences.  I listened to him tell me, verbatim, that “What I really need is someone who will just sit on my couch next to me, all day, every day, and help support me to avoid drugs and behave in the right way.”  He was baffled at the idea that this might be seen as excessive.  I listened to him simultaneously describe grandiose career plans while preemptively rationalizing why he couldn’t possibly ever actually function as a productive adult.  I watched him emotionally abuse his fiancee, and I watched her take it.

Finally, I got tired.  Most assessments take about half an hour, with the bulk of my time going into the process of finding a hospital bed if it goes longer than that.  This guy didn’t need to be in a hospital.  He needed a firm and decisive smack upside the head with a two-by-four and an enthusiastic set of consequences for his ongoing manipulative and snotty behavior.  But since I couldn’t provide either of those, at least not legally, then I was trying to provide his family with some of the tools necessary to protect themselves against him.  When it became clear that no one was interested in changing a thing about their lives, I said, “Listen, Joe, I realize that you’ve had a long day.  Let’s cut to the chase: you have a mental illness, and you also have an unpleasant personality.  The first does not excuse the second.  Are you safe to go home again, or do you need to be in a hospital for a few days?”

“Oh.  Well.  Um.  No, I can go home, I never meant to kill myself in the first place.  It was my fiancee’s fault, for not paying enough attention to me.  It was –”

“OK, thanks, Joe.  Take care.  Follow up with your case manager on Monday.  Good night!”



  1. I just wanted to commend you for your use of he word “Asshattery”. IMHO it’s woefully underutilized, not unlike the bwain of your little receptionist there.

  2. Oh, man, I love your equanimity. I don’t think I could do that.

    deerinheadlights, if you like “asshattery”, you should go here and read. The author uses it with regularity.

  3. OMG.. see, this is why I do peds instead of psych. I would have hit him upside the head.

  4. hahaha “the first doesn’t excuse the second.” If only we could revoke someone’s self-imagined Asshat License(tm).

  5. Can I hit him with the 2×4 PRETTY PLEASE??? OMG you have got to be kidding me, and his family what are they thinking? Boy aren’t they a bunch on enablers!! I just couldn’t do it-I’m not as nice as you, at least not with adults, many are victims to their own self centered vices. Did he even have a reaction to what you said or is he that wrapped-up in himself?

  6. Somebody ought to smack his wife upside the head as well, sitting there taking that crap.

  7. Did he have a wife or a fiancee? Or both, or was he just making shit up as he went along? Anyway nice work on him.

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