As part of its “medical mysteries” series, the Today Show on Friday aired a segment about Susannah Cahalan, a young New York woman who woke up one day with her left side feeling numb. By nightfall, she had become — as her father, Thomas, later put it — “totally psychotic.”
Susannah would begin “crying hysterically” and then “become giddy.” She was taken to the NYU medical center but doctors there didn’t have a clue why she was acting so oddly. Several times, Susannah tried to escape, and her father said she was “hallucinating.”
Susannah stayed in the hospital a month and a specialist finally diagnosed her as suffering from a rare auto-immune problem called ANTI-NMDAR Encephalitis. Here’s a link to the story
http://today.msnbc.msn.com/id/26184891/vp/34877317#34877317 )
Today Host Meredith Vieira wondered how many people, who have been diagnosed with a mental illness, might actually have ANTI-NMDAR.
I am happy doctors were able to solve Susannah’s problem, but the real MYSTERY here is how did her loved ones get her the help that she clearly needed!
Based on Susannah’s symptoms – laughing one minute, crying the next, totally manic — it would be fair to assume that most emergency room physicians would have thought she had bipolar disorder. At that point Susannah would have been shown the exit unless she was posing an immediate danger either to herself or others.
That’s the law and that’s what happened to my son, Mike.
The only way her family could have kept Susannah in the hospital against her will — remember she tried to flee several times — would have been to have her involuntarily committed. And if her loved ones would have tried that, Susannah would have had an attorney appointed to protect her right to be “crazy.”
That’s the law.
That attorney would have fought to get her out of the hospital.
That’s the attorney’s job.
In fact, the more I think about Susannah’s case, the more alarmed I am. Someone should notify the New York office of protection and advocacy and demand an investigation. Susannah’s constitutional right to be crazy was clearly violated. Quick, call the Bazelon Center for Mental Law and file a lawsuit against her parents for holding her against her will in a hospital. Punish them for trying to help her from her psychosis.
Obviously, I am being facetious to make a point.
Susannah got help despite our mental health system, not because of it.
Somehow her loved ones managed to get her admitted into a hospital even though she wasn’t dangerous. Somehow they were able to get her insurance company to pay for her to stay there (when was the last time you heard of someone with a mental illness getting to stay in a hospital for a month?)
Somehow her loved ones were able to get a doctor to spend enough time examining her to discover what was happening inside her brain.
I wonder if her parents realize how fortunate they are that Susannah is not delusional, homeless, and wandering the streets right now — with her civil rights fully protected.
(If you found this of interest, share it with a friend. It’s time we found a way to safeguard a person’s rights, but still get them help when they are sick.)
About the author:
Dear Pete,
With all due respect, your experiences with the mental health care system have been quite the opposite of mine. As a former resident of New York State and a former psychiatric patient in NYS private and public hospitals, I had no problem being admitted to psychiatric wards against my own free will. As a matter of fact, in New York State anyone can make an anonymous phone call to a psychiatric ward and claim a person with a known history of mental illness is acting odd and should be admitted for treatment. Social workers will then be called out to make an assessment of the individual and decide if they should be picked up by the police and admitted for psychiatric care.
There were times I did not have insurance to cover the hospitalization and ended up with thousands of dollars of debt, the hospitals gladly worked out a payment plan. At one point I had excellent mental health care benefits and the hospital used every excuse in the book to keep me there for the full month even though I was clearly very stable after two weeks.
On another occasion I was having serious neurological problems including sudden severe headaches, numbness going down my left arm, cognitive impairment and loss of perihelial vision. I drove myself to the hospital and asked to have my neurologist notified. I told by a resident psychiatrist that I was manic and could only be admitted to the psychiatric ward. I refused admittance and told him I would leave. He politely escorted me to my car and made a sexual advance. I refused his advance and told him I was not manic. The following day I sought help from an acupuncturist and other alternative practitioners and my condition improved greatly. On my own I filed a claim with NYS Division of Human Rights against the hospital and it was settled. There are many cases of mental health care professionals taking advantage of persons with symptoms of mania.
Meredith Vieira is exactly right, how many other people LABELED with a mental illness actually have a medical condition causing the symptoms?
By consensual agreement within the American Psychiatric Association (Diagnostic and Statical Manual III-revised, 1987), psychiatric diagnoses are descriptive labels only for phenomenology, not etiological or mechanistic explanation for syndromes. Thus, a psychiatric diagnosis labels a pattern of signs and symptoms, but offers no hypothesis concerning the mechanism(s) of the clinical phenomena.(Davidoff et al., 1991).
There are people who have been LABELED with bipolar disorder (notice the word disorder, not disease) who were later found to have Creutzfeldt-Jakob “disease”, or lyme “disease”, or heavy metal “toxicity” etc. There are many underlying causes to symptoms of mental illness. Is it so far fetched to believe Mike’s symptoms of mania were triggered by a combination of stress, poor diet and maybe some kind of substance abuse that depleted the neurotransmitters in his brain?
Ask yourself
Was Mike a depressed child or teenager? Did he have symptoms of ADHD?
Is his condition hereditary? Who else in your family ever acted like that?
“Somehow her loved ones were able to get a doctor to spend enough time examining her to discover what was happening inside her brain.”
As a parent and a mental health advocate, please spend the time listening to this:
http://a-medicine-of-hope.blogspot.com/2009/05/mood-disorders-causes-and-solutions-dr.html
Dear Pete,
With all due respect, your experiences with the mental health care system have been quite the opposite of mine. As a former resident of New York State and a former psychiatric patient in NYS private and public hospitals, I had no problem being admitted to psychiatric wards against my own free will. As a matter of fact, in New York State anyone can make an anonymous phone call to a psychiatric ward and claim a person with a known history of mental illness is acting odd and should be admitted for treatment. Social workers will then be called out to make an assessment of the individual and decide if they should be picked up by the police and admitted for psychiatric care.
There were times I did not have insurance to cover the hospitalization and ended up with thousands of dollars of debt, the hospitals gladly worked out a payment plan. At one point I had excellent mental health care benefits and the hospital used every excuse in the book to keep me there for the full month even though I was clearly very stable after two weeks.
On another occasion I was having serious neurological problems including sudden severe headaches, numbness going down my left arm, cognitive impairment and loss of perihelial vision. I drove myself to the hospital and asked to have my neurologist notified. I told by a resident psychiatrist that I was manic and could only be admitted to the psychiatric ward. I refused admittance and told him I would leave. He politely escorted me to my car and made a sexual advance. I refused his advance and told him I was not manic. The following day I sought help from an acupuncturist and other alternative practitioners and my condition improved greatly. On my own I filed a claim with NYS Division of Human Rights against the hospital and it was settled. There are many cases of mental health care professionals taking advantage of persons with symptoms of mania.
Meredith Vieira is exactly right, how many other people LABELED with a mental illness actually have a medical condition causing the symptoms?
By consensual agreement within the American Psychiatric Association (Diagnostic and Statical Manual III-revised, 1987), psychiatric diagnoses are descriptive labels only for phenomenology, not etiological or mechanistic explanation for syndromes. Thus, a psychiatric diagnosis labels a pattern of signs and symptoms, but offers no hypothesis concerning the mechanism(s) of the clinical phenomena.(Davidoff et al., 1991).
There are people who have been LABELED with bipolar disorder (notice the word disorder, not disease) who were later found to have Creutzfeldt-Jakob “disease”, or lyme “disease”, or heavy metal “toxicity” etc. There are many underlying causes to symptoms of mental illness. Is it so far fetched to believe Mike’s symptoms of mania were triggered by a combination of stress, poor diet and maybe some kind of substance abuse that depleted the neurotransmitters in his brain?
Ask yourself
Was Mike a depressed child or teenager? Did he have symptoms of ADHD?
Is his condition hereditary? Who else in your family ever acted like that?
“Somehow her loved ones were able to get a doctor to spend enough time examining her to discover what was happening inside her brain.”
As a parent and a mental health advocate, please spend the time listening to this:
http://a-medicine-of-hope.blogspot.com/2009/05/mood-disorders-causes-and-solutions-dr.html
Pete,
As you are more than aware of from the visit to the emergency room with your son Mike that you described in your book, having psychotic symptoms alone will not ensure admittance into a hospital. I’ve had similar frustrating experiences of not being able to get my daughter help when she was so obviously in need of effective treatment, which, in her case, included anti-psychotic mediations.
Involuntary commitment orders, depending on the state where you reside, require some proof of dangerousness. In my state, Pennsylvania, that means the person must be a “clear and present danger to self or others.”
The criteria to meet that level of dangerousness is extremely stringent. Any descriptions of behavior used to determine if an individual is eligible for involuntary commitment into a hospital can only include what happened in the previous thirty days.
So, even if the individual consistently stops treatment, has numerous hospitalizations, incarcerations, or a history of violence prior to the past thirty days, that information cannot be used to determine a current attempt to get them treatment in a hospital through an involuntary commitment order.
When an individual does meet the “clear and present danger” criteria, a stay in the hospital these days usually means just three to five days, which often is not enough time for someone to stabilize on the medications that may have been prescribed.
Upon discharge from the hospital, a person can decide to stop medications or discontinue any prescribed treatment. If so, then once again, if psychotic symptoms reoccur, then that person will need once again to meet the “clear and present danger” criteria of the past thirty days.
For this reason, I am an advocate for a compassionate assisted outpatient treatment (AOT) law, to amend our outdated Mental Health Procedures Act of 1976 and to provide continuity of treatment in the community.
Legislation has been introduced in both the Senate and House through State Senator Greenleaf’s SB 251 and House Representative Scavello’s HB 2186. These bills are modeled after New York’s highly successful Kendra’s Law.
For anyone who is interested in seeing this common-sense legislation become law in our state, I encourage them to visit the Treatment Advocacy Center’s web page http://www.treatmentadvocacycenter.org/ and click on Pennsylvania to join our advocacy effort to see timely, effective treatment for those with a severe mental illness who may lack the insight to seek and remain in treatment.
Pete,
As you are more than aware of from the visit to the emergency room with your son Mike that you described in your book, having psychotic symptoms alone will not ensure admittance into a hospital. I’ve had similar frustrating experiences of not being able to get my daughter help when she was so obviously in need of effective treatment, which, in her case, included anti-psychotic mediations.
Involuntary commitment orders, depending on the state where you reside, require some proof of dangerousness. In my state, Pennsylvania, that means the person must be a “clear and present danger to self or others.”
The criteria to meet that level of dangerousness is extremely stringent. Any descriptions of behavior used to determine if an individual is eligible for involuntary commitment into a hospital can only include what happened in the previous thirty days.
So, even if the individual consistently stops treatment, has numerous hospitalizations, incarcerations, or a history of violence prior to the past thirty days, that information cannot be used to determine a current attempt to get them treatment in a hospital through an involuntary commitment order.
When an individual does meet the “clear and present danger” criteria, a stay in the hospital these days usually means just three to five days, which often is not enough time for someone to stabilize on the medications that may have been prescribed.
Upon discharge from the hospital, a person can decide to stop medications or discontinue any prescribed treatment. If so, then once again, if psychotic symptoms reoccur, then that person will need once again to meet the “clear and present danger” criteria of the past thirty days.
For this reason, I am an advocate for a compassionate assisted outpatient treatment (AOT) law, to amend our outdated Mental Health Procedures Act of 1976 and to provide continuity of treatment in the community.
Legislation has been introduced in both the Senate and House through State Senator Greenleaf’s SB 251 and House Representative Scavello’s HB 2186. These bills are modeled after New York’s highly successful Kendra’s Law.
For anyone who is interested in seeing this common-sense legislation become law in our state, I encourage them to visit the Treatment Advocacy Center’s web page http://www.treatmentadvocacycenter.org/ and click on Pennsylvania to join our advocacy effort to see timely, effective treatment for those with a severe mental illness who may lack the insight to seek and remain in treatment.
Pete:
Great blog. Dead on.
Susan: The fact that you can anonymously report someone and then they get evaluated, is not limited to mental illness. One can report any crime or activity and that will often lead to an investigation. Presumably, if the report is false, that’s the end of it.
As for sexual advances during your attempt at getting treatment, I am sorry for that, but again, it has little to do with Assisted Treatment Laws. We see frequent reports of this from dentists and other professionals.
And as for overmedicalization of ‘psychiatric’ illnesses, you are right. This has eaten up resources that should be going to the seriously mentally ill. See my blog at
http://www.huffingtonpost.com/dj-jaffe/mental-health-kills-the-m_b_426672.html
Assisted Treatment in NYS has dramatically cut down hospitalizations, incarcerations, suicides and violence. Assisted Outpatient Treatment is less expensives, more humaine, and less restrictive than it’s alternative: inpatient commitment. That is why over 80% of patients who have actually experienced it, approve of it.
Learn more at Treatmentadvocacycenter.org
“80% of patients…” LMAO! what a load of… DJ, if you want to pretend to be a ‘reporter’ or a voice of any credibility, so called statistics should have the source simply cited.
Pete:
Great blog. Dead on.
Susan: The fact that you can anonymously report someone and then they get evaluated, is not limited to mental illness. One can report any crime or activity and that will often lead to an investigation. Presumably, if the report is false, that’s the end of it.
As for sexual advances during your attempt at getting treatment, I am sorry for that, but again, it has little to do with Assisted Treatment Laws. We see frequent reports of this from dentists and other professionals.
And as for overmedicalization of ‘psychiatric’ illnesses, you are right. This has eaten up resources that should be going to the seriously mentally ill. See my blog at
http://www.huffingtonpost.com/dj-jaffe/mental-health-kills-the-m_b_426672.html
Assisted Treatment in NYS has dramatically cut down hospitalizations, incarcerations, suicides and violence. Assisted Outpatient Treatment is less expensives, more humaine, and less restrictive than it’s alternative: inpatient commitment. That is why over 80% of patients who have actually experienced it, approve of it.
Learn more at Treatmentadvocacycenter.org
DJ:
I recognized and appreciate the value of using counseling/therapy for mental health care patients and assisted outpatient treatment. I hold in high regard the successful example set by the Delancey Street Foundation in helping individuals with criminal backgrounds, many of whom have mental health problems to deal with.
I fully support Assisted Treatment Laws, but would it be possible to include testing for and treating the many underlying medical conditions that manifest as “mental illness”.
100% of the patients who have actually experienced being treated for the cause of their psychosis approve of it. Unfortunately, there are not that many of us.
The fact that a person labeled mentally ill was denied access to medical treatment by a psychiatrist is an example of the harmful dilemma created by the psychiatric labeling process. Is a person mentally ill, or physically ill, and who makes this determination?
My blood pressure was 60/40, yet I was dx as manic and told I could only be admitted to the psychiatric ward. I asked the psychiatrist to consult with my neurologist who a week earlier had told me I had brain damage. The psychiatrist told me “the brain damage is all in your head”. I was diagnosed as bipolar and treated like an idiot.
On one occasion I was told by 3 different psychiatrists that I was depressed and they recommended Prosaic. My complaint was extreme exhaustion to the point that I could not function. My mother suggested I have my thyroid tested. My TSH was 147.93 (normal range is .35 – 5.5) Mine was at a dangerously high level that could have caused permanent heart damage. How many other individuals dx with bipolar disorder have thyroid problems?
This is why Susannah Cahalan's case is so important. Perhaps other people have the same illness and the correct dx could explain the bizarre psychotic behavior of individuals like Dena Schlosser and Otty Sanchez.
Treating the medical condition that causes psychotic behavior is more humane, cost effective (except for the pharmaceutical industry and “pill pushers”), and works better than ignoring the problem.
Here is a list of just some of the underlying causes of psychotic/manic behavior. The list focuses on illnesses that manifest as acute symptoms as they should be the easiest to figure out there is more than just a psychological problem going on. Dr. Torrey's research is included.
http://www.investigatingmentalillness.blogspot….
I appreciate your comment and your advocacy.
DJ, here is a “successful” case result posted on a Florida criminal defense attorney's website to promote his business. The defense in the case used the victim's diagnosis of bipolar disorder in order to have their client's criminal charges reduced. This is an example of how the psychiatric labeling process creates a class of people deprived of equal protection. An individual with a psychiatric diagnosis should be afforded equal protection under the law. This is obviously not the case. Clearly the State of Florida discriminated against this woman because of her psychiatric label and the attorney is bragging about it as a success.
“Husband Accused of Threatening Wife and Violating an Injunction Escapes Criminal Conviction with a “Slap on the Wrist” and Fine
Our client appeared in court for a final hearing on a domestic violence injunction. The petitioner in the case claimed that he made the comment “you’re finished”. Our client stated that he was making that comment in reference to his girlfriend returning from the bathroom. He was then charged with a 1st degree misdemeanor for making contact with the petitioner.
RESULT: It was then discovered that the petitioner was bipolar where she had falsely accused our client of breaking the injunction eight separate times in one day. The State announced its intention to try and exclude testimony relative to the petitioner’s mental health and false accusations. After diligent negotiations with State that the mental health of the petitioner would more than likely be admissible, the state offered no conviction, no probation and a limited fine.”
DJ, here is a “successful” case result posted on a Florida criminal defense attorney's website to promote his business. The defense in the case used the victim's diagnosis of bipolar disorder in order to have their client's criminal charges reduced. This is an example of how the psychiatric labeling process creates a class of people deprived of equal protection. An individual with a psychiatric diagnosis should be afforded equal protection under the law. This is obviously not the case. Clearly the State of Florida discriminated against this woman because of her psychiatric label and the attorney is bragging about it as a success.
“Husband Accused of Threatening Wife and Violating an Injunction Escapes Criminal Conviction with a “Slap on the Wrist” and Fine
Our client appeared in court for a final hearing on a domestic violence injunction. The petitioner in the case claimed that he made the comment “you’re finished”. Our client stated that he was making that comment in reference to his girlfriend returning from the bathroom. He was then charged with a 1st degree misdemeanor for making contact with the petitioner.
RESULT: It was then discovered that the petitioner was bipolar where she had falsely accused our client of breaking the injunction eight separate times in one day. The State announced its intention to try and exclude testimony relative to the petitioner’s mental health and false accusations. After diligent negotiations with State that the mental health of the petitioner would more than likely be admissible, the state offered no conviction, no probation and a limited fine.”