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Help Herself

Help Herself

Surprises abound at The Stone Institute. Days are filled with both scheduled and unscheduled patients. You never know who will turn-up unannounced. We have a rule in the office; if any of our Stone Family are acutely ill, come in for urgent or emergent care. Our policy usually delays the care of scheduled patients, however it benefits all who need urgent care.

Yesterday was an interesting day. I worked without knowledge of an episode of unusual behavior unfolding throughout the day. The story of this patient goes back many years. At the time I first evaluated her, she was a bright, active clinical psychologist working in a busy private practice. She had her own home, two big dogs and a live-in boyfriend. She came to see me wanting an evaluation for poisoning. She thought her boyfriend was trying to kill her. She had come to her conclusions after researching the potential causes of her months of fatigue, brain fog and muscle weakness. Her boyfriend attended the session and she spoke freely about his alleged actions.

For me, her chief complaint was a relatively common one since two of my specialty qualifications are in the areas of medical toxicology and clinical pharmacology. Patients seek me out to evaluate them for possible poisoning fairly often. In her case, she believed her boyfriend was putting something in the air which only affected her. She believed that the air in her house was contaminated and she wanted a full panel of tests to find the toxin or toxins responsible for her illness.

She was given every benefit of the doubt. I ordered extensive blood and urine testing to help affirm or refute her beliefs. Her boyfriend appeared to be a remotely normal gentleman and denied putting anything into the air for any reason. Over a short period of time, it became clear that her beliefs were extreme delusions of common everyday exposures. Ultimately I realized she had some sort of psychotic break. She decided to move back home to live with her elderly parents because her own house was unsafe.

It did not take long before she was accusing her boyfriend of poisoning her octogenarian parents and her. She became so disturbed that she was involuntarily committed by her father to Parkway Village for management of her acute episode of psychosis. She was hospitalized for several weeks. When she was released from treatment, she was extremely paranoid even though she was considered in remission. She could no longer practice clinical psychology which devastated her income.

Through the years, she has visited the office on a regular schedule to re-evaluate her mental and physical health. Her father has tried several times to admit her into one of the few mental health facilities in the area, but she has refused. She has a large old white Cadillac that she uses for transportation. She lives out of hotel rooms in northern Mississippi.

When I was in medical school, State and Federal Tax dollars were used to house people like her in large institutions. Weighing the pros and cons of such a solution to the mentally ill has been argued in the past and most, if not all of these mental health facilities have been closed. Families are left alone with trying to find ways to help and support their loved ones as their loved ones struggle to find their way. Even though I helped this patient get disability and she lives on monthly social security benefits, there is no doubt that the majority of her expenses are not covered by her income. Hence her loving father has spent his life savings to try to get his daughter help, even in the face of extreme resistance from her.

On her most recent visit to the office, she stayed longer than three hours. She was evaluated and treated right away; there was no delay in her medical therapy. After which she changed her clothes three times, one of those times she disrobed outside in the parking lot. The other two were in one of our three bathrooms, occupying the bathrooms for over thirty minutes at a time. Finally we had to ask her to leave because she could not homestead in our office.

There have been times when I have worked at my shop on weekends, and she would be parked in front of the gates with her car windows propped open and her automobile running. When I woke her up and asked her to leave, she complied. Two hours later, she was back in front of the red gates, sleeping in her car. She is not defiant nor violent in any way. She has no place to go and she refuses to stay with her parents because they wish to get her treatment for her psychological disturbances.

I think of her as living in a prison of delusion and paranoia. We have tried countless medications to help her, some of them are very effective. However, she does not take them regularly so their benefits are short lived. She is not willing to undergo inpatient treatment nor see a psychologist or psychiatrist on an outpatient basis. I suspect the white Cadillac she drives is her only certainty in an uncertain world.

Next time you see a woman next to a white Cadillac wondering around aimlessly, lost in a world of delusions and paranoia, don't just assume she is an abstract painting of a life of drugs, alcohol and rock and roll. Sometimes people just crack under the normal pressures of life and they lose their sense of self. The problem is that they have a tendency to sink their entire family ship with them if they don't or won't get the proper care to return themselves to the real world. We're still trying to help her.

But I think she's stopped trying to help herself.

Doc

Posted by Amanda Sanders at 8:42 AM
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