A series of studies from a stint at the psychiatric ward, with illustrative slides.
After more than three years of a medical school education that had left me hostile, nauseous, and far better manicured than I liked, I chose to spend a month working in the psychiatric ER. I didn’t think of psychiatry as particularly intellectual or (for that matter) barbaric, reductive, a kind of violence, madcap fun, an exciting field reinvigorated by neuroscience, a good lifestyle, or useful; I just thought of psychiatry as kind of OK. I was looking forward to the rotation, mostly because it would give me a break from having to touch people all the time.
As it turned out, my attending psychiatrist was tall, easily startled, laconic, and beautiful in the tradition of nocturnal creatures. I desperately wanted to impress or eat cereal with him; such feelings were, in my medical career up to then, unprecedented. The former goal seemed more within my reach, or at minimum a precursor, so I thought I’d try to keep notes—try to win some approval from Dr. K.
However, writing in front of people as I interviewed them—it seemed offensive. Or excessively flattering. Or maybe I was just lazy. Or maybe I in fact didn’t care for Dr. K. I kept almost no notes. I never even internalized or deployed the standard case-presentation format. I never asked for sexual histories and could barely ask after drug and alcohol use. I was happy though, that month. For whatever reason. Maybe for being wrong so often.
, 56-year-old male, brought into the ER because he kept taking his clothes off in the dining room of his housing center for the mentally ill. NB says voices were instructing him to do this. He explains to me that he was watching a movie about espionage and then he just understood everything. “What is everything?” I ask. He replies, “You know, fusion, quantum mechanics, deep things.” I tell him I didn’t know what he means; could he tell me more? “You don’t know what I mean? I’m saying that I want to father a child.”
, 14-year-old male, brought in because he got into a verbal fight with his grandmother after she refused to buy him a scooter. On further questioning, this really does seem to be the entirety of the conflict. Grandmother relates the family story: JL was a crack baby, and he lives with his grandmother because his mother is still addicted to drugs. (She recently married and plans to change her life. “But I’m not holding my breath,” the grandmother says.) His father died in October of AIDS. JL often fights with his grandmother over the money from his father’s pension check, which she refuses to give him. JL hasn’t been going to school. He says he prefers to ride his dirt bike on 125th Street.
, sitting in the ER yelling at others in the room. Everyone is either a Nazi Jew or a Black Jew. The Black Jews are good, on his side, there to defend him.
, 25-year-old male, brought in after his mother called his day-treatment program because he was “scaring her.” H/o schizophrenia. Extremely calm and polite during interview. Initially denies hearing voices, denies any symptoms. Says he was brought in because he has been drinking wine. He is drinking wine because it is the blood of Christ and the more he drinks the more he will be like Christ. The cops are like the Romans who crucified Jesus. God is his father. When he was twenty, God gave him wings. He’s angry with his father for bringing him into the world and just leaving him there. His mother believes in a white Christ, the wrong Christ. His program director, present for the interview, reveals that HM has a history of arrests for aggravated assault. “They’re trying to clip my wings,” HM says. “I have no choice.”
, 62-year-old female, brought in by her niece, who reports that when she visited HF’s house, she found the kitchen floor, counters, and cabinets covered in Comet cleaning powder, knives, and scraps of cardboard. The stove was on.
HF reports that invisible thieves (whom only she could see) had attempted to rob her, but she had trapped them in her closet. “I didn’t give them the doors to my keys,” she explains. The thieves yelled out to her that she had to marry John Hicks. She was in love with John Hicks, and he with her. He was a musician, but he was with that white girl who was on the stage. Black people didn’t clap for that girl, but the white people did; the white girl would take her “bows of marriage.”
By her own account, HF has neither eaten nor slept for four days and is pregnant with quadruplets. During the intake interview, HF returns repeatedly to the topic of cleanliness. She keeps saying she is dirty—dirty but kosher. She says she only eats meat because the babies want it. After the interview, she exclaims: “I like to eat clams with hot sauce, so I’m not crazy, you see.”
(HF’s daughter reports by phone: HF was first hospitalized at age nineteen. She successfully completed college and used to work in retail at Bloomingdale’s. Her husband, a musician, left her and avoids contact, but HF insists they are still in love and calls him asking for concert tickets. HF claims to have made millions in computers, but she lives on food stamps and welfare.)
, 48-year-old female, reports coming to the ER because she is depressed and worried about not being able to pay her rent. She wants to know what the hospital ward looks like. She cries several times during the interview, clearly stressed. Poor impulse control. At one point in the interview, she shouts, “You white people don’t have feelings the way that we Latinos do. You don’t feel deeply. You’re just a little girl.” SF says she wants to check into the hospital, but she gets frustrated while waiting to go up to the floor, yells at the nurses that they’re lazy, and leaves.
Call log, ER staff phone
: Unidentified woman rings three times in a row, complaining, “They Clintonized me in Israel.”
, 54-year-old woman, s/p 1998 pancreas/kidney transplant, brought to the psychiatric ER from rehab center s/p hip replace-
ment because she was throwing things at staff members and loudly accusing them of murdering another patient. On interview, MH says the nurses are after her because she knows they run a secret prostitution and drug ring in the rehab center. She explains: “At 11 p.m., a low-class prostitution ring of blacks and Hispanics, servicing police officers, working-class people. At 2 a.m., a high-class Asian-only ring servicing doctors and medical students.” MH knows this because she overheard her doctor bragging about it and “hears furniture being moved around."
MH says she doesn’t like being at the rehab center because she's an academic and therefore is not meant to socialize with the people at the center, who “often don’t have more than a year of education.” She doesn’t like “rural people, people who grew up walking barefoot to get water from the well.” She proudly claims they call her Goldilocks at the center and says she only associates with the Jewish women there. She once studied to become an Orthodox Jew and “met many friends but never converted.”
MH reports having no children of her own. She and her ex-husband couldn't have kids, but after they got divorced he ended up having four “ugly children with his Eskimo wife—half-Eskimo, half-Norwegian. You can imagine what those kids looked like.” She adds that her family dates back to before the Mayflower. In her youth, she was a labor organizer and active in the civil rights movement. “Now I just want to give up and leave the city.” She is currently on high-dose steroids. It is unclear to what extent the medication contributes to her paranoid ideation and irritability.
On presenting MH’s case to Dr. K, he informs me that several months prior to MH’s most recent admission, an article in the Post
had uncovered a drug ring that was operating out of MH’s previous nursing home.
Eadweard Muybridge slides by the author, photographed by Hannah Whitaker.