Race, madness, and involuntary commitment: How a Cards Against Humanity staff writer was fired

[beginner2011]

I came across an account of a staff writer for Cards Against Humanity regarding their treatment as an employee and their experience with mental health services via involuntary commitment. I believe the events occurred in IL. I'm not familiar with the involuntary commitment laws in IL, but some of their claims were pretty shocking to me. In my state people can't be forced to be inpatient without evidence of imminent risk of harm to self or others, or inability to care for extremely basic needs (the bar is very high for this criteria). Also, the author's report of the attending psychiatrist's construal of his claims about his own childhood seem to verge on malpractice. Specifically:

I was admitted on a Friday at 6pm so I didn’t see a psychiatrist until Monday. She was tall, blonde and flanked by two med students. When I told her I had been in a stressful home environment growing up due to poverty and the fact that my parents told me I had to be better than the white boys to compete, she told me that was preposterous. Why would two anti-racist scholars teach their son to see white boys as competitors? Anti-racists would teach their son that race didn’t matter at all. I asked her if we could bring a single person of color into the room besides me to illustrate how common I felt it was to be taught this, she said no. She later listed my concerns as “spontaneous delusions” on “racial topics.”

I'm curious to hear others' thoughts on this.

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[psych.meout]

I'm curious to hear others' thoughts on this.

That there's a whole lot being left out and this is not the entire picture of what happened?

E.g.,

Andy reached out to my sister who was a senior in college. He told her that I was going to be disciplined at work for my behavior and could lose my job, which so frightened my parents that they drove from New York to Chicago overnight. My dad came to my apartment and asked me to “see someone.” I agreed, since I was imagining a therapist on a couch asking me if I was suicidal. He drove me to Illinois Masonic, where the combination of my parents’ concern and the collateral of a co-worker who was operating with the head writer were enough to have me forcibly kept there.

 

[futureapppsy2]

That there's a whole lot being left out and this is not the entire picture of what happened?

E.g.,

Agreed. There's some huge gaps in this story missing, and the fact that the writing seems so tangential isn't giving the author's story more credibility for me on this point, tbh. There's a fair amount of racism baked into how we diagnose and treat mental illness (and blinded studies that demonstrate this), so I don't discount that they could play in here, but there are definitely some considerable gaps in this story as well.

 

[psych.meout]

Agreed. There's some huge gaps in this story missing, and the fact that the writing seems so tangential isn't giving the author's story more credibility for me on this point, tbh. There's a fair amount of racism baked into how we diagnosis and treat mental illness (and blinded studies that demonstrate this), so I don't discount that they could play in here, but there are definitely some considerable gaps in this story as well.

Exactly. The writing style isn't doing him any favors and the level of detail given to certain parts of the narrative (e.g., conversations at work, the process used by staff to develop the card content) vs. others (e.g., what was specifically said to his sister and parents by his employers, why his parents were so frightened by just the prospect of him getting fired, what the hospital staff were told) is quite stark and revealing, though it's uncertain if this is intentional or just poor insight.

 

[DynamicDidactic]

For that article

 

[BuckeyeLove]

Collateral contacts and interviews. Things would get a lot clearer. As is the case in 50-75% of our acute admissions. (unrelated, but are we allowed to admit yet? That would be nice, as I'm pretty sure I could do a better job than the Psych NP's at my facility).

 

[psych.meout]

Collateral contacts and interviews. Things would get a lot clearer. As is the case in 50-75% of our acute admissions.

Is this a new form of haiku?

Regardless, I love it.

 

[psychRA]

Whenever I read media coverage about someone's personal account of being hospitalized - especially involuntary - I wish that journalists could require subjects to sign a release of information that would allow the hospital to add their perspective. I'm not saying that the patient's perspective isn't valid, and I think that there's a real risk of important pieces being left out when only one perspective is included.

 

[psych.meout]

Whenever I read media coverage about someone's personal account of being hospitalized - especially involuntary - I wish that journalists could require subjects to sign a release of information that would allow the hospital to add their perspective. I'm not saying that the patient's perspective isn't valid, and I think that there's a real risk of important pieces being left out when only one perspective is included.

It's not even saying that the patient's perspective is invalid (at least not in most cases). For one, it's about the context. If someone is being involuntarily hospitalized, even if only for the 48-72 hour observation period, they likely came to the hospital in the middle of a crisis and therefore may not have been mindful of everything that was going on or remember it clearly.

They also weren't privy to all events or communication. Their family may have been taken aside by the hospital staff and not really know what was said. You can't really criticize the hospital if you don't have all the information upon which they based their decisions.

Also, most of these accounts are from lay authors. They don't really understand the procedures, practices, conceptualization, etc. What may seem relatively innocuous to the author and audience may, in aggregate with other details, be a sign of serious mental health concerns for professionals. And this goes the other direction for laypeople being aghast at, say, the involuntary hold, but which may be perfectly reasonable with all the pertinent data.

Even without the hospital's perspective, there's enough here (in what is explicitly shown, what is implied, and what is conveniently left out) to lend itself to taking the hospital's side, at least provisionally.

 

[WisNeuro]

Whenever I read media coverage about someone's personal account of being hospitalized - especially involuntary - I wish that journalists could require subjects to sign a release of information that would allow the hospital to add their perspective. I'm not saying that the patient's perspective isn't valid, and I think that there's a real risk of important pieces being left out when only one perspective is included.

Oh, if I could only count the number of times inpatients have accused providers where I am of "inhumane" treatment for not being allowed to leave the grounds for smoke breaks, or to eat whatever they like due to cardiac diets.

I am sure that some atrocities do indeed exist, but the flip side also exists in extreme hyperbole and significant embellishment on the patient side. I've been lucky not to really see any of the former on my inpatient stints, but plenty of the latter.

 

[psych.meout]

Oh, if I could only count the number of times inpatients have accused providers where I am of "inhumane" treatment for not being allowed to leave the grounds for smoke breaks, or to eat whatever they like due to cardiac diets.

I am sure that some atrocities do indeed exist, but the flip side also exists in extreme hyperbole and significant embellishment on the patient side. I've been lucky not to really see any of the former on my inpatient stints, but plenty of the latter.

And it's all about how the "inhumanity" is relayed. From a non-psych side of things, I've seen patients complain about how cruel the hospital staff were to take away homecooked food that their poor mother slaved over all day. People who aren't in the field or aren't very familiar with hospitals can be forgiven for buying into these horror stories. Well, at least until someone explains to them that there are good medical reasons to not allow this kind of thing, especially for patients on special diets or who are on restriction for certain procedures.

 

[WisNeuro]

And it's all about how the "inhumanity" is relayed. From a non-psych side of things, I've seen patients complain about how cruel the hospital staff were to take away homecooked food that their poor mother slaved over all day. People who aren't in the field or aren't very familiar with hospitals can be forgiven for buying into these horror stories. Well, at least until someone explains to them that there are good medical reasons to not allow this kind of thing, especially for patients on special diets or who are on restriction for certain procedures.

Yeah, the nothing in from the outside thing is very serious. Ask anyone who's worked on inpatient units for a while and they can tell you a story about how drugs were snuck in, or something was given to a pt and the patient later died from suicide or had an OD from the drugs. Those rules are there to keep you alive, at least when you are in the hospital in crisis mode.

Anyway, yeah, things make a lot more sense when you understand the facility side. Not to say all of teh JHACO guidelines are sensical, but many are life-saving.

 

[futureapppsy2]

Whenever I read media coverage about someone's personal account of being hospitalized - especially involuntary - I wish that journalists could require subjects to sign a release of information that would allow the hospital to add their perspective. I'm not saying that the patient's perspective isn't valid, and I think that there's a real risk of important pieces being left out when only one perspective is included.

It’s also a telling omission that the author includes screenshots from his discharge summary but not elsewhere.

That being said, I do think there’s a conversation to be had about how we can better treat psych patients, especially in Emergency Department settings, while still maintaining safety. We (healthcare professionals and people broadly) do tend to dehumanize people with SPMI.

 

[DynamicDidactic]

It’s also a telling omission that the author includes screenshots from his discharge summary but not elsewhere.

That being said, I do think there’s a conversation to be had about how we can better treat psych patients, especially in Emergency Department settings, while still maintaining safety. We (healthcare professionals and people broadly) do tend to dehumanize people with SPMI.

its a tough line. I feel for both sides. However, empirically and anecdotally psychologist, psychiatrists, and social workers seem to do a better job. Nursing and other staff seem to do a worse job.

 

[clausewitz2]

I posted this on another venue about this piece:

As a psychiatrist I don't have much faith in the rigor of the involuntary commitment process. However, the fact that his parents, who he claims are anti-racism scholars, thought they needed to take him to a psych hospital is very telling. Surely they did not want their son hospitalized mainly to perpetuate racist oppression?


One of the really insidious things about mania is that people often simply don't remember a lot of their behavior but often remember the bad things that happen to them while hospitalized. I have worked with many people who can tell you at some length about how they were restrained or forcibly injected with medications and wax eloquent about the injustice of it because it was clearly for no good reason at all. They don't remember the part where they were trying to sell their house so they could move to London to marry the drummer from Judas Priest or deciding that a reasonable alternative to someone's doorbell not working was to throw a hubcap through their living room window. Running naked through the corridors of the unit singing Disney songs at the top of your lungs and groping every male staff member you come across is remembered as 'those evil psychiatrists drugged me because I dared to make a joke'.


It is not uncommon with classical bipolar I disorder for people not to accept that there is anything troubling or unusual about these episodes until they have happened many times and burned many bridges. It's a shame because there are medications that can work well and untreated it has a very high rate of mortality and probably higher rate of incarceration.


It is 100% possible that the CAH leadership are enormous racist assh*les AND they were genuinely trying to do the right thing.