Here’s the latest battle-cry of the psychiatric patient.  After coming by EMS, or with law-enforcement, after punching out walls and windows, then taking a ‘handful of pills,’ which are actually missing from the recently filled bottle of Oxycontin or Ativan, or after cutting their wrists deeply while screaming, ‘I want to die,’  after holding a gun to their head or intentionally wrecking their car, they state, ‘I didn’t mean it…I was just upset!’

No one seems to understand that words and actions, like ideas, have consequences.  So, in the midst of personal turmoil, in the throes of addiction or the aftermath of relationship disasters, many patients talk about suicide and act out their plan up to a point.

I understand that these are often legitimate cries for help.  I want to help.  So I examine them, talk with them, have a psychiatrist speak with them (via our Telepsych program).  I talk with their families, and frequently the consensus is that they need a psychiatric commitment.

At that point, it all blows up again.  One man recently said to me, ‘well you’re not man enough to keep me here!’  Another screamed profanity, and blamed her very patient mother, rather than her illustrious methamphetamine habit.  They rant and rave; ‘I’ve got a job in the morning! I have dogs to feed!  I have bills to pay!’  As if, by shooting themselves or dying from an overdose, all jobs would be finished, all debts paid, all dogs fed.

‘You can’t keep me here!  I refuse to go!’  They tell me they have a right to leave, and will call their lawyers.  ‘Call them. I can hold you.’  I tell them this calmly.  Usually, they fall asleep.  Sometimes we find a bed in a psychiatric facility for them.  Sometimes they are admitted for a while, then discharged from our hospital.  Occasionally, they are arrested.

But I can’t get past the statement, ‘I didn’t mean it, I was just upset.’  Admittedly, coping skills in modern America are at an all-time low.  And maybe, the ambulance, the police-officers, the phone calls to terrified family, the brief respite in the hospital, are all means of attention, means of some twisted solace.  But mostly, I fear, the statement is just a reflection of our society’s love of endless, 24-hour, reality-show drama, brought to an ER near you.

They don’t understand that we simply can’t say, ‘I know you were going to shoot yourself, but if you want to go home, just promise me you won’t do it!’  In a culture without wall-to-wall attorneys, maybe we could filter through some of the drama.  ‘Good acting!  Sorry you were so upset,’ we might say; they might look back at us and grin, sheepishly.  But not now.  Despite inadequate psychiatrists, funding and facilities, we are duty-bound to make an effort to stop these folks from killing themselves, even if that wasn’t really in the plan.

So, no matter how they fuss, I’ll still be committing them.  And no matter how many holes they punch in the wall, I’ll still be explaining the situation.  And no matter how much they just didn’t mean it, I’ll have to believe them when they say, ‘I want to die.’

Edwin

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