Today, my medical student and I had the chance to accompany one of our patients to court for an involuntary commitment hearing. Picture, if you will, a small courtroom, not entirely unlike a TV courtroom without the audience section. The defendant, a rather large woman, has three of her four limbs restrained in a wheelchair. She is carrying several rolled up wall-chart pieces of paper, and is sitting with a blanket over her head. She states that she has fired her public defender and wishes to represent herself. The judge does allow this... for about two minutes, at which point it becomes clear that the patient has no concept of what this trial is about, or about law in general, and thus the public defender is reinstated.
Once the trial re-commences, the patient states that she wishes to speak on her own behalf. This motion is granted. She removes the blanket from her head and proceeds through her series of charts (which are covered with semi-sensical diagrams and random technical phrases), becoming louder and angrier. After running out of charts, she states that "You want to know my evidence? Here's the evidence against you!" With this statement, she proceeds to lift up her hospital gown, spread her legs (to the degree that one can do so while restrained), and, um, manipulate herself. The judge's bench happens to be positioned such that our esteemed jurist has a view pretty much straight down the barrel.
I tell you with the greatest respect and amazement that our judge did not bat an eye or in any way become agitated. She continued the trial, her face perfectly composed, and merely asked whether a blanket was available to cover the patient. A blanket was provided, the trial resumed, and the patient continued to engage in her behavior, but mercifully away from our eyes.
It's not quite a Johnnie Cochran strategy, but it certainly did make an impression. Fortunately for our patient, it made the right impression and she'll be spending a few months on mandatory hospitalization so we can get her back to normal.
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**Can you** get her back to normal? Is that possible?
ReplyDeleteYes. I hope. She has a track record of getting back to at least a functional, community-living baseline (albeit supervised living, as she tends to stop her meds once she's feeling better).
ReplyDeleteThat's the point of this story: not just to say "wow, look how crazy my patients are", but to explain that there really IS such a thing as mental illness, and the solution to it is not jail, but medicine.