Twelve Patients: Life and Death at Bellevue Hospital by Eric Manheimer
Authors: Eric Manheimer
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childhood emotionally intact, considering what she had been given?
Tanisha’s diagnosis at admission was provisionally depression with suicidal thinking secondary to PTSD or post-traumatic stress syndrome. There were a million social risk factors listed in the diagnostic categorization. Every box was checked off. She had not been given her medication by her “family.” She made it clear she wouldn’t have taken it under any circumstances, since the medications made her feel worse and gain weight. She had been on an anti-depressant and an anti-psychotic medication used to “augment” or improve the effectiveness of the anti-depressant. I had seen the drug advertised on television, in popular magazines, and on the subway.
PTSD is a diagnostic category that emerged from the Vietnam War. In the 1970s when the war was grinding its way to a close, the range of symptoms seen among returning vets did not fit other categories of mental illness. The cluster of symptoms was not just depression, not simple anxiety, not only related to the use of drugs or alcohol. The PTSD complex included flashbacks of the traumatic events, extreme vulnerability, irrational fears, nightmares, depression mixed with anxiety and rage. Vets were placed on cocktails of prescriptionmedications—with mixed results—as the diagnosis became widely accepted and many millions of dollars were invested by the federal government to understand the syndrome or “disease” better. PTSD was made an “official” disease in 1980. This is twenty-seven hundred years after Homer described the effects of war on warriors in his majestic
Iliad
.
Recently the category was being refined to fit kids who had been subjected to violent and abusive events. Some kids who witnessed parental abuse and violence or had been physically or emotionally abused became emotionally unhinged. Tanisha lost control of her emotional regulators. She couldn’t think her way out of a flash emotional discharge. Her emotional centers were “hijacked.” Ordinarily children learn how to control their emotional states. This is one of the major tasks of childhood. When kids are subjected to trauma during vulnerable developmental periods that make them children and not mini-adults, they miss the development of emotional control. This emotional dysregulation flows through many childhood disorders. It is almost a universal symptom.
Tanisha described a fleeting anxiety—what she called her “third eye”—continuously scanning the environment for dangerous people. They could be anywhere, her experience had taught her. “They look just like you, Doc. How do I know you are not one of them? You can’t tell by just looking at someone. The worst shit has happened to me from the most smiling, most friendly, let-me-help-you-out-young-lady bullshit ones. In fact, they are the ones I worry about the most. They want you. They want you to like them and they disarm you. Man, I been there and done that and never again doing that. I have an alarm detector, a regular LoJack for that shit.” Then, when it got activated, she said, “I don’t even remember what happens, it is so fast. I am being pulled off someone or in the hospital injected with one of your latest and greatest medications and then I just go to sleep for a whole day. I have no idea what goes on when it hits me.”
I left to go back to my office. The back stairs to my office are down the hall from the emergency room. Yolanda from the Organ DonorNetwork spotted me before I saw her. “
Qué tal
, Dr. Eric, how are you?” she boomed, carrying a cardboard tray of coffees and croissants.
“What’s up, Yolanda?” I asked. “You are not here for good news?”
“You heard about the kid, Ignacio?”
“I haven’t heard anything, Yolanda. I’ve been locked up for hours with a patient and had my cell phone off.” I remembered and reached down to fiddle with the buttons.
“Kid wearing iPod earbuds leaned too far into the path of an
Tanisha’s diagnosis at admission was provisionally depression with suicidal thinking secondary to PTSD or post-traumatic stress syndrome. There were a million social risk factors listed in the diagnostic categorization. Every box was checked off. She had not been given her medication by her “family.” She made it clear she wouldn’t have taken it under any circumstances, since the medications made her feel worse and gain weight. She had been on an anti-depressant and an anti-psychotic medication used to “augment” or improve the effectiveness of the anti-depressant. I had seen the drug advertised on television, in popular magazines, and on the subway.
PTSD is a diagnostic category that emerged from the Vietnam War. In the 1970s when the war was grinding its way to a close, the range of symptoms seen among returning vets did not fit other categories of mental illness. The cluster of symptoms was not just depression, not simple anxiety, not only related to the use of drugs or alcohol. The PTSD complex included flashbacks of the traumatic events, extreme vulnerability, irrational fears, nightmares, depression mixed with anxiety and rage. Vets were placed on cocktails of prescriptionmedications—with mixed results—as the diagnosis became widely accepted and many millions of dollars were invested by the federal government to understand the syndrome or “disease” better. PTSD was made an “official” disease in 1980. This is twenty-seven hundred years after Homer described the effects of war on warriors in his majestic
Iliad
.
Recently the category was being refined to fit kids who had been subjected to violent and abusive events. Some kids who witnessed parental abuse and violence or had been physically or emotionally abused became emotionally unhinged. Tanisha lost control of her emotional regulators. She couldn’t think her way out of a flash emotional discharge. Her emotional centers were “hijacked.” Ordinarily children learn how to control their emotional states. This is one of the major tasks of childhood. When kids are subjected to trauma during vulnerable developmental periods that make them children and not mini-adults, they miss the development of emotional control. This emotional dysregulation flows through many childhood disorders. It is almost a universal symptom.
Tanisha described a fleeting anxiety—what she called her “third eye”—continuously scanning the environment for dangerous people. They could be anywhere, her experience had taught her. “They look just like you, Doc. How do I know you are not one of them? You can’t tell by just looking at someone. The worst shit has happened to me from the most smiling, most friendly, let-me-help-you-out-young-lady bullshit ones. In fact, they are the ones I worry about the most. They want you. They want you to like them and they disarm you. Man, I been there and done that and never again doing that. I have an alarm detector, a regular LoJack for that shit.” Then, when it got activated, she said, “I don’t even remember what happens, it is so fast. I am being pulled off someone or in the hospital injected with one of your latest and greatest medications and then I just go to sleep for a whole day. I have no idea what goes on when it hits me.”
I left to go back to my office. The back stairs to my office are down the hall from the emergency room. Yolanda from the Organ DonorNetwork spotted me before I saw her. “
Qué tal
, Dr. Eric, how are you?” she boomed, carrying a cardboard tray of coffees and croissants.
“What’s up, Yolanda?” I asked. “You are not here for good news?”
“You heard about the kid, Ignacio?”
“I haven’t heard anything, Yolanda. I’ve been locked up for hours with a patient and had my cell phone off.” I remembered and reached down to fiddle with the buttons.
“Kid wearing iPod earbuds leaned too far into the path of an
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