PsychiatricTimes Members: Login | Register

|     

PsychiatricTimes SearchMedica Medline Drugs

Powered by SearchMedica

 
Risk Assessment
News
Current Issues
Blogs
Special Reports
CME
Conferences
Resources
Careers
Multimedia
About Us
 

Home » Blogs » Couch in Crisis

Psychiatric Times. Vol. 28 No. 6
Pages: 1  2  
Next
COVER STORY 

Tales from the New Asylum: The Valediction

By James L. Knoll IV, MD | April 11, 2011
Dr Knoll is associate professor of psychiatry at the SUNY Upstate Medical Center in Syracuse, NY, where he is director of forensic psychiatry, and director of the forensic psychiatry fellowship at Central New York Psychiatric Center. He is also the editor in chief of Psychiatric Times.

When the truths of love are planted firm
They won’t be hard to find
And the words of love I speak to you
Will echo in your mind

Without despair we will share
And the joys of caring will not be replaced
What has been must never end
And with the strength we have won’t be erased

...I believe when I fall in love with you it will be forever.1

Whenever a suicide happens in the New Asylums, a palpable, muted dread descends over the institution. It stays there in full force for weeks and months afterwards, sometimes longer. After that, it is added as another sedimentary layer to the strata and culture of the particular institution. Before things get too deeply buried, it is important to excavate.

Many excavations expose little. One is still left with agonizing, unanswered questions. But on rare occasions, a careful processing reveals a recorded history. The more well preserved these remains, the greater the likelihood they will be preserved in the mind of the excavator. Here then, are some findings from one well-preserved dig.

The prison Investigations Officer had called me early in the morning. The previous evening, an inmate I’ll call Nick, leapt to his death from a 5-story prison dormitory balcony. The investigator’s voice had been curt and official: “Morning, Doc. I have a recording in the phone bank that the Warden said you would be interested in hearing.”

It turns out that all phone calls inmates make or receive in the New Asylums are assiduously recorded for posterity—in most cases, for “security purposes.” I had listened to many recorded calls, all saved on a computer database. The reasons for my having to listen to these calls were never pleasant.

I knew Nick. He was among the caseload the mental health team followed in general population. He was a survivor of many tragedies, most notably the Vietnam War, which had left him battling chronic depression and PTSD for most of his life.2,3 He had about 3 years left to serve of his 10-year sentence for “accomplice to fraud.” There had been some speculation among mental health staff that he may have “taken the fall” by refusing to implicate his wife Cora, who had remained married to him despite his prison sentence. As far as I could recall, the team in general population had no recent concerns about Nick. He had made good use of treatment and had become a leader in his prison Alcoholics Anonymous group. As I headed over to the investigator’s office, I knew I was likely to find something unexpected and cataclysmic happened in Nick’s life.

Sitting in front of the computer bank, I placed the headphones over my ears. Clicking play unearthed the following conversation: 

Nick: You there baby?
Cora: Yes, I’m here.
Nick: Can’t we please talk about this?
Cora: Nick, I said everything you need to know in my letter.
Nick: So that’s how it is? You won’t even come here to tell me face to face?
Cora: You know that wouldn’t do either one of us any good.
Nick: Baby...12 years...You expect me to just sit in this place and let this happen?! Not try to do something about it? Save something important?
Cora: It’s too late, Nick. Things are... different now. We reached an impasse.
Nick: You....told me...we were forever...
Cora: Everything’s changed now, Nick. You know that...I can’t take it anymore. We both need to be happy.
Nick: Happy?
Cora: Nick...You can’t be the man I need you to be.
Nick: So this is it then? All the plans we had? Moving to the coast? The house...
Cora: I’m sorry, Nick. We tried. I’m sorry it didn’t work out.
Nick: You with another guy?
Cora: That’s not important now, Nick.
Nick: You’re a quitter. I never quit on us. You quit.
Cora: Don’t you judge me. You don’t get to do that any more. I have to go now, Nick. Don’t call me back, I won’t answer. It has to be this way, Nick. Goodbye.
Nick: I... I can’t believe you’re doing this...after everything. I wake up thinking about you and I go to bed thinking about you. You are the only thing that gets me through the day in this place. I...I live for you Babe.
Cora: Goodbye, Nick.

[...Click and dial tone....]

The computer database tells me the exact day, the exact time, this conversation happened—approximately 20 minutes before other inmates reported they saw Nick pacing anxiously on the balcony. Approximately 30 minutes before other inmates say they see Nick climb up over the railing with a look of determined fear on his face. Approximately 30 minutes, 10 seconds before they start yelling at him to stop. He didn’t.

Pages: 1  2  
Next
 

Join the Conversation

Want to join the conversation? If you're a healthcare professional, we'd like to hear your comments. Just sign in or register today to become part of our growing, online community.

  • Oldest First
  • Newest First

by Ronald Pies | June 30, 2011 10:30 PM EDT

Very compelling and moving piece, James...Best, Ron






 
TOPIC INDEX

Addiction Medicine
Alzheimer Disease
Anxiety Disorders
ADHD
Bipolar Disorder
Child & Adolescent Psychiatry
Dementia
Depression
DSM-5
Geriatric Psychiatry

 

Health Care Reform
Major Depressive
Disorder
OCD
Personality Disorders
Schizoaffective Disorder
Schizophrenia
Sleep Disorders
Somatoform Disorders
All Topics

 


 
FROM PHYSICIANS PRACTICE
Five Steps to Improving Patient Access
Judy Capko,  May 21, 2013
Patient access is getting increased attention through reform initiatives. Here are five steps you can take to make sure patients get appropriate access to care in your office.
Growing HIPAA Threat – Ignore Windows XP at Your Own Peril
Marion K. Jenkins,  May 21, 2013
Chances are good that you have some major ticking software time bombs lurking in your medical practice's computer environment, namely Windows XP and Server 2003.
Finding Physician Work-Life Balance in the Small Moments
Jennifer Frank, MD,  May 21, 2013
At my practice and at home, things are always busy. There's laundry or homework, or a patient with needs.
Three Areas to Reduce Costs at Your Medical Practice
Greg Mertz,  May 19, 2013
By taking a hard look at reducing costs for staffing, overhead, and technology at your medical practice, you may see increased physician compensation.
Dos and Don’ts for Starting a Physician Blog
Michael Woo-Ming, MD,  May 18, 2013
Starting a physician blog can provide your medical practice with marketing benefits, but it's important to do it right.
 

 

 
MOST POPULAR
  • Most Popular
  • Most Emailed
  • Most Recent
  • Developmental Psychopathology Comes of Age
  • The Moral Struggles of Practicing Psychiatrists
  • Grief and Depression: The Sages Knew the Difference
  • Update on Mental Health Benefits and Substance Use Disorder Services Under the Affordable Care Act
  • Synthetic Cathinones: Signs, Symptoms, and Treatment
  • Grief and Depression: The Sages Knew the Difference
  • Successful Aging: Strategies to Help Maintain and Nurture a Healthy Brain
  • Developmental Psychopathology Comes of Age
  • Synthetic Cathinones: Signs, Symptoms, and Treatment
  • Psychiatry and the Myth of “Medicalization”
  • Experts Discuss Changes, Updates in DSM-5
  • The Paradox of Choice: When More Medications Mean Less Treatment
  • Will Your Clinical Records Support You in Court?
  • Refinements in ECT Techniques
  • Successful Aging: Strategies to Help Maintain and Nurture a Healthy Brain
Click here to subscribe to our newsletter
 
COMMENTS
  • Most Commented
  • Most Recent
  • Psychiatry and the Myth of “Medicalization”
  • Grief and Depression: The Sages Knew the Difference
  • Is it Time for a Treatment Manual to Complement DSM-5?
  • Diagnosis and its Discontents: The DSM Debate Continues
  • Lamotrigine for Major Depressive Disorder Is Inappropriate
  • New Insight Into the Neurobiology of Depression
  • Tie One On for Patients
  • NIMH vs DSM 5: No One Wins, Patients Lose
  • Psychiatry and the Myth of “Medicalization”
  • Parity Laws: Powerful Weapon—or Pipe Dream?
Click here to subscribe to our newsletter


 
CAREER CENTER

  •   Featured Jobs  
  •    Resources   
  • Psychiatry and Nurse Practitioner Opportunities
  • Associate Medical Director - Psychiatrist Delray Beach, Florida
  • Retiring Child Psychiatrist Seeks Replacement August 2010 or Before
  • Chairperson, Dept of Psychiatry Needed
  • FT Staff Psychiatrist - Excellent Benefits
  • BC Adult and Child Psychiatrits - PT and FT Positions Available
  • Managing Risks When Practicing in Three-Party Care Settings
  • 12 Tips for Making Your Practice Greener
  • Keys to Avoiding Malpractice: Standard of Care in Psychiatric Practice
  • Take This Job and Shove It
  • Merging Administrative and Academic Careers in Psychiatry


CancerNetwork | ConsultantLive | Diagnostic Imaging | Musculoskeletal Network | OBGYN.net | PediatricsConsultantLive |
Physicians Practice | Psychiatric Times | SearchMedica | Medical Resources

© 1996 - 2013 UBM Medica LLC, a UBM company
Privacy Statement - Terms of Service - Advertising Information - Editorial Policy Statement - UBM Medica Network Privacy Policy