For I do not seek to understand in order that I may believe, but I believe in order to understand. For this also I believe—that unless I believe I shall not understand. — St. Anselm
Mrs. P is a 54-year-old woman admitted to the acute medical unit with uncontrolled hypertension secondary to non-adherence and a non-healing ulcer, the result of venous stasis related to high blood pressure. For the first few days of the hospitalization she is pleasant and cooperative with the medical team and nursing staff.
On a Saturday morning of her first week in the hospital, Mrs. P begins to say that she no longer needs treatment for her hypertension or wounds because “God has told her she is healed.” Despite this unusual claim, Mrs. P continues to participate in the treatment plan saying, “ I want to help the doctors and nurses, and so I will let them do what they need to do.
On Sunday Mrs. P begins to tell the team that she doesn’t need to be in the hospital because she is healed. The team is concerned that Mrs. P will try and leave against medical advice. They become seriously concerned about her decision-making capacity and advise Mrs. P that they feel she needs to stay in the hospital as her blood pressure is still not well-controlled and she needs wound care several times a day. Mrs. P says, “I cannot leave the hospital. I don’t need to be here for me as I am healed, but God wants me to remain until I have ministered to everyone in the hospital.” Mrs. P is still accepting treatment. The team is beginning to really question Mrs. P’s mental state.
The team decides to call psychiatry. Because Mrs. P believes she has been healed and has a mission, they are now sure that she suffers from a mental illness. In addition, Mrs. P increasingly says she does not need medication because she is miraculously healed. It takes considerable time and effort to persuade her to take the medication. The psychiatrist, Dr. H, sees Mrs. P on Monday morning and conducts an extensive interview as well as record review. Looking at Mrs. P’s records, Dr. H sees that Mrs. P had been seen several years earlier as an outpatient because of irritability and depressive symptoms for which antidepressants were prescribed. She stopped taking the medication and did not return for follow up. There is no history of psychiatric hospitalizations, suicide attempts, violence toward others, or psychotic symptoms. Psychosocially, Mrs. P has been married for 25-years, has no known substance use, and is working full-time as a salesperson at a department store.