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So last week I started an earlier post about my experiences at state inpatient facilities and how too many overt Axis 2 folk are put on units to just prey and disrupt without end, much to the dismay of staff and patients who truly are primary psychiatric in need.  Then I got side tracked once again by the pervasive Axis 2 BS outside these walls, but, we know that is not going to subside much less be eliminated.  As so well said in the first Avengers movie by the old man who stood up to Loki, “there will always be men like you…”

But, why are there men, and women, who like the Lokis are just personality disordered people who are NOT interested in insight, change, and accepting responsibility and yet forced on us mental health care providers by the state?  I can’t fix insight and judgment with pills, nor therapy, and hell, I ain’t a substitute for lead bars or gravesites.

Anyway, I received the November issue of Psychiatric Times, and there was this article regarding emergency psychiatry entitled “Suicidal Patients: defining and addressing emergencies” (which I will try to link but the site requires membership, free mind you but have to register), and in there this vignette:

CASE VIGNETTE 2

A 35-year-old man is brought to the ED by 4 police officers just before midnight. While high on cocaine and synthetic marijuana, Mr. S drove his car into the side of an ambulance stopped at a red light. The ambulance was totaled, although it fortunately was not transporting a patient at the time and the EMS crew was not injured. Mr. S was unscathed and initially feigned cooperation with police officers on the scene, then ran from them and was caught. The officers are ambivalent about taking him into custody because of his disruptive, “crazy” behavior.

In the ED, he is profane, making a number of threatening statements about his own safety and that of others; he boasts about his sexual prowess as he is escorted to an open room. In addition to any charges he might face for this event, he has a court date in 2 days that may lead to prolonged incarceration on drug distribution charges. His psychiatric record reveals self-reported diagnoses of both bipolar disorder and schizophrenia that were thought dubious because 2 past admissions at this facility were for diagnoses of adjustment disorder, substance use disorder, and antisocial and borderline personality disorder traits.

His half-brother and an uncle died by suicide, and a paternal cousin was involved in the drug trade and died under suspicious circumstances. His other family history is notable for multiple family members with mood and substance use disorders. In between threats to kill himself and everyone else in the ED, he screams, “You have to admit me—I’m suicidal,” and insists the crash was a suicide attempt.

Well, they go on to note in the next section of the article this:  “The patient in the second vignette provoked a strong reaction in providers, who were subjected to his threats and taunts.  Some resented that he had totaled an ambulance in a limited resource community and believed that he was ‘putting on a show’ as a way of escaping consequences.”

Really, with a court date coming up facing serious serious incarceration time?!  This reflects exactly my point, the courts and the state in more general think we are about treating the scum and villainy of our society?!  No, all we are about is identifying there is no primary Axis 1 illness of mood, thought, or cognitive deficits that are amenable to care interventions, and if it is revealed we have a cretin in our facility, then please, transfer to the appropriate alternative facility that handles antisocial shit, thanks!

But, as I tried to somewhat diplomatically note in the last post, where are the administrators of these mental health care facilities to stand behind their providers who are just nowadays the front line grunts being harassed, threatened, and if not outwardly at physical risk, like the vignette above, subjected to endless taunts and threats, which in my opinion are risks for violence when repeated endlessly?

As I have said in the past, no judge has ever called me to inquire to my opinion as to how to proceed with dealing with a person in the courtroom who appears to be somewhat psychiatrically impaired, but equally if not moreso a loser.  No, judges these days are more and more about just passing the proverbial “fuck”, er, “buck”.

Oh, the link for the above vignette:

http://www.psychiatrictimes.com/suicidal-patients-defining-and-addressing-emergencies

I’m not going to pontificate further on this issue, I think the readers here who know the beast I am addressing get the point.

Anyway, little more than three weeks until this blog fades into the sunset, note my banner for the blog was a sunrise, so I’ll have to find the best sunset show to close up things by December 26th.

Maybe I’ll start with my repeats of past favorite pictures as I start my fond farewells, hope this is a good beginning?

burn out redefined

For the topic at hand, who do you think illustrates the sociopath?…

common sense headstone

always loved this one, used it a few times…

silly shot

And, let’s end with a laugh, the lighter side of princesses…

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