People who equate truth with fact are missing the point.

A Dislocation of Mind

My 17 year old daughter, Abbie, broke her leg the other day; a bad break in her femur. She was in terrible pain, begging me to make it stop, to help her feel better, so I took her to the emergency room. We went there, and we waited for 6 hours, and finally a Bone Health Specialist came and told us that we should go home and make an appointment to see an orthopedist.

“I can’t take her home like this!” I said. “She’s in too much pain, and she can’t walk! Can she at least have some medicine for the pain?”

The Bone Health Specialist was aghast. “A doctor can’t prescribe medicine without seeing the patient. That would be unethical!”

I brought Abbie home and made her as comfortable as I could before I got on the phone. I called every orthopedist whose number I could find. Many of them didn’t return my calls, and of those that did, more than half told me that they were not accepting new patients, and the few who I spoke to who were accepting new patients made appointments 4-6 weeks in the future or put her on waiting lists that were months long.

*          *          *

Oh, wait, no, sorry. I got a little confused for a second there. Actually, I took Abbie to the ER for an asthma attack. She was terrified, begging me to help her breathe, so I took her in hopes of getting her some relief and making sure she didn’t die. We went there, and we waited for 6 hours, and finally a Breathing Specialist came and told us we should go home and make an appointment to see a pulmonologist.

“I can’t take her home like this!” I said. “She can barely breathe, and she could die! Can she at least have a nebulizer treatment?”

The Breathing the Air Specialist was aghast. “A doctor can’t prescribe medicine without seeing the patient. That would be unethical!”

I brought Abbie home and gave her every kind of over-the-counter medicine I could think of to help her breathe better before I got on the phone……

*          *          *

Oops, no, wait, it was diabetic shock, and after we waited we saw a Blood Sugar and Insulin Specialist who told us to go home and make an appointment with an endocrinologist……

*          *          *

Gosh, sorry, I just don’t know where my head is. I took her to the ER because she was in a car accident and she was unconscious from head trauma, and after we waited we saw a Consciousness Restoration Specialist who told us to go home and make an appointment with a trauma surgeon……

*          *          *

Or wait, no, I did take my daughter to the ER, and we did wait for hours, but what was really wrong was depression. She felt suicidal. I had already called more than 30 psychiatrists by the time we went, and had already discovered that I could not get her an appointment in a reasonable amount of time. 6 weeks, 2 months, 3 months, we’ll add you to the waiting list…and in the meantime my daughter begged, “Please, Mom, can’t you make it stop? I just want it to stop!”

It is always awful to witness one’s own child suffering. From a baby’s first cold, there are few things in life that feel worse. Part of the way I endured excruciating pain after a surgery in 2007 (a stitch had slipped and I was bleeding internally) was to chant over and over to myself, better me than one of my kids, better me than one of my kids. But when there is treatment for what ails that child; when we know exactly what would bring some relief but we cannot deliver it despite our best and biggest efforts, there is an extraordinary anger that could change the path the moon travels in the sky if only I could figure out where to point it.

I took Abbie to Kaseman Presbyterian in Albuquerque because it is one of two hospitals in the city that has a psychiatric emergency department. I took her to the ER because, as I have been busy trying to get her an appointment with a psychiatrist, she has gotten more depressed. When left untreated, illnesses more serious than common viruses have a tendency to get worse. Untreated diabetes causes organ damage (or death); untreated asthma causes scarring in the lungs (or death); untreated depression causes more acute depression (or death).

We waited some 6 hours at the ER and finally we saw a Behavioral Health Specialist (BHS). She interviewed Abbie, and then she spoke to me. “She’s clearly very depressed,” said the BHS, “but she doesn’t meet the criteria for admission. She has some suicidal ideas, and she knows what she would do if she decided to end her life, but she hasn’t definitely decided to do it. Criteria for admission is an immediate suicide plan or extreme psychosis. You should take her home and make an appointment with a psychiatrist.”

“Won’t she see a psychiatrist today?” I asked.

“No, there are no psychiatrists in the emergency department.”

There are no psychiatrists in the psychiatric emergency department.

There are NO psychiatrists in the PSYCHIATRIC EMERGENCY DEPARTMENT.

“I can’t take her home without a prescription or an appointment or something,” I said.

The BHS looked horrified. “She can’t have a prescription. No doctor will write a prescription without seeing the patient. That would be unethical!”


Let’s talk about ethics.

Let’s talk about the ethics of insurance companies that reimburse so little for mental health treatment that hospitals have no incentive to keep their psychiatric units open.

Let’s talk about the ethics of a mental health funding system that pays psychiatrists less than most other doctors so medical students enter other specialties in hopes of paying off their student loans before they reach retirement age.

Let’s talk about the ethics of having a psychiatric emergency room with no psychiatrists in it, ever.

Let’s talk about the ethics of naming psychiatric care “behavioral health care,” as if the issues were in one’s actions instead of in one’s brain.

What about my ethics? How ethical is it for me, as a parent, not to get my daughter the medical care she needs? It doesn’t feel quite ethical to go to sleep at night, posing as it does the risk that she may hurt herself when I am unavailable to supervise. No, that doesn’t feel ethically sound at all.

When Abbie dislocated her knee at school 18 months ago, an ambulance transported her from there to the ER. At the ER, they put her knee in place, put a brace on her, gave her a dose of pain medicine and a prescription for pain medicine to take at home, and we walked out with a follow-up appointment with an orthopedist for the very next day.

There is no equivalent care for a dislocated mind. There is no method to deliver care immediately to a person who is suffering deeply but who has not quite gotten to the place where she seals the garage, or swallows the pills, or puts a blade to a vital artery.

By all means, let’s talk about ethics. Let’s talk about the ethics of a mental health care system that meets the needs of such a small minority of suffering people that suicide is the third leading cause of death among teens and young adults in the US, in spite of the fact that most people with mental illness can be successfully treated with appropriate care, and 90% of people who complete suicide have a diagnosable mental illness at the time of their deaths.

I sure am glad the doctor who “treated” my daughter the other night got to protect his ethics. Now how about we get busy protecting people’s lives? How about we talk about systemic ethics? How about we talk about treating suffering that originates in the brain the same way we treat suffering that originates in the heart, the liver, and the bones?

How about someone out there with a prescription pad helps me keep my daughter alive? How about we all start treating this like the emergency that it is?

My daughter will get the treatment she needs. I found someone to see her in two weeks (still an outrageous amount of time, but we’ll manage), and in the meantime we’ll do what we have to do to keep her safe, somehow.

The same cannot be said of the nearly 40,000 Americans who will end their own lives this year.

There are no disposable people, but we sure as hell act as if there are.

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37 comments to A Dislocation of Mind

  • Kate

    This nearly made me cry and scream outloud in anger. Thank you so much for this post.

  • Staceesmith

    Consider moving to Canada – little sister was depressed, anorexic and had OCD (and eventually horrible panic attacks) from the age of 11. Sick Kids Hospital in Toronto saved her life – they have a pediatric psych unit that is second to none. K was inpatient four or five times (the longest was right weeks; the average was about four weeks) and a social worker whose job it is to set up all the outpatient services she needed. Heck, she — like all their patients, so long as they are not married — was permitted to remain their patient until age 21. So was spared having to deal with all new doctors *just* as she was starting college. They made housecalls when she was too spooked to go to clinic.I cannot say enough good things about them! (They were also super-nice and called in a favour when I had a breakdown my sophomore year in college in an other province – got me admitted inpatient right away when I was sucidal, rather than throwing me to the wolves like your daughter). K is now 26, a college graduate a d a social worker (and still on a v low dose of meds to take the edge off her panic disorder). Appropriate intervention saves lives. I’m so so so sorry you’re stuck dealing with a mess.

    I’m praying for you and your girl.

    • Oh, we have definitely considered it. My husband’s company has one employee who is based in Canada and I’ve encouraged him to go for that job if that person retires. The trouble for us is the whole blended family and custody thing, or we might have done it years ago when our youngest was first diagnosed. It just shouldn’t be this hard. The care your sister got sounds like a dream to me. I mean, FOUR weeks of inpatient care? That’s so rare here! Even if my daughter had been admitted, it would have been for 2-3 days at most.

  • This breaks my heart. I am so sad and angry that our mental health system would fail you like this. Would fail us all. Sending love to you and your daughter.

  • i just don’t understand this. the place where I go for therapy has a 24-hour line and if you feel suicidal, they will see you immediately…no matter what time of day it is or whether or not you are their patient. I just…I don’t understand how someone can say, “well, she thinks about how she would die, but since she didn’t SAY TO ME that she was for sure going to do it, we just have to wait and see.” WHAT THE BLOODY HELL?

    I just…I just don’t understand.

    I feel like the second someone makes any remark about suicide, Pine Rest (where I go and is the leading mental health care facility in our area) scoops them up and doesn’t let them out until they are SURE they are no longer a risk. We have students who seem FINE one day, gone for a week or more the next day because they MENTIONED depression that was so serious they thought about death.

    I just…I really just don’t understand.

    Oh how I am praying for Abbie and you and the souls of those bastards who are telling you to wait WEEKS before you can get in to see a psychiatrist. I mean, they don’t bump you up when you say “she is talking about suicide?” There is NO OPENING AVAILABLE FOR THAT???

    I just don’t…I just don’t get it.

  • I don’t, I mean. I just don’t even know what to say.
    My brain is swirling, holy hell. I can’t even.

    I survived teenagehood without medical help because my mom didn’t believe mental illness was a real thing. (Until I ended up in the hospital, naturally.) If there’s any way I can help, you’d better believe I will.

    Also, this.

  • My husband and I have spent the better part of the past year fighting to get him the help he needs (bi-polar/depression, 2 instances of suicidal actions and 1 time he just up and left w/o telling me where he was going)…but getting a) someone to actually help and b) someone that will do it without costing us a fortune…is impossible.

    It’s heartbreaking to see my husband go through this when all he wants is to be a good (and present) dad for our kids. At the moment we are blessed to have him in a good place, but it’s all his own doing. Not one ‘medical’ resource has helped him for the past 4 months (not for lack of us trying)…we’ve had to resort to finding our own ways to treat and help him…including alternative methods.

    Thank you for writing this. It says everything I’ve wanted to say for a year.

  • This makes me so sad and angry. Mental health care needs to change. Now. It is SO important. your daughter deserves care. Deserves it today not 6 weeks from now.

  • I’ve been there. I’ve had to wait weeks when I was suicidal – praying to God that I wouldn’t hurt myself before it was too late. My brain was telling me things and I feared one of those days of waiting I would listen.

    I’m so sorry you’re going through this. A broken mind doesn’t also need a broken system.

  • Oh this makes me angry and frustrated for Abbie and you. At least she has you for a mom, she’s in good hands there.

  • This makes me sick. How do we get to this point? How do we fix it? I don’t know, but I do know that the system is broken right now.

  • I think most of us dealing with mental health problems either ourselves or through a loved one, have been there, done that. And that is a sad statistic. I know you will do everything you can to help your daughter and I know from trying to get my husband help how immensely frustrating it tends to be when they are suicidal but not enough to get the care they need. Or because there are no open beds even when the help is needed.

    • That’s one of the things I didn’t even touch on – sometimes a person who meets criteria doesn’t get a bed because there aren’t any. I’ve watched over the past 20+ years as almost every inpatient psych facility in Albuquerque has been closed. We used to have something like 15 facilities, not counting places that were exclusively treating addiction. Now, just two hospitals have beds for psych patients, and both have just a handful for adolescents. One has beds for children. It’s appalling and dangerous.

  • I understand completely. What can we do to help?

    • I wish I knew. What we need is some way to deliver urgent care to people with psychiatric illness, someplace people can go to get treatment right away even if they don’t need inpatient care. I’m going to write to media and state gov’t. We need so many things (more beds, more docs, more EVERYTHING), but an urgent care/triage center would be a place to start. In the meantime, I’m medicating my daughter at night for sleep, and that seems to be helping a bit. I’m spending too much money buying her makeup and other little things but getting her out of the house for a little shopping or poking around is a good thing.

  • I’ve been there. I was told that my child could not be admitted to inpatient treatment unless I called them right in the middle of an episode. It didn’t matter that the episode just happened the night before. Next time, although it might not be “ethical,” tell your daughter to lie about exactly how suicidal she is. That’s what my husband was ADVISED TO DO in order to get inpatient treatment for depression.

  • This infuriates and sickens me. And it makes me sob in pain for you and your family. I don’t have any resources to offer other than my love and prayers. And my ability to share this with my friends and ask them to share it as well. To ask people to stand up and make noise until we are heard and something is done.

  • How awful. I hate that our health care system sucks. I hope the next few weeks go by quickly. Or better yet, that there’s a cancellation somewhere and your daughter gets seen sooner.

  • I wish I could offer some words of advice, or wave a damned magic wand for you and your daughter. I went through something similar with my daughter and an eating disorder. It was nearly impossible to find someone who specialized in eating disorders AND accepted out insurance. So much so that my ex took me to court over it, thinking it was his ticket to custody. I told the judge if they could find anyone who would take her I’d kiss the ground they walked on, literally. I have never been through something so frustrating as trying to obtain her the help she needed before she ended up dead. I am happy to report she is doing well today, 6 years later. I will keep you, your family, and your daughter in my thoughts and prayers.

  • staceesmith

    Adrienne – If a kid is suicidal, what on earth is 2-3 *days* of in patient treatment going to do for them?! I was told that many (if not most) of the meds for depression take at least a week or two to kick in and that it’s really important to monitor the child closely since the risk of suicide goes WAY up just as they’re *starting* to feel a bit better, i.e. no longer *so* depressed that you don’t have the energy to get out of bed and hurt yourself.

  • I am so sorry. Keep us posted on how to help, for the time being will be sharing this post!

  • My heart goes out to you and your daughter.

    I can’t help but correlate this situation other situations where mental health is being discussed nationally… What if instead of suicidal ideas, it was homicidal ideas? I think some kind of intervention would have happened immediately. Now, it probably would not have been the most positive experience, but there would at least been some professional help.

    After the Newtown shooting (shooting doesn’t sound serious enough… massacre?), mental health is being reevaluated at state levels, but since 2009, billions of dollars have been slashed from state budgets for mental health programs. Hopefully, that money and more will be reinstated in the wake of Newtown, and something good will come from it.

    In the meantime, the National Alliance on Mental Illness has a lot of information and resources that may help.

    Here’s local contact info for you:

  • TheNextMartha

    I’m sorry and I’m angry for you.

  • […] post is dedicated to Adrienne and Casey and all the other people in my life who, along with me, have suffered a mental disorder […]

  • This is beyond infuriating. Sending love to you all.

  • Tish

    Thank you for sharing. As someone that suffers from depression and anxiety [GAD] this story speaks volumes to the lack of treatment for mental illness and the stigma attached.

    I’ve been to the point of no return and often felt very confused on the “waiting time” for help in my situation. The difficulty to access needed medications and the guilt that comes from having a brain that’s working against you.

    It’s very good to know that your daughter has someone in her corner ready and willing to fight for her. So many of us suffer in silence…

    I have tears in my eyes…because depression is a serious condition and it just eats away at you. I’m wishing her well in her journey. She has an AWESOME mother!

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  • Mabel

    Hello Friend i have something to share with you !!! There is an great joy in my heart which i want to share with every one that is privilege to listen to me.My name is Mabel, i am from USA.I have a misunderstanding with my Lover few years ago which led to us broken up and he never wanted to hear my voice again because he saw a beautiful love more prettier than my self but as time want on i Met Doctor Zaza a great spell caster (medicine man ),i contacted him through his email and explain every thing to him and then he said that i shouldn’t worry that my lover will come back to me on his knees begging for forgiveness. i bought some item which he told me to buy for the preparation of the spell and after every thing was prepared he told me that my lover will come to me with 24 hours begging and my greatest joy now is that he actually came back to me and fell on his knees begging for forgiveness and today we are happy with each other. Do you have any problem with your loved one and you do not know what to do? Well worry no more because Doctor Zaza can provide you with a spell to get he or she back with the help of a spell just as he helped me ok. contact Doctor Zaza today for your spell via email:

  • […] A Dislocation of Mind from No Points for Style – A very smart and meaningful post about healthcare in the US. […]

  • […] choose 12 and invite those writers to read them onstage. When I got the email inviting me to read A Dislocation of Mind I was honored, but I had no idea what it really […]

  • […] piece she read, A Dislocation of Mind, brought me to tears. Like, practically […]

  • […] perspective: I wrote A Dislocation of Mind, about the many weeks it took to get my daughter some psychiatric care in this state, over three […]

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  • You just wrote my life. Depression and suicidal ideation are in the midst of an epidemic in my neighborhood. 3 of my closest friends have taken their children (2 girls, one a boy) to hospitals in the middle of the night for suicidal thoughts. Our daughter, who, last spring, hadn’t eaten in 3 days and who couldn’t get out of bed for longer COULD NOT GET INTO A HOSPITAL because there was no room for her because THERE’S ONLY ONE HOSPITAL in our area that treats children and adolescents and they need the space for children who are wielding knives. It’s appalling. Because we’ve been dealing with this for so long with our daughter, and because we have a good therapist and psychiatrist finally (who by the way, had no pull with the hospital whatsoever even though both called and tried to get her admitted) our 17 year old was able to pull herself out of bed finally after many nights of either my husband or myself lying wide-eyed awake on her floor. Maybe this new healthcare will change things or help things. I have my doubts. But it’s an epidemic, there’s something crazy in this world and I don’t know how to fix it or protect my children from it. All I can do is stay very, very, close by.

  • williams

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