Professional Documents
Culture Documents
I introduce myself and then deliver the news: Ive had to hospitalize
your son, Jacob.
What are you talking about? she says. Theres nothing wrong with
my son.
I explain that his roommates brought him in earlier that day. They told
me that he hadnt slept in a week and had barely had anything to eat or
drink.
I know, she says. They called me. But hes just adjusting to school.
He arrived a month ago. Hes a freshman, for Gods sake.
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9/29/2015 'Dear Parent, Your Child Has Had a Psychotic Break' - The New York Times
So why couldnt you wait until I got there to see what was going on?
she asks. I could get a flight in a few days and meet with you and my son.
I agree that it would have been better if she and Jacob and I could have
met in my office together. But I reiterate that it wouldnt have been safe to
wait until she got here. Jacob was so confused and scared that I wasnt sure
he could have made it back to his dorm.
I had spent over two hours with Jacob. I called in another psychiatrist
to meet with him and offer her opinion. She agreed that he needed help in a
hospital setting right away. If only his mother could have seen him,
disheveled, wearing a heavy sweatshirt even though it was 90 degrees out,
looking away from us and mumbling at voices only he could hear.
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9/29/2015 'Dear Parent, Your Child Has Had a Psychotic Break' - The New York Times
I suggest that she get on the plane as soon as possible and meet with
Jacob and his treatment team at the hospital inpatient unit. I tell her that I
dont know how long he will be in the hospital. It may be a very short period
of time.
I tell her that I generally recommend that a person who has had a
psychotic episode take the semester off, so that he has time to fully recover.
No, hell be back in school, she insists. And we end the conversation
there.
A few days pass, and there is no word from the hospital. I hope, for
Jacobs sake, that he will be going home. Some people recover quickly from
a psychotic episode, but others can take months. Jacob would be better off
under the watchful eye of a parent who could catch signs of a relapse
quickly. Perhaps he could transfer to a college near his mothers house.
Ten days after I hospitalize Jacob, I get a phone call from the hospital.
Im told that Jacob is back at school and wants to see me.
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9/29/2015 'Dear Parent, Your Child Has Had a Psychotic Break' - The New York Times
level treatment measures after the patient leaves the hospital, for which
insurance companies should provide reimbursement. Jacob needs more
help than he will get as a college student living on campus. But options are
limited.
Im glad youre feeling better, I say. Tell me what it was like being in
the hospital?
I was only there for four days, and it was strange, he says. I do think
the medication they gave me is helping, because Im sleeping and
concentrating better.
I tell Jacob that for the time being he and I should meet every week. I
ask him to tell me if he starts feeling confused or having difficulty sleeping,
so that we can adjust his medication if needed. If things keep going well, I
explain, we should be able to taper his medication eventually.
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9/29/2015 'Dear Parent, Your Child Has Had a Psychotic Break' - The New York Times
After a first episode of psychosis, some people will have a full recovery
and will not require medication long term. Others may need continuing
medication because of an underlying condition such as bipolar disorder or
schizophrenia.
In the meantime, I do the best I can with the resources I have. I refer
Jacob to a psychotherapist. Jacob also agrees to meet with his case manager
in the dean of students office. She will work with him if he needs to adjust
his course schedule.
Jacobs mother was able to come to town for a few days while Jacob
was in the hospital, but had to return home to take care of her daughter and
go back to work. She speaks with Jacob every day on the phone. He permits
me to call his mother for feedback on how he is doing.
I have seen many scenarios play out when young adults have psychotic
episodes. The toughest cases stick with you the most.
Her father subsequently became her legal guardian, lived with her and
made sure she took her medication. She decided to leave school and focus
on her recovery. The patient and her father came in together for her last
visit with me, and brought me a plant as thanks for my help. I was touched.
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9/29/2015 'Dear Parent, Your Child Has Had a Psychotic Break' - The New York Times
who had bipolar disorder. Before I started working with him, he became
psychotic and made a serious suicide attempt. After a week in the intensive
care unit, two weeks in a psychiatric hospital and a semester at home, he
returned to school on a mood stabilizer and an antipsychotic. He was not
having manic or psychotic symptoms when I began to see him, so I met
with him every month to do therapy.
How will Jacobs story unfold? I dont know. But I want Jacob and his
mother to know that there is always hope. I see it every day.
MarciaMorrisisapsychiatristattheUniversityofFlorida
CounselingandWellnessCenter.
Detailshavebeenalteredtoprotectpatientprivacy.
2015TheNewYorkTimesCompany
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