Tales from the Couch

Seeing the patient from psychiatry’s perspective

The Man in the Box

Sometimes, we're just not prepared for what we think we want to see.

Some years ago, I was contacted by an attorney and asked to evaluate his client, the plaintiff in a lawsuit. I’ll call her Mrs. Jones, a 35-year-old widow, who was suing a funeral home. 

A year earlier, her presumably healthy 40-year-old husband, died suddenly of a massive heart attack while at the gym. 

At our consultation, Mrs. Jones was obviously bereaved and quite sad. This was not out of the ordinary, because the bereavement process often takes a full two years. But, what was severely complicating this process; occasioning the lawsuit; and bringing her to my office was the following unusual story: 

At the time of her husband’s death, Mrs. Jones was in such a state of shock, she refused to view her husband’s body. She left the identification of his body up to a relative, and while making funeral arrangements, vehemently insisted she wanted the casket “closed”. 

On the day of the funeral, she suddenly changed her mind: she wanted one last look.

The funeral director did his best to dissuade her, but she was adamant.

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The coffin was opened. 

What Mrs. Jones saw was horrific: 

Mr. Jones was a tall man—six-five. To fit him in the casket, his neck had been broken, and his head, now twisted to the side, was jammed into a corner of the coffin.

At the sight, Mrs. Jones fainted and was led away from the funeral in a state of shock.

For the months leading up to our meeting, she had repetitive, intrusive thoughts and horrifying recollections of her husband’s broken body. She kept “seeing” it incessantly. These flashbacks were accompanied by feelings of anguish and terror. She bolted awake each night from recurrent dreams of peering into the coffin and seeing her husband’s broken body, or finding him hung from a tree limb, dangling limply by a rope.

At trial, I testified that Mrs. Jones suffered from Post-traumatic Stress Disorder as a direct result of seeing her husband’s grotesque body; and that viewing was responsible for severely complicating her bereavement process. 

While the jurors sympathized with Mrs. Jones, they decided the case in favor of the defendant. The plaintiff had asked for a closed casket, the agreed-upon arrangement with the funeral home. By demanding the casket be opened, Mrs. Jones had departed from that agreement. She therefore undertook the risk associated with abrogating the arrangement.

As sad and traumatic as her experience was, Mrs. Jones got what she asked for.

Mark Rubinstein, M.D., is a former professor of psychiatry at Cornell. His most recent book is the novel Mad Dog House.

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