I am a psychiatrist who has cared for patients for decades, run many different types of mental health services, and for the past 15 years been a public health doctor in municipal and state government. Yet I still cannot bear to read or hear a story of a fatal outcome for a person with a serious mental illness who dies from neglect or the failures of our public services.
When I found out that Rachel Aviv’s extraordinary The New Yorker article (May 30, 2011) was being made into a documentary I was eager to view it. I am glad I did, since it delivers a compelling, deeply personal and illuminating story about how our public mental health care system has lost its bearings: That unbridled concerns for the privacy and liberty of people with serious mental disorders have produced conditions that result, to paraphrase, in people "dying with their rights on."
This 97-minute documentary, which debuts March 31, takes us into the life of Linda Bishop, and her family and caregivers. She was found dead in a home she had broken into in New Hampshire several months after she left the state’s public mental hospital after a two-year stay. She kept a daily journal, which was found with her body; her last journal notation was in January 2008 but she was not found until May. The report of the Medical Examiner stated that the cause of Bishop’s death was starvation.
Neither Bishop’s sister, a longtime advocate for her (who had worked in the justice system), nor Bishop’s daughter were informed of her condition during her extended stay in New Hampshire’s state hospital—nor were they told when she was discharged. What we learn in the cinematic telling of her story is that Linda Bishop had imagined a fantasy marriage with a man she met when a waitress, who was married and had no contact with her. She waited dutifully for him to come save her, through what seemed like unbearable cold and hunger, until she succumbed.
Linda Bishop had been a creative, smart young woman who became ill with schizophrenia, leading to time in jail (for non-violent offenses) and mental hospitals. Her illness led, as well, to her abandoning her teenage daughter, who appears regularly on the screen, as does Bishop’s sister. Bishop refused to let her family be involved with her care in the hospital nor let them assist in her aftercare when the hospital decided it had done all it could and would “try” a discharge.
State laws throughout the United States stipulate that patients, like Linda Bishop, must consent to professionals contacting family members during the hospital stay or at the time of discharge. Bishop also had the “right” to live where (and how) she wanted; that is no reason, however, for the lack of planning that seemed missing from her pre-discharge days, as her sister stresses in a heartbreaking way. The letter of the law had been met. And the patient died.
Arguments have been made on the polar extremes of privacy and liberty. Some patient rights advocates assert patient self-determination, no matter how impaired a person may be. There are also many advocates (and professionals) calling for increasing the authority of mental health professionals to take what can be life-saving, but liberty constricting, actions, including less stringent criteria for hospital commitment and for contact with families and other loved ones.
When you watch this powerful film, which is artfully rendered with compassion and intelligence, you will appreciate that these types of cerebral arguments should fall to the wayside when a person’s life is at stake. Linda Bishop did not need to suffer, nor die. Her death was a failure in care produced by blind obedience to spurious logic and to professional diffidence.
Dr. Lloyd Sederer is a psychiatrist and public health doctor. The opinions offered here are entirely his own. He takes no support from any pharmaceutical or device company.