Bedlam’s Door

The Book Brigade talks to clinical psychiatrist Mark Rubinstein.

Posted Dec 01, 2016

Used with permission of author Mark Rubinstein
Source: Used with permission of author Mark Rubinstein

The real stories of people with mental illness can be baffling, terrifying, or heartbreaking. Each case is distinct, and distinctly challenging, but when clinicians, whether working in private practice, in an emergency room, or at a maximum-security prison, take the time, pay attention, listen, and engage, they can help patients overcome paralyzing stigma and get the care and consideration they need.

What led you to write this book?

I was writing this book for more than 30 years. In a very real sense, many of the stories of the people I've treated remain vividly with me. Psychiatry is unlike any other medical specialty. I don't palpate an abdomen, listen to someone's lungs, or look down a patient's throat. People come to me, most willingly but some involuntarily, and the most intimate details of their lives are explored during the course of their treatments. Experience has taught me that, most of the time, even the most baffling of symptoms can be understood if time is spent and attention is paid.

What are some examples of such cases?

Nathan B., a 64-year old Hungarian-born man, was brought to the psychiatric emergency room in a highly agitated state by the police. He was found ranting on the streets of Manhattan, shouting at the top of his lungs that he was “King of the Puerto Ricans.” What caused this staid, married man who had worked productively as a carpenter for more than 40 years to suddenly decompensate? Or consider the shabbily but elegantly dressed man brought to the psychiatric E.R. by the police because he appeared to be a loitering vagrant. What were the contents of the well-worn but expensive leather briefcase he clutched as he entered my office? Would this man's life story emerge as he sat before me, lighting a cigarette with his gilded lighter? There have been so many people whose lives have touched me deeply. I wrote Bedlam's Door to demystify mental illness while at the same time paying tribute to the people I've been privileged to treat.

What’s the greatest misconception about mental illness?

There are three answers to this question, and they are distinct, yet interrelated. First, the mentally ill aren't all so different from the rest of us. No one would think to shun someone because they have diabetes or heart disease, but many people are frightened by the prospect of having anything to do with someone with a psychiatric illness. Second, recent recurring events—school shootings, mass killings in theaters and malls, disturbed people threatening police or pushing someone in front of an oncoming train—have brought public attention to a very small subset of violent mentally ill people. Many suffer from schizophrenia, but the vast majority of schizophrenics aren’t prone to violent outbursts. Third, whether the diagnosis is schizophrenia or some other disorder, with proper care and medication, most people can function fully in society. The popular misconception is that many mental patients belong in locked wards and should not live among us. The reality is just the opposite, despite what the occasional headline suggests.

The patients you describe take some disturbing and risky actions. What can be done to help keep such patients safe?

Willie Mae E., whose story I share in the book, heard voices commanding her to kill herself. She had had this symptom before and knew she needed to be hospitalized, yet the psychiatrist at an emergency room refused to admit her and instead prescribed medication, gave her a subway token, and told her to go home. She begged to be hospitalized, but to no avail. She went to the subway station and leapt into the path of an oncoming train, as the voices commanded her to do. She survived, but lost a leg. Had the psychiatrist listened to her and taken appropriate action, none of that would have happened. Emergency room personnel must spend sufficient time with patients to thoroughly evaluate their situation. And doctors should listen to their patients and not summarily dismiss what they say.

Through your work in forensic psychiatry, what conclusions have you drawn about mental illness and incarceration?

We’ve turned over to the penal system the responsibility for providing treatment for the mentally ill. It’s been reported that because they exhibit disturbed behavior, approximately 2 million people with severe mental illness cycle through America’s county and municipal jails each year. This creates an enormous strain on local governments, which must provide treatment that should be provided by outpatient mental health facilities. Not only would patients receive more appropriate treatment at clinics, but punitive incarceration is not the way to treat mentally ill people.

What is the most important message you want to get across?

I didn’t write the book to send a message. I wanted to share some of the stories that affected me deeply, both at the time I treated these people and years later when I wrote the book. These stories simply reflect the rich tapestry of the human condition.

Who would most benefit by reading this book?

I think Bedlam’s Door will appeal to anyone who enjoys reading about people. I recently learned the book is being used in some medical schools to introduce the subject of human behavior to students during their psychiatry rotations. 

About THE AUTHOR SPEAKS: Selected authors, in their own words, reveal the story behind the story. Authors are featured thanks to promotional placement by their publishing houses.

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Bedlam’s Door

Used with permission of author Mark Rubinstein
Source: Used with permission of author Mark Rubinstein