Charlene

Charlene

The first time I met Charlene was when she was brought to the psychiatric unit by police on a detention order with a request to evaluate her to see if there was probable cause for commitment to psychiatric treatment.  She related an interesting story.  She had been driving her car when God told her that she should take her hands off the steering wheel and leave the driving to Him.  This was obviously a dangerous variation of the Greyhound bus “leave the driving to us” theme.  Not surprisingly, her car went off the road and didn’t stop until she crashed into the local WallMart store. 

She was grossly manic.  Her speech was loud, rapid, uninterruptable and mixed with singing and shouting. She would rapidly switch from topic to topic.  She was inappropriately seductive.  She was almost constantly on the move and would alternate skipping with pacing up and down the hallways.  She was grandiose. .  Her mood was euphoric. She had no insight regarding the potential danger to herself and others related to her recent behaviors

Charlene responded well to a combination of Lithium along with frequent intramuscular doses of a major tranquilizer and within 2 weeks she was no longer showing signs of mania.  She then presented herself as a bright, emotionally stable lady who had functioned well as a mother as well as in her job as an executive secretary. Her recall of her psychotic episode was scanty but she was able to accept the idea that she should continue her Lithium with the hope of preventing this from happening in the future.  She was discharged and agreed to continue seeing me on an outpatient basis to monitor her medication.

Charlene did well for the next couple of years except for some minor side effects from her medication that were easily managed.  Then she decided that she no longer needed treatment, stopped her visits and discontinued her Lithium.  About 3 weeks later, the police brought her back to the psychiatric unit on another detention order.  She was manic and had once again accepted the advice to take her hands off the steering wheel and leave the driving to God.  This time she had smashed into a parked car. 

Charlene responded well to the same treatment given during her first episode and, in fact, did so, so rapidly, that 3 days later when she was scheduled for a probable cause hearing she was no longer showing signs of mania.  She had, however, confided to the nursing staff that she did not think she really needed to take medication and intended to immediately discontinue it as soon as she would be discharged.

At the time of the hearing I was asked whether she met the criteria for commitment for further treatment based upon being at that time imminently dangerous to herself or others.  I said that in her current state she was not, but based upon her stated plan to discontinue her medication and her prior history, was likely to soon become so.   I was asked whether I could state with medical certainty that this would occur.  I asked the judge and the attorney appointed to represent her if they could furnish me with a percent of certainty that they would accept as being reasonable and was told my place in the hearing was to answer questions, not to ask them.  So I went on to say that based upon my medical training and experience I thought there was more than a 50% chance that she would stop her medication, that her mania would recur soon and that this would be accompanied by the emergence of behavior dangerous to herself and others.  The decision was made that she did not meet the criteria for imminent danger caused by mental illness and that she could not be detained against her will.

Charlene was immediately discharged and a voluntary follow up appointment was scheduled at my office the following week.  She did not keep her appointment and her family reported that she had vanished from the area.  A few days later they reported that she had decided to drive her car to Canada.  They had been informed that while on a Canadian highway she had followed the advice of God to let Him do the driving.  She had ended up in a ditch and had been taken to a psychiatric facility nearby where she was being treated for her mania.  Further follow ups with the family revealed that she had been hospitalized there for a little over 3 months before her physician and the court decided it was safe for her to get back on the road.

I saw Charlene periodically after her return and she required no further hospitalizations. She was compliant with taking her Lithium in spite of the development of some side effects that gave us both causes for concern. To the best of my knowledge she never again accepted an offer from the Designated Driver.

2007