#00099: Schizophrenia or Trauma?

“Schizophrenia cannot be understood without understanding despair.” –  R.D. Laing

E is a 54 year-old female that was brought by the police to the forensic clinic. In the police report, it says that she asked to be examined by a forensic physician claiming being beaten while in custody. When Dr. M entered the room, Ms. E took off her clothes and stood naked. And then, she started screaming and shouting her son’s name, before asking to use the toilet.
That’s what Dr. M told me after the whole thing happened.

Rewind.

I was upstairs chilling with the folks in management. The entire forensic department were in the field dealing with a disaster. More than 12 people have died in a fire, and many more are still missing. Half bodies were found, parts of skull were scattered on the floor, and the Pugilistic position was clearly evident of a catastrophe. But that’s an entirely different story. (Remember when Dr. I called you at 5am to tell you about it?)

While I was chilling with the folks upstairs, a call came from the nurse in the clinic.
“Patient locked herself in bathroom and refuses to get out. She is screaming and shouting.” I ran downstairs and I began hearing the incomprehensible words being shouted. When I got to the clinic, the entire floor was soaked with water.
At first, I thought that someone might’ve died. Then I thought that maybe the patient is trying to drown herself?

Fire department arrived. Very efficiently and professionally, they managed to unlock the door in less than 20 seconds. Ms. E was standing at the far corner of the bathroom. She was holding the shower hose and splashing water everywhere.
She was yelling someone’s name over and over. Her stance was defensive, and she appeared to be very scared. (Now I wonder if that was a reflection of how I felt at the time.)

I stood outside the toilet, trying to talk to Ms. E. Police started rushing in the building. It was chaos.

Intuitively, I took control of the entire situation. (On reflection, it seems that I can’t run away from chaotic situations. My focus sharpens. My voice softens. I guess I’m a mediator.)

I asked Ms. E about her story. “I was beaten by your government!” she yelled, “Is this how you treat humans?”
“Please tell me what happened.” I begged, “I’m a doctor here and I want to help you.”
“Liar! You’re all liars!” She took the shower hose and tied it around her neck.
Shit. This is real. Someone in front of me is threatening to commit suicide if her demands were not met.

I asked about her demands. I tried various approaches to get her out of the bathroom. I tried to understand her story.
And then I fucking noticed it. The exact positive symptoms of schizophrenia.
Racing thoughts. Jumping from one topic to another. Delusions of persecution. Everyone is out there to get her. Hallucinations? I wasn’t sure.
But I also wondered if this is the result of a major trauma.

I didn’t have time to think. She was tightening the hose around her neck.
She was demanding that her son and grandchildren be released.
From where? She didn’t know.
When did she last saw them? She doesn’t know.

Now she’s crying. And then she starts screaming again. Suddenly she’s calm. More screaming and shouting. Crying. Repeat.

She loosened the pseudo-noose after I pretended to call the place where her son and grandchildren were held. I demanded that she be deported from the country immediately and her demands be met.
It worked. Almost.
She calmed down, thinking that I was going to succumb to her demands.
What she didn’t know, however, was that I’ve ordered the officers to get ready to enter the toilet and grab her.
I instructed them on how to approach her, since she will be tightening the hose around her neck in an attempt to kill herself before being apprehended.
It takes time and energy to kill yourself in the method she was threatening to use.

Bam. 4 officers swarm the toilet while trying not to slip from all the water in the bathroom.
My plan worked. Her hands were grabbed and the hose was loosened.
She did bite one of the officer’s arm, snatching some meat out of it.
Ms. E, the 54 year-old female, was now in custody.
My job was done. (Or was it? Did I do the right thing? I don’t know)

Dr. M, who was now in the morgue trying to identify the charcoaled bodies, along with the rest of the department, later told me that she saw Ms. E on several occasions.
“She has a very long psychiatric history” Dr. M said, “This is not the first time she tries to commit suicide.”

This experience is an unforgettable one. But I kept wondering, “Was she mentally unstable? Or was she so traumatized that her story seemed so surreal?”
I don’t know.

I still have a very long and challenging hill to climb.

I hope Ms. E gets better soon.

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