Every patient has a story to tell, and in his decades as a psychiatrist, Dr. Mark Rubinstein has heard some strange and memorable ones.
There was the man, born in Hungary and living in New York City, who seemed to snap one night and ran down the street shouting that he was “king of the Puerto Ricans.”
There was the woman to convinced surgeons to operate on her more than a dozen times – even though there was nothing physically wrong with her.
How does a doctor unravel the mysteries of a mind gone awry in such unpredictable ways? Or in any of the countless other, perhaps less colorful but equally urgent ways that mental illness may appear?
How can a doctor determine whether a patient is making aas a gesture to send a message or has reached a point of hopeless despair and intends to succeed?
Rubinstein, a novelist and former practicing psychiatrist, explores these questions and more in his new book, “Bedlam’s Door: True Tales of Madness and Hope.”
Formerly a clinical assistant professor of psychiatry at Cornell University Medical College and an attending psychiatrist at New York Presbyterian Hospital in New York City, Rubinstein has decades of experience that range from psychiatricand hospitals to private practice to a maximum security prison.
CBS News spoke with Rubinstein about his inspiration for writing “Bedlam’s Door,” what he’s learned from his nearly 40 years in practice, some of the patients he’ll never forget, and what needs to be done to address the country’s mental health care crisis.
What was your motivation for writing this book and what did you hope to accomplish with it?
I decided to write this book and provide these case histories in a narrative, sort of novelistic form because I wanted people to read and appreciate that every patient is complex and really has a fascinating story to tell.
You can have 100 different people all presenting with depression but there are 100 different stories these people all have that leads them to the final common pathway of depression.
I also wanted to demonstrate that mental illness in its various forms presents challenges that at least up until now have not been adequately met. It challenges the patients, the families, and mental health professionals and it also I think brings to light this country’s pressing need to address mental health.
How did you select the patient stories you decided to include in the book?
I chose a variety of different things: a schizophrenic patient, a patient with a phobia, a patient with(OCD), another with (PTSD). First of all, because they were all different. Second of all because they are compelling and have stuck with me through the years.
Is there any patient story that particularly impacted you?
They’ve all stuck with me obviously because here I am decades later writing about them all. But particularly, there’s the fellow named Nathan in the first chapter in the book, titled “King of the Puerto Ricans.” When you think about a man born in Hungary running down a city street shrieking at the top of his lungs “I’m the king of the Puerto Ricans” and urging all his countrymen to follow him, that he’s going to lead them to salvation, you have to wonder, “what’s going on here?” What’s driving this man in such a bizarre way? He’s definitely unforgettable.
Does anything about the human mind still surprise you?
Every patient is capable of surprising you. People have secrets and little hidden coves in their psychology. We all do. I’ve encountered people who have been married 30 or 40 years and they keep secrets from each other. We even keep secrets from ourselves.
Every now and then a patient will come out with a revelation that would be the last thing I would expect from such an individual. These things often orbit around sexuality and aggression when people admit some of the thoughts and fantasies that they have.
Although, I have to acknowledge after a certain number of years, things surprise you less and less. Especially in the forensic area, you’ve seen so much, you’ve heard so much, you’ve encountered such, at times, human depravity and at other times human nobility. You encounter so much that after a while you think that nothing can surprise me or upend me anymore, and then something comes along, and it does.
Has there ever been a patient who has completely stumped you?
In one of the stories in the book, I conclude by saying “while everyone has a story to tell, not everyone will tell his story.” Some stories end happily, others in tragedy and some end on a note of uncertainty. None of us knows all the answers, although a great deal of progress is being made in understanding mental illness. There are new and innovative treatments that are coming out all the time, but again we don’t know all the answers and we probably never will.
You make a point in the book that a lot of these patient stories highlight the many areas where the health care system is lacking in regard to mental health. What are some of the changes you’d like to see be made?
I’d like to see the Veterans’ Administration do a lot more for our veterans in terms of and MBD, or minimal brain damage, and TBI, , which of course occur now with tremendous frequency as opposed to previous wars because of these IEDs which create concussive blasts that jar the brain within the skull and cause TBI.
I’d like to see more awareness of and more money dedicated to mental health treatments to identify potentially dangerous people.
I’d also like to see more money and resources be allocated toward mental health care. For instance, Medicaid and Medicare only allow something like six or eight sessions with a psychiatrist per year. There’s a double standard because if you have high blood pressure or if you have heart failure, you can go [to the doctor] as often as you need to go to maintain control over your condition. In psychiatry, if you have a chronic who needs to be seen once a month to make sure that he/she is taking medication and is under control, the patient can’t be seen once a month because the mental health allocations are far less and they only will sanction the patient being seen once every other month. That may not be a sufficient number of sessions or there may be too large a window of time during which the patient is unsupervised, unseen, unassessed and where something bad can happen.
The other thing I would like to see is equal parity given to psychiatrists, social workers, and psychologists, all of whom are on the front lines and in the trenches of what I think is a mental health crisis in this country. I’d also like to see the same parity given to the mental health world as what is given to physical health.