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Offline agate

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  • MS diagnosed 1980
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Julie Holland, MD, became a psychiatrist and landed a post as the weekend attending physician in the Bellevue CPEP (Comprehensive Psychiatric  Emergency Program, the psychiatric ER at Bellevue)—a position she stayed in for 9 years, until, after having two children, the lure of the comparative safety of motherhood, home and hearth—and a (probably lucrative) private practice led her to quit.

This book purports to be about her weekends at Bellevue.
We do get to know about some of the patients she saw—probably the more sensationally lurid ones, like the man who had concealed a razor in his rectum. But all too much of the book is given over to miscellaneous details from the author's life: her first colonoscopy, a well-nigh interminable account of her first labor, and later a description of the very scientific way she and her husband went about trying to conceive their second child. We also get passages about her association with actor/monologist Spalding Gray. We become aware that she and her family have not only a Manhattan apartment but a country house as well. She makes it clear from the outset that one attraction of working intensive weekends at Bellevue (a couple of 15-hour shifts) for her was that she would have her week free to do whatever she wanted.

Fair enough, and understandable, particularly for someone in a high-stress job such as hers must have been. But how is she performing on that high-stress job? After the catastrophe of 9/11, she wants to find out if she’s needed at the hospital, and says she spent 30 hours on the phone trying to reach the hospital. She didn’t go in until days later. In fact, days after 9/11, she decides to get her nails done: “’I haven’t had a manicure in months.’” She spends the days after 9/11 kayaking and hiking in the woods.

She doesn’t soon leave her world of cocktail parties, Cape Cod, and sailing just because emergency personnel might be in great demand during  a national disaster.

At another time she tells a patient she’s giving him the Methadone he’d requested but actually intentionally gives  him the very powerful (and often dangerous) drug Thorazine even though she knows that lying to a patient about what medicine she’s giving is against the law. She seems almost proud of herself for being flexible enough to do something like this—mostly to accommodate a cop who wants this man sedated to a “dead weight.”

She makes it clear that she’s often in danger as an ER doc at Bellevue. She gets threatening phone calls and anonymous suggestive phone calls. She’s afraid she’ll bump into a rapist. One patient punches her.

OK, it’s a dangerous job. I wouldn’t argue that point for a minute. But she has police flanking her at all times. She knows all of them personally and works closely with them.

--As, of course, she would need to, given the system she is working for. The mental health system, at least in the US,  is organized around a flagrant violation of human rights, after all, even though most people prefer not to think about this fact.

There are several ways in which a person can be locked up for mental illness, and none of them is truly voluntary--unless that person has money (quite a bit of it) and can sign himself up in a private mental hospital of his choice, in which case he is free to sign himself out as well. The rest of the US citizenry finds that “voluntary” hospitalization is really an illusion. Someone who has been reported as being a danger to himself or others is offered two choices: go voluntarily with the officers who will transport him to a locked mental ward, or else the officers will take that person by force.

As anyone who has ever observed any part of this process knows, “force” means just that. There are several police, fit as fiddles and of course armed. If the person puts up too much resistance, more force is applied. “Restraints” are used. A hypo is given—an injection speedily and efficiently administered so that the person quiets down fast. Later he will become aware that he is in a place with bars on the windows, from which there may be no escape.

“Voluntary”? And yet in her Glossary for this book, Holland provides the shorthand used at Bellevue: “913” for a voluntary admission, “939” for an involuntary one, and then there is the “940” category, for a 72-hour hold, for an admission to the Extended Observation Unit or EOU.

All through this book I felt that there was an elephant in the room, and Holland never saw it. The system she was serving is a brutal way of locking up people society finds inconvenient or threatening, getting them out of the way, and usually doing so very  expeditiously. A psychiatrist can diagnose psychoses like paranoid schizophrenia after interviewing a patient for only a few minutes. Who looks at how long that diagnosis written on a form took? Who looks at how that diagnosis was made? Nobody.

Julie Holland goes jauntily along, rather evidently enjoying her immense power. She can decide whether a patient will be sent to a different facility, sent back to prison, released, medicated.  Many people’s lives have been altered irreversibly by people like Julie Holland, MD.

While she’s at it, she emphasizes her own desirability. She gleefully details her several sexual encounters in the call room with male doctors. The boy friend who must have become her husband at some point in these nine years isn’t mentioned in this connection.  Later she gets a new boss, Maxwell, who kisses her effusively and unexpectedly on the lips at a party—sickening her. And so on.

This book is appallingly bad. Not just because it reveals the author to be alarmingly unprofessional (and apparently almost proud of the fact) but because she indulges in trendy language, as in “My tough-guy confrontational thing is so over,” and the account is sloppily written.

And yet towards the end Holland is exuding compassion for the homeless on the street: “They’re my people”—as she prepares to leave Bellevue forever, and she smugly concludes that “Not everyone is built for Bellevue like I was.”

Her specialty seems to be psychopharmacology and she clearly has great faith in the efficacy of drugs in overcoming mental disorders. She is presumably whipping off prescriptions in her private practice even now. One can only be glad that she is no longer at Bellevue, but there is the unfortunate probability that other psychiatrists, like her or far worse, have come along to replace her.
MS Speaks--online for 13 years

SPMS, diagnosed 1980. Avonex 2001-2004. Copaxone 2007-2010.