Wednesday, September 23, 2015

College note to home: "Dear Parent, your child has had a psychotic break." It's the news no parent wants to hear but should have the right to hear.

(Sept. 23, 2015) I sit in my small office at the university counseling center, sighing as I pick up the phone to make the call that I always dread. I have worked as a psychiatrist with college students for 20 years, and this part never gets easier. One, two, three rings, and the mother of a student who had been in my office minutes earlier answers the phone.
helpI introduce myself and then deliver the news: “I’ve had to hospitalize your son, Jacob.”
“What are you talking about?” she says. “There’s nothing wrong with my son.”
I explain that his roommates brought him in earlier that day. They told me that he hadn’t slept in a week and had barely had anything to eat or drink.
“I know,” she says. “They called me. But he’s just adjusting to school. He arrived a month ago. He’s a freshman, for God’s sake.”
I concede that freshmen can have a tough time adjusting, but emphasize that Jacob is having a psychotic episode. He was afraid to leave my office, I tell her, because he felt he was being followed on campus. He said he had not been able to get any work done because he was confused and distracted by voices in his head. The hospital, I explain, is the safest place for him right now.
I understand her denial. I have college-age children. If one of them became psychotic, I would be in shock. And I would be angry with the messenger.
In an ideal world, there would be somewhere else for Jacob to go until his mother arrived, someplace other than a hospital, where he could get support and be encouraged to eat, sleep and take some medication. But we don’t have anything like that on campus or in our city.
I had spent over two hours with Jacob. I called in another psychiatrist to meet with him and offer her opinion. She agreed that he needed help in a hospital setting right away. If only his mother could have seen him, disheveled, wearing a heavy sweatshirt even though it was 90 degrees out, looking away from us and mumbling at voices only he could hear.
I have seen many scenarios play out when young adults have psychotic episodes. The toughest cases stick with you the most.
I had another patient, a thoughtful young man, a psychology major, who had bipolar disorder. Before I started working with him, he became psychotic and made a serious suicide attempt. After a week in the intensive care unit, two weeks in a psychiatric hospital and a semester at home, he returned to school on a mood stabilizer and an antipsychotic.
We talked about any stressful situation he was experiencing and about ways to cope. I never had to alter his medication. In fact, he felt the medication was so helpful that he never wanted to lower the dose. I was very happy for him when he was accepted into a Ph.D. program in neuroscience.
How will Jacob’s story unfold? I don’t know. But I want Jacob and his mother to know that there is always hope. I see it every day.
MARCIA MORRIS
PSYCHIATRIST, UNIVERSITY OF FLORIDA COUNSELING AND WELLNESS CENTER
(Photo: Denise P.S./Flickr)
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