PTSD Following Compulsory Admission

Article excerpt

SUMMARY

A woman developed post traumatic stress disorder (PTSD) after being compulsorily admitted far psychiatric treatment. This report warns of such a possible development in certain situations following involuntary admission. Keywords: autonomy, compulsory admission, PTSD, personality, suicide

INTRODUCTION

In DSM-III-R (American Psychiatric Association, 1987), post-traumatic stress disorder (PTSD) may occur following a stressor that Is Outside the range of usual human experience and would be markedly distressing to almost anyone. McGorry et al (1991) found a prevalence of PTSD in 35% of a group of psychotic patients 11 months after their hospitalisation. They suggested that involuntary admission, which often involved police, duress, forced sedation, restraint and seclusion, and finding oneself in a closed environment with a member of other psychotic or disturbed individuals, may predispose the development of PTSD. Physical restraint has been described by some patients to be parallel to the experience of rape or physical abuse (Blanch & Parrish, 1990). We report here a case of a woman who developed DSM-III-R PTSD following compulsory admission.

CASE REPORT

T.K., a 30 year old Chinese woman sought help in a psychiatric outpatient clinic of a local general hospital following the death of her pet dog which had been her constant companion for the past 15 years. Her husband, a drug addict, had also recently been detained at the drug rehabilitation centre.

The middle child of three siblings, she had since young felt unloved by her parents. Her parents' marital relationship which had all along been very poor had ended in divorce. To avoid conflicts during the marriage, her father would absent himself from their home. Her mother was especially punitive towards T.K. because she bore a strong semblance to her father. There was no childhood history of sexual abuse. Since her childhood, T.K. has found it much easier to relate to animals than to humans. She is generally distrustful of fellow human beings and found animals to be more trustworthy, loyal and devoted.

After her secondary school education, she worked at various jobs, and while working as a veterinary assistant, she met her future husband who was a drug addict. Not long after their marriage, he was sent to a drug rehabilitation centre for a drug related offence. It was during this time, that her dog died. Feeling very miserable, lonely and deserted, she entertained frequent thoughts of killing herself so that her soul could go to purgatory to look for her dog; she believed her dog possessed a soul which had been sent to purgatory. Her state of ambivalence often caused her to be agitated. Her psychiatrist, believing that she was depressed and possibly psychotic because of the seemingly unusual reason for wanting to kill herself, had on several occasions suggested hospitalisation. T.K. had, however, vehemently refused each time. On one occasion, in a telephone call to her psychiatrist she expressed this desire to kill herself. Thinking that she might be in danger, the psychiatrist called for police intervention at her home--an act which the patient perceived as unwarranted and humiliating. Shortly after this episode, she went to the same clinic without an appointment and was seen by another doctor. Hospitalisation was again suggested whereupon she became very agitated and aggressive. Unable to calm her, and of the opinion that she was psychotic and suicidal, the doctor decided on involuntary admission. In the process she put up a vigorous struggle and had to be restrained and sedated. She was transferred to the state mental hospital. Evaluation was not possible until the following day because of her sedated state. She was subsequently reassessed by a different team of doctors. She was calm and co-operative, and admitted that she became upset because of the insistent suggestion that she should be admitted, an option which she neither wanted nor thought necessary. …