I got up and pulled aside the manager to request he call to have the man taken for a psychiatric evaluation rather than to a jail, and told him I would try to calm the man down until responders came. I introduced myself to the man and noticed I didn’t smell any alcohol on his breath, as his slurred speech had made me assume there would be. I told him I am a psychiatrist, and he responded that he was a doctor too, quizzing me on the anatomy of the head and neck. I found he actually did know the names of muscles and ligaments of the neck better than I did, so many years removed from anatomy lab! He explained he served in Vietnam for 2 years as the only African-American coroner at the time. I asked if he saw a Veterans Affairs (VA) psychiatrist, which he said he had. On a hunch, I asked if he’d ever been on Haldol, and he told me he took it for years, but that he “didn’t need that anymore.”
The more I talked to the man, the more he calmed down. He continued to tangentially verbalize delusional beliefs, such as personally performing the autopsies of Elvis Presley and a number of other celebrities, but he also opened up about his life too. He talked about the hard times he had fallen on that led him to look for refuge in a different hotel room every night. He had been sleeping in his car since his daughter kicked him out of her house and got a restraining order against him. About a week before the night I met him, he couldn’t find where he had parked the car, and had been wandering the city ever since.
I brought up his movements and told him what TD is. I wanted him to know there are medications that can treat it now, and he asked me to write them down so his doctor at the VA could prescribe one, because he is a 100% service-connected disabled veteran. I gave him the names of the medications on a hotel notepad and told him that even if the doctor said it was too new to get it, he actually could. I said it would just take a lot of paperwork like anything at the VA, and that made him laugh. Shortly after that, two police officers arrived at the lobby, and when they approached the man, they did so deftly and gently, obviously used to working with people with mental illness. They never treated him like a criminal, and when they asked if he wanted to go with them to the hospital, he immediately agreed and walked out peacefully with them.
Well into the era of atypical antipsychotics, TD is not as rare as we all wish it was. But seeing TD is hard because we live in a society in which it’s easy to become a bystander to everyday life. In hindsight, it’s apparent how identifying TD in this unusual situation made a clear impact on this man’s life. But the opportunities each of us has to find TD in our practice every day are no less consequential. Simply by recognizing TD where it exists, we can give a voice to those who are afflicted by it.
We need to start by choosing to educate ourselves on TD and admitting that it does exist in our practice more frequently than we’d like. Unlike Parkinson’s Disease, which has a famous personification in Michael J. Fox to advocate for its recognition, TD has no such singular humanizing embodiment. Solving the problem of unrecognized TD is going to require everyone in the mental health field to not only be champions for people with TD in our clinics, but everywhere in the world.
Craig Chepke, MD attended the New York University School of Medicine and completed psychiatry residency at Duke University. He is board certified by the American Board of Psychiatry and Neurology and is a Fellow of the American Psychiatric Association. Currently, he is in private practice in Huntersville, NC and specializes in neuropsychiatry and treatment-resistant/severe persistent mental illness. Dr. Chepke serves as an Adjunct Clinical Professor of Psychiatry for the University of North Carolina Medical School’s Charlotte Campus and is the medical director of Timber Ridge Treatment Center, a level 3 residential facility for adolescents. He is a member of the CURESZ Foundation’s Clozapine Experts Panel and is as a member of the International Parkinson and Movement Disorder Society.
The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of the Psychiatry & Behavioral Health Learning Network or other Network authors. Blog entries are not medical advice.