My first internship was very interesting. I was with a mobile crisis team for Gouverneur Hospital in New York City's Lower East Side. Basically, relatives, friends or even strangers would call us if they noticed that someone was acting bizarrely. And, in New York, it took a lot to fall into that category.
Our job was to assess the person. If they were a danger to themselves or others, we arranged for hospitalization at Bellevue. If they weren't dangerous but needed treatment, we would set up an appointment for follow-up care. And sometimes the person obviously would benefit from therapy or medicines but wasn't dangerous and declined our offer. In those cases, we would thank them for their time and leave.
The psychiatrist on the team at the time was a very good teacher. She was also a beautiful, elegant woman. She was always dressed and coifed immaculately and in the latest fashion. She had a trace of a Middle-European accent and was charming. (If you're thinking that I had an unrequited crush, you might be right.)
Anyway, one day we get a call about a woman who would go out on to the streets at night and seem to bring odd things home. The caller noted that there was a terrible smell coming from this person's apartment.
So, the doctor, the driver (forgive me for not recalling his name but he was excellent, too) and I went off to visit this woman.
We got to the apartment and immediately noticed the smell. The doctor knocked on the door and the woman appeared. [Almost all the time, the person did not know that we were coming because we made our trips based on tips from callers.] The doctor introduced us and asked if we could come in. The surprised woman led us to her living room.
I have never before or since seen anything like that apartment. The woman told us that she had a habit of making nightly trips to the garbage cans on the street corners. She would bring home virtually everything that was in the trash. The apartment was filled with this stuff. Imagine, briefly if you will, what might be in a New York City garbage can. And she literally had every type of garbage from floor to ceiling. There were narrow paths from one room to the other. I saw what must have been world record size cockroaches at eye level in the mounds boldly looking about for their next meal.
The stench inside the apartment was overwhelming.
The woman asked if we would like to sit on the couch as we chatted. Dr. Blokar gently declined the offer and we remained standing.
As the doctor conducted the interview, I was sure that this was going to end up in an involuntary hospitalization at Bellevue.
However, as the evaluation progressed, it became clear that this woman did not have a thought disorder, was not psychotic and had no intention of harming herself or anyone else. She simply had a compulsion to hoard things she found on the city streets and in the trash.
To our surprise, her son emerged from a bedroom mid-way through. He also was competent and posed no danger to anyone. He intensely disliked his mother's hoarding but found that he could not stop her. He did the best he could to look after her and be helpful.
After a while, the doctor offered the woman an appointment for outpatient medication evaluation and therapy. She politely said no thank you. Soon after that, the meeting ended and we left.
I was confused. Why had we not involuntarily hospitalized her? At the time, I thought that there must be some grounds for that given her irrational habit of collecting garbage and the condition of the apartment. I speculated that since the contrast between the doctor's personal habits and this woman's could not have been more stark, the doctor would be especially prone to take action.
However, the doctor started explaining the condition of hoarding and its relationship to obsessive compulsive disorder. That day, I learned valuable lessons about psychiatry, the law, civil rights and tolerance for other people's idiosyncrasies. While this might be a matter for the landlord or the Department of Health to take up with her, it did not constitute a case of psychiatric emergency qualifying for involuntary hospitalization.
Editor's Note: For more information on Hoarding, click here to check out our latest Wise Counsel Podcast which featured an interview with Gail Steketee, Ph.D. on Hoarding and Obsessive-Compulsive Disorder.