Some were true emergencies, but a fair number of cases entailed such activities as skipping school, smoking an occasional joint, and defying authority figures. In other words, the kids were doing things that, in other times or places, would have resulted in such measures as suspension from school or withholding of privileges at home. Many panicked parents have learned, however, that an involuntary hospital stay produces a more immediate and marked impression. In some instances I felt genuinely sorry for adolescents whose parents seemed inadequate and vengeful. In the chaos of the emergency department it is difficult at times to ascertain where therapy ends and discipline begins.
Treatment is, after all, a word with many connotations.
Much overdue attention has rightly been lavished upon the subtle imbalances of power in psychiatrist-patient relationships and their perils of emotional and sexual exploitation. Just as oncologists often become numb to death, so do psychiatrists tend to grow insensitive to the everyday exercise of what is, after all, an incredible degree of social power. Medical students are typically amazed to learn that by filling out a simple form, any psychiatrist, even one just out of medical school, can effectively force a patient to be detained against his or her will until a court hearing occurs, which can take up to a month, at least where I work. Residents' familiarity with commitment often breeds a certain contempt, and the procedure soon becomes routine on a busy inpatient service. In fact, we time-pressed residents even tend to become a bit cross when we are called to court to testify, as if we had received an unwelcome rebuff to our authority.