Stories reveal the gamut of the human condition

As a psychiatrist, Wilton author Mark Rubinstein has naturally been interested in the human condition. And as he says in his latest work, he’s seen just about every manifestation: fear, courage, guilt, perseverance, duplicity, integrity, guile, honesty, strength, weakness and more.

They make their way into his latest book, Beyond Bedlam’s Door, as 21 stories culled from his private psychiatric practice in New York and Wilton. Published last month by Thunder Lake Press in paperback and as an ebook, these “true tales from the couch and courtroom” follow his previous work, Bedlam’s Door, which was a collection of stories from Rubinstein’s work in psychiatric hospitals.

Bedlam’s Door told stories of psychiatric inpatients. This new work focuses strictly on outpatients.

“I wanted to show that even in a relatively healthy, non-hospitalized group of people there are many psychiatric issues,” he said recently in his Wilton office. Some are commonplace, such as the teenager whose contrariness is driving his parents to distraction, others less, so such as the man who manipulated his wife’s anxiety medication to keep her from becoming too social, to the incredible, such as the young man who suffered from panic attacks and sought therapy only to be drawn into a bizarre murder plot by his therapist.

At the end of each story, Rubinstein takes readers behind the scenes either to explain the psychiatric issue at hand, the options he had in treating a patient, or, if known, the ultimate outcome.

“I was trying to demonstrate there are a multiple of psychiatric issues, be it in litigation, in private practice, in a nursing home, in an assisted living facility, by spending a little more time after each story talking about it from the perspective of the psychiatric issue and also some of my own reactions that the psychiatrist is human.”

Some of Rubinstein’s most unusual cases are centered around the courtroom as he acts as an expert witness in civil litigation.

“Criminal law, the stakes are very high, and I avoided criminal law,” he said. “I found that everybody lied, so I just couldn’t do it.

“In civil law, invariably there’s money involved. … and when money, the law and medicine intersect truth often goes out the window. It’s axiomatic,” he said.

Most attorneys he found to be honorable, he said, with many just seeking to find out, through a plaintiff’s psychiatric examination, where their case stood. In some cases, Rubinstein might suggest the attorney settle if he thought the psychiatric damage to a patient was overwhelming.

“There were other attorneys who wanted you to shade the truth or exaggerate or dampen down the damages,” he said. In one case, a woman had been raped by a man who got into her apartment building because the lock on the front door was broken. He held a knife to her child, forced her to undress, and raped her. The landlord’s attorney wanted him to minimize the trauma she had experienced.

Sometimes an attorney with a flimsy case would turn on him, as the expert witness, and try to portray him in an unfavorable light.

“Doctor, how many times have you testified in court?” Rubinstein said by example.”

“‘Doctor, how much are you being paid for your testimony today?’ “I’m not being paid for my testimony I’m being paid for my time in court.”

“The courtroom, above all, is an arena of conflict. You have two opposing sides, sometimes with opposing experts presenting opposing opinions, and the jury is the finder of fact of evaluator of opinions.”

He described speaking to juries as an art.

“You have to provide them with medical and scientific information be it about dementia or depression or anxiety or PTSD, you have to do it in a way that’s not only informative but that’s interesting,” he said. “That keeps them interested without boring them to tears. And it’s not easy and I tried to convey some of that in the book.

“In the forensic arena I saw patients and the kind of pathology I would not have ordinarily seen in a regular private practice, where you see people who are unhappy with their lives and I thought it would be interesting to put them in a book and provide readers with a look at the human condition.”

The story Rubinstein described as the “oddest thing I’d seen in my life,” was the case of the young man with the panic attacks and agoraphobia.

Rubinstein examined the fellow as part of a malpractice case against his psychiatrist. The psychiatrist had helped the man, who had a motorcycle repair business at home, and then began befriending him. Eventually he talked his patient into making financial investments with him and then the psychiatrist asked him to help him get a pistol and ammunition “and basically seduced this young man into aiding and abetting him … he intended to kill six people.”

In addition to giving his opinion on whether the psychiatrist had departed from standard practice, Rubinstein was asked to evaluate what damage had been done to the patient. He was never able to trust another therapist and all his anxieties came back.

This, and another instance of a psychiatrist having a sexual relationship with his patient, involved “massive transgressions and abuses of transference by psychiatrists.”

“They stand out because they were so outrageously beyond the pale.”

There are only so many psychiatric diagnoses, but every patient follows a different path.

“Everyone has a story to tell,” Rubinstein said. That gives him a lot to work with.