True tales from the psych ward

Mark Rubinstein loves stories. It was a major factor in why he chose to specialize in psychiatry as he was working toward his medical degree.

General medicine was too uniform, he said — high blood pressure, gall bladders, heart ailments. “There are no stories,” he said in an interview with The Bulletin late last month. “I love stories.” As a psychiatrist, he said, “I was privy to some of the most amazing things.”

Now a Wilton author most noted for a run of novels including Mad Dog House and The Lovers’ Tango, Rubinstein has taken some of those stories and arranged them in an engrossing new work of nonfiction, Bedlam’s Door: True Tales of Madness and Hope.” The book, which was published Sept. 1, includes 15 stories taken from Rubinstein’s decades of practice.

His reason for writing the book was to clear up misunderstandings about psychiatry, mental health “and what madness means.”

“I have this wealth of stories, many of which read like fiction and in a sense truth is stranger than fiction,” he said. While the names and a few other details have been changed, “these things actually happened. … the basics are all true and some of them are hard to believe,” he added.

“I picked those that are most memorable — either they were odd or something I couldn’t get out of my mind. Some of them are 25 to 30 years old.” They include a man who manages to commit suicide while hospitalized, a man in an expensive, but tattered suit and carrying a mysterious briefcase, who seeks “accommodations” at a hospital, a woman whose hair-dying episode leads to endless house cleaning, the son of a mobster who seeks counseling because his family does not respect him.

The stories primarily stem from his work first as a resident and then as an attending physician at a major New York City hospital. Most came through the doors of the emergency room, hence the title, Bedlam’s Door.

With each chapter he tells a story and then adds an afterword, either filling the reader in on what happened to the patient, relating how the case affected him, or how it fit in on the continuum of mental health care.

“I tried to pick an array of tales that show an aspect of pathology,” Rubinstein said. They deal with PTSD, depression, suicide attempts, obsessive-compulsive behavior, schizophrenia, survivor’s guilt and more. But behind them all are the stories — stories of people’s lives and the events that brought them to Rubinstein.

“You can see 20 people with depression and hear 20 different stories,” he said.

Each story offers an inside look at how a psychiatrist confronts each case and begins to search for what can be a very elusive reason for a person’s behavior. Without the physical symptoms available to an internist, the psychiatrist must rely on the patient’s willingness to make what can be very painful revelations.

When asked which patients are the most difficult to treat, the answer was not what one might expect.

“The easiest to get asymptomatic are the severely psychotic patients,” he said. Medications can “suffocate” schizophrenic and bipolar symptoms. And those who are clinically depressed can also be helped immensely with medication.

“The most difficult to turn around are the garden-variety people who have what we sometimes refer to as neurotic patterns,” he said. These “maladaptive interactive patterns of behavior” such as the passive-aggressive person who is alway late, the super-aggressive person who always says what’s on their mind and drives others “insane,” the woman who always falls for the guy who pays no attention to her, the man who always finds a woman who berates him because as a child his mother was very harsh.

These are the kinds of problems that are very difficult to change, he said. “They are not serious mental illnesses, but they are conditions that create unhappiness,” Rubinstein said. “Most come [for help] when they realize how unhappy they are after a long time.”

Forensic psychiatry

In Bedlam’s Door Rubinstein also reveals something of himself. Several of his stories focus on forensic psychiatry, the field in which the practice of psychiatry intersects with the law — an area in which Rubinstein specialized.

His first foray into that arena involved a patient he refers to as Patricia. She was grieving the sudden loss of her husband and suffering from PTSD, brought on by the trauma of seeing him lying in his coffin with his neck broken, an act committed by the funeral home to make the tall man fit into an inadequately sized casket.

There was reason to believe Patricia was going to commit suicide, and so she was hospitalized. But, as is her right, she petitioned to be released and thus a hearing was scheduled before a judge. Rubinstein, who was a first-year resident at the time, was tasked with testifying for her continued hospitalization. He recalls his nervousness as he was cross-examined and his efforts to keep Patricia in the hospital where she could be treated.

Rubinstein’s next foray into a courtroom was as a paid expert witness in a malpractice case brought by a woman who attempted suicide by jumping in front of a subway train. The woman, referred to as Willa Mae, had gone off her medication and began hearing voices that were telling her to harm herself. She went to a hospital that was not the one where Rubinstein worked, and asked the psychiatrist who examined her to admit her. He was not convinced she was a danger to herself or others and told her to go home. He even gave her a token to take the subway. She begged him to admit her but he would not.

After she did indeed listen to the voices that told her to jump, Willa Mae wound up at Rubinstein’s hospital where her leg was amputated. He was asked to evaluate her and she told him her story.

Months later he received a call from an attorney explaining Willa Mae, was suing the doctor who sent her home for malpractice. Would Rubinstein be interested in testifying as an expert witness for her? He agreed and recounts the courtroom drama, “the thrusts of the attorney’s questions,” and his feelings throughout.

It was a path he would follow throughout his career as he was eventually asked to evaluate plane crash survivors, rape victims, car crash victims as well as more than 300 survivors of 9/11.

Life lessons

As for the stories in his book, Rubinstein considers them lessons in life.

“I view each as a mini-mystery — why does a woman say ‘I can’t stop washing my hands?’”

He has at least 300 more he could write about, which is why a second book is already in the works based on cases from his private practice.

Bedlam’s Door is published by Thunder Lake Press of Laguna Hills, Calif. Information: