Informed Consent, or Lack Thereof in My Psychiatric Experience

Doctors are “the priests in the white coats” as some might say, because most people, lacking the full medical knowledge of their own bodies, have almost boundless faith in another class of individuals to understand and cure their injuries, maladies, and disorders. Growing up, I was the son of a medical implant inventor father and physician mother. I remember it being my dad who as a biomedical scientist brought in a life-size skeletal model to show to my fourth grade class. I grew up immersed in an environment of medical knowledge, from browsing my mom’s medical textbooks when bored, to playing with the implant prototypes my dad brought home. While having an MD mom enabled me to perhaps see the doctor’s office less often than other kids, I still had implicit trust in the practitioners of medicine, for that included my own parents.

When it came time for college, I managed to get into the University of Chicago. Despite never having visited due to lack of means, I committed to going with only partial financial aid, having faith that this well-regarded institution might serve me in well in my career and my life, as it had seemed to do so for many others. My first year went well enough: I made friends, joined extracurriculars, was elected to house council in my dorm, and even helped lead some activism on campus. But from even earlier there was something simmering in me that was only now arriving at a boil — not a so-called “mental illness,” but rather, my gay sexuality.

From at least middle school, I knew I was physically attracted to men. From even earlier, I knew that I had no attraction to women whatsoever. During my college freshman year, I continued straight-acting to the point that I dated a wonderful, attractive, and intelligent girl, but to whom I sadly realized I could never reciprocate romantic affection. Over the following summer break, I quietly resolved to come out of the closet when I resumed school.

I had been raised up in a socially conservative, churchgoing Catholic family who had made sure that I went through all the hoops to be a “full” Catholic, which included going to church weekly, and even attending afterschool religious education courses, despite my verbalized lack of enthusiasm the whole time. My dad literally warned me about “the gays” right before I headed off to Chicago, as if homosexuality were some contagious disease spread by proximity. Previously, he had prevented me and my straight, younger brother from using the jacuzzi at a hotel in Scottsdale, saying: “gays with AIDS had sex in there and we could contract it.” Somehow this opinion seemed fully sound in the mind of a person with the knowledge to invent multiple patented FDA-approved surgical implants that have demonstrably saved lives.

My second undergraduate year, when I returned to campus, I finally publicly came out of the closet. Despite fearing the worst, my friends kindly accepted me as if it was no big deal. I managed to work up the confidence to lose my virginity in a drunken hookup at a party, and awkwardly had a few dates together afterward. While I was somewhat upset at my very first “relationship” not working out, I had not yet experienced romantic love. Seeking continued justification for the leap I had just taken, it was not long before I found myself in the arms of another man. With this new person, it felt different. We truly appreciated each other’s company. We had lengthy thoughtful conversations, and it was not long before I believed I was madly in love. Only mere months after my public coming out, I was so infatuated that I was honestly ready to spend the rest of my life with this man. When he eventually broke up with me over coffee, I was absolutely devastated, crying in public at the museum café; something I could not even bear to do at my mother’s two different funeral processions when I was twelve.

Before he ended things, I had already felt our relationship dissipating and had begun to feel depressed. I was somebody who did not have any experience in my pre-college years with any romantic relationships, straight or gay, and given my situation, my family could offer no solace from heartbreak or depression. Confiding my emotions in my then boyfriend only hastened our separation, and instead of offering himself to be a friend or support during this time, he suggested that I start going to the University of Chicago’s Student Counseling Service. I naively obliged. At the time, I thought this was a rational action for returning my mental health back to a non-depressed state. For a month before the breakup, I was attending weekly sessions with a psychotherapist. However, with my first real relationship rapidly disappearing before my eyes, my depression only worsened despite repeated talk therapy.

During my first session following the breakup, my therapist, observing my worsening depressive state of mind, scheduled a quick follow-up appointment for me with a Student Counseling shrink. After only 30 minutes of discussion (including a cursory “Do you know what a black-box warning is?”) she prescribed me 100mg of Wellbutrin daily. This was not only to combat my depression, but because, as she claimed, it was a nice “peppy” study drug that allegedly carried few side effects compared to other antidepressants.

With my breakup in the rearview mirror, I would now have normally expected to have slowly gotten better as I bit-by-bit gained the wider perspective and numbness to past pain that time gives. The first few days to a week of my medication compliance saw little effect, with my depression continuing, but at least not worsening. The second week, my symptoms skyrocketed, as unbeknownst by name then to me, my prescription was starting me on a roller coaster of ‘mixed states.’ They were a combination of both mania and depression: being restless and ruminating, sometimes uncontrollably pacing, sometimes too fatigued to do anything but lay in bed. I lost the ability to sleep normal hours, becoming a hypersomniac by day, and a hyposomniac at night. With my prescription clearly not working, my second appointment elapsed 15 minutes, resulting in an increase in my dosage of the same drug to 150mg daily, rather than discussing possible side effects in greater detail.

With the new potency, I began to spiral into ‘akathisia,’ a sensation where you are so uncomfortable with yourself that some describe it as “your mind separating from your body.” I had constantly racing thoughts; every insecurity that earlier was only kindling my depressed feelings was now consuming every iota of conscious energy that I had. My body, my skin, my hair: they all felt foreign and strange to my own touch. Looking at myself in the mirror set off uncontrollable tears. I hated myself so much that I began to think everything and everyone else would be better off without me. Some days I could not stop crying for hours once I was able to retreat from classes to my dorm room.

Six days following my last psychiatric appointment with the dosage increase, or twenty days since I began taking any prescription psychotropic medication, came a decision that I would regret for the rest of my life. Although I was in this medication-induced state of mind, that morning I still planned on simply going to my usual morning psychotherapy session, and then going to the rest of my classes that day. Despite having feelings of depression, and now increasing akathisia-induced suicidal ideation, my academic performance until that fateful day had yet to show noticeable change. I was still going to class, continued to be involved on campus, maintaining my friendships, and had never engaged in any physical self-harm.

During that session, right after telling my psychotherapist that I had been thinking about suicide in these medication-fueled states of mind, a darkened look came across his face and it became harder for him to look at me directly.

“Vitas, given what you’ve told me, you have two options.”

Assuming this was related to some type of therapy or treatment, I asked: “What do you mean?”

“We can do this either voluntarily or involuntarily.”

“Wait, what?!?” I asked in disbelief, as if I was being apprehended, and as it turned out, I was.

“If we do it involuntarily or you do not consent to your treatment plan, then you give up your legal rights and we might need to restrain you, up to, and including, a straitjacket on a stretcher, as we take you to Chicago Lakeshore Hospital. If you agree and consent voluntarily to be placed according to your treatment plan, then you’ll be able to maintain your rights such as petitioning for release. Given what you’ve told me, this is necessary given liability to the university, and you have no other options. Chicago Lakeshore is a great hospital, UChicago partners with them, sends our medical school residents there. They’re the best option, and they even have an LGBTQ program: perfect for you!”

Aghast and shaken, I did not want to lose my rights, and assuming everyone in this medical system had my best interests at heart I reluctantly agreed to go voluntarily without any protest. A different psychiatrist again evaluated me, to get a confirming second opinion, offering the same diagnosis and recommendation for psychiatric hospitalization. After waiting under their supervision, never having an opportunity to pack for a weeklong trip, a school administrator arrived in a taxicab to whisk me across Chicago to the psych ward. While with him, I asked that my parents not be informed of my treatment, as I felt this inevitably would lead to being forcibly outed as gay and potential estrangement from my father. The administrator said he would try to follow my request, but that he might be legally forced to disclose certain things given my ideation of self-harm, despite my never having cut myself, or starved myself, or acted in any way to demonstrate that I was actually intent on physically hurting myself beyond ideation.

We arrived at the hospital, and being a busy school administrator, my so-called guide quickly disappeared to do more important things as I waited during my intake process at Chicago Lakeshore Hospital, elapsing eight hours. Initially, I was in a waiting area with chairs and magazines just like any doctor’s or dentist’s office, but soon I was walked to a small 6’ x 10’ room with bare walls, devoid of any fixtures or objects aside from a desk and two chairs. I waited most of my eight hours alone in that room, waiting for hospital staff to tell me if I could be admitted depending on how long of a stay my insurance company might approve. I used my cellphone during this time to let my friends know what had happened, given my sudden disappearance; something for which I would later be interrogated and investigated by both hospital and UChicago SCS staff.

Despite my light suicidal ideation, my assigned psychiatrist decided that a weeklong stay was best, magically coinciding with how long my insurance was willing pay for. In fact, most patients here who were higher functioning all magically got weeklong stays, and nobody got out sooner unless they were petitioning for release as a voluntary patient. Even with that route, leaving took three days minimum, assuming you managed to maintain access to communication. And that was assuming that your psychiatrist does not convince higher-ups that you’re still a harm to yourself or others, which they had full financial incentive to do.

Due to my “suicidal” nature, I was initially placed in the psych ward equivalent of an ICU for two days. A place where the suicidal, homicidal, hallucinating, and psychotic were all put together for their shared recovery. A place where even having shoelaces or your own clothes was giving you too much freedom, as that was all taken away while you undressed under the watchful gaze of professional staff. A place where violence routinely occurs against and between patients, despite lack of shoelaces or provocative clothing. No visitors are allowed, except prearranged ones for long-term residents. Everyone wore identical teal medical smocks and pants, and the staff treated the patients with almost identical paternalistic, dehumanizing condescension. When I asked for an aspirin or ibuprofen for a growing headache, despite noting chronic headaches on my intake report, it took asking multiple staff members until a kinder social worker there actually believed me enough to help. This same person was also the only staff member there who ever allowed me to make any contact with my friends, dormmates, or later parents, contrary to the stated right to communication for mental patients under Illinois state law.

I spent most of my time on this hospital floor hiding on my bed in my room, where through the constantly open doorway I could hear the commonplace verbal and physical altercations. Food usually was plain ham and cheese or PB&J white bread sandwiches with school-cafeteria-style milk and juice cartons. The common room had a TV that, either by the will of some patient or employee, was constantly turned to History Channel specials such as how aliens were involved in the construction of the ancient wonders; somehow clinically appropriate material for the audience.

An existing medical condition I additionally noted to clinicians during my intake was ‘vasovagal trypanophobia:’ a needle-phobia that triggers a blood vessel reflex shutting off blood to one’s head, causing fainting. I can take most vaccines or shots just fine, but blood withdrawals often trigger syncopes or fainting in my individual case. So guess how medically-trained psychiatric professionals decided to wake up someone with this stated syncopal needle-phobia after their first night: to start taking an intravenous blood withdrawal from that fainting-prone person while they are still asleep. I awoke feeling the pain of the needle in my arm as they jabbed it in multiple times trying to find a vein. I verbalized my intense discomfort and managed to rebuff staff before they managed to collect a second full blood vial from me. Despite never being told why, or what my results were, it was too late to keep me from feeling light-headed or only partly conscious the rest of the day. Other straight patients told me that this did not happen to them.

Later this same day, I met with my assigned psychiatrist, the hospital CMO, for the first time, whereupon he decided to double my dosage to 300mg daily, continuing the rest of my hospitalization. He laughed and shrugged off my complaint when I told him about my morning incident. Again, this appointment, alongside the rest we had, contained no warning or discussion that I might possibly be experiencing a common medication side effect despite repeated attempts to broach the subject.

It was only with years of hindsight, years of withdrawal symptoms, and years of digging through my experience, analyzing the possible variables, that I realized I was a victim. Victim to a mental health system that currently has little capacity for self-criticism or inclination to reform to minimize iatrogenic harm. Years before my stay, numerous patients at Chicago Lakeshore had been found to be neglected and abused, and still years following, numerous other patients at Chicago Lakeshore are being found to have been neglected and abused. Most of the reported cases are more serious and tragic than my personal story, like the ones involving foster kids who are Illinois state wards, but those cases along with mine reflect what I sadly believe to be institutionally and professionally widespread unethical practices in mental health.

The University of Chicago Student Counseling Center no longer refers students for inpatient hospitalization at Aurora Chicago Lakeshore Hospital (CLH). However, the University of Chicago Pritzker School of Medicine, the university’s graduate medical school, continues to maintain a full partnership with CLH, with doctors sharing teaching and clinical positions between the Pritzker School of Medicine and CLH. Psychology and psychiatry residents from the medical school still have educational rounds as part of their training at CLH. While CLH has been and is currently under investigation by multiple federal and state entities (with one investigation grievous enough to revoke CMS certification, unfortunately soon reinstated), Aurora Chicago Lakeshore Hospital has yet to ever be closed, face any significant regulatory action prompting meaningful reform, or yet be threatened with termination of its relationship as a teaching hospital.