Up@dawn 2.0

Tuesday, May 2, 2017

Anna D. Final Post Assignment -- Part Two

On Osheroff, Medical Ethics, and a Doctor’s Duty

**I apologize for the editing because I've had to post this using my cell phone.

When Raphael Osheroff took shelter at Chestnut Lodge, a psychiatric hospital in central Maryland, he sought relief from his depressive episodes and severe anxiety that put his business dealings in jeopardy. The hospital was known for hosting prominent psychoanalysts of the midcentury era who treated Osheroff along analytic to uncover the root cause of his neurosis. His treatment team anticipated a hospital stay of at least 3 years to work out the cause of unconscious distress. Osheroff’s condition worsened, he became more agitated, he paced constantly, but his medical team refused to give him medication. 
A statement from one of his psychiatric aides expressed worry: “We are concerned about him be when looks like he is depressed, he probably is really depressed and the nursing staff feels like we have to watch him closely.” Osheroff was viewed as suicidal. However, the medical doctors viewed his issued in psychological terms and the ward administrator stated: “He asked to be put on medication but I told him it would interfere with what he came here for! I told him that he needed every neuron to absorb what we are telling him here and that medication would interfere with that. I told him that if his pacing got out of control we would have to wrap him up in a cold wet sheet pack! The social worker told us his agitated behavior was reminiscent of the obnoxious conduct that his father indulged in.”
The ethical dilemma in this instance is self-evident: Osheroff’s doctors wholly believed in their treatment plan, even considered it superior to medication. At what point is the treatment team held responsible for negligence. If Osheroff had committed suicide, could the doctors be held responsible, or could Osheroff’s mental state be blamed for his demise? I believe the medical team should be charged with negligence because medication, a possible treatment option, wasn’t even considered and the patient wasn’t showing improvement with psychoanalysis treatment solely. Osheroff was at the Lodge for seven months until a friend transferred him to another hospital. 
At Sliver Hill in Connecticut, he received antidepressant and antipsychotic medication and the patient showed marked improvement after just three weeks. Osheroff was discharged after a three month and returned to his businesses. The main point of dispute was the patient’s diagnosis; the Lodge psychotherapist argued he was treating personality disorder, specifically narcissism, and a Silver Hill’s clinician cited depression when the insurance was billed. 
When the lawsuit was taken into arbitration, the case was in favor of Osheroff; the patient’s quick recovery after medication and agony during the Lodge stay painted the psychoanalysts’ actions as erroneous, even cruel. The implications of Osheroff v. Chestnut Lodge were powerful: hospitals were now at legal risk if the treatment staff denied medication to vulnerable patients, especially if the medication had efficacious clinical trials. 
When Kramer spoke to Osheroff for his book Ordinarily Well, Osheroff  was seventy- three, and Elavil, a nerve pain medication and antidepressant, had sustained him thus far, and would for the rest of his life. 

Great piece from The Washington Post that further details Osheroff’s stay and treatment at The Chestnut Lodge

My second on Installment II: The Biophilla Hypothesis
The reasoning behind why nature is restorative is fascinating. Simply letting our executive networks take a break can bring us more mental clarity. Also puts much importance on public spaces like parks, and walking & biking trials so those should become a priority for any major city.

My first comment on Installment I: The Biophilla Hypothesis:
Great report. To echo previous comments, I certainly feel time spent outdoors is time well spent. Looking forward to reading the second installment.

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