Endocrinologists like myself are the most frequently consulted specialists in a psychiatric unit where the nursing staff cannot avoid bedside glucose monitoring and occasional lithium generated thyroid, calcium and electrolyte dysfunction. All this needs to be coordinated with the psychiatric needs, always usually severe enough to require hospitalization beyond the 72-hour form #302 involuntary diagnostic commitment allowed by the Commonwealth of Pennsylvania with a subsequent length of stay, sometimes voluntary, sometimes court approved, that far exceeds length of hospitalization on other medical units. I never saw any families there when I did my consultations and periodic follow-up rounds, though undoubtedly the psychiatrists and social workers would regard the impact on family as a core part of their medical advice. I was shielded, making the discussion from a family perspective an interesting revelation for me. I also have a medical perspective, noting what could have been many lost opportunities to achieve a better result for her father, her brother, and her family. And as happenstance would have it, a review of schizophrenia, with a brief section on non-medical psychosocial support, appeared in the New England Journal shortly thereafter.
https://www.nejm.org/doi/full/10.1056/NEJMra1808803
As the doctor in the room among the dozen discussants in the room, my focus immediately gravitated to the medical, with some resentment on her part. Like it or not, as the NEJM review indicates, the fortunes of these people depend on how well the medicines are managed, both their therapeutic benefits and the undesired effect. If you pick up one end of s stick, you pick the other one up as well. The obligation of the physician is first to the one designated as ill. The family becomes a form of collateral damage, something to be addressed though not necessarily by the medical expert. As she noted in her presentation, the medical community was not a reliable source of empathy or family repair. These patients can function surprisingly well at the workplace, as her father did with a perceptive supervisor who minimized the employee's tenuous social interactions, focusing on productivity at work. He supported a family economically for an entire career but inevitably the household lacks the resources of a medical institution or a major corporation so disruption emerged.
People with bizarre affect, socially marginal behavior, or atypical appearance get noted. They also get avoided, and as my OLLI classmate noted, the close family gets avoided as well. That aspect has not done as well as modern medical care. She is a survivor, though not unscathed. Her father has passed away, late life divorce for her mother's safety. His death, found alone and unresponsive, took its toll on her, probably more than on him. A sibling drifts along, unstable socially, managed professionally by the medical and correction communities, but leaving the lingering impression on her that her brother was basically written off for lack of the employable skills that her father had acquired that secured a better level of protection for him, if not for the other family members.
While the treatment of schizophrenia has advanced and the chronic psychiatric hospitals that functioned more as a warehouse have waned, the people are still amid the public, identifiable as outliers and largely avoided by those who do not have a direct professional or family responsibility for their welfare. Good medical care, as her discussion noted, does not fix that.
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