Leaning into Perplexity: A Case of a Patient Who Did Not Want Treatment But Also Did Not Want to Leave

Abstract

This article presents the case of a young, second generation American Muslim man who was admitted involuntarily to an adult psychiatric inpatient unit. The patient's clinical picture was unclear-the treatment team was unsure if he demonstrated signs and symptoms of bipolar disorder or if a personality disorder (antisocial or narcissistic) better explained his presentation. His clinical picture after a couple of weeks of hospitalization was not sufficiently acute that he needed to remain in the hospital, but he refused to leave because he wanted documentation that he had no mental illness. This article considers the patient's history, the nuances of psychiatric diagnosis, the issues involving psychiatry and the law that arose in this case, and the collaboration of the psychiatric providers with the Chaplain Imam at the hospital. The case illustrates a collision between the limitations of science and the expectations of the patient and his family within our broader social, cultural, and professional contexts.

Keywords: Diagnosis; Forensic psychiatry; Personality disorder; Spiritual care.