Sometimes Amazing Things Happen in Psychiatry

BOOK REVIEWSometimes Amazing Things Happen: Heartbreak and Hope on the Bellevue Hospital Psychiatric Prison Wardby Elizabeth Ford, MD; New York: Simon & Schuster;
2017 • 272 pages • $27.95 (hardcover)
Reviewed by Nadia Gilbo, MD

In her book, Elizabeth Ford, MD, chronicles her journey from a newly minted psychiatry intern to a full-fledged correctional psychiatrist. She describes her role on the well-known forensics unit at Bellevue Hospital and her experience at one of the most notorious correctional systems: Rikers Island in New York.

She begins by introducing the reader to the common challenges faced by a psychiatrist in training. She deals with acute medical situations (eg, seizures, traumas), which are only made more complex by the patients’ delicate state of mind. On many occasions, she successfully de-escalates her agitated patients by listening to their troubled pasts. Despite the long-standing practice of using medication to control agitation, Dr. Ford reveals that even in this setting, listening and reflecting can be an equally powerful sedative.

As she develops her clinical acumen, we are drawn into the fight with her, rooting for her success. Through her training, she learns how to navigate the complicated bureaucracy and economics of the health system for the sake of her patients and, ultimately, learns to say farewell to them, hoping for a successful outcome. When it comes to her patients, she is fearless, compassionate, and doggedly determined to help them to the best of her ability.

Once she has completed her training in general psychiatry and a year-long forensic psychiatry fellowship, she accepts the position of unit chief on the forensic unit at Bellevue Hospital. During this period, we see Dr. Ford face new and more intimate challenges. While her commitment to the disenfranchised patients of the forensic unit is palpable and undeniable, she also offers an honest account of the dangers, hesitations, and compromises that accompany the life of a female correctional psychiatrist. How does one manage the fears and need for safety that arise from working with violent patients? Or set aside the feelings of anger and disapproval of their crimes?

We also get glimpses into Dr. Ford’s management of conflicting work and family obligations. How many hours at the hospital are too many when you are seemingly your patient’s only advocate? We follow her as she becomes exhausted and angry -and eventually decides to quit her job to find balance.

After regrouping and refocusing, with a galvanized sense of purpose and a strong support system, a reenergized Dr. Ford returns to the forensic unit as the director of the forensic psychiatry service. We see her seamlessly settle into her new position with the same enthusiasm and commitment she had before. Dr. Ford’s skill, paired with fierce determination, is essential when both staff and patients must endure new challenges -most notably, the devastation brought by Hurricane Sandy.

During this time, she visits Rikers Island and is exposed first-hand to the dismal conditions inmates are subjected to because of a lack of resources and staff psychoeducation as well as overcrowding. This experience has a lasting impact and enables her to better understand patients’ motives in invariably returning to Bellevue Hospital. Eager to ameliorate the conditions and perceptions of forensic patients, she decides to quit her job as the forensic director at Bellevue Hospital and “move to the source” at Rikers Island to reform the mental health care there.

Always fascinating and thought-provoking, the stories she shares are compelling, sometimes hair-raising, raw, but deeply heartwarming. Her book is an invigorating work for anyone who wishes to learn more about the challenges and opportunities in the world of correctional and forensic psychiatry.

This article was posted on 9/6/2017 and has since been updated.

Disclosures:

Dr. Gilbo is a third-year resident in the Department of Psychiatry and Behavioral Sciences at Montefiore Medical Center, Bronx, New York.