Sectioned on Christmas Day

Back in the days when I used to do out of hours on call duties, Christmas Day was generally considered a good shift to have – you got double pay for the bank holiday, and no-one ever called Social Services on Christmas Day – Boxing Day, yes, New Year’s Day, yes, but never Christmas Day.

Unless someone had chosen that day to go mad.

It was a snowy evening, very festive. I had had my Christmas dinner, and was settling down in front of the TV, confident I would not get a call, when my home phone rang. Robert was a 30 year old man who lived alone. He had only a minimal history of mental illness. He had been referred to the CMHT a few months before after having had an odd transient psychotic episode following general anaesthetic for minor surgery. I had actually seen him on one occasion, and although I had found him a little odd, he had not displayed any overt symptoms of mental illness and had not been seen again.

His father, who lived in a village some miles from Robert, had decided to invite him for Christmas dinner. Since Robert did not have any transport, his father had picked him up and brought him to his house. His father had found him rather quiet and subdued, but Robert had been like this for some months, so he thought nothing of it.

But as the day progressed, Robert’s father became increasingly worried about him. He appeared very stiff, as if his muscles were seizing up, and had to be helped to the dining table. His father would try to engage him in conversation, and got the impression that Robert was trying to reply, but no words would emerge. Robert had sat motionless throughout the meal, staring at his plate, but had eaten nothing. After the meal, his father had been unable to persuade him to leave the table. He called the duty doctor, who gave him a physical examination and found nothing wrong with him, but was equally unable to persuade him to talk or move. He came to the conclusion that mental illness was the only explanation, and called us.

I managed to locate the duty psychiatrist, who was surprisingly easy to persuade to attend – perhaps he had had a fraught day with his family – and we arranged to meet the GP at the house.

Robert was still seated in the chair at the table. The table had been cleared, and he seemed to be staring intently at the table cloth.

“Hi, Robert,” I began, sitting down at the table with him. “Do you remember me?”

His eyes flickered, as if he were straining to move them in my direction, and eventually they moved enough so that he could see me. However, his neck and body stayed absolutely still. I could see his throat quivering, as if he were trying to speak, but the only sound that came out of his slightly open mouth was a low gurgle.

We asked him a number of questions, but during the 20 minutes or so of the interview the only words he managed to utter, and clearly with much effort, were: “My heart.”

It was impossible to make a further assessment. Our impression was that it was a classic case of catatonic schizophrenia, which can be characterised by a complete inability to move or speak. He clearly needed further assessment, was unable to give any indication of consent, and we concluded that he needed to be detained in hospital under Section 2 for assessment.

When the ambulance arrived, the crew had to physically lift him, still in a seated position, into the ambulance, and he remained in that position all the way to the hospital.

He did indeed have catatonic schizophrenia, and in fact I was called on a number of occasions in subsequent years to assess him, frequently with the same presentation. But never again on Christmas Day.

Festive postscript:
As I was collating the paperwork and writing up my assessment at the hospital, I suddenly noticed his date of birth. It was the 25th December.