Climbing through the Milwaukee County Civil Commitment Process

Civil commitment has become a practically unavoidable process .for today's practicing psychiatrist. It creates a complicated triangular relationship involving the legal system, the medical system, and the pat ient. This article is a first person narrative qf a case which helps describe the Wisconsin civil commitment process as it operates in Miltoaukee County. It illustrates the frus trations that a psychiatrist (and in this case a fi rst year psychiatry resident) can experience in such a system. Finally, it addresses these problems associated with civil commitment and discusses possible solutions. I first becam e initia ted into th e Mi lwaukee County (W isconsin) civil commitment process duri ng my firs t year of psychia try train ing. During my first test imony, I had been qu es t ion ed sa tisfactorily by th e patient 's attorney, and th en the Cou nty a tt orney ask ed me confide n t ly, " Doc to r, how lon g have you been a psych ia t ry resid ent?" I a nswe red, "abo ut two weeks." Wh en th e j udge a nd everyone else in th e court room finall y st opped lau ghing and my emba rrassme nt had fad ed , we were ab le to put th e focu s back on th e issu e at hand. Wi th tha t being my introduction to th e fru stration of th e Mil waukee County civil com mit ment sys te m, I now use it as a prologue for a case report whi ch illust rat es ma ny of the shortcomings of that syst em, as well as the com plexity of th e Wiscon sin laws of com mit me nt, as th ey are practi ced in Milwaukee Co unty. Work ing with this patient showed me th e importan ce of th e in terface bet ween th e legal syst em and psychiatry. This is th e case ofj.S. (ce rtain identifyin g features have been changed for th e sa ke of confide n tia lity). j.S. is a 4 1 year old woma n diagnosed wit h chronic schizophre nia . She had bee n hospi talized many times over the last 20 yea rs sec ondary to psychot ic st a tes which usually occurred aft er Miss S. had stopped ta kin g her pr escribed neu rol epti c medication. Sh e becam e quit e dangerous at th ese times developing delu sions focus ed on a need for excessive weight loss. In May of 1990 , Miss. S. was hosp itali zed under simila r circumsta nce s. Two mont hs previous to this admission, becau se of a simi lar episode of dangerous weigh t loss, her fat her had been appointed her tempora ry gua rd ian. J on A. Lehrmann, M. D. is a PGY-III res iden t in th e Dep artment of Psychi a try a t the Medical Co lleg e of Wiscons in in Milwaukee.