Monday, July 7, 2008

Case Study: Rashida Comes to the New World

Rashida is a 22-year-old female from Iran. She arrived in our emergency room, accompanied by family and friends. She sat forlornly in her hospital bed, quiet and guarded. Her family did most of the talking. From them I learned that Rashida had only been in the US for three days. She had just come as a political refugee, by way of Austria.

Since arriving in the US, Rashida has been increasingly agitated, paranoid and threatening. So much so that she had reportedly threatened to murder her family. Mind you, Rashida had been evaluated just the day before and was cleared psychiatrically by two different mental health professionals.

It seems she went home that evening, told the family she was going to kill them, and was caught in the middle of the night hovering over her sleeping mother with a butcher knife. Apparently such behavior was nothing new for Rashida, as her family told me of two separate assaults on her mother, both in Iran and in Austria. Today her mother was still sporting a black eye, and various bruises from Rashida's last attack. So they know she's capable of exacting violence on the family and at this point, they are scared and unable to sleep in their own home while she's there. While the family explained all of this, Rashida sat in her bed, staring vacantly at all of us. "Do you know why you're here," I asked.

"Because I want to go to university," she replied. It seems the family had told her that in order to go to school in the US, she would have to go to the hospital for blood tests. They said that was the only way they could get her into the hospital.

"Have you threatened to hurt any of your family?" I asked.

"No, no. I would never ever do anything like that to my family."

"Did you threaten to kill them yesterday? Or today?"

"Of course not!"

By now, Rashida had gotten out of her bed and, as we spoke, she inched closer and closer to the door. Two security officers moved towards her. Rashida panicked. She suddenly lunged for the door, pushing her body weight as hard as she could against all of us. More staff rushed over, subduing her in a way that we are trained to do, but which is never comfortable. It is especially disconcerting to this day, when it is a female you’re subduing. Restraints were applied at her wrists and ankles. Rashida screamed, surely cursing us in her native tongue.

Between screams, she spat at us. She tried to bite us. She writhed on the bed, using all her might to squirm her way out of the restraints. Her nurse rushed in to the rescue armed with a syringe filled of psychotropic medications. Rashida would be getting a potent cocktail of Haldol, Ativan, and Cogentin in her right butt cheek. This scenario played out for about 15 minutes, getting the attention of nearly every patient and staff in the emergency room.

I promptly wrote my 5150 and advised her that, at least for the next 72 hours, she would be staying with us.

When everyone's adrenaline had declined, I had an opportunity to meet with Rashida's family. Over the course of the next few days, I would learn a great deal about Rashida and how her life had come to this. It seems that Rashida had been a local celebrity singer in Tehran. Then one day, about a year and a half ago, Rashida's parents decided they would be immigrating to the US. Rashida, they said, must go. After all, she was single and had no commitments, to her father's way of thinking, that might keep her in Tehran.

Not only was she feeling it imprisoned by the 3000-year-old ways of her family, Rashida was harboring yet another secret. While she was still in Iran, she had been hospitalized in one of the country's archaic asylums. A brutish doctor largely dismissed her while a fat, filthy orderly raped her. Repeatedly. And beat her. With sticks. Her terror of even setting foot into a hospital now seemed a rational response to the hell she had endured. Even murderous rage makes sense when faced with such a horrifying possibility. When we look closely, all behavior makes sense, doesn’t it?

What bubbled to the surface was less a story about a young woman’s mental illness than a culturally-imposed female ethic, if you will, enforced by the consequence of being labeled crazy. And if that doesn’t work, you will be beaten into submission.

The extension of this misogynistic system is the enmeshed family. In Middle Eastern cultures boys and girls are a treasured and controlled part of the family, often until marriage. But we boys have it easier; we’re expected to get our lives together, to branch out, to separate, at least to a degree. But girls, well their lives are to be centered on the nuclear family of origin, until a new nuclear arrangement is found by them or for them. In other words, woman has no life beyond her family.

Not so for Rashida. She had gotten a taste of life beyond and she refused to go back. When her efforts seemed to be paying off, she was shunned, dispossessed, sabotaged and spiraled downward into a deep sadness. Nothing that serving a few months in the mental hospital wouldn’t cure, and put her back in her rightful place.

Throughout her treatment, Rashida improved rapidly and with a new joy found not so much because of her lessening depression, but because of her newfound freedom. Strangers that we were, we had given her deep comfort in telling her that no, it’s okay to grow up, to be separate, to be free. She had finally arrived at the New World. Welcome.
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