"Medicalization and Demedicalization — A Gravely Disabled Homeless Man with Psychiatric Illness"

A 55-year-old   man,   Mr.   N. presented  to  the  UCLA  emergency  department  (ED)  reporting  auditory  hallucinations  and  thoughts  of  suicide. This was his sixth visit to the UCLA ED over a period of a few months;  each  visit  was  precipi-ed  by  his  losing  his  medication  and  experiencing  worsening  psychotic  symptoms  and  suicidal  thoughts.  During  all  but  one  of  these  visits,  the  examining  physicians  concluded  that  Mr.  N.  did  not  meet  the  criteria  for  psychiatric  inpatient  care.  A  typical  note  read,  “He  is  only  in  the  ER  for  od   and   shelter.  .  .  .  He   has  been homeless for many years. Given  that  he  came  to  the  ER  to  seek  shelter,  he  has  proven  himself  capable of making plans.”