Summary

A young woman's life was transformed when a vigilant emergency physician, Dr. Elizabeth Mitchell, followed her intuition and conducted a CT scan, revealing a severe case of hydrocephalus that had been misdiagnosed as mental health disorders for years.

Abstract

Chloe R. Coral, a university student, experienced a series of misdiagnoses for mental health conditions, including depression and bipolar disorder, after developing depressive symptoms and memory problems in 2015. Despite her mother's observations and concerns about potential physical causes, psychiatric interventions prevailed without thorough physical investigation. The situation escalated in 2022 when Chloe became violent, leading to an emergency room visit where Dr. Mitchell's intuition prompted a CT scan. The scan revealed an extreme case of hydrocephalus, a condition causing cerebrospinal fluid to accumulate in the brain. Neurosurgeon Ray M. Chu performed a minimally invasive procedure to alleviate the pressure, leading to Chloe's swift recovery. This case highlights the need for psychiatry to consider physical tests when symptoms align with potential brain disorders, emphasizing the life-altering impact of accurate diagnosis and the consequences of misdiagnosis.

Opinions

Psychiatry's subjective nature and reliance on reported symptoms without clinical investigation can lead to misdiagnosis and harm.
The Diagnostic and Statistical Model (DSM) provides only a semblance of objectivity in psychiatric diagnosis.
Once labeled with a psychiatric diagnosis, it is extremely challenging to alter the course of treatment or perspective of healthcare providers.
The case underscores the importance of listening to patients and their families, as well as the value of a physician's intuition.
There is a call for psychiatry to reassess its practices and incorporate physical tests, such as brain scans, when there is evidence suggesting underlying physical conditions.
The financial and emotional toll of misdiagnosis on patients and their families is significant and should not be underestimated.

How a Compassionate Doctor’s Gut Instinct Saved and Transformed a Young Woman’s Life

Will psychiatry reinvent itself?

“I was speechless. All I could think was ‘How did no one figure this out?’ ” (Elizabeth Mitchell, emergency physician, reported by washingtonpost.com)

Psychiatry has saved lives, but it has also destroyed lives.

No branch of modern medicine is as subjective as psychiatry. In most cases, doctors do not conduct any clinical investigation. A brain scan that can reveal underlying physical causes is rarely ordered.

Psychiatric diagnosis is based on reported and observed symptoms. The Diagnostic and Statistical Model (DSM) only offers a fig leaf of objectivity.

Patients and their families suffer extreme hardships and financial trouble if mental health symptoms camouflage a rare physical brain disease. A psychiatric label is the hardest thing to change in this world. Once a patient gets a diagnosis and a label, no amount of persuasion or evidence is enough to change the minds of doctors who treat them.

Chloe R. Coral was a lively young woman who developed depressive symptoms in 2015 while she was studying at a university. She developed memory problems. Shunted from doctor to doctor, hospital to hospital, she received different mental health diagnoses like depression, bipolar disorder, ADHD, etc.

Alison Houghton Kral, her mother and life coach, did all she could, to save her daughter. When she reported her daughter’s odd gait, the doctors should have been forewarned about a possible brain disorder, but they did nothing.

One day in 2022, Chloe became violent and the police decided to take her to the emergency room at Cedars-Sinai Marina del Rey Hospital, before moving her to a closed psychiatric ward at a nearby mental hospital.

Emergency physician Elizabeth Mitchell was on duty. When she interviewed Chloe, Mitchell’s gut instinct warned her something was off. Chloe talked normally and said she did not drink or take drugs.

Mitchell ordered a CT scan. She was stunned when she saw the result. She immediately called a meeting of all the staff. Chloe had a life-threatening condition, which Mitchell described as “the most severe case of hydrocephalus I’ve ever seen.”

According to the Washington Post columnist, Sandra G. Boodman.

Hydrocephalus, popularly known as “water on the brain,” is caused by the accumulation of cerebrospinal fluid in cavities known as ventricles. Spinal fluid, which cushions the brain, is critically important to a wide variety of brain functions. Excess fluid was compressing the brain’s frontal lobes — responsible for memory, decision-making and emotion — against the inside of Chloe’s skull because it could not be reabsorbed. Without treatment, hydrocephalus, which can be present at birth or occur later in life, can cause brain damage, coma or death.

Mitchell immediately referred Chloe to neurosurgeon Ray M. Chu, who performed an endoscopic third ventriculostomy, a minimally invasive procedure that creates a permanent pathway to relieve the pressure and allow fluid to drain properly.

Chu said, “If there’s anything funny going on, it doesn’t hurt to get brain imaging.” He also said, since Chloe did not experience headaches, the doctors might have missed the diagnosis.

The next day, Chloe woke up and called her mother who was stunned when her daughter told her, “Oh, hi Mom, can you bring some magazines or something? It’s boring here.”

Chloe went home after five days. She resumed driving and rejoined the university.

Alison, her mother, said,

“I felt utterly overwhelmed. I saw her life disappearing and felt utterly powerless to know what to do to help her. I have a lot of sadness around that and the things she’s had to go through. And then of course how much it has cost us financially.”

It took a compassionate and conscientious doctor’s intuition to rescue a promising young woman from a life of lifelong captivity in a psychiatric ward.

Misdiagnosis, especially in psychiatry, is a serious problem. Psychiatry needs to reevaluate its practices and protocols and show the flexibility to order physical tests like brain scans when doctors see palpable evidence of underlying physical manifestations.

Thanks for reading!