Monday, July 19, 2010

A Grand Rounds Hypothetical: Part 1

Grand rounds are a ritual of medical education, consisting of presenting the medical problems and treatment of a particular patient to an audience consisting of doctors, residents, and medical students.

The year is 1950. A man confined to a mental hospital tells his psychiatrist, "In July 1969, 19 years from now, an American will walk on the moon, drinking artificial orange juice." (Artificial orange juice? Why would anyone drink artificial orange juice? Who would manufacture artificial orange juice?) After questioning the patient the psychiatrist diagnoses the man with paranoid schizophrenia. The psychiatrist concludes that even if an American were to walk on the moon in 1969 (drinking artificial orange juice) there is no way the patient could know that. The man's beliefs are delusional and bizarre.

The year is 1992: An unemployed man was terminated by his employer in October 1991 for mental health reasons. The employer had been advised by a psychiatrist that the man suffered from severe mental illness that rendered him potentially violent and not fit for employment. The man writes several letters each week to his sister that describe his bizarre ideation. One of the letters describes a student who designs a nuclear weapon as part of a research project. The letter appears to be the product of the man's psychotic mental illness.

In June 1993 the man submits the letter to the U.S. Social Security Administration in support of his claim for disability benefits. The man claims to be unemployable and eligible for benefits because of severe mental illness. In August 1993 the U.S. Social Security Administration approves the man's claim.

In the year 2003 the Defense Department discloses that in the year 1964 the federal government had enlisted a physics student to design a nuclear weapon to determine how easy it would be for a person without access to confidential nuclear secrets to devise a nuclear weapon.

There is no way the social security claimant could have known about a top secret Pentagon study carried out in 1964. Confirmation that the man's fantasy about the Defense Department approximated an actual Pentagon study does not alter the fact that the man is a delusional psychotic.

Query: Does psychosis by estoppel attach? Did the Social Security Administration affirm that extrinsic confirmation of the accuracy of a delusional psychotic's ideations does not alter the fact that the claimant's ideations are the product of psychotic mental illness?

No comments: