In a locked psychiatric ward, what your doctor writes about you can matter more than how you’re actually doing. I nearly lost a year of my life to that distinction.
One morning in the psychiatric ward where I was a patient, the charge nurse asked if I could meet with her privately in her office right after breakfast. I hoped I was not going to get in trouble.
She got straight to the point. She knew I was a physician. Would I be interested in teaching some of our daily afternoon sessions for the other patients?
I was stunned. She was the first medical professional there to treat me as a peer.
I may have been out of my mind in many ways, but my knowledge of physiology remained intact. I lectured on anatomy, nutrition, and pain medications. My final lecture focused on more effectively managing life’s stressors, and I felt uniquely positioned to address this topic. After each lecture, my cohort always applauded politely and asked questions. The nurses described my lectures as a “brilliant job that impressed the staff.”
It felt…normal. Like I was a doctor again.
Meanwhile, my psychiatrist was preparing to have me declared incapable of making my own treatment decisions.
Seven Diagnoses in 16 Days
It was the summer of 2007. I was in my mid-50s, confined at Washington Hospital in Fremont, California, during the fourth of eight involuntary hospitalizations over six months. (Another four, for suicidal depression, were to follow.) A sleep specialist’s misdiagnosis and excessive prescriptions of Mirapex and Provigil, compounded by severe sleep deprivation from untreated sleep apnea, had driven me into paranoid psychosis.
When I entered the psychiatrist’s office for an intake interview, he barely looked up from his computer. I introduced myself.
“I know who you are,” he responded coolly, then stiffly gestured to a chair. For all of my problems, I hadn’t lost my sense of what good bedside manner was.
He, on the other hand, struck me as disagreeable, aloof, smug, and incurious.
Over 16 days, the psychiatrist — whom I shall call Dr. Nolak — cycled through seven psychiatric diagnoses in his notes. Not once did he consider substance-induced psychosis.
During my hospitalization, a psychiatrist forgot to continue prescribing Mirapex and Provigil. I was hit full force with withdrawal symptoms, including the deepest depression known to man and intense suicidality — which, had I been successful, the physician would not have been found complicit (dead men tell no tales).
However, without those medications my slow return to clarity was drawing others’ attention.
The Threat of Conservatorship
On August 3, the social worker conveyed Nolak’s reassurance to our family attorney: he had “no intent to initiate conservatorship” because I had been “very compliant with treatment here.”
Less than 24 hours later, Nolak requested a temporary conservatorship. If approved, it could have led to a one-year conservatorship and the loss of my right to refuse treatment.
On the conservatorship form, Nolak asserted that I was “gravely disabled.” The reason was left blank. He claimed he had informed me of his plan. In reality, I was never notified, nor given any option to object. The form was signed by him under penalty of perjury. The line for my signature is blank.
His report described me as hearing voices and refusing medication. Neither claim was true. Nurses documented that I was “pleasant, insightful, and cooperative” and “compliant with medications.” His associate recorded “psychotic features resolving.”
These records were more than mere notes; they could determine whether I walked out or remained confined.
I can’t establish Nolak’s motive, but the power he sought was clear. Removing my right to refuse treatment would make it easier to secure compliance with whatever medications he chose.
A Last Minute Intervention
Sharon, my former fiancée, visited nearly every day. When she asked to take me home, Nolak declared that I would instead be transferred to Sacramento for six months.
“I think we should discuss this with Scott’s family,” she said.
“I already have,” he responded dismissively.
His progress note labeled her “very aggressive.” Assertive, perhaps, but never aggressive. Apparently, Nolak didn’t appreciate self-assured women.
Without telling me in order not to raise false hopes, Sharon conducted her own research on how to intervene and offered to take responsibility for my food, clothing, shelter, and transportation to outpatient treatment. A judge approved her request, and the conservatorship attempt was withdrawn.
On the morning of my scheduled transfer, the charge nurse smiled and announced, “a change of plans.” I would be going home with Sharon. It felt like a cruel joke. As I became convinced it was not a nasty prank, I was astonished, then elated.
The ambulance — and the restraints I would have been strapped into — was already waiting in the driveway when Sharon arrived with the judge’s writ.
What Families Need to Know About Psychiatric Confinement
For families confronting psychiatric confinement, three things matter:
- Ask exactly what is proposed: a longer hospital stay, transfer, or conservatorship? What evidence supports it, and what rights would the patient lose?
- Seek access to the records through the patient’s written authorization or an authorized legal representative. Compare the psychiatrist’s account with nursing notes and other assessments. Document discrepancies.
- Contact a patients’ rights advocate or an attorney familiar with psychiatric detention promptly. The person behind the locked door may be unable to challenge what’s happening.
My return to the shelter of Sharon’s home was not the end of my misery. The battle wasn’t over — far from it. But for the first time in a long time, the next move was mine.
Author Bio
Scott Standage, MD, is a Stanford-trained specialist in physical medicine and rehabilitation (PM&R) with more than two decades of clinical experience in musculoskeletal and neurological rehabilitation. He’s practiced medicine at leading institutions, including Stanford and Santa Clara Valley Medical Center, and currently sees patients at an outpatient clinic in California.
After being misdiagnosed and treated with powerful psychiatric medications for a sleep disorder, he endured years of medical maltreatment that cost him his career, his reputation, and nearly his life. His new book, White Coats and Black Swans: A Doctor’s Descent into Misdiagnosis and Madness (Amplify Publishing, Oct. 13, 2026), advocates for diagnostic reform, mental health accountability, and evidence-based treatment pathways. Learn more at scottstandage.com.