Crazy and cruel

Photo credit: This photo is taken from the superb 1991 movie Fisher King with Robin Williams and Jeff Bridges. Williams' character lives in a hole in the wall, talks to invisible "fat people," and believes a fire-emitting, mounted knight is constantly pursuing him. When the movie literally depicts the knight chasing Williams' character through the streets of a major city on a huge black horse, you see what schizophrenia actually looks like, including, most especially, the terrifying auditory and visual hallucinations that are frequently present.

Photo credit: This photo is taken from the superb 1991 movie The Fisher King with Robin Williams and Jeff Bridges. Williams lives in a hole in the wall, talks to invisible “fat people,” and believes a fire-emitting, mounted red knight is constantly pursuing him. When the movie literally depicts the red knight chasing Williams’ character through the streets of a major city on a huge horse, you see what schizophrenia actually feels like, including, most especially, the disorganized thoughts and the terrifying auditory and visual hallucinations. It is horrible.

A guy walks into the Washington Navy Yard . . . . Sounds like beginning of a demented joke. And, it is, sorta.

To understand that the “joke” is on us, you must read The real Navy Yard scandal by Charles Krauthammer. As an aside, you don’t have to buy Krauthammer’s right-wing views about guns to appreciate his insights as a Harvard trained and board certified medical doctor and psychiatrist. Here is the heart of his article:

As was the case in the Tucson shooting — instantly politicized into a gun-control and (fabricated) tea-party-climate-of-violence issue — the origin of [the Navy Yard] crime lies not in any politically expedient externality but in the nature of the shooter.

On Aug. 7, that same Alexis had called police from a Newport, R.I., Marriott. He was hearing voices. Three people were following him, he told the cops. They were sending microwaves through walls, making his skin vibrate and preventing him from sleeping. He had already twice changed hotels to escape the men, the radiation, the voices.

Delusions, paranoid ideation, auditory (and somatic) hallucinations: the classic symptoms of schizophrenia.

So here is this panic-stricken soul, psychotic and in terrible distress. And what does modern policing do for him? The cops tell him to “stay away from the individuals that are following him.” Then they leave.

(Emphasis added.)

Here is what should have happened:

Had this happened 35 years ago in Boston, Alexis would have been brought to me as the psychiatrist on duty at the emergency room of the Massachusetts General Hospital. Were he as agitated and distressed as in the police report, I probably would have administered an immediate dose of Haldol, the most powerful fast-acting antipsychotic of the time.

This would generally have relieved the hallucinations and delusions, a blessing not only in itself, but also for the lucidity brought on that would have allowed him to give us important diagnostic details — psychiatric history, family history, social history, medical history, etc. If I had thought he could be sufficiently cared for by family or friends to receive regular oral medication, therapy and follow-up, I would have discharged him. Otherwise, I’d have admitted him. And if he refused, I’d have ordered a 14-day involuntary commitment.

About 35 years ago, I had more than a few experiences similar to those recounted by Krauthammer. Serving as the chairman of the mental health board or representing people who appeared before the board, I saw many  schizophrenics in a florid state. Some readers may recall that I have written about two of those tortured people here and here.

I also dealt with one of these poor souls in a situation roughly similar to the Navy Yard shooter. My man was in his early 20s and, like so many of his fellow sufferers, he became seriously disturbed when he stopped taking medications.

One afternoon, the young man’s mother, a good client, a long-time school teacher and a very dear person, came to the office upset and concerned about her son. He was squirreled away in the family home, refusing to leave for any reason. As happened from time to time, he was off his meds. He was terrified because of the delusion that people hidden in the walls of the house were talking about him and planning to do him harm.

I knew the young man, and he knew me. Despite his schizophrenia, it was clear to me that he would never intentionally harm anyone. That didn’t mean, however, that he wouldn’t hurt himself or someone else if his hallucinations became severe enough.

I went to the home, and he let me in. He was shaking from fright and held two antique pistols that his late father had collected. I couldn’t tell if they were loaded. He was very glad to see me. He talked non-stop and excitedly about the voices coming from the wall. Additionally, he earnestly recounted that “they” were probing for him with x-rays that came from behind the wall. He had taken protective measures he told me and the tin foil he had placed all around the sofa partially blocked those rays.

Because he was so far gone, I dove into the kid’s hallucination and agreed with the him that I too could hear the voices and even see the tingling of the x-rays as they bounced off the tin foil. I suggested that we had to make a run for it, and get to the police station right away before the bad men could get him. He agreed.

So I opened the front door. I urged him to creep quietly toward the door. I  whispered to him to leave the guns on the sofa so the x-rays wouldn’t pick up the moving metal on his person as we escaped. He did. Then, we ran out the door to my car.

When we got to the police station, I told him the police would protect him by putting him in a room where no one could hurt him. They would also stand guard outside to stop the bad men from getting to him. I assured him that no x-rays could enter the police station because of the special shielding the police used to stop such things. He willingly allowed the police to put him a holding cell. Soon thereafter he was transported to the Regional Center where he was treated with Haldol and released after several days. He was a different person when he got out.

Why didn’t that same thing happen to the Navy Yard shooter? In our modern zeal to respect the civil rights of the mentally ill, we have so over-legalized our approach to the incapacitation of the floridly psychotic that we place ourselves and those poor souls in grave danger. We require a recent overt act showing danger to self or others before we forcibly treat these extremely demented people. Invisible men bent on killing the patient and killer alien rays are not enough. That’s crazy and cruel.

RGK

11 responses

  1. Very fought provoking.

    I have a tendency to not want police themselves to administer drugs, but if they have to shoot him to stop him without the drugs, why not use a tranquilizer gun? We’d do it for an escaped zoo animal.

    I agree the best answer is hospitalization and evaluation. The problem is that the “stabilization” of the situation is often difficult. Schizophrenia is not a one-size-fits-all illness. dean@nasserlaw.com

  2. Dean,

    I agree with you that schizophrenia is not a one-size-fits-all illness. Indeed, the absolute number of people who suffer from this horrible disease is very small, and, of that number, the population of patients who act out against others is even smaller. That said, when these patients are in a florid state (expressing outlandish fears that their lives are at risk and they couple those statements with bizarre actions to protect themselves) it seems silly to me to ignore the natural tendency of all humans to “fight” or “flee.” The problem is that we don’t know which action will subsequently ensue. That being the case, when the psychosis is florid in the manner described, I see no good reason why a short deprivation of liberty plus forced administration of anti-psychotic medication is constitutionally unacceptable even though the patient may not have committed a specific and recent dangerous act.

    All the best.

    RGK

  3. Your last paragraph pretty much sums up the problem. By the way, The Fisher King is a fantastic movie, one of my all-time favorites. Aside from giving you a “front-row seat” to the effects of untreated schizophrenia (while not particularly pleasant it is part of the human condition of which we should be cognizant), I think the movie “teaches” the important lesson of helping/healing yourself by helping/healing somebody else.

  4. Noob,

    Yes, you are surely correct that one can heal oneself by helping others. The movie does indeed have redemptive significance. That said, when the two thugs slice open William’s character as the poor devil envisions the red knight thrusting a lance into into his chest, a cynic might say,”Why bother.”

    All the best.

    RGK

  5. This is a very interesting issue that is particularly prescient in the Omaha area. The dismantling of the mental health structure that Krauthammer and yourself are recalling has had a secondary effect – unprepared law enforcement officers are left to deal with unstable people when they are in their “florid” state. The problem is two fold, the dismantling of the prior system is a questionable decision. Secondarily, it has not been replaced by anything.

    The lack of a replacement system is dangerous for society (evidenced by the recent shooting). It is also dangerous for the mentally ill ( See, City of Omaha v. Roberts, 11-cv-359, District of Nebraska- Mentally unstable man shot in his own bed six times by police officers with ZERO training for handling mentally unstable and without Judge Kopf’s intuition). The Roberts case I just mentioned is my own. It is interesting because there have been seven additional shootings involving mentally ill on just Omaha since January 2011. In every case, the lack of any mental health strategy is the biggest problem. In terms of the law, I think this is an obvious ADA violation as the local governments have failed in their duty to develop a system that accounts for the well-being of the mentally ill. (District of Nebraska (Batallion) agrees, 8th Circuit disagrees).

    Anyway, this issue won’t go away. A system is needed to protect society and the mentally unstable.

    Sorry for the soapbox.

  6. Ross,

    No need to apologize. Incidentally, while I obviously take no position on cases pending in our court, the problem you so eloquently describe is nationwide and certainly not limited to the big O.

    Thanks for taking the time to write. All the best.

    RGK

  7. I am hoping the nationwide nature of the problem will be a good reason for the Supreme Court to take my appeal and address this “public policy” issue.

  8. Thank you for starting a discussion on this. Those of us who work in bar associations often speak to these people. While we’re aware of resources to refer them to, with government cutbacks in services I fear there are fewer resources. It’s important to understand the pattern and scope of behaviors that accompany these delusions. Humanity depends on it.

  9. HH,

    You are most welcome. While the resources are surely dwindling, I hope you will continue to do your best to refer these poor souls to whatever help remains.

    All the best.

    RGK

  10. It is so wonderful to read your compassionate ‘cry’ for more reasonable and rational care of our mentally ill citizens. Unfortunately we still respond to mentally ill people with stigma and little to no understanding about mental illness and how to help when they are in a state of crisis, or, when they know they need help and no one listens. We need to treat mental illness like any other disease and health insurance needs to cover treatment as with any other illness. We need to train our law enforcement personnel (as well as many other key contacts in our daily interactions) so that opportunities such as the phone call from Alexis get a proper, supportive response. Unfortunately we keep moving in the wrong direction as we look at ways to cut costs. My daughter has a mental illness and I know how we have struggled to work with the health care system, as well as the legal system, over the last 16 years. I remember one incident when my daughter was in college and began to have suicidal thoughts. She reached out for help to the dormitory resident assistant. The college’s response was to call the police who arrived with several cars (lights and sirens) as well as a helicoptor. My daughter was taken, handcuffed and in the back of a police car, to a psychiatric facility. No wonder people are afraid to ask for help. It’s still a fight and it shouldn’t have to be this way.

  11. Sherry,

    Thank you for taking the time to comment. I am sorry about your daughter’s illness. While cold comfort, your daughter is fortunate to have you by her side. So many times, the mentally ill are alone.

    All the best.

    RGK

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