TREATMENT ADVOCACY CENTER
Visit our web site www.psychlaws.org
July 11, 2003
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1. AS TRAGEDIES MOUNT, PROVEN
SOLUTION IS IGNORED - ORLANDO SENTINEL, July 10, 2003
2. THE SICK AND THE DEAD
- WASHINGTON CITY PAPER, July 11-17, 2003
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1. ORLANDO SENTINEL (FL), July
10, 2003
[Editor’s Note: Being at the vanguard of the movement for the
reform of Florida’s Baker Act, Seminole County Sheriff Donald Eslinger has made
the E-News before. We have a feeling this won’t be the last time.]
AS TRAGEDIES MOUNT, PROVEN SOLUTION IS IGNORED
Commentary
By Donald Eslinger | Special to the Sentinel
Five years ago this week, a bad law killed Deputy Eugene Gregory and Alan
Singletary.
Florida's Baker Act keeps families from getting help for loved ones with
untreated severe mental illnesses until they become dangerous, and then limits
that help to inpatient treatment. Florida is one of only nine states that
doesn't allow court-ordered outpatient treatment, a proven way to help people
stay on their medication while remaining in the community.
People with severe mental illnesses are four times more likely to be killed in a
confrontation with law enforcement than the general public. Like Singletary, 43,
who killed Gregory during a 13-hour standoff in which he also wounded two other
law-enforcement officers before being killed himself. Singletary's family had
tried for years to get him help for his paranoid schizophrenia, but the Baker
Act stood in their way.
This April, the Florida House wisely approved a Baker Act reform bill by an
overwhelming 113 to 2. The momentum for passage was strong, but a short session
and a procedural maneuver kept the bill from a full vote in the Senate.
So instead of reform, Floridians face continued tragedies. So far in 2003,
states such as New York have been using assisted outpatient treatment to reduce
hospitalization, homelessness, arrests, incarceration, harmful behavior and
victimization. We are still waiting.
People in New York's program, Kendra's Law, experienced a 77 percent reduction
in hospitalizations. That could have helped Alan Houseman, hospitalized under
the Baker Act 13 times. His disproportionate use of emergency psychiatric
services ended when he was killed in March in an altercation with a Tampa police
officer after once again stopping medication.
In New York, homelessness was reduced 85 percent for Kendra's Law participants.
That could make a big difference in Florida, where an estimated 15,000
Floridians with untreated mental illness are homeless. Like Thomas Albert
Wallace, 52, who was fatally shot by police in May in St. Petersburg. Wallace
reportedly threatened someone with a knife, then attacked responding officers,
who killed him. Wallace was a marine biologist with a master's degree -- and
untreated schizophrenia.
New York's law also resulted in an 83 percent reduction in arrests. A similar
reduction in arrests in Florida might have diverted J.C. Conyers, 40, from the
terrible path he was on when he was shot and killed in May after attacking two
Orange County deputies. His brother explained that Conyers had his biggest
problems when he didn't take medication for schizophrenia. He had a history of
21 arrests -- a ridiculous expenditure of resources.
Fewer arrests would also mean fewer incarcerations. Between 7,511 and 10,798
inmates with severe mental illnesses are in Florida's jails -- three to four
times more people than are in remaining state psychiatric hospitals. The 83
percent reduction in arrests noted in New York could reduce this population, and
might have saved Ryan Thomas Green, 19, who has been in Escambia County Jail
since February on charges of first-degree murder and attempted first-degree
murder. It also could have saved his alleged victims, a 59-year-old retired
Pensacola police officer and a 26-year-old house painter, who were killed and
critically injured, respectively, in the shooting spree. Green had quit taking
medications for schizoid tendencies and bipolar disorder in December.
People with severe mental illnesses who are taking medication are no more
violent than the general population. But when they stop medication, the risk of
violence increases. New Yorkers in the Kendra's Law program saw the risk of harm
to others reduced by 44 percent, and a study by Duke University showed a
reduction in violence of 50 percent. A 2002 North Carolina study also showed
that individuals with severe psychiatric disorders who were on outpatient
commitment, and thus were taking their medication regularly, were victimized
half as often as those who were not on outpatient commitment. Victimization is
one of the consequences of lack of treatment that often fails to make headlines.
Yet multiple studies have shown that individuals with severe psychiatric
disorders are especially vulnerable to being victimized. Like Colleen Francis
Wells, who was allegedly beaten to death by her son in April, a sad example of
how reducing violence and victimization would have saved two pe! ople in one
family. Both Colleen and her son, David Bruce Wells, had schizophrenia and were
known to stop taking medication. David Wells had been previously involuntarily
committed and had an extensive criminal history that ended up erupting in
violence.
When Gene and Alan died, we hoped that a new law would prevent similar
tragedies.
We are still waiting.
Donald Eslinger is the sheriff of Seminole County.
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2. WASHINGTON CITY PAPER,
July 11-17, 2003
[Editor’s Note: Preventing crime is often the focus of
politicians, governmental leaders, intellectual think?tanks, the media and, of
course, law enforcement. The answers are almost as numerous as those giving them
– community policing, beefing up the ranks of law enforcement, advanced
information systems, the war on drugs, school education programs, gun control,
three strikes laws, the elimination of parole, Megan’s Law, etc.
Today’s cover story from the Washington City Paper asks an almost unanswerable
question – why is getting treatment to those rendered unable to control their
actions by severe mental illness almost never mentioned?
With help from our President, Dr. E. Fuller Torrey, the author of this piece
makes a good case that it should be.
Just for accuracy – while Dr. Torrey’s office is in Maryland we are not, as is
stated below, based in that state. Our focus is national and our offices are in
Arlington, Virginia.]
THE SICK AND THE DEAD
Activists Say A Professionally Managed, Fully Staffed Police Department Could
Control D.C.'S Climbing Murder Rate. So Could A Professionally Managed, Fully
Staffed Mental-Health System.
by Stephanie Mencimer
A few months back, D.C. Police Chief Charles H. Ramsey had some explaining to
do. Crime statistics had shown that, including the recent triple slaying at
Colonel Brooks' Tavern in April, Washington was witnessing the sharpest spike in
homicides since the late '80s. Up 40 percent in two years, homicides were
occurring with such frequency that by the end of the year, the final tally
threatened to reach 325—almost one a day and the most since 1996. The numbers
bespoke enough carnage to recall the District's days as the nation's murder
capitol—and sparked a predictable debate over crime prevention: Were Ramsey and
his troops doing enough to stop murders?
When cornered on such matters, Ramsey often falls back on well-worn rhetoric
about crumbling family values in embattled urban neighborhoods. This time,
though, he shunned broad-brush sociology in favor of specifics. To prove that
policing can prevent only so many murders, police officials pointed to the
following cases:
***A 49-year-old woman who allegedly set a fire that killed her elderly aunt;
***A 60-year-old man who allegedly stabbed his mother to death;
***A 45-year-old woman who was charged with pushing her drinking companion over
a third-floor railing and killing him; and
***A 46-year-old man who allegedly shot and killed his grandmother and wounded
his brother.
"You could be next door and you couldn't have stopped some of these things,"
Executive Assistant Chief of Police Michael Fitzgerald told the Washington Post.
And so the debate followed a predictable pattern, with the police chief arguing
that stepped-up patrols wouldn't have a great impact and his
detractors—consisting chiefly of activists and D.C. council members—saying they
would. The terms of the discussion, too, were familiar; both sides talked about
police service areas, foot patrols, staffing levels, and so on. Yet no one
bothered to highlight the one factor that unifies most of the "unpreventable"
murders cited by Ramsey: mental illness.
Take a look:
Sharon D. Williams, the woman who allegedly set fire to her aunt's house, was
under the care of a psychiatrist and involved with a mental-health program for
the first half of 2002. After the fire, in February, a judge ordered a
competency evaluation to determine whether Williams was fit to stand trial,
according to court records. On May 19, the psychologist who did the exam
reported that Williams was uncooperative, and on May 22, she was sent to St.
Elizabeth's Hospital for a 45-day mental observation. The fire hadn't been
Williams' first run-in with the law, either. In 1997, she was charged with
stabbing her father to death; the charges were later dropped.
William Whitlock, the man charged with stabbing his mother to death on April 10,
was found unfit to stand trial and sent to St. Elizabeth's for treatment and
mental observation.
Tanya Lyles, the woman accused of pushing her drinking companion over the
railing, was described in pretrial reports as having "emotional problems"; the
charges against her were dismissed.
As for Jeffrey Daniels, the man who shot and killed his 96-year-old grandmother
and wounded his brother, court records do not reveal his mental state.
These tragedies are part of an epidemic that unfolds before us daily. Just as
Alzheimer's disease turns the elderly into wraiths in nightgowns wandering
across suburban golf courses and diabetes can make a sober driver act drunk,
mental illness can saddle its victims with alternative realities, which all too
often lead to violence.
The press and the public look for motives in these cases, trying to weave a
narrative, ferret out a rational answer for an incomprehensible act. When
Virginia scientist Robert Schwartz was killed with a 27-inch sword, the four
young people charged with conspiring to commit the crime—including Schwartz's
19-year-old daughter, Clara—were described in the media as "goths," or kids
"obsessed by vampires, assassins, and magic." In fact, the two key figures in
the case were suffering from mental illness. (Kyle Hulbert, who actually killed
Schwartz, has been alternately diagnosed with, among other things, schizophrenia
and bipolar disorder; he has been in and out of mental institutions almost his
whole life.)
The public narrative constructed around such horrible crimes is mostly artifice,
comforting window dressing that obscures the one and only explanation for them,
which is serious, untreated mental illness. Even in a region that's home to
dozens of criminal-justice think tanks, the National Institute of Mental Health,
the federal Center for Mental Health Services, and both the American Psychiatric
Association and the American Psychological Association, the conversation on
public safety hasn't yet acknowledged that the mentally ill are wreaking an
untold amount of misery, with no public-policy solution in sight.
When activist Dorothea Dix founded St. Elizabeth's in 1855, she declared that the
hospital's mission was to provide the "most humane care and enlightened curative
treatment of the insane of the Army, Navy, and District of Columbia." Her vision
of mental-health care was rooted in the 19th-century ideal of the "asylum," a
benevolent institution that would provide a serene and enriching setting where
people with "nervous disorders" could be restored to health. The 300-acre St.
Elizabeth's campus was as verdant as any Ivy League college, offering large
gardening projects and other outdoor recreational activities for the patients.
By the '40s, the hospital housed some 7,000 people.
But as time went by, St. E's, and with it mental-health care in general, lost
its idyllic trappings. It got lumped in with all the other places where people
committed against their will were put in straitjackets and forced to get
lobotomies and massive shots of Thorazine.
These days, the mentally ill don't get an asylum or even forced treatment. They
generally don't get anything for what ails them, in part because there is simply
nowhere for them to go. According to data compiled by the Maryland-based
Treatment Advocacy Center, more than 90 percent of state-psychiatric-hospital
beds have been eliminated since 1960. It's a trend that has only accelerated in
recent years. During the '90s, for instance, 44 state psychiatric hospitals
closed their doors—more closings than in the previous two decades combined.
Nearly half of state-psychiatric-hospital beds were eliminated between 1990 and
2000.
In 1955, there were 559,000 individuals with serious brain disorders in state
psychiatric hospitals. If the same proportion of patients were in hospitals
today, 893,000 mentally ill people would be in institutions. In fact, there are
fewer than 70,000. The Washington area has participated fully in the
de-institutionalization. According to a federal survey, Washington, Maryland,
and Virginia had a grand total of about 5,100 patients in mental hospitals in
1998, with fewer than 600 of those at St. E's. That's down from almost 28,000 at
the end of 1955. If hospital admissions had kept pace with population growth,
43,000 people would be in Washington-area mental hospitals, according to data
collected by psychiatrist and Treatment Advocacy Center President E. Fuller
Torrey.
New developments in pharmaceuticals and a better understanding of brain
disorders, to be sure, have cushioned the spillover from institutions, allowing
for more people to be treated in less restrictive community settings. But there
are still a large number of sick people in need of more intensive mental-health
care. An estimated 4.5 million Americans today suffer from the severest forms of
brain disorders, schizophrenia and bipolar disorder. The National Advisory
Mental Health Council estimates that 40 percent of these individuals, or 1.8
million people, are not receiving treatment on any given day.
Ramsey and his foot soldiers know exactly where those folks have ended up—on the
streets, in homeless shelters, and in jails. Never before have these places held
more people who look a little bonkers and seem a bit dangerous—and probably are.
Untreated serious mental illness is a huge risk factor for violent crime,
particularly among those released from mental hospitals. A 1992 study by Dr.
Henry Steadman, now the chair of the national advisory board of the Center for
Mental Health Services & Criminal Justice Research, found that 27 percent of
released patients reported having engaged in at least one violent act within
four months of being discharged. Those findings mirror older research suggesting
that discharged patients had arrest rates for violent crimes 10 times that of
the general population. Another study, published in the American Journal of
Public Health in 2002, found that about 14 percent of adults with severe mental
illness (schizophrenia and bipolar disorder) had been violent within the
previous year. Not surprisingly, then, 16 percent of jail inmates are estimated
to be mentally ill, according to the Justice Department—some 300,000 people, or
four times the number who are in mental hospitals today i! n the United States.
The people most vulnerable to violence by the mentally ill are their family
members, who are liable to be harmed in just the kind of cases that Ramsey
suggests can't be prevented. According to a 1994 Department of Justice
Statistics Special Report, Murder in Families, 12.3 percent of defendants who
killed a spouse had a history of mental illness and were not being treated at
the time of the crime, like 16 percent of parents who killed their children.
Parents of mentally ill children are particularly vulnerable—25.1 percent of
children who killed their parents fit the same description.
One researcher, Dr. Peter Marzuk, wrote in the Archives of General Psychiatry in
1996, "In the last decade, the evidence showing a link between violence, crime
and mental illness has mounted. It cannot be dismissed; it should not be
ignored." And yet, it is ignored, in favor of new police-patrol boundaries.
Washington is perhaps the nation's premier destination for nut cases. Close a
mental hospital in Florida and you get Juan Tubbs, the man who recently stymied
police with a fake grenade in a high-profile encounter at Union Station. The
region just happens to house many of the institutions that pop up in delusional
fantasies—the CIA, the FBI, the White House. What better way to bring your
conspiracy theories to the world than to make a splash at their front doors?
Unfortunately for area residents, mentally ill people capable enough to get to
D.C. to try to press their cases with the president can be very sick and very
dangerous. Paranoid schizophrenics, in particular, seem especially attracted to
Washington.
A 1990 study published in the American Journal of Psychiatry found that men who
had been detained by the Secret Service after showing up at the White House were
between two and five times more likely to be arrested later for violent crimes
than the general population.
And where does the Secret Service take these people if they aren't charged with
a crime? Usually to a D.C. homeless shelter, which is also where they often go
after being released from St. E's.
Examples of D.C.'s magnetic effect on dangerous lunatics abound. The most
famous, of course, is John Hinckley Jr., who in the course of watching the movie
Taxi Driver 15 times became obsessed with actress Jodie Foster. Hinckley's
parents asked his psychiatrist to institutionalize him in Colorado, where he
lived, but his doctor rejected the idea, suggesting that his parents cut him off
to force him to grow up. So they did, and in 1981, Hinckley flew to Hollywood
from Colorado, boarded a bus to D.C., and arrived at the Washington Hilton in
time to take a shot at President Ronald Reagan in an attempt to get Foster's
attention.
Francisco Martin Duran, 26, made a similar trek from Colorado to D.C.
in 1994, after he started hearing voices telling him to combat a "mist" over the
White House. After a man crashed his airplane on the south lawn of the White
House, Duran believed he had final confirmation of his orders to attack the
mist. So on Sept. 30, Duran told his wife he was going to buy some stuff for
"target practice," got in his Chevy pickup adorned with "Fire Butch Reno" and
right-to-bear-arms bumper stickers, and drove to Washington. On Oct. 29, he
stood outside the White House in a trench coat and opened fire on the mansion.
Because he was apparently attacking only the "mist," no one was hurt. Duran was
later diagnosed with paranoid schizophrenia.
In 1998, Russell Weston Jr., another paranoid schizophrenic, shot and killed two
Capitol police officers and wounded a bystander in a bizarre assault on the U.S.
Capitol. Weston thought the CIA was out to kill him and that the government had
been spying on him from a neighbor's satellite dish. He had a history of making
threats against people and had assaulted a nurse when he was involuntarily
committed to a mental hospital in Montana for several months in 1996. At the
time of the Capitol shootings, Weston had refused to take medication to control
his symptoms for many years—the major predictor of violence among the mentally
ill.
It's too soon to know for sure the mental state of sniper suspects John Muhammad
and Lee Malvo—the government is more interested in executing them than
diagnosing them. But their behavior certainly fits the profile of people with a
brain disorder, particularly Malvo, whose prison writings and drawings suggest a
certain mania.
On balance, mentally ill people don't commit all that many crimes. The Justice
Department estimates that they're responsible for about 5 percent of all
homicides nationally, and mentally ill people who are taking medication are no
more dangerous than the rest of the public, according to a MacArthur Foundation
study of violence and mental illness. But the crimes committed by the
unmedicated sick people tend to be unusually spectacular and disturbing because
they are so often seemingly random.
For instance, Peter Odighizuwa, a 44-year-old Nigerian native, allegedly went on
a shooting spree in January 2002 at the Appalachian School of Law in Grundy,
Va., after being suspended for poor academic performance. Odighizuwa is charged
with killing three people, including the dean of the school, and wounding three
others. Like Weston, Odighizuwa suffers from paranoid schizophrenia. He believes
he is the victim of a government conspiracy and harassment by the FBI and CIA.
Odighizuwa was found mentally incompetent to stand trial and was transferred to
Central State Hospital in Petersburg, where he has remained, like Weston, mostly
psychotic as prosecutors wait for drugs to restore his sanity so a jury can put
him on death row.
In September 2000, Ronald Edward Gay walked into a gay bar in Roanoke, Va., and
shot six people, killing one of them, because he claimed he was tired of being
teased about his name. Gay, a Vietnam vet, had been hospitalized for
post-traumatic stress syndrome and diagnosed with schizophrenia. Prior to the
shooting, he had been living in a tent in the mountains above the city. He had
recently stopped taking his medication.
Since the Sept. 11 attacks, the media have covered terrorists with customary
overkill. Investigative reporters have gone back through the lives of al Qaeda
terrorists in search of the "roots of their anger" and other data that might
explain their actions. When the topic of their mental profiles arises, experts
on the psychology of terrorism who chatter on cable about such things insist
that we must not consider Islamic terrorists crazy people. For example, Willard
Gaylin, co-founder of the Hastings Center, a research institute for the study of
ethical issues and the life sciences, has argued that viewing terrorists through
such a psychological prism trivializes their crimes and even romanticizes the
perpetrators.
And Jerrold Post, who founded the CIA's Center for the Analysis of Personality
and Political Behavior, told this year's annual meeting of the American
Psychiatric Association that, on the basis of his interviews with 21 Islamic
extremists in Israeli and Palestinian prisons, "We should not think of these
individuals as crazed fanatics, as seriously psychiatrically ill. It's a
security risk to have an emotionally unstable individual in your terrorist group
just as it would be in the Green Berets."
And yet mental illness seems to lurk everywhere you turn in stories about al
Qaeda. Radical Islam and its associated terrorist groups seem to have a
tremendous draw for those suffering from brain disorders—in fact, judging from
the sheer number of them who've been apprehended, one might argue that al Qaeda
is recruiting them on purpose. After all, as psychiatrist Torrey observed, "Who
else is stupid enough to try to cut the cables on the Brooklyn Bridge?"
Torrey was referring to Iyman Faris, the Pakistani man secretly arrested in
Columbus, Ohio, this year after prosecutors alleged he was linked to an al Qaeda
scheme to destroy the Brooklyn Bridge. He had several bouts with mental illness,
and his ex-wife told the Columbus Dispatch that Faris heard voices and suffered
hallucinations in which he thought someone was choking him. He attempted suicide
and spent some time in a mental hospital in the late '90s.
The father of Wael Ali al-Shihri, a 26-year-old Saudi who is thought to have
studied at a Florida flight school before joining the other hijackers on Sept.
11, told the Times of London that his son had a history of mental problems. Al-Shihri's
father hadn't seen or heard from him since he had gone to the holy city of
Medina during Ramadan so he could be treated by a cleric for his psychological
problems, according to the Times interview.
Then there is the "20th hijacker" Zacarias Moussaoui. The 34-year-old
French-Moroccan man is the only person charged in relation to the events of
Sept. 11. He was arrested after a flight-school instructor tipped off the FBI
that he had asked to learn only how to fly, but not to take off or land. The
government is working very hard to persuade people that this is a serious
prosecution of a man who was supposed to join 19 other terrorists in hijacking
four passenger planes on Sept. 11. They would like the world to believe that
Moussaoui is a dangerous threat to national security and a calculating operative
of al Qaeda who should be executed. But Moussaoui's behavior has made that an
uphill battle. His filings in federal court led lawyers interviewed by Legal
Times to dub him "crazy as a loon."
Moussaoui, who is representing himself, insists on referring to himself in court
documents as "slave of Allah." According to a story in the New York Times
Magazine, by the time Moussaoui was 27, he had become deeply paranoid and
reactionary, combative with his mother, and a conspiracy theorist—all possible
symptoms of serious mental illness, which tends to strike people in their early
to mid-20s. Two of his sisters have been pegged as schizophrenic, and one has
made many suicide attempts. Schizophrenia has a strong genetic component.
Moussaoui refused to cooperate with a competency exam in the legal
proceedings—even after his own mother asked for a second one—so it's hard to
know exactly what if anything is wrong with him.
In his legal filings, Moussaoui has asked for a forensic expert to examine the
things the FBI seized from him. His main concern is an electric fan, which he
claims was "mysteriously left on my car like a present" in Norman, Okla., and in
which he believed the FBI had planted a bug or a tracking device.
Apparently even the real al Qaeda terrorists thought Moussaoui was too nuts to
work for them. Ramzi bin al-Shibh, who is supposed to have masterminded the
attacks and is in U.S. custody somewhere in the world, has said that Moussaoui
was too unstable to be trusted in the hijacking.
Alleged terrorists rounded up around the world after Sept. 11 have also proved
to be a complicated bunch. One of the first captives released from the U.S.
prison camp at Guantanamo Bay, Cuba, was Abdul Razeq, a 25-year-old Afghan who
was shipped back to a locked ward in Afghanistan after U.S. officials realized
he was psychotic, according to news accounts. Military officials in Cuba have
suggested that the 5 percent of detainees in the camp who are currently on
antidepressants were suffering from mental illness before they got there—a claim
that human-rights activists dispute.
Last year, when a Palestinian man, Mahmoud Abu Rideh, was detained in England
under the new British anti-terrorism act, a prosecutor dubbed him one of the
"most dangerous men in Britain." Abu Rideh had a long history of mental illness
and was under the care of psychiatrists when he was arrested with nine others
for allegedly associating with Abu Hamza, the radical imam of London's Finsbury
Park Mosque, which shoe-bomber Richard Reid and Moussaoui both attended.
Another alleged terrorist, Venezuelan Hazil Mohammed Rahaman, was arrested in
February at London's Gatwick Airport with a grenade in his luggage. He had been
hospitalized at a psychiatric clinic for a few weeks in the late '90s, before
heading off to Afghanistan and other countries in what British authorities
believe was preparation to form a Latin American al Qaeda or other terrorist
cell.
And these are only the cases we know about.
For years, Maryland had one of the least useful civil-commitment laws in the
country. The statute made it virtually impossible to do anything for mentally
ill people in need of treatment, even those who were potentially dangerous.
But then in 2001, four people, including two law-enforcement officers, were
killed in the state within a 48-hour span by unmedicated schizophrenic men with
a history of violence. In the first case, a man in Columbia allegedly bludgeoned
and stabbed his mother and a boarder to death, hours after he tried to seek help
at a local mental-health clinic.
Two days later, two police officers were shot to death while responding to a
complaint at the Eastern Shore home of a schizophrenic man off his meds. As if
that weren't enough, a year later, two more Maryland sheriff's deputies were
killed while serving an emergency psychiatric petition on another man, whose
mother had been trying without success to have him committed to a psychiatric
hospital.
Nothing moves legislation quite like the murder of police officers. Following
the killings, state legislators in Annapolis finally amended the law to make it
easier to get a court-ordered emergency psychiatric evaluation of someone
suffering from mental illness, in the hope that early intervention could prevent
such tragedies. Gov. Robert Ehrlich signed the bill in May.
The Maryland episodes demonstrate how much grief our society must sustain before
acknowledging the scourge of untreated mental illness. Even as the wreckage of
this crisis makes headlines weekly, fixing it isn't a priority for local
governments or public-safety advocates. As a result, treatment is so difficult
to come by these days that family members of the mentally ill often want them to
get arrested so they might get the help they need.
Certainly the mental-health system is suffering the same fate as other social
services—namely, underfunding. Mental hospitals are expensive to maintain—which
is the main reason so many have been closed—and group homes require careful
monitoring. It's much cheaper to warehouse the sick in homeless shelters, like
the now-closed Open Door shelter at 3rd and C Streets NW, where rusting trailers
once overflowed with floridly psychotic women, many of whom used to reside in
hospitals. Still, in the big scheme of things, it's not exactly cheap to have
dangerous lunatics prowling city streets unencumbered, either. The millions that
will be spent to prosecute Russell Weston could fund good community programs for
D.C.'s mentally ill many times over.
Money, though, doesn't explain in full why this region—and the country—treats
the insane the way it does. The real reasons go much deeper. Famously recovered
schizophrenic mathematicians aside, brain disorders are simply misunderstood.
Science has vastly expanded its understanding of the biochemical roots of
serious mental illness, abolishing forever the notion that a disease like
schizophrenia could be brought on by such external forces as bad parenting, a
theory popularized by Sigmund Freud. Yet very little of this understanding has
trickled out into the popular culture and civic institutions.
The diseases themselves also resist easy definition. Mental illness is complex,
its symptoms mercurial, changing depending on the environment. Just as the press
and public demand a narrative to rationalize horrific crime, so do insane people
attempt to create their own story lines to explain the frightening chaos in
their brains. The narrative is a coping mechanism. With a disease such as
schizophrenia, which can cause aural, visual, and even corporeal hallucinations,
most people either have to face the reality that their brains are malfunctioning
or come to believe, as Weston did, that a neighbor's satellite dish really is
spying on them. The brain seems to prefer the fiction, which often is less
frightening.
When creating their narratives, the mentally ill draw heavily from cultural
cues, in an attempt to make their tales socially acceptable. That's why, when
extraterrestrials and UFOs started to enter pop culture through books and radio
in the '50s, delusional people started claiming to have been abducted by aliens.
The 1953 movie Invaders From Mars set off a wave of such reports. In the United
States, schizophrenic people often claim they're being spied on by the CIA or
the FBI. In Ireland, delusions focus on the IRA, and in the Middle East, the
guilty party is often the United States or Israel and Jews.
Often, too, delusions have some basis in fact, with slight distortions. For
instance, when a schizophrenic claims that the CIA did mind experiments on him,
he knows that it's not totally outside the realm of possibility, because the CIA
really has done mind experiments on people. Or when African-Americans claim AIDS
is a government conspiracy to wipe out their race, they only have to point to
the Tuskegee syphilis study as evidence of what unthinkable horrors the
government is capable of.
The cultural context of delusions blurs the line between sanity and insanity in
a way that makes it difficult for people to intervene with a mentally ill
individual before he blows up a federal building. For instance, before Clara
Schwartz conspired to have her father murdered, she claimed that he was abusing
her. Because such allegations are common—and commonly ignored—no one really
challenged her assertion or recognized it as a symptom of illness, even when
Schwartz went so far as to make the rather paranoid charge that her dad was
poisoning her food. And certainly no one ever imagined that she would make the
leap to violence.
The classic example of these blurry lines is the Unabomber, whose manifesto is a
surprisingly coherent document that touches upon all sorts of relevant issues
such as technology and its impact on humanity. Accordingly, people are still
debating whether paranoid schizophrenic Ted Kaczynski is really sick or a
misunderstood and eccentric genius.
Complicating the contextual issues of mental illness is the nexus with religion.
The most common symptom of psychosis is hearing voices, and when most people try
to come up with an explanation for those voices, there are only so many
culturally acceptable options to choose from. In America, if you're hearing
voices, your brain isn't malfunctioning. It must be God! And if God is talking
to you, you must be someone special, a chosen holy representative.
That's why so many mentally ill people speak the language of religious
fanaticism and are drawn to fundamentalist religions. Those groups offer a
refuge from a real world that constantly challenges their belief systems. A
delusional person can blend in a lot more easily in a church where people
routinely fall out of their seats and speak in tongues. "The fundamentalist
religions include a disproportionate number of people with psychosis," says
Torrey. "But that's not very politically correct to say."
America is not a place where one can freely dub religious fervor "crazy." Faith
is something we respect, even in its extreme forms. So when Zacarias Moussaoui
refers to himself as "slave of Allah," or writes to his mother that when the
U.S. government "fabricate[s] proofs and witnesses....Allah will make their plot
ridiculous," we don't question his sanity in any official capacity. After all,
if Moussaoui is crazy, what does that make the man who is prosecuting him?
Attorney General John Ashcroft, a fundamentalist Christian who anointed himself
with oil each time he took public office, espouses a faith that embraces
prophecy, miraculous healing, personal conversations with God, and ecstatic
revelation.
Whatever its packaging, mental illness is still just that: an illness, and one
that is not so different from Parkinson's or Alzheimer's. Yet many, many people
still refuse to accept the science as fact, particularly in the context of
violence. Americans don't like the idea of mental illness as a mitigating factor
in criminal punishment because it diminishes our sense of vengeance and the need
for black-and-white issues of culpability. Law-and-order types insist that
mental illness is no excuse for lawlessness.
It doesn't help that the mentally ill are often young, vigorous, and, especially
when they're eating out of dumpsters and failing to bathe regularly, hard to
sympathize with. It's now unconstitutional to execute retarded people, because
most people recognize that their impaired brains make them less responsible for
their crimes. But someone like Weston, who also has an impaired brain but who
could chop wood for 12 hours straight and get organized enough to file a lawsuit
against an elderly woman in Montana, is still a target for the death penalty.
On the flip side, people who do sympathize with the brain-disordered recognize
that often helping them—and protecting the public—requires treading heavily on
civil liberties. The nature of the disease is to lack insight into one's own
condition. The mentally ill are often cursed by an inability to seek help. And
the most dangerous people are the ones like Weston, who refuse to take
medication because they don't think they're sick. Consequently, protecting the
public—as well as helping the sick person—often requires treatment by force and
a lifetime of coerced medication.
Lots of people are uncomfortable with this notion because of its potential for
abuse. We also are very reluctant to deprive someone of liberty on the grounds
that he might someday become dangerous—which is why the United States has such
lax civil-commitment laws. So instead, we wait for something horrible to happen
before taking action. For better or worse, though, so many horrible things have
happened in recent years that some states are starting to recognize the problem.
New York, for instance, passed "Kendra's Law" in 1999, after an untreated
schizophrenic man pushed 36-year-old Kendra Webdale in front of a subway train
and killed her.
The law allows for court-ordered community treatment for violent mentally ill
people who have a history of refusing medication, so that failure to take their
medications can now land them in an institution. Kendra's Law has been such a
success that advocates for the mentally ill are lobbying to get similar statutes
on the books across the country. The only blemish on the story's happy ending is
that crazy people had been pushing innocent strangers in front of subway trains
for years before anything happened. Researchers D.A. Martell and P.E. Dietz even
published a study of New York subway pushers a decade ago in the Archives of
General Psychiatry, showing that all but one of 20 people who had pushed or
attempted to push a stranger in front of a train were severely mentally ill. It
wasn't until Webdale's family made it a cause célèbre that the state finally
decided to act.
In Maryland, even as the new law helps nudge recalcitrant people into treatment,
the state's budget crisis is closing mental-health programs left and right,
meaning that those same people might have nowhere to go for their court-ordered
help. Similar trends are playing out nationwide.
Without serious money invested in better mental-health services, we'll continue
to wake up to newspaper stories like those of June 10. That edition of the Post
reported the following events from the previous day:
Damien Lee, 26, stood in the middle of the 1600 block of E Street NE, blocked
traffic, and pointed a sawed-off shotgun at people and cars. Wearing a
bulletproof vest, Lee yelled profanities and declared to passers-by, "I am God."
When police arrived at the scene, Lee started shooting indiscriminately. The
officers shot back but missed. Rather than run to evade capture, Lee walked
away, threw down his rifle, and cursed it. Then he took off his vest and
stripped naked. Police apprehended Lee after siccing a dog on him.
That same day, in Montgomery County, jurors heard final arguments in the murder
trial of Erika Sifrit. Sifrit is charged with killing Martha Crutchley and
Joshua Ford in Ocean City in a bizarre incident in which Sifrit and her husband
allegedly lured the couple to a luxury penthouse suite, then killed them and
dismembered the bodies. During closing arguments in her trial, her lawyer argued
that Sifrit was a "fragile, psychologically weak young woman" who relied heavily
on the prescription drugs Xanax aid Paxil. After she was convicted, a judge
ordered a psychiatric evaluation of Sifrit before sentencing.
And Juan Tubbs, a 38-year-old homeless man, tried to rob a Redskins souvenir
store in Union Station that day by threatening to pull the pin out of a grenade.
His demands? Twenty bucks. Tubbs, who had been living in a shelter on
Massachusetts Avenue, had a history of bizarre criminal-assault charges in
Georgia and Florida, where he lived before coming to D.C. a month earlier.
According to court files, Tubbs had "emotional problems" that had endured for
some 17 years and for which he had been treated at a veterans' hospital.
At least one person that day saw the writing on the wall. Capitol Police Chief
Terrance Gainer, while referring to Tubbs, could have been speaking for many of
the defendants in the paper that day: He said that Tubbs "is in need of mental
help."
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