Monthly Archives: March 2019

What’s Normal?

A few years ago, I knew someone who was so depressed we needed to admit them to the psychiatric ward of a hospital. I watched as the police officers took them away. The next day, I decided to visit this person on my lunch hour. Not knowing exactly where to find this person at the hospital, I asked for directions from the reception desk. When the receptionist looked up this person in the directory, she told me they had admitted no one to the hospital by that name. I knew that was a mistake, so I pressed further. I told the receptionist I knew the person was there, as I watch the police drive off with them. When she asked why the police were involved, I explained the person was severely depressed. After she informed me that she wasn’t supposed to tell me where this person was, she directed me to the mental health ward.

The ward was locked. I had to sign in, state whom I was there to see, and my relationship to the patient. When I was finally let into the ward, I was horrified. Patients were everywhere, most not even in rooms, but lying on cots up and down the halls. One of the nurses, seeing the shock on my face, explained that they were busier than usual, as it was just after Christmas, which was always a busy time for them. Looking around, I asked myself, how could anyone receive any real help in a place like this? How indeed.

Because the person I visited was an adult, privacy laws governed. If I hadn’t known the person was there, I never would have found them. I also learned, when admitted involuntarily by a police officer, the facility can hold the person for only up to 72 hours without a court order declaring the person incompetent (unless the hospital reasonably determines the patient is a danger to themselves or others). In short, under current laws and practices, if you are the spouse, parent, another family member, or friend of a person who has a mental illness, there is almost no way to get that person any lasting help. And unfortunately, many of those who have mental illness don’t fully comprehend that they need help.

But it used to be worse. We have all heard stories of abuses of the system where perfectly sane people, for a variety of reasons, ended up committed in state asylums. The film Changeling,[i] based on a true story, is a perfect example of this. In 1928 Los Angeles, a single mother returned home from work one day and found her 9-year-old son missing. Five months later, a boy, who generally fit the description of her son, and who claimed to be the missing boy, turned up in Illinois. Mother and son were happily reunited – but not so fast. The mother claimed the boy was not her son. Who would know better than her? But the police did not listen to her. When the mother would not back down from her claims, this happened:      

Once committed to the asylum, patients could expect this kind of treatment, regardless of whether or not they had a mental illness:

In reaction to these kinds of abuses, the government began reforms. Federal and state legislatures strengthened privacy laws and made it more difficult to commit and keep someone in an institution against their will. Specifically, the Kennedy administration pushed through Congress the Community Mental Health Act of 1963. The law’s purpose was to release the mentally ill from deplorable state-run institutions and get them into community-based mental health facilities. While states were eager to shut down their mental hospitals (and pocket the savings required to run them) few, if any, communities built local mental health centers. The result? On the fiftieth anniversary of the Act, according to Michelle Smith of the Associated Press, 90 percent of the beds in state hospitals had been eliminated, leaving only the streets, jails or prisons for those with severe mental illness. A 2016 report found that in every county with both a jail and a psychiatric facility, a higher number of mentally ill adults were incarcerated than in a mental health facility. Not surprisingly, then, an estimated 16 percent of inmates in jails and prisons have a severe mental illness. Accordingly, anyone with a mental illness is three times more likely to be behind bars than in a psychiatric facility. More statistics: The number of patients cared for in state psychiatric facilities in 1955 totaled about 560,000. That number had dropped to 45,000 in 2015. Looking at it another way, the number of psychiatric beds for every 1 million residents in 1955 equaled 680. In 2005, the number of those beds for every 1 million residents had dropped to 34. Sadly, less than 40 percent of adults with severe mental illness did not receive any psychiatric care within the last year.

The story of Tyler Haire illustrates the problem of the lack of beds for those who have a mental illness. Haire, a 16-year-old boy who received seven different diagnoses of mental illness from health professionals, stabbed his father’s girlfriend, so authorities placed him in jail awaiting a court-ordered psychiatric evaluation. Tyler ended up spending almost three and a half years in prison on the waitlist for one of the 15 beds in the state mental hospital. During this period, he never saw a psychiatrist or a therapist, and no doctor ever prescribed him any psychiatric medicine. Instead, correctional officers repeatedly put him in solitary confinement, which only worsens the symptoms of the mentally ill.  

Most people who have a mental disability are not violent. Many are brilliant. Various films provide us with examples of that. Here are three of my favorites.

Who can forget lovable Raymond Babbitt, the autistic savant, who is the subject of the true story of Rain Man:[ii]   

Or the true story of Nathaniel Ayres, a homeless, mentally ill, musician, discovered by journalist Steve Lopez, who attempts to improve Ayres living conditions in The Soloist:[iii]

Or finally, the mathematical genius of Nobel Prize winner, John Nash, who battles paranoid schizophrenia in A Beautiful Mind:[iv]

Most, if not all, of us, have a family member or a friend who has a mental illness. Perhaps we, ourselves, are the sufferer. Everyone has their individual quirks that others might find abnormal. I mean, what’s normal anyway? I happen to be highly claustrophobic. Trust me; you don’t want to be in a stuck elevator with me or seated next to me on a long plane ride or be the doctor who has to perform a procedure on me that requires me to remain still for more than a minute. I realize my phobia is entirely irrational, but my panic attacks are real. Medication, when needed, has become a lifesaver for me, as well as someone there to help me get through the panic attacks. I have relied on my good wife to talk me through more than a handful of such attacks.

But that’s part of the problem with many who have a mental illness. Those most willing to help those suffering, are not allowed to do so. We need to rebalance privacy and civil liberties laws against the need to provide real treatment – making it easier, with appropriate safeguards, for the family to intervene to help their loved ones. And we need to decriminalize mental illness by utilizing mental health courts and emphasizing treatment over punishment. Along with that, first responders (usually the police) need to be better trained to deal with the mentally ill. Sadly, at least one in four persons fatally shot by police have a mental illness. That seems incredible, but when you think about it, unlike other noncontagious diseases like cancer, diabetes, or heart disease, who do we call first when dealing with mental illness? Not a medical professional, but the police. Things need to change. It seems to me that mental health reform would be one area where both sides of the aisle of Congress could agree.

Most of us have little power to change laws or secure funding for more mental health facilities (although we can, and should, express our concerns to our respective legislative representatives). So, what can each of us do to help?

First and foremost, love the sufferer. I realize from my own experience that is not always easy to do. I sometimes feel similar Alicia, the wife of John Nash, who answers the question, “Alicia, how are you holding up?” in A Beautiful Mind this way:

“I think often what I feel is obligation. Or guilt for having ever wanted to leave. Rage, against John, against God. But then I look at him and I force myself to see the man that I married, and he becomes that man. He’s transformed into someone I love. And I’m transformed into someone who loves him. It’s not all the time, but it’s enough.”

When dealing with family and friends who have a mental illness, let’s not forget the underlying person we love.

Second, but equally important, is help reduce the stigma around mental illness. If a loved one or we are suffering from a mental illness, we don’t like to talk about it because we are ashamed or embarrassed. But a person with mental illness, like any other disease, did not ask for their condition, and they should not be defined by it. Fortunately, we are starting to stop referring to people with a mental illness as “He’s bipolar,” or “She’s schizophrenic,” but instead, as someone who suffers from such diseases. But still, the stigma continues. Most of us still find it hard to admit to others (and often ourselves) that we need medication to help us get through the day.

 The documentary, Bedlam,[v] premiered at the recent Sundance Film Festival. I have not had a chance to see it yet, but I heard about it from a Radio West podcast.[vi] The documentary dives into the unacceptable conditions of our current mental health system. In one scene, the sister of a person with mental illness describes the problem that arises from the stigma we place on these diseases:

“My mom didn’t want to tell people about my brother’s mental illness, and at first she didn’t. There is a lot of shame, in black communities in particular, around mental illness. Shame is dangerous because shame makes you hide things. And when we hide things, we don’t get the support we need. And when we hide things, we are not as honest and transparent about our needs. And I think that shame literally kills people. Shame kills our possibilities of having something different.”

We need to do better. If you have a mental illness, large or small, find the help you need. If your loved one has a mental illness, help that person get the help he or she needs in the spirit of love and understanding.

Mental illness is everyone’s problem. It is time we own it.

[i] Changeling:

  • Production Companies: Imagine Entertainment, Malpaso Productions, and Relativity Media
  • Director: Clint Eastwood
  • Screenwriter: J. Michael Straczynski
  • Starring: Angeline Jolie, Colm Feore, and Amy Ryan
  • Release date: October 31, 2008

[ii] Rain Man:

  • Production Companies: United Artists, The Guber-Peters Company, and Star Partners II Ltd.
  • Director: Barry Levinson
  • Screenwriter: Ronald Bass (based on the story by Barry Morrow)
  • Starring: Dustin Hoffman, Tom Cruise, and Valeria Golino
  • Release date: December 16, 1988

[iii] The Soloist:

  • Production Companies: DreamWorks, Universal Pictures, and StudioCanal
  • Director: Joe Wright
  • Screenwriter: Susannah Grant (based on the book by Steve Lopez)
  • Starring: Jamie Foxx, Robert Downey, Jr., and Catherine Keener
  • Release date: April 4, 2009

[iv] A Beautiful Mind:

  • Production Companies: Universal Pictures, DreamWorks, and Imagine Entertainment
  • Director: Ron Howard
  • Screenwriter: Akiva Goldsman (based on the book by Sylvia Nasar)
  • Starring: Russell Crowe, Ed Harris, and Jennifer Connelly
  • Release date: January 4, 2002

[v] Bedlam:

  • Director: Kenneth Paul Rosenberg
  • Screenwriter: Peter Miller and Kenneth Paul Rosenberg
  • Starring: Eddie Anderson and Patrisse Cullors
  • Release date: January 2019

[vi] Radio West Podcast hosted by Doug Fabrizio of KUER Radio, dated February 1, 2019