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.


%d bloggers like this: