Imprisonment V; Mental Illness

Long ago, when I started my practice, I befriended a psychiatrist who had a busy practice. Most mental health professionals prefer to deal with people who have insight. These patients realize that something is not right with the way they feel, and they seek help, or they agree to an evaluation if their family pressures them to do so.

My new friend liked to treat people who had schizophrenia. One of the hallmarks of this diagnosis is that these patients think that their behavior is “normal.” They will tell you, with a straight face, that the government is spying on them through an old radio that is not plugged in. Treating these people is twice the work, and because almost all of them are unemployed, half as lucrative since they have no insurance until the government decrees that they are disabled.

I became the medical doctor for these individuals. A fascinating, at times frightening, experience. Words cannot describe the fantasy worlds that these (mostly young and smart) patients led me into. As the years passed and treatments improved, I witnessed miraculous recoveries. Sometimes the return to “normalcy” was so complete that some patients saw no need to continue their medicines. Those that we could not convince to remain on treatment invariably relapsed. Jobs were lost; families stopped trying to help. Many of them ended up entangled in the legal system. A few were imprisoned. Having no support systems, prosecuted by a society that had little understanding of their disease, they deteriorated into abandonment and hopelessness.

There was the young man who had been the valedictorian of his high school class. Some of his teachers noticed inappropriate behavior late during his senior year. His parents were alarmed when he decided to spurn his college scholarship to join the military. Still, many young men go through these adolescent spells. No help was sought.

At first, he did well. His commanding officers were impressed by how quickly he learned, and how adept he was at explaining material to others who were not as gifted as he was. One day his best buddy was helping a large vehicle to unload its cargo. Somehow the safety protocols were not followed. His friend was crushed by the truck and some of its cargo, in front of his eyes. He was never the same.

Years later, he could not help but smile as he described in painstaking detail what happened. Although he did not outrank anyone in the group, he felt that he should have foreseen what was coming. His superiors in the Army were sympathetic at first, but a depressed soldier is not useful to the military. He was discharged; eventually he got a small disability settlement. Medication helped to control the voices that he heard, but he could not go for an hour without reliving his agony. He felt that a divine power was going to punish him; that immense suffering was coming his way, without warning.

He was lucky that his parents did not give up on him. He could live at home. He got compensated for an occasional odd job. He endured countless snide comments from relatives and former “friends” who felt that he was strong and healthy enough to support himself. He overdosed on his medicine once (this is where I met him, in the hospital psychiatric unit) and almost succeeded. He told me that eternal sedation using alcohol or extra medicine seemed like a reasonable alternative to his existence.

We were able to help him refocus. Many others cannot. Studies show that at least 10% of federal inmates, much higher in local jails, suffer from serious mental illness. Although federal law says that every prison must have a psychiatrist and psychologist on staff, this rule does not apply to other penal systems.

These totals have been increasing. Many experts believe that we made a mistake when we released tens of thousands of mentally ill patients from state and municipal mental hospitals. No support system was funded to keep track of them. These people are not always employable, and poverty begets poverty. They do not have a chance.

Medication alone will not help as much as it could. In a way, these people feel better when they do not have any insight, because then they do not realize how much they have lost. To go from first in your class to being dependent on the kindness of society and family is a steep drop. Extensive and intricate support systems need to be built. We have not devoted the money and the resources that this gigantic chore will entail.

The benefits that control of these illnesses provide are numerous. Over the decade or so that I helped my friend with his patients I saw teachers, musicians, artists, even a couple of attorneys that were functioning in society. The indescribable joy that I felt in witnessing these recoveries was always tempered, however.

Medicines have side effects. Some of our patients required weekly blood tests. Any abnormality would have forced these people to stop taking the medicine that had given them back their life.

Insurance was an issue. If the patient were offered a better job, often they felt obligated to turn it down, because there would be a “gap” in their insurance and medication coverage. Those who were on Medicare disability could not accept remuneration for odd jobs they did, because if they exceeded a certain income their insurance and disability payment would be taken away.

Patients who are doing well must lead more than exemplary lives. A traffic stop can progress to a confrontation if a policeman is suspicious of a patient’s behavior. Some of them are difficult to relate to; they have a way of communicating that can best be defined as distant. Many of them are made fun of; they are challenged to fights; they are taunted because they refuse a drink (alcohol will almost always make them worse). If by any chance these people are whisked into a prison, years of hard work may be undone.

Millions of Americans are undervalued because their brains are wired a bit different from the “norm.” If we could only convince the lawmakers of the enormous potential that could be unleashed if we offered them an “out” of their mental agony!

WE know the numbers. We have the facts. There is uniform agreement that we have good treatments. The savings generated by lower imprisonment rates and higher levels of functioning in society would more than cover the cost of a solid mental health care system. Why not go ahead? If not now, when?

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