FROM MY FILES FRIDAY: Vladimir Putin — Russia’s Egotistic Thief

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9-19-14 FROM MY FILES FRIDAY: In February 2011, I wrote a blog that described Russian President Vladimir Putin as a common thief. His recent foray into Ukraine is a testament that Putin is much more — he is a dangerous and pompous threat to freedom loving people. 

The World’s Biggest Thief 

Advocating for better mental health care is a top priority to me, but it’s not my only interest. I took time last week to have lunch with a friend of mine who works for a U.S. intelligence agency and our conversation quickly turned to Russia.

I have been fascinated with the Kremlin and Moscow much of my life.  Perhaps, it started when I was a youngster living in Pueblo, Colorado when my mother began storing food items in the bathroom closet in 1962. The bathroom was the only room in our small house that didn’t have windows, which was why it was chosen as our family’s emergency bomb shelter if the Soviet Union attacked.

For those too young to remember, 1962 was when the Cuban Missile Crisis happened and at the elementary school that I attended, we did drills where we either hurried into hallways or ducked under our desks. That was supposed to help us if  bombs fell.

Being a cost conscious  minister’s wife, my mom didn’t want to toss out the stored food after the crisis passed so she decided one night to add water to the packets of dehydrated meat that could be kept without refrigeration. Eating that miserable tasting stuff made me more angry at the Soviets than their plans to install missiles off our shore.

I also remember a billboard near our house that showed an angry Nikita Khrushchev about to pound his shoe on the table. I still remember the wording on that poster. It said: “We will bury you!”  That image might have terrified other children, but it made me wonder what sort of people these Communists were. Only later would I learn that both the shoe pounding incident and the translation of Khrushchev’s words were in dispute. I’d also discover the photo on that billboard was fake.

Regardless, I jumped at the chance to visit Moscow in 1994 and 1995 while researching Confessions of a Spy: The Real Story of Aldrich Ames.  It turned out to be a fabulous time to visit.  Muscovites were adjusting to the collapse of the Soviet Union in 1991. While the nation was struggling with hyperinflation and the emergence of the Russia mob, most of the individuals I met and interviewed were wonderful folks, no different in many ways from you and me. They were eager to begin a new era of freedom. This was especially true of students and, of course, Russian journalists.

Although I’m certainly no expert on Russia, I still have several friends there and what has happened since 1991 is a tragedy. I suspect that historians will eventually describe it as a major missed opportunity to create a freer and modern nation.

Rather than helping his people rise to greatness, Boris Yeltsin turned out to be drunk who helped his Oligarch buddies loot the nation.  As the second Russian president, after Yeltsin suddenly resigned, Vladimir Putin took the reins with high U.S. expectations.  (Remember President George Bush’s famous statement – “I looked the man in the eye. I found him to be very straightforward and trustworthy. ..I wouldn’t have invited him to my ranch if I didn’t trust him.”)

While Putin re-established political and economic stability, as well as, the rule of law, it now is obvious that he also has taken the low road as a leader.

Putin has used his power to imprison his political enemies, muzzle the media and undermine the democratic system by installing a puppet president. Yes, he stripped Yelstin’s  Oligarchs of their stolen wealth. But he promptly turned his buddies lose to rape the country.

Russia has gone from being an oppressive regime to a shiny example of a kleptocracy, which is defined as being a nation “ruled by thieves.” 

What prompted this blog? A recent Wikileaks revelation in Russia and a comment by my lunch guest who told me that a recent U.S. intelligence assessment pegged Putin’s personal wealth at $20 BILLION.

$20 BILLION!

If that is accurate, then poor Putin may have actually lost money. In 2007, there was speculation in the English press that Putin’s worth was in excess of $40 Billion. And this week, the Russian version of wikileaks revealed that Putin has spent an estimated $1 billion constructing a secret palace for himself on the Black Sea. The website that contained that story was immediately shut down in Russia by the Russian government. Last year, Putin and the Kremlin said there was little money to give federal workers, such as teachers and doctors, modest pay increases. Yet, somehow Putin has managed to become one of the wealthiest men in Europe even though his yearly salary, according to the Russian government, is less than $63,000 per year.

The people of Russia, especially those who fought to end Communism, deserve better than this puny egotist.

Putin’s $1 billion palace under construction on Black Sea.

Health and HOPE: Are they linked?

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9-15-14  My former CIA friend and fellow author Robert Stephan sent me a fascinating article from The New York Review of Books entitled The Dying Russians. Over a period of time, Masha Gessen  noted that a large number of her Russian friends were dying.

The deaths kept piling up. People—men and women—were falling, or perhaps jumping, off trains and out of windows; asphyxiating in country houses with faulty wood stoves or in apartments with jammed front-door locks; getting hit by cars that sped through quiet courtyards or plowed down groups of people on a sidewalk; drowning as a result of diving drunk into a lake or ignoring sea-storm warnings or for no apparent reason; poisoning themselves with too much alcohol, counterfeit alcohol, alcohol substitutes, or drugs; and, finally, dropping dead at absurdly early ages from heart attacks and strokes.

Gessen decided to learn why and with a keen eye examined possible scientific explanations, studying and comparing fatality rates caused by smoking, heart attacks, cancer and other typical illnesses before she eventually reached an unexpected conclusion.

Russians were dying at much higher rates because of a lack of hope.

Hope might have persisted after the Soviet Union collapsed—for a brief moment it seemed that this was when the truly glorious future would materialize—but the upheaval of the 1990s dashed it so quickly and so decisively that death and birth statistics appear to reflect nothing but despair during that decade.

Hope is one of those intangibles the medical profession has been unable to quantify. But I believe it is essential to recovery from a mental illness. I am not a Pollyanna. I believe severe mental disorders are cruel illnesses that all too often destroy lives. Much like cancer, not everyone will recover.

However, none of us is so wise that we know who will recover and who won’t. That is why it is important for us to do whatever we can to encourage and offer hope to someone who becomes mentally ill.

To quote Hal Lindsey:

Man can live about forty days without food, about three days without water, about eight minutes without air…but only for one second without hope.

From My Files: Why Don’t You Take Your Medication?

9-12-14 FROM MY FILES FRIDAY:  In a blog that I originally published on March 12, 2010, I tried to explain why my son resisted taking medication for several years after his first break.  “Why won’t my son/daughter take their pills?’ is still the question that I am asked the most. Much of what I wrote remains germane. 

“Why won’t you just take your medication? I take pills for my cholesterol every night and its no big deal.”

“Every psychiatrist we’ve seen has said you have a mental illness. Why won’t you accept it? Why would the doctors tell you that you’re sick, if it weren’t true?”

“Let’s look at when you were doing well and when you have gotten into trouble. What was the difference? Medication. It was the difference. When you were on your meds, you were fine. And when you weren’t, you got into trouble. Can’t you see that?”

These quotes may sound familiar to you if you are a parent and have a a son or daughter with a severe mental illness. I’ve said everyone of them to my son, Mike. It often is frustrating for us – parents — to understand why our adult children will not take anti-psychotic medication or take it only until they get better and then stop. The remedy seems so clear-cut to us, so simple – and watching them experience the mania, depression, and delusions that happen when they become psychotic is heartbreaking and horrific.

Early on, I tried every trick out there to get Mike to take his pills. Those of you who have read my book know that during one of his first breakdowns, I crushed his pills and mixed them into his breakfast cereal only to be caught by him. That damaged our relationship.

I snuck into his room and counted his pills too one day and when I discovered that he had stopped taking them, I followed the advice of a therapist who had told me that I needed to practice “tough love.” I told Mike that if he didn’t take his medication, he had to move out of my house. He did – that very same day. Again, that hurt both of us.

Another time, I offered to pay him to take his medication —  $1 per pill.

It was my friend, Xavier Amador, author of the book, “I’m Not Sick, I Don’t Need Help” who finally convinced me to back off. “I can promise you, Pete,” he said, “your son knows exactly how you feel about medication. You don’t need to ever mention it to him again.”

And since that day, I haven’t. Not a word.

So why do persons with mental illnesses refuse to take their medication or stop taking them as soon as they become stable? I am asked that question more than any other after I give a speech.

Let’s skip the obvious reasons –that some anti-psychotic medications can dull a person, make them feel physically lousy, kill their sex drive, cause them to gain weight or send them to bed exhausted even though they are already sleeping for 16 hours a day. Let’s ignore the fact that no one really knows the long term health impact that medication can cause on a person’s body.

Is there a deeper reason?

One day, I asked Mike to explain to me in writing why he had struggled so much when it came to taking his medication.

Denial was a strong factor in my understanding and even when evidence of my own madness would be presented, my mind would find a way to weave out of the circumstance and an obtuse reasoning would somehow form that would keep my own pride intact. Always two steps ahead of the truth, my brain would tap dance its way into a room where I was not at fault, where it was everybody else versus me, where I was some sort of prophet or special medium who was undergoing visions, not hallucinations, and I was important, not a victim.

It is very hard to understand that one’s own credibility is broken. There is a lot of personal shame one undergoes when they realize that they are no longer in line with society’s understanding of sane. It makes one doubt one’s own instincts and second guess the movements and decisions that one makes. Suddenly, the veil of confidence and ability has been lifted and one is a wreck, struggling to piece together the remnants of what are left of one’s self image.

I learn a lot from my son. One lesson he has taught me is recovery involves much more than simply having a pill given to you.  For many it can be a bedrock to stability but it is a starting point, not an ending one. Our loved ones need and deserve much more.

FIRST DO NO HARM: Good and Bad Psychiatrists

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9-9-2014

Finding a good psychiatrist can be difficult.

Three of my son’s doctors have been compassionate, talented and skilled psychiatrists who have helped my son and our family. For them I will always be grateful.

Three other psychiatrists who dealt with him didn’t bothered to learn anything about him except for his diagnosis so they could write a prescription, send him out the door to social workers, collect their pay and move on to their next patient.

And two were really awful.

When his insurance carrier changed, my son went to see an HMO psychiatrist to get his prescription refilled for an anti-psychotic medication. It was during a time when he was going on-and-off his medication, and also going from being stable to unstable. Without  examining him, she agreed to renew his script but added, “I don’t know of anyone this drug really helps. It’s nothing but a placebo.”

She wasn’t the most irresponsible. One of his first doctors hurriedly misdiagnosed him and prescribed a medication that made him sicker and endangered his life.

I received an email from a reader this week who asked me what he should look for in finding a psychiatrist for his daughter. “How do you know if a psychiatrist is a good fit?”

I received another email from a reader who asked if I knew how she could sue the psychiatrist who had been treating her son. She had gone with her son to his appointment and been assured that everything was fine. Two hours later, her son had become violent and psychotic. He was arrested and now faces up to five years in prison after being charged with two felonies. Was that really the doctor’s fault? She thinks so.

This doctor had maxed my son out on meds — the highest he had ever had in six years…I believe it was this doctor’s fault that he suffered some sort of serotonin overload syndrome but I’ve been told that I can’t sue him. Why not?

Other doctors can use blood tests and a wide range of physical exams to diagnose and treat an illness. Psychiatrists must depend on clusters of symptoms that often are described to them by their patients. This makes psychiatry one of the most difficult of the healing arts. It also requires more than medical knowledge. Whether or not the surgeon about to operate on you is compassionate and a good listener doesn’t matter as much as finding those traits in a psychiatrist.

How would you answer the two emails that I cited? Are you willing to share your experiences either on my Facebook page or via email? I’m not interested in anti-psychiatry rants, but I would like to hear stories that might help others avoid pitfalls and find doctors who can help them or someone who they love.  I’d like to hear positive stories too about psychiatrists who have gone beyond the call of duty. What makes them exceptional? You can send your comments to me at [email protected]  I might not be able to respond to all of the emails, but I will post the best advice and helpful stories in a future blog. Meanwhile, be well and thanks for reading.

 

NAMI Convention Inspires: We Need To Get Furious

 

Personal reasons kept me from attending this year’s National Alliance on Mental Illness convention in Washington D.C. except for a reception on Saturday night, one of the final events.

I was told by several attendees that Demi Lovato’s appearance during the opening night session was one of the convention highlights. The singer, television star, and writer not only talked frankly and openly about her bipolar disorder and addictions but also spent the next day on Capitol Hill speaking  to key congressional representatives. 

I want to show the world that there is life — surprising, wonderful, unexpected life — after diagnosis.

Bravo Ms. Lovato!

Representative Tim Murphy got three ovations when he spoke opening night about his Helping Families In Mental Health Crisis Act. Earlier, there was some grumbling because the  Pennsylvania Republican had not been on the schedule but was extended a last minute invitation after he asked to speak. 

I was fortunate enough to bump into Dr. Joyce Burland, the author of NAMI’s  Family to Family course, which is one of the best programs that NAMI offers the public. She helped found NAMI Vermont in 1989 and has returned for another stint on the NAMI board.

“We need to get FURIOUS!” she told me. Dr. Burland said the time for talking and lamenting about poor mental care is over. It is time for us to get angry and demand action.

NAMI’s new director Mary Giliberti spoke briefly at the reception, saying that she never wanted to hear NAMI referred to again as one of our nation’s best kept secrets. She revealed that she periodically leaves the executive director’s office to answer the NAMI hotline as a reminder of why NAMI’s advocacy  is necessary.  She drew a laugh when she said one caller asked if she could make sure that the people at the top of  NAMI heard what he had to say. He didn’t know he was talking to  its director.  She assured  him that she could do that. 

After her brief remarks, several NAMI members near me said they hoped NAMI would take the lead in forging a compromise between stalemated House Republicans and Democrats who have locked horns over Rep. Murphy’s bill and an alternative called the Strengthening Mental Health in Our Communities Act.  It was introduced by Arizona Representative Ron Barber at the urging of the House Democratic leadership.

Andrew Sperling, NAMI’s director of federal legislation, has been working behind the scenes to help  draft legislation, but it’s been a difficult task because NAMI’s membership itself is sharply divided.  

Talking about the need for compromise is much easier than actually achieving one.

 

 

Part Two: CNN’s Incredible Story About Joe and Will Bruce, Forgiveness and Recovery From Tragedy

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This is the second half of CNN’s story about Joe Bruce and his son, Will, and their lives after Will murdered his mother in 2006 during a psychotic break.

 

I’VE JUST BEEN TOLD THAT SOME READERS ARE HAVING TROUBLE READING THIS BLOG BECAUSE OF PROBLEMS WITH THE MARGINS. WHILE I TRY TO FIX THIS ISSUE, I’D SUGGEST THAT YOU GO TO THE CNN SITE BY CLICKING HERE TO READ THE STORY.  THANKS FOR YOUR PATIENCE 

9-5-2014

The only way to honor Amy, Joe decided, was to follow the guidance from her undelivered letter — to not give up on Will. Joe wanted to make sure his son was forced into treatment this time. But to do so, he would have to become Will’s guardian.

 

 

He would need a state-certified assessment of his son, a diagnosis and a prognosis showing that Will was incapacitated and could not act in his own interests.

That wouldn’t be hard to get, he thought. After all, Will had killed his mom and the court found him insane. Wouldn’t those facts support Joe’s request?

Joe contacted the psychiatrist whom prosecutors used to deem Will insane. He refused to help; he said it would be a conflict of interest.

Next, he asked members of his son’s legal team about using their expert. They told him they represented his son, not him.

On January 4, 2007, Joe called Dr. Robert Sena, Will’s treating psychiatrist at Riverview; the psychiatrist told Joe he would not help declare his son incapacitated.

My son IS incapacitated! Joe said.

At the height of his own PTSD struggles, alone and in despair, Joe downed two bottles of Bordeaux a night. It felt like nobody gave a damn about his son.

Even with what happened to Amy, Joe couldn’t learn what was going on inside Riverview.

“It was like the front door was bolted shut.”

His quest for the needed information dragged into weeks, then months. Finally, a hearing was set for February 6, 2007. Joe told Piscataquis County Probate Judge James R. Austin about the roadblocks he’d encountered. The system seemed rigged to prevent him from being involved in his son’s care.

Two days later, Austin sided in Joe’s favor, noting the legal Catch 22 that hindered the father’s efforts.

“The proposed guardian finds himself in an unenviable position,” the judge wrote. “He is unable to produce a report because he has no legal authority to obtain one, and he cannot secure a guardianship appointment because he has no medical report to support it. Given the extraordinary circumstances of this matter, this court believes a guardianship for a period of 90 days is appropriate.”

Within a week, Joe had his son’s medical records — 1,400 pages. He returned home and sat in Amy’s favorite wicker chair, turning page after page. Anger and outrage overcame him.

“This patient … would be dangerous to others if released from the hospital,” Dr. Jeffrey Fliesser wrote on March 27, 2006, less than a month before Will was released.

He refused medication and his paranoid delusions were intensifying, the records showed. He made obscene gestures at staff and told one, “I got your number.” He had threatened to suffocate another patient.

Amy Bruce ran a slipcover and drapery business out of this workshop near her home in Caratunk. Worried what her son might do, she kept the numbers of emergency personnel posted inside.

It was strongly advised Will not be released.

The more Joe read, the more baffled he became. He’d expected the records to contain the proof he needed to show Will was not competent to act on his own behalf. He didn’t expect them to reveal that the hospital had released Will knowing he might cause harm. Why?

On another page, Joe paused. Patients’ rights advocates — those who fight for the rights of the mentally ill — had taken up his son’s cause. Stationed inside state psychiatric hospitals, the advocates act independently of the state and federal government and are there to protect and advocate for patients. They can sit in on treatment meetings if a patient asks, and they can provide legal services. That’s what they did in Will’s case. They questioned the veracity of the psychiatric assessments and suggested the hospital would keep him until he completely melted down.

At a treatment meeting on April 6, 2006, the records showed, patient advocates were coaching Will on how to answer questions aimed at determining whether he should be allowed to go into the community on short-term passes. “They want to see that you can play nicely in the community. Just say yes,” one advocate told Will, according to notes of the meeting.

By then, Fliesser was no longer Will’s psychiatrist. Will had moved to the care of Dr. Daniel Filene.

When Filene asked Will if there were any risk that he would not return to the hospital while on leave, the advocate said to Will: “Just say no,” according to the records. Will responded with: “No.”

Fliesser, who told CNN he was removed as Will’s doctor because his contract with Riverview was up, is now in private practice in St. Augustine, Florida. It’s “very upsetting” for any psychiatrist to learn that a former patient has killed, he said. “We’re healers fundamentally. We don’t want anyone in the community to get hurt. We don’t want the patients to get hurt. So, it is devastating.”

Filene declined to talk about specifics, but he told CNN the Bruce case “is one of the saddest things that I’ve encountered in my career.”

Joe had never seen medical records before, not even his own. Nor had he ever heard of patient advocates. It was as if he were watching in slow motion the buildup to Amy’s death.

Will was released on April 20. His discharge summary noted the hospital had missed the deadline to file paperwork to extend his court-ordered stay. Doctors explored holding him involuntarily under emergency procedures but felt Will would not “meet criteria” of dangerousness, the records showed.

“Thoughts were largely logical and coherent with occasional subtle psychotic content of a paranoid and grandiose nature,” the discharge papers said. “He denied auditory or visual hallucinations. He denied suicidal or homicidal ideation.”

But the records note this key fact about the untreated paranoid schizophrenic the hospital was about to set free: “He had no insight into even a remote possibility that he may have a mental illness.”

Stunned, Joe placed his face in his hands and cried.

YOU SONS OF BITCHES! he screamed.

The fight to become Will’s full guardian became a protracted legal battle that went on for more than a year, even after Joe had gained temporary guardianship.

In January 2008, Dr. Robert Fisher, a Riverview psychiatrist, provided an evaluation for the court that said Will remained psychotic, “profoundly delusional” and dangerous. On April 15, 2008, the judge awarded Joe full guardianship.

For Will, those days before treatment are mostly a blur. He worked out relentlessly his first year in the hospital, believing he might be contacted by the CIA to carry out another covert operation. He was dubbed a “2-to-1,” meaning he had to be escorted by two staffers at all times because he was considered such a threat.

Will credits Fisher and his father with turning his life around. Fisher strongly believed the antipsychotic medication Abilify would greatly improve Will’s condition and asked Joe for permission to prescribe it. He said they could see if Will would take it willingly, or he could administer it with a needle against his will.

Dad told the doctor to go for it. Will agreed to take the medicine without resistance.

“I started to come out of the fog of being in psychosis for so long,” Will says. “Within a week, I was starting to recover. Like truly recover.”

It was like getting socked with a cold bucket of water. His whole belief system disintegrated: Mom was no longer a terrorist, and suddenly, he had to grasp the gravity of his actions.

Will sank into a deep depression. He contemplated suicide. He dreamed of burning in hell, “like my body was melting.” He was despondent. Just seeing his father became excruciating because he had to confront what he’d done.

Joe Bruce found his wife of 26 years bludgeoned to death in the bathtub on June 20, 2006. Amy was 47. He remembers her as “the most beautiful person in the world.”

He took to pen and paper. “I’m so sorry for what I did. I have just started to realize how mentally ill I really am,” he wrote his father in late 2008. “I’m having a very hard time coming to terms with it. Part of it is because of the burden of what I did.”

“I love you very much and I’m very sorry for what I did. I know it’s too much to ask for forgiveness. I really miss Mom. She would be here helping me get through this.”

His father remembers the first phone call he got from Will after he went on the medication. It was as if someone had finally given him back his boy.

“I knew I was talking to Will, my son,” he says. “It’s hard to describe, but when he was in psychosis you couldn’t have a conversation with Will. He would talk, but he wasn’t there.”

Fisher died of pancreatic cancer in May 2011. Will spoke at a memorial service at Riverview, sobbing throughout and thanking the doctor for never giving up on him.

Finally accepting he had mental illness made Will receptive to other therapies that helped with thoughts, moods and behaviors. He learned how to decrease self-destructive impulses and use more positive coping skills.

One 14-week group session called “Are you ready to change?” helped him realize the severity of his illness. “You start to contemplate it. Then, you move on to the action where you do something about it.”

As Will’s health improved, he was able to petition the court for leaves from the hospital, initially with a staff member, then on his own for four hours. With a judge’s approval, he took classes at the University of Maine at Augusta. He also worked jobs around the hospital: buffed the floors, mowed the grass, cooked hamburgers at the staff cafe.

There were slip-ups. He got busted smuggling Skoal Wintergreen tobacco into the hospital and distributing it to others. That resulted in being stripped of various privileges. Just last year, he twice told the hospital he was one place with a friend, when he actually went somewhere else.

He was ordered to receive individual psychotherapy with the unit psychologist, who helped him understand the “thought process that leads to rule breaking; his feelings and how they inform his behavior; and the impact of his behavior on others,” his medical records state. “He has also gained greater insight into his criminal thinking.”

His most important therapy came from a closed group session that included only those who had killed family members.

“Our struggles are very similar, as far as having to confront family members and to confront yourself,” he says. “I’m now an advocate for facing emotions. I never used to do that.”

Will stands in stark contrast from his release in 2006. He is outgoing and cordial, introspective and thoughtful. If he stood next to you at a coffee shop, you’d never suspect his past.

His current court order allows for an eight-hour pass with family members and four hours for personal excursions outside the group home, up to 20 hours per week. He must take his medication, 25 milligrams of Abilify, in front of staff at the group home every day.

He is not allowed to drive a vehicle. He cannot own or possess a firearm or other weapons. Drinking alcoholic beverages or consuming illegal drugs is not allowed. Curfew is 11 p.m.

He returns to Riverview to see a psychologist almost every week and a psychiatrist once every two weeks. He meets once every three months with a community treatment team, which includes a psychiatrist, psychologist and other mental health professionals who help him set goals and work with him on controlling anxiety.

Will Bruce became friends with Chuck Petrucelly, right, inside the hospital. They share a tragic bond, having both killed a family member. Now living on the outside, they like to go biking together.

Members of his treatment team denied repeated requests for interviews. But progress notes by his psychiatrists, provided to CNN by the Bruces, show that Will’s transition into the community has gone smoothly. “The patient is cooperative. There is good eye contact. Speech is coherent and non-slurred. Thought content reveals no delusions, no suicidal and no homicidal ideation,” one psychiatrist wrote on August 4, five months after Will’s release. “Plans will be to closely monitor the patient’s mood and behavior in the community.”

If he violates the treatment plan or “if there is probable cause to believe that he has committed new criminal conduct,” according to terms of his release, all of his freedoms can be revoked and he can be sent back to Riverview.

Will says he’s worked too hard to let that happen. He goes for jogs, rides his mountain bike and reads to relax. “It’s real important that I succeed.”

When Will moved to the group home, a caseworker said Will was the 11th person he had helped return to the community. None has been ordered back to the hospital. Keep the number strong, he told Will.

“That kind of stuck with me,” he says. “I don’t ever want to go back there. Dear God, you have no idea.”

Joe Bruce stands near the phone on the kitchen table. Voices boom out of the old silver-and-white Radio Shack model. One woman says she has a son who also killed. Another mom has twice been assaulted by her son. Still another keeps a journal for the day she believes her son will kill her. “He is a walking time bomb,” she says.

In almost every case, their boys are over the age of 18.

These are Joe’s comrades — families who have suffered trying to raise a seriously mentally ill child. They’ve joined the conference call from California, Washington state, Virginia.

From all over the country.

Almost every one of them is a pillar in their community. They are active with groups like theNational Alliance on Mental Illness; most were pushed into action because they couldn’t get help for their sons.

Their aim is to get mentally ill patients treatment before tragedy strikes. And that is exactly what they call themselves, Treatment Before Tragedy. During the call, they sign off on articles of incorporation in Virginia to make the organization official.

Most mentally ill people are more prone to be attacked than commit a violent act. That’s a fact driven home by mental health experts. But it can serve to make families like the Bruces feel marginalized because their loved ones are the outliers.

Joe believed he would rob Amy’s legacy if he kept quiet. He sobered up and poured his efforts into mental health reform. “When somebody turns a machine gun on a couple of people and he can’t even meet the standard for treatment,” he says, “then it’s like: Why are we pouring billions of dollars into this system?”

He testified at the Capitol in Augusta for changes to Maine’s restrictive privacy laws; he fought for lessening restrictions on laws pertaining to medication over objection; and he pushed for an assisted outpatient law that requires seriously mentally ill patients to adhere to a treatment plan as a condition for living in the community. More recently, he went to Washington to speak on behalf of the mental health reform bill sponsored by Murphy, the congressman from Pennsylvania.

His relentless activism remains on display. “If I could’ve listed a thousand things that I thought I might be doing later in life, this would never have made the list,” Joe tells the group. “The fact that we as family members are doing this, in a way I resent it. That we have to form this organization to get something done.”

He struggles to breathe.

“I know that Amy, if she could’ve been here with us, she would’ve loved every one of you.”

Will slides on his blue polo in preparation for work. Getting a job on the outside was one of his top priorities, and he’s proud that it didn’t take long.

That’s not to say it came without a challenge. He wondered how much to reveal about the past or whether he should check the box on the application that asks if you’ve committed a felony. (Technically, by law, he didn’t. But it still will show up on any background check or Internet search.)

A well-known tale among NCR patients is the time the local news outlets did a story on a killer who had moved out of the hospital and was hired by a big-box store. People picketed, and he got fired.

Will decided to be transparent. He landed one sales job, only for it to be rescinded shortly after the offer. The hiring manager called him and told him not to be so honest. “I was bummed,” he says. “But I didn’t want to lie to them and hide it.”

The psychiatric hospital doesn’t assist in the job hunt, but guys like Will learn by word of mouth about businesses friendly to forensic patients. He heard managers at a local Kmart had a sympathetic ear, and he filled out an application for a stock boy position.

Store manager Ryan Colgan invited him for an interview. “I told him everything,” Will says, “my story, my situation.” Colgan was shocked, but he was captivated by Will’s “willingness to change and to grow and to become a better person.”

“I didn’t think twice. I don’t judge the history. I judge the man,” Colgan says. “Just the fact he’s trying to get a job, trying to rebuild his life. Sometimes, you just need a break. Somebody needs to give you a chance.”

Will stocks shelves and helps customers haul big items to their cars. He enjoys the interaction. He makes $7.50 an hour and logs about 20 hours a week. He receives disability benefits to supplement his income but doesn’t like being dependent on the government. He hopes he can one day work a full-time job to support himself. His court order restricts him to working no more than 24 hours a week.

Will has been an exemplary employee, Colgan says.

Working in the real world, says Ann LeBlanc, director of the State Forensic Service, is a big step toward rehabilitation. “You have to learn to deal with other people. You have to manage that successfully,” she says. “And that’s one of the strongest ways that these NCR patients are able to demonstrate that they’re ready to move on.”

Building relationships is another sign of normalcy. Will has been dating a woman for two years, and she has been a particularly strong guide in helping him navigate his new life.

They connected through Facebook, and she visited him in the hospital. She knew Will’s mother and admired her free spirit. She sees that in Will, too. She accepts the whole of him. People need to understand, she says, the untreated Will was a different person, someone lost in a different realm.

Joe Bruce decided to live in the family home, even after his wife’s death, because of the good memories they made there.

“Everybody has a past to a certain extent,” she says. “It’s not who he is. So I don’t even think of it when I look at him.”

What does she see?

“I like that he’s motivated. He’s intelligent. He’s refined. He’s fun to be with.”

She asked that her name be withheld because her family isn’t aware of the relationship. The two talk about the possibility of getting married, but that’s a ways off. “I’d have to talk with dad — you know, can’t have a guardian and get married at the same time,” Will jokes.

He turns more serious and says he’s determined to honor his mother by fulfilling his goals. “I know my mom, and she’d just want me to be happy.”

His girlfriend adds, “She’d be proud that you’re working and going to school.”

He hopes to finish his degree in justice studies at the University of Maine at Augusta and move on to law school. He wants to be a lawyer because he can relate to people going through rough times.

Will and his father sit on a bench together in a hotel banquet room, surrounded by bright lights and four rolling cameras. Just a few years ago, it would have been impossible for Will to sit still for an interview. He’d have smashed the cameras. Or worse, heard orders from top-secret government agents to attack the interviewer.

Asked about that scenario, father and son nod: It would not have been pretty. “You wouldn’t have gotten me in this room,” Will says.

He prefers to remember the good times, piling into the family station wagon on vacations to Nova Scotia and stopping for Tiger Stripe Ice Cream. That was before everything went so awry. Before paranoid delusions consumed him and wrecked his family.

When we come to that part of the interview, Will bawls his eyes out, burying his head between his knees, unable to speak further. Tears swim in the eyes of his father. Silence consumes the room.

After a long pause, Dad breaks the stillness. He reassures his son that it was his illness, not Will the person, that acted that day.

Forgiveness, Joe tells me, didn’t happen overnight. There was no magic, eureka moment. It took time, a gradual process of working through grief and post-traumatic stress while grappling with conflicted emotions of paternal love for an ill son.

“It was a struggle,” he says. “I understood that it was the disease. I knew that what he’d done was not his fault.”

But it didn’t make it easy to accept.

Will remains steeped in a personal struggle, managing feelings of guilt about the past while trying to look forward. He says in retrospect he wishes he had taken his medication when he was hospitalized before the killing, or that it had been given to him forcibly. Abilify was one of the medications suggested all those years ago.

But he was so sick he could not string together a coherent thought. How was he in any state, he wonders, to make logical decisions about his health?

“Killing my mother is something I’m going to regret for the rest of my life and trying to forgive yourself for something like that is not easy to do,” he says. “I look back on it and think, Jesus, had I just taken some medication.”

Hearing Will articulate his thoughts and show such remorse is proof of how far he has come, Joe says.

“I’ve watched his struggle with his treatment. I’ve watched him work so hard. He’s gone through ups and downs. We both have. He’s continued to progress. He’s made me very proud.”

Father and son know one thing out of their control is the forgiveness of others. Will understands many people, including family members, will never accept him. He respects that sentiment, as hard as it may be.

His mom’s sisters stopped all communication. Yet one of Amy’s brothers has stood by Will, visiting him regularly and seeing him through his treatment. “I worry about meeting my maker one day and facing him and my sister and having to account for why I turned my back on Willy,” says Wally Bruce. (Amy’s maiden name was the same as her married name.)

“My sister didn’t give up on him. And after having some time to reflect on it, I said, ‘If she didn’t give up on him, then I’m certainly not going to turn my back.’ “

Will’s two brothers wrestle with a range of emotions — the memories of an untreated Will still raw, their feelings constantly in flux.

His middle brother, Bob, 31, the one whose arm and leg Will broke, is glad his brother has received the treatment he so desperately needed. Returning to the community, Bob says, is vitally important for the rehabilitation of forensic patients. He knows that. He sees it every day as a pulmonary and critical care doctor in his second year of residency in Washington state. “But from a more personal standpoint, it’s hard to think of that.”

“I guess I spent too many years either actively fighting with him or afraid of what he might do,” he says. “There’s a lot of pretty unpleasant memories growing up with him.”

At his mother’s funeral, Bob stood in the pulpit and told those in attendance of the need to forgive Will. “The irony is, as time passed, I often feel like I’m the last one in the family to be able to forgive him. That’s something I still can’t bring myself to do,” he says. “That’s honestly something I struggle with daily.”

He visited Will just twice over the last eight years, once in November 2006 and the last time in the spring of 2013. The latest visit was mostly out of a sense of obligation, Bob says, because he was moving away to the Pacific Northwest. Whatever was discussed, he says, has mostly been purged from his memory.

“It was a tough visit, of course.”

Will Bruce rides his mountain bike on trails to help relieve stress. He manages feelings of guilt about the past while trying to look forward.

Will’s youngest brother, Wallace, 27, has forgiven him, but is not comfortable with the idea of him living in the community. He saw Will multiple times over the years in the hospital, but stopped last year because his emotions became so intense, partly because of his brother’s impending release. Wallace lives in Los Angeles. He spends summertime in Maine and plans to see Will later this month.

“I would love to say with 100% certainty that I’m OK with Will living in a group home. But the fact is I’m not. There’s still a part of me that thinks it’s a horrible idea.

“Having seen what happens when he’s not on medication,” Wallace says, “that’s a hard thing to shake.”

Both brothers admire their father. They know their mother would’ve wanted him to advocate for Will, and it’s helped give their father a mission. Both believe it is good for their brother to tell his story, that it could help others with mental illness.

Will respects his brothers’ opinions and their distance. He knows reconciliation may never come. “That’s the toughest thing,” he says. “I can’t expect them to forgive me. I haven’t forgiven myself yet. I just try to live every day the best I can.

“It would be so much easier for them to say they hate me, but they don’t. And that gives me hope.”

Will knows he will deal with these issues forever. There are times when he feels overwrought with guilt. “At the end of the day, I killed my mother. There’s a part of me that feels I should be punished for that.”

He asks himself, Why should someone who did what I did be able to walk free?

Sometimes, his mother appears in his dreams.

“Will, I forgive you,” she whispers.

He awakes crying.

About this story

Will Bruce and his father, Joe, allowed CNN to document Will’s transition from a Maine state psychiatric hospital to a group home in the community. In March 2014, reporter Wayne Drash made the first of several visits to Augusta, Maine, and to the family home in Caratunk, Maine. Video producer Brandon Ancil and photographer John Nowak also spent time with the Bruces.

Drash examined hundreds of pages of medical documents relating to Will’s treatment and discharge as well as the progress notes made by psychiatrists since his release. The reporter also reviewed the autopsy report on Amy Bruce and a transcript of Joe Bruce’s 911 call. He interviewed the commissioner of Maine’s Health and Human Services Department, the commissioner of the state Department of Corrections and the director of the State Forensic Service.

Italics are used for dialogue of past events as recalled by a participant.

Follow CNN’s Wayne Drash on Twitter or contact him by e-mail.