What Voices Do We Hear?

Resilience_0509

10-20-14  The first review of RESILIENCE, the memoir that I helped Jessie Close write, has appeared and it’s complimentary.

The reviewer calls the book, “an honest tale” and notes that Jessie “holds nothing back.”

“The author candidly discusses her multiple marriages and her continued inability to understand her alternating manic and depressive states, which appear to have escalated in intensity with age. It was only when her son, Calen, was hospitalized and eventually diagnosed with schizophrenia that Close began to look more seriously at her own extreme mood cycles and seek permanent help to stop her abusive drinking and to silence the voice in her head that insisted she kill herself. With the help of her sister and family, Close was able to afford good treatment for herself and her son, and Close’s sister went on to establish the nonprofit organization Bring Change 2 Mind, which targets the stigma and misunderstanding surrounding mental disorders.

The critic concludes, “the book is packed with emotion and courageous personal reflections.”

That’s heady praise from a critic whose job is, well, to criticize.  But the review did contain one tiny barb.

The critic wrote that our book got off to a slow start because we spent a few initial pages explaining Jessie’s lineage. The reason why we included her lineage is because one of her relatives had a serious mental illness that went untreated –a nugget we felt needed to be explained – but a connection the critic failed to grasp.

The fact that I was bothered by the critic’s one jab in an otherwise flattering review prompted me to think about how I handle criticism. And that thought eventually caused me to wonder about how someone with a serious mental illness deals with a voice inside their head that is constantly criticizing them.

I have interviewed dozens of men and women who are hearing voices. I’ve never met anyone who heard a voice praising them. Jessie is a good example. When she was manic, the voice in her head was telling her to kill herself.

We describe this in the opening paragraph of RESILIENCE:

“Kill yourself! Kill yourself! Kill yourself!”

I couldn’t stop the voice. It was struck in my skull like a bad song, playing over and over and over again.

“Kill yourself! Kill yourself! Kill yourself!”

Those commands were being screamed at me by the Creature. It was pure evil. It was in my head, just behind my left ear. It was terrifying. Worse, it would not stop screaming.”

I once asked a friend, who is black and grew up in the South, how he overcame the racial slurs and attacks aimed at him. He said the criticism didn’t bother him because he didn’t respect the racists attacking him. The opinions that mattered to him came from his family and members of his church.

Thinking of the creature in Jessie’s head and how my friend had overcome racist attacks as a young boy gave me perspective. It also reminded me that it takes courage, if you have a serious mental illness and are hearing voices, to not let them destroy you.

One way we can help someone who is hearing destructive voices (in addition to traditional treatments, such as medication) is to provide them with a supportive environment that counters those screams in their head. We need to be the “church members” and the “family” that tells them the negative thoughts in their heads are unmerited.

We need to be the voices that they hear.

RESILIENCE goes on sale January 15th.

 

Why I Am Proud To Support NAMI

NATIONAL ALLIANCE ON MENTAL ILLNESS LOGO

10-17-14  FROM MY FILES FRIDAY: Four years ago, I explained in a blog why I am a lifetime member of the National Alliance on Mental Illness (NAMI).  I occasionally receive emails from readers grumbling about what NAMI either has or hasn’t done.  But nothing that has happened since I first joined NAMI has caused me to lose faith in it. Perhaps this is because the heart of NAMI to me has always been its people and the common goal that all of us share: helping persons with mental illnesses. Patti and I support NAMI monthly with a donation because I believe in NAMI and its programs.

NAMI Helped Me, first published June 28, 2010. **

When I was a Washington Post reporter, I did not believe in joining groups or organizations. I needed to be independent in order to be objective. Then my son, Mike (Kevin), became sick and the first thing I did after I finished writing my book, CRAZY: A Father’s Search Through America’s Mental Health Madness, was join the National Alliance on Mental Illness (NAMI.)

Why?

The first reason was a selfish one. I was not the first parent to be completely baffled by our badly fractured mental health system. Nor was I the first to have a son become entangled in our criminal justice system because of his mental disorder. I realized that other parents would be the best guides for me when it came to helping my own son. They would understand my fears and the emotional roller-coaster that I was riding. They would be able to offer me advice that was based on practical experiences.

I also realized that being involved in NAMI would help me keep my son’s problems in perspective. Oftentimes, when I would feel as if I had hit bottom and was losing hope, I would attend a NAMI meeting and listen to someone recount what had happened to their son or daughter. Stories about recovery gave me hope. Stories with less happy outcomes made me even more determined to change our system. I marveled at the resilience that NAMI members showed. I remember listening to a mother in Miami whose son refused her help and was homeless for 12 years. She drove by the corner where he panhandled on her way to  work each day and often arrived at her job in tears. I remember  two parents in Philadelphia whose only son committed suicide. They were both psychiatrists yet they could not save him.  I remember a telephone call that I received from parents whose son was on death row.

I also heard incredible stories of recovery, such as: the wife who had been involuntarily committed more than a dozen times but had been doing well for the past two years and was back with her family; the father who’d returned to work after battling major depression; the graduate who’d recovered from a debilitating breakdown after having been diagnosed with schizophrenia.

NAMI became, for me, a lifeline.

Which brings me to some of the other reasons why I am so proud to be a lifetime member of NAMI.  NAMI offered me  excellent educational programs. Family to Family is a course that helps parents and siblings deal with having a loved one who is sick. In Our Own Voices is a fantastic speakers’ program that puts a human face on mental illness by having consumers deliver positive testimonials that prove recovery is possible. Stigma-busters helps educate the media and fight prejudice.  Peer to Peer training is helping transform mental health services by giving persons with mental illnesses a strong voice in their own treatment and the recovery of others. NAMI Walks raises much needed money and increases public awareness. I am especially proud of how NAMI has reached out to different ethic groups and has been active in explaining the importance of understanding cultural diversity in treating mental disorders. And, of course, I can’t mention NAMI programs without talking about its leadership in pushing Crisis Intervention Teams, perhaps the most successful program in America when it comes to educating law enforcement and helping bring a team approach to solving community mental health problems.

Having spent 36 years in Washington D.C. as a reporter and at one point covering the U.S. Congress, I understand the importance of having a strong advocate on Capitol Hill and NAMI has been an effective  voice there for all of us.  One of NAMI best tools in both educating the public and exposing our failing system has been its Grading the States report, which gives a report card grade to every state based on how well it is doing. These grades have gotten widespread coverage in the media because they expose how much we need to do to repair a mental health system that has been described as being “truly insane.”

Of course,  NAMI isn’t perfect. None of us is happy about how much of NAMI’s budget comes from big pharmaceutical companies. We also disagree in NAMI, often heatedly, about such emotional topics as involuntary commitment, self-determination, assisted outpatient treatment, the continued closing of state hospitals, and even expanding the role of consumers within our own ranks. But even during the worst of these arguments, when I have stepped back and taken a deep breath, I have realized that everyone in the room feels passionate because they care so deeply about persons with mental disorders. Our hearts are in the right place and that is what bonds us together.

I like to say that NAMI is not like the ski club or your local wine tasting group. Few of us joined because we thought, ‘Hey, that looks like a cool group to attend.” But since I became a member, I have made friends with some of the finest persons I’ve ever met and that has been a much treasured bonus.

Because of my book, I have been able to visit NAMI chapters in 48 states and the one commonality that I have found is determination. Against some of the cruelest challenges and indignities that life can slap them with, NAMI members pick themselves up, dust themselves off, and like a boxer who doesn’t know when to quit, they stand up and prepare for another punch.  We are relentless because we must be. We are hopeful because we believe in recovery. And we are successful because we know that our course is just, fair and right.

**This version has been updated and edited.

 

Courageous Judge Administers Justice In Horrific Police Shooting

0613-laboy
It was a horrific crime.

Voices inside Kashif Bashir’s head were saying his brain was being reprogrammed. If he wanted to reach a higher state of consciousness, he needed to commit three violent acts – a robbery, a rape, and the shooting of a police officer.

The 29-year-old cabdriver bought a pistol and drove to a shop in a Washington D.C. suburb where he intended to rape an employee. She persuaded him to leave the store and then locked the door after he did.  He returned the next day and noticed a police officer inside the shop.

The shop employee told Alexandria Officer Peter Laboy about Bashir’s strange behavior. The 46-year-old officer gestured to Bashir who was in his cab, but rather than stopping, the cab driver fled. Officer Laboy went after him and when Bashir finally stopped his vehicle, he emerged from behind the wheel with a pistol and shot Laboy  before he could dismount from his motorcycle. The bullet struck the father-of-four in his skull. Bashir sped away, leaving Laboy critically wounded.  Bashir was caught after he crashed his taxi.

Miraculously, Officer Laboy survived but not without lasting damage. He has a traumatic brain injury.

Bashir was forced to take medication in jail so he could be made competent to stand trial.  Knowing that jurors rarely believe an insanity defense, Bashir’s attorney requested a trial before a judge. The case ended-up on Alexandria Circuit Court Judge James C. Clark’s docket.

Bashir was diagnosed with paranoid schizophrenia. Commonwealth Prosecutor Bryan Porter didn’t dispute that, but he argued that Bashir was tailoring his behavior to fit the insanity defense. The cabdriver’s actions were “so planned and predatory that they belie the term criminal insanity,” he said.

Forensic psychologist William Stejskal testified that Bashir did not understand what he was doing at the time of the shooting because of his mental illness. He “believed that something else entirely was taking place.” He thought Laboy would reappear elsewhere. Bashir’s family testified about his traumatic childhood and deteriorating mental state.

A former police officer himself, Prosecutor Porter told Judge Clark that Bashir had not appeared mentally unbalanced when he was buying a handgun. After shooting Laboy, Bashir had been mentally aware enough flee from the police, which suggested he recognized the difference between right and wrong.

After reviewing the testimony, Judge Clark ruled that Bashir was insane at the time he shot Officer Laboy. Bashir was remanded to state mental health officials.

Comments posted in response to a news story about the trial written by Washington Post reporter Matt Zapotosky were predictably critical. One writer suggested the police should be slow in responding if Judge Clark or his family need help in the future.

Shootings of police officers always are heartbreaking, especially this one. What happened to Officer Laboy is awful.

But Judge Clark made the right call.

A common misconception is that individuals with mental illnesses are always out-of-control and acting oddly. This simply isn’t true. I have interviewed countless individuals who appear quite normal but are hearing voices and delusional. I didn’t think one young man was ill until he began telling me about “mazers” the CIA was firing into his head. Many homeless, severely ill individuals know where to go for meals, shelter, and which library will permit them to come inside from the cold if they sit quietly and don’t disturb others. The fact that Bashir could appear calm when buying a gun isn’t that surprising. Nor do I believe his fleeing after shooting Officer Laboy suggests that he understood right from wrong. I remember meeting a psychotic inmate who’d murdered a close friend because his mind told him an alien had entered his friend’s body. The police were aliens too so, of course, he ran from them.

Another common misconception is that defendants who are found insane have beaten the system. Had Bashir been convicted, he would have been sentenced to prison for a fixed term. While there, he would not have received any meaningful treatment. After he completed his prison term, he would have been released without any restrictions or monitoring. Plus, he would have been sicker than when he was sentenced.

Because Bashir was ruled insane, he will be sent to a locked state mental facility where he will be evaluated, medicated, and required to attend 20 hours of treatment a week. He will not be discharged — if he ever is — until a Virginia judge (not a doctor) decides that he no longer poses a threat. Even then he will be discharged under strict conditions and monitoring.  Chances are Bashir will be filled with remorse once he is well enough to comprehend what he has done

Judge Clark could have bowed to political pressure. Neither Bashir nor his family appeared to be wealthy nor did they seem politically connected. Instead, Judge Clark followed the law.

His decision doesn’t diminish the horrific harm done to Officer Laboy.. As Judge Clark stated, “To characterize this case as a tragedy, I would suggest, grossly understates the facts.” But the judge’s decision was not only the most humane, it was the most effective at protecting the public. What Judge Clark did was administer justice rather than vengeance.

That takes courage.

My Beautiful Bride: 16 Years and Counting

wedding

10-10-14

I usually publish blogs on Fridays that I’ve posted previously but today is an exception. It’s my wedding anniversary.

Patti and I have been married 16 years and I’m going to brag a little. Our’s is a true love story. I was recently divorced and she was recently widowed when a mutual friend introduced us in 1996.  I don’t wish to get mushy and sound as if I’m reading a  Hallmark Card, but from the moment we met, we connected and it has been a non-stop adventure ever since.

First, we had to blend two sets of children together into one family. Seven in total. In the movies, it’s a snap. In real life, it takes patience, understanding, forgiveness, and love. I never imagined that I’d be a father to seven children. Now, I can’t imagine not being one. I’m tremendously grateful for our children.

Next came a number of unexpected challenges. When my son developed a mental illness, Patti became my rock. She helped Kevin in his recovery. Both of Patti’s younger sisters were diagnosed with cancer. Both died too young. My elderly parents arrived and were under our roof  for four years until my mom died in December and my father’s dementia became so severe that we moved him into a memory care unit. Patti was wonderful with them and she visits my father faithfully. Every relationship has ups and downs. Granted, I’ve caused most of the downs. But there have been many more happy times and ups than down ones.

My friend, Walt Harrington, once told me that no one gets through life without getting beaten up. I mentioned our challenges not to seek your sympathy but because in a marriage and in life, it is the difficult moments that reveal your true character and either solidify or undercut a marriage.

If you are fortunate, you find a partner who makes the difficult moments bearable and  the joys  even more glorious.

Patti is that partner for me so forgive me for writing today about how fortunate I am because she is in my life. I hope you have a “Patti” in your life too. If so, give that person a hug and be thankful.

 

My Book Appears In Gone Girl & Its Story Is Told In An Important New Book

gone

10-6-14   I’ve always wanted one of my books to make it onto the big screen in a major motion picture and this weekend that happened — only not exactly as I had planned.

Circumstantial Evidence: Death, Life, and Justice in a Southern Town can be seen briefly in Gone Girl, the psychological thriller based on the best-selling book by Gillian Flynn.

I don’t want to spoil the movie so  I’ll simply say that the camera pans slowly over several nonfiction crime books, the last being mine, while a killer is plotting a murder. Yep, my book  is a prop.

Ironically, the same week that Circumstantial Evidence appeared in Gone Girl, I received an advance copy of Just Mercy by Bryan Stevenson, which will go on sale October 21st, and already has been nominated for several awards.

Bryan is the hero in Circumstantial Evidence, which describes the murder of a white teenager in the same Alabama town that inspired To Kill A Mockingbird. A innocent black man is convicted and sentenced to death.  With help from two of his colleagues, Mike O’Connor and Eva Ansley, Bryan agrees to investigate the case and defend Walter McMillian.  All three of them face threats as they doggedly peel back an onion of lies. Eventually, they prove that McMillian is innocent but despite overwhelming evidence,  the criminal justice system in Alabama refuses to release him from death row until prosecutors and judges are shamed nationally by a 60 Minutes broadcast that exposes how witnesses  lied and evidence was hidden.  circumevidence

In Just Mercy, Bryan revisits the McMillian case, offering fresh insights and details that should outrage readers as he shows  how racial prejudice and poverty result in justice being anything but blind.

just-mercy

Circumstantial Evidence won an Edgar Award from the Mystery Writers of America and the 16th Annual Robert F. Kennedy Book Award. But only Bryan can tell the complete story and I am glad that he is doing that in his remarkable new book.

In addition to the McMillian case, Bryan puts a human face on other true stories about justice being denied to defendants, including those with mental disorders. Today he is recognized internationally as a champion for persons who are marginalized in society. He is founder of the Equal Justice Initiative in Montgomery, Alabama, and the most compelling speaker that I’ve ever heard.

And I’ve heard a lot.

MGM bought the movie rights to Circumstantial Evidence but its executives didn’t like the script so the story was shelved. I’ve always regretted that because Bryan, Mike O’Connor, and Eva Ansley are in real-life what Atticus Finch was in Harper Lee’s novel. Their investigation of the McMillian case would make for an exciting and important movie.

I hope Just Mercy is bought by Hollywood and the McMillian story finally gets told on the big screen. It deserves more than being used as a prop.

 

 

Getting More Than A Bandage: Reader’s Son Got Long Term Care

sailing-boat-at-sunset

10-3-14  FROM MY FILES FRIDAY – I can’t always answer the mail that I receive, but I do read every email that is sent and this letter from a mother that I published in January 2010 was especially poignant. It raises a common frustration that I continue to hear nearly five years later.  

OUR SON COULDN’T BECOME STABLE BECAUSE HE WAS ALWAYS PUSHED OUT THE DOOR 1-8-2010
As you probably know Tom spent most of the summer in jail for taking a sailboat out into the Atlantic Ocean “to sail back to his birthplace.” The Coast Guard picked him up and thankfully handed him over to the local police.
We did not bail him out this time or even try to get him out for we told him last spring, when it seemed like he would flee, that he wouldn’t. He was released at the end of July with a misdemeanor and made his way 170 miles back home. I heard something way before dawn and was startled by him outside the window by my desk. This began a difficult time.
We were doing nothing to help him by giving him anything but help.

If we gave him food, shelter, money, a ride, a room, a drop of water, a piece of fruit, a meal, clothing, a shower, we were keeping him away from getting the help he desperately needed. This place, home, could only represent one thing and that was help. We questioned this move every day. We had no choice, the cycle of hospitalizations and running nowhere only to come home which would lead to chaos had to stop.
In October, we managed to get Tom, now actively psychotic, admitted into a local hospital. We were trying to get him into (a  state hospital)  because we knew another short term hospitalization would do nothing to stop this cycle. We were unable to do this and again, upon admission the discharge plan began. I told the social worker on the unit that if they planned to release him in 5-7 days, they might as well not waste the time and resources and let him go right now. He needed longer term so the medication can have a chance to work, that was our only hope.
I was told, “…there is no such thing as long term hospitalization anymore…they don’t do that anymore…”
But I knew there were patients at (the state hospital) for months.
We continued to listen as the days passed “…we don’t do that anymore… they don’t have long term up there anymore…”
And the most disturbing “…I only send the really difficult patients up there…”Even Tom’s psychiatrist, who I respect said, “…well…..we don’t normally like to transfer….they don’t like it when we do this… …I don’t think we’ve ever transferred someone up to (state hospital) after a 7 day inpatient here…”
I’m confused because during this time I’m talking to the professionals at (state hospital) who are hearing me and they’re ready for him. They want to help and yes, there are patients who have been there for two weeks, two months, four months, a year and more.
Finally, an angel at (state hospital) says, “It’s a shame ya’ gotta get ugly, isn’t it?” She gave me a direct phone number to a doctor who would coordinate the transfer if (local hospital) would make the transfer. I tried to explain to the annoyed staff at (local hospital) that I wasn’t trying to make their jobs difficult. How many fewer admissions there would be if the hospital was not pressured to discharge so soon? The rotating door admissions would certainly decrease, which would save valuable time and resources and would give the patient a chance to recover.
So Tom was transferred to (state hospital) in mid October where he remains today. It has been a difficult time for Tom but he’s hanging in there. Initially, he presented very well and after a month they moved him to the research unit where he managed to escape for 24 hours. They placed him back in the high security unit which was a low point.
Let me back up.
As soon as Tom arrived at (state hospital) I noticed something different. First, it is not a “nice” facility…the hospital is old and dingy. But the staff, the medical treatment teams are like nothing we’ve experienced in five years at (short term units.”
Here, the focus is on the patient, not discharge. It is the first time I spent over an hour with the “medical treatment team” asking me questions and truly interested in the answers- the patterns, the symptoms, the cycles, the compliancy, the running away, the running back home, the diagnosis, the medication, the explanation of his psychotic breaks, and so on.
They use this information with the information they get from Tom to give him the best care.
Here, we are not a headache to the staff, we are a welcome and a vital part of recovery. This is a (university connected hospital)  were everyone was working to understand brain disorders like schizophrenia and to hopefully find a cure.
Last week, after over two months, Tom moved up to “2 South.” It is still secure but there are many fresh air breaks and the real perk is the “therapeutic mall.” Here Tom takes classes from 9am-3pm and he learns about his illness, the medications, relapses, symptoms, art and daily living skills. There is a gym and even a band consisting of patients –some who have been there for years.
So (during the holidays), I see  college kids coming home and I find myself wondering where Tom would be if he hadn’t gotten sick. I need to remind myself that today he is better than he’s ever been. He expressed enjoyment in drumming during a music therapy class on Saturday and that is a first in a very long time. A beautiful gift. He is more in the moment and the doc said he was “chipper” on Monday. He asks about family and friends and these are all signs that he’s getting well. Discharge will come eventually when the time is right.
 
For the first time in a long time, we have hope.
Signed Tom’s Mom
State hospitals are not popular and continue to be closed down in favor of community treatment. Some people with severe mental illnesses need long term care to fully recover. Unfortunately, this care is generally not available in most community settings, especially those that don’t offer Assertive Community Treatment teams.
No one wants anyone “dumped” into a hospital. No one wants to go back to the asylum days when hospitals were giant warehouses with no exit signs. But before we padlock all of our state hospitals, we need to ask ourselves where will  persons who are severely ill get the in-patient help they need to become stable so that when they return to the community (as they should) they will be ready to successfully move forward with their lives?
What safeguards can we build into our system to guarantee that no one is abused, but everyone can get the quality of help that they need without being caught in a cycle of crisis care that only applies band-aids before shoving people out the door?
We need to have a frank and honest discussion about whether it is possible, even with great community services, to eliminate hospitalizations or should mental hospitals perform the same role as other hospitals by offering emergency care when people are in crisis and need critical care and stabilization?