Nathaniel Ayers of Soloist Fame & Forced Medication

Nathaniel Ayers

What became of Nathaniel Ayers, the talented musician who was diagnosed with a severe mental illness and ended up homeless on the streets of Los Angeles? You will recall that he was the subject of Steve Lopez’s best selling book, The Soloist as well as the powerful movie based on that book.

Steve tells us in a thought-provoking column printed last night that explores the difficult choices that many of us with loved ones face.

A tough call on medication 

* Nathaniel Ayers has won victories in his battle to function despite schizophrenia. But he lands in a courtroom, and hard decisions await.

By STEVE LOPEZ,

Howard Askins grew up in New York, the son of blue-collar transit authority employees who expected him to go far, and he did. His first stop was Brown University, and then he was off to Harvard, where he earned both medical and law degrees before moving on to psychiatric residency at UCLA.

Nathaniel Ayers, like Askins, grew up working class — in his case, Cleveland was home. His dream was music, not medicine, and his hard work landed him at the prestigious Juilliard School for the Performing Arts in New York City, where he played for a time in the same orchestra as Yo-Yo Ma.

On Monday, the two African American men sat across from each other in a former pickle factory on San Fernando Road that serves as the mental health division of Los Angeles County Superior Court. The two have a deep mutual respect for one another, but a great difference of opinion.

As he stated from the witness stand, Dr. Askins believes Mr. Ayers is a highly intelligent, charming and talented gentleman who suffers from a mental disorder so severe he can’t fully grasp how ill he is. The doctor has recommended medication that he believes could help control Mr. Ayers’ paranoia and emotional swings, along with occasional threatening behavior of the sort that landed him in court.

Mr. Ayers has a decidedly different take. Yes, he told the Commissioner Laura Hymowitz, he has acted inappropriately at times and deeply regrets it. But he is adamantly opposed to forced medication and believes he can function well without it. He disputed the doctor’s comments about his paranoia, telling Hymowitz that his neighbors in Hollywood are too lovely to be feared. He also said he likes music, and that the Hollywood Bowl is a beautiful place where the seats are often filled. If you can’t get a ticket, he said, you just wait until the next concert.

I managed to hold it together pretty well until that point. And then I lost it. His humility, his 40 years of torment, the lost career he’d wanted so badly — it all got to me.

There’s no one I admire more than Mr. Ayers; no one who has taught me more about courage and about believing in something and remaining faithful to it regardless of the challenges. The journey we began more than nine years ago has taken us from skid row to the White House, where Mr. Ayers performed and met President Obama.

But along with the great moments, I’ve also witnessed Mr. Ayers’ daily struggle with a relentless and debilitating disease that often clouds reason and judgment. As I sat in court, I wrestled again with my enduring conflict, part of me respecting Mr. Ayers’ wishes not to take medication, and part of me wishing he would at least try to do it Dr. Askins’ way.

Thousands of people confront these issues for years on end. Forced psychiatric commitments, and forced medication, are at the center of a decades-long legal, moral and medical debate over the civil liberties of people with mental disorders. There are compelling arguments on all sides, no stock answers, and no two cases alike.

When his condition worsened a month ago, Mr. Ayers was taken to a psychiatric hospital against his will, but without incident, by an L.A. County unit consisting of both mental health officials and police officers. He handled it pretty well, calling me daily with updates on his activities and new friends. Dr. Askins and the staff at the hospital determined that he needed medication, but Mr. Ayers refused, and he prevailed at his first two court appearances.

That led to Monday’s conservatorship hearing, with the county trying to establish that Mr. Ayers was unable to care for himself and needed the appointment of a conservator — his stepsister — who will have the authority to consent to forced commitments and medication even if Mr. Ayers objects.

Mr. Ayers rejected all of that. Now 63, he remembers too vividly the zombie-like side effects of electroshock therapy and the meds he was administered as a young man. He told the commissioner his eyes rolled back and his tongue swelled, and he wasn’t buying Dr. Askins’ claim that such side effects are less likely with newer drugs.

And yet, what’s the alternative?

Mr. Ayers’ life is a concert of disjointed movements, with sweet reckonings and crashing dissonance. He sometimes turns on those working hardest to help him. Two highly regarded supportive housing nonprofits — LAMP Community and Housing Works — have had great success with him, but disappointments as well. There is no cure for schizophrenia, and small triumphs carry no guarantee of encores.

“I’m an optimist,” Dr. Askins said in court, arguing that with treatment, Mr. Ayers might one day prosper back in the community rather than in a locked ward.

Askins told me after court that his parents instilled in him a duty to serve people in need. He was drawn to psychiatry by a desire to “be an advocate for people who are the most vulnerable in our society,” and to “uphold people’s dignity in very trying circumstances.”

I’ve come to learn it’s not just the drugs Mr. Ayers opposes, but the idea of being controlled. And yet he often has no control over his own emotions. Can the side effects of medication be as disorienting as the direct effects of a maddening neuro-chemical disorder?

Commissioner Hymowitz would later tell me, in chambers, that she considers it a privilege to try to help the reeling patients and shattered families who come before her.

When she started in mental health court 15 years ago, she wasn’t a big advocate of forced medication. But after seeing so many lives transformed, even if only temporarily, she’s become a believer in at least trying to find pharmaceutical relief.

When the moment of truth arrived in the case of Mr. Ayers, Hymowitz ruled in favor of a conservatorship. You can’t really say she ruled against him, though. I think that she, like others in the courtroom, had his best interests in mind.

Mr. Ayers declared that he will contest the ruling, and he’s entitled to a jury trial. In the meantime, though, the meds can be administered.

As he left the courthouse I handed him the violin he’d been asking for, so he could take it back to West Covina with him. He called me when he got to the hospital, but said he couldn’t remember why he had. I told him I was glad he called. When you can’t be sure what lies ahead, there’s small comfort in hearing a familiar voice.

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About the author:

Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.

Learn more about Pete.