(9-22-22) Should someone with a severe mental illness be blamed for “choosing” to be ill if they refuse treatment and later become violent?

A prosecutor in Genesee County, New York, argued earlier this month that Nicholas Maher, age 38, deserved a maximum prison sentence because he’d refused to take medication and seek treatment prior to him fatally stabbing his 69 year-old father, Martin Maher, last year.

“Nick Maher is a college-educated person,” District Attorney Kevin Finnell told a judge. “He’s smart enough to know that he needs to get mental health treatment and that he needs to take his medication, even if it doesn’t make him feel real good. But he chose not to do that.” Finnell said Maher was clearly responsible for his father’s death, even though the prosecution and defense agreed that Maher was legally insane when he attacked his father.

Maher had no prior criminal history, but he had a long history of mental illness, his defense attorney, Public Defender Jerry Ader told the court. “I sincerely believe that our community, our country, has a difficult time dealing with mental illness, especially when it comes to mental illness in the criminal justice system.” Ader questioned whether Maher had enough insight to “choose to be ill.”

“Some (said) he chose to do these things, and that he could have done something else. And I’m just not quite sure that’s true. And I don’t think anyone can know for sure if that’s true. It’s easy to say because we don’t understand mental illness. But in my experience, when someone is placed in a psychiatric hospital, it could take years in order to get a patient, an inmate, to understand, to have the insight as to their illness, why they need help and why they need medication.”

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(9-14-22) The National Alliance on Mental Illness is publishing its first book: YOU ARE NOT ALONE, written by its Chief Medical Officer Dr. Kenneth Duckworth. Dr. Duckworth has kindly allowed me to publish an excerpt discussing anosognosia – a lack of insight.  The book goes on sale September 20. More information about You Are Not Alone and the national schedule of Dr. Duckworth’s appearances to discuss the book can be found at  https://www.youarenotalonebook.org/.

YOU ARE NOT ALONE

A book by Kenneth Duckworth, M.D., published/copyright by NAMI. (Excerpt used with permission of NAMI.)

When someone is affected by a brain-based condition, it can be difficult to recognize or assess the extent to which their emotions and thoughts are affected by an illness process. My dad periodically experienced this state during his episodes, so I know intimately the challenge, pain, and helplessness it can generate for family members. The same microwave he truly thought was communicating to him during an episode of psychosis was just an appliance he used to heat up his coffee a few months later. We were lucky that his awareness would return once his episode ended, after months in the state hospital. He knew something had happened that prompted hospitalization, and he would take the prescribed lithium and antipsychotic medication, but he didn’t want to discuss his illness or treatment. He would rather take me to a Detroit Tigers game and engage in playful stories. It was also easier for me to take all the good in him and deny his painful episodes. 

That kind of denial on our part was a separate issue from that of anosognosia, which is inherent to the brain and not a conscious or unconscious choice. Dad happened to have both sides of this coin: episodic lack of awareness and self-protective denial after an episode. Anosognosia is the brain; denial is the mind. In fact, both of us had denial, but that can be worked on…. The brain dimension of anosognosia, however, is an ongoing challenge that science has yet to understand.

I asked two experts—Xavier Amador, author of I Am NotSick, I Don’t Need Help, and Kate Hardy, a leader in cognitive behavioral therapy for psychosis (CBTp)—to share their approaches to care in this critical area. Because anosognosia is brain-based, not everyone who lacks awareness of their illness can gain it—even with the best relationship support and treatment. I believe one way to better understand what your family member is going through is to listen to someone who has lost awareness, regained it, and can talk about it.

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(9-13-22) The National Alliance on Mental Illness (NAMI), the largest grassroots mental health organization in the nation, is publishing a wide ranging practical guide – You Are Not Alone – this month written by its Chief Medical Officer Ken Duckworth. Long-time NAMI advocate (and a good friend of mine) Ron Honberg offers up this information.

You Are Not Alone: Ken Duckworth’s Practical Advice

Guest blog by Attorney Ron Honberg, former National Director of Policy and Legal Affairs at NAMI.

Dr. Ken Duckworth’s motivation was simple.

He remembered the day his father was diagnosed with severe bipolar disorder, the need his family had for clear, practical advice about how they could best support his father, and how this information was never provided by those responsible for his father’s treatment.

He soon realized this was a common experience for so many other individuals and families – back then and even today.  He knew that peers and families throughout the country have a story to tell and that lessons from these stories could be integrated in a practical way to help others.   He resolved to write a book that would combine personal experiences with current clinical, research and policy information.

The result is “You Are Not Alone,” which is being released on September 20^th.  Unlike most books, where the author holds the copyright, NAMI owns this book and will receive all of its royalties.  This is the first time NAMI has published a book.

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(8-26-22) Several years ago,  Michael L. “Mike” Wade, then the Republican sheriff in Henrico County, Virginia, and I argued during a state-wide meeting about the value of mental health courts. We still don’t agree, but I have come to admire his unwavering efforts to help those with mental illnesses and substance abuses, his humor, and his vast experience based on his forty-five years in law enforcement.

Why do individuals with mental illnesses have to be in crisis to get help?

Guest blog by retired Sheriff Michael L “Mike” Wade

I started my career right out of high school as a clerical employee of the FBI, at 21 years old, I became a police officer in Henrico County (Va.) where I served for 22 years as a patrol officer, investigator and sergeant.  In 1999, I was elected Sheriff of Henrico County and took command of Court Security, Civil Process and the County’s two jails.  I retired, on December 31, 2019. While serving as a police officer, I graduated from Virginia Commonwealth University (VCU).

Those are my law enforcement credentials.

In 1985, my father passed away and the cause of his death on his death certificate reads, “Alcoholic Liver.”  I struggled with his written cause of death.  In the fall of 1985, I took a class in Alcohol and Drug Rehabilitation at VCU. In that class a movie was shown on Medical Aspects of Alcoholism. It could have been about my father because it documented all of the medical problems that led up to his death.  I wanted to learn more so I earned a Master’s Degree in Alcohol and Drug, Education and Rehabilitation Program (A.D.E.R.P), graduating in 1990.

I believe years in law enforcement, my education in substance abuse and my own family experiences have given me a perspective that might be helpful to your readers.

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(8-19-22) How do you accommodate grief? Are there silver linings in tragedies? 

I first met Joanne Tubbs Kelly and her husband, Alan, several years ago when I spoke to a NAMI group in Boulder, Colorado. Their son, Joshua, had a serious mental illness.

Little did we know what the coming years would bring. 

(Please tell me on my Facebook page what has helped you when you face difficult times.)

Good luck? Bad luck? – who knows? 

Mental illness? Mental health? — who knows?

by Joanne Tubbs Kelly, author of Walking Him Home, helping my husband die with dignity.

Forgive me for starting this essay with a tired joke.

You’ve probably heard the one about the ancient farmer whose horse died, so he couldn’t plow his field. All his neighbors commiserated, saying “Sorry for your bad luck.” The farmer replied, “Good luck? bad luck? — who knows?”

Because his horse died, the farmer’s son came home from the next village to help his father plow the field by hand. His neighbors say, “How lucky you are your son came home to help you!” and the farmer once again replies, “Good luck/bad luck, who knows?”

The son breaks his leg while he is working in the farmer’s field. The neighbors tell him what bad luck he is having and the farmer replies with his now-famous response. And so on. The broken leg keeps the son from being drafted into the military.

There’s no punch line per se, just the constant refrain, “Good luck? Bad luck? — who knows?”

Now tuck that story away and listen to the story of mental illness in my family:

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(8-8-22) In this third installment about recent books, emerging author Luther Kissam V finds power and healing writing poetry. Thrilled to reprint his story and a poem.

Have I Told You About My Superpowers

by Luther Kissam V (copyrighted material used with author’s permission.)

It was about 10 p.m. at my rural, Pennsylvanian boarding school when my mother found me running nearly naked through the snow and freezing weather. She was visiting, and I had just jumped out of her moving car, paranoid that she was trying to stop me from fulfilling my purpose.

I told her I had superpowers that the moon had given me, and that I was on fire. Neither of those things were true, but my delusions of grandeur were overwhelming. I was manic with psychotic features. Serendipitously, a teacher stumbled upon us, and was able to coax me into his car before taking me to the school infirmary so I could be hospitalized.

I left the hospital with a diagnosis of bipolar disorder, and a prescription for Lamictal. In some ways being diagnosed with bipolar disorder was a blessing; at least I finally knew the cause of my worsening emotional instability. For years I rapidly cycled through episodes of depression and mania, impacting my relationships and potential future.

I was getting by but barely.

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