A Digital Remedy–Or a Digital Intrusion?

If neurochemistry can be thought to have a cruel side, it is evidenced in anosognosia. This loathsome side-effect of severe mental illness accompanies about fifty percent of all cases. As the link explains, it renders its victims incapable of understanding that they are afflicted, and prompts them to strongly resist doctors’ efforts to medicate them and, in cases of active psychosis, commit them to hospital treatment.

My family is acquainted with anosognosia and its lethal power.

Kevin Powers

Our younger son Kevin almost certainly was a victim of this ride-along predator, and it cost him his life. He accepted psychiatric treatment and medications for most of the three years after he was diagnosed with schizophrenia, yet never acknowledged the disease itself, insisting that it was merely a “condition.” Near the end, after he had been re-diagnosed with schizoaffective disorder he renounced medication of any kind. He hid the pills that we continued to insist he take, and committed suicide just days before his twenty-first birthday.

Kevin’s older brother Dean, stricken a few years after his sibling’s death, has been more fortunate. An enlightened psychiatrist observed Dean’s own resistance to intervention, and turned it to my son’s advantage: In brief, “Report to a clinician for a monthly antipsychotic injection, or be legally hospitalized when the inevitable psychosis erupts.” Dean has taken this carrot/stick choice seriously, and has significantly improved from his psychotic depths.

Abilify® (aripiprazole) 10mg

Now comes medical science (via the pharmaceutical industry) with a product designed to defeat anosognosia. The Food and Drug Administration has approved the digital modification of a popular oral medication, Abilify® (Aripiprazole, manufactured by Bristol-Myers Squibb). As explained in this  New York Times story, each pill will be equipped with a digitalized sensor that can transmit electronic data to doctors and family members, reporting whether and when the patient took the medication.

The device will surely be welcomed by parents who have exhausted themselves begging in vain for their children to accept professional intervention, and watched helplessly as their children have refused, and deteriorated into deep psychosis, and sometimes, as with Kevin, death.

My own instinct (naturally) is to celebrate this promising solution to a scourge that would be called “evil” if there were sentience behind it. Yet reason tells me that celebration is premature.

An obvious roadblock to the product’s success is that those who most need it may not take it. If anosognosia leads SMI sufferers to resist acknowledging their illness, why would it not lead them to reject a medication that treats a “nonexistent” illness? (It should be noted that the digitalized medication will also be marketed to older sufferers of various discomforts who tend to forget taking their meds.)

Another barrier is popular distrust–legitimate distrust, to an overwhelming extent–of Big Pharma itself. The distrust has been earned.

Bristol-Myers Squibb is a part of a massive industry that has recently been rated as the second-most hated in America. (The top pariah varies from website to website.  The far-flung electronic communications industry is often the No. 1 contender, or nolo contenderer.) Pharmaceutical companies raked in a composite global revenue of more than one trillion dollars in 2014. This ongoing bonanza has made them virtually impervious to the restraints of the law. In 2012, for instance, GlaxoSmithKline paid the U.S. Department of Justice three billion dollars in a false-claims settlement, the largest in the long and bloated history of penalties assessed Big Pharma. Bristol-Myers Squibb’s history of producing Abilify® has been tainted with lawsuits: the watchdog organization drugwatch reports that as of September, 365 actions were pending against the company. Most of them charged that Abilify’s® side-effects include compulsive tendencies toward gambling, eating, shopping and sex.

Big Pharma’s excesses are making headline news, and disrupting America’s social fabric, to this very day. The October 30 issue of the New Yorker carries a bold and searing investigative essay by the writer Patrick Radden Keefe. Keefe’s immersive journalism meticulously lays out the chain of greed, recklessness and “ruthless marketing” that led to our present opioid crisis. Keefe trains his sharp lens on the family of multi-generational philanthropists and drug entrepreneurs, the Sackler family, private owners of Purdue Pharma, which has built them a net worth of thirteen billion dollars, and which is responsible for the prescription painkiller OxyContin. OxyContin’s active ingredient, as most people now know (many of them through catastrophic experience) is oxycodone, a chemical similar to heroin.

Oxycodone

Keefe reports that “Since 1999, two hundred thousand Americans have died from overdoses related to OxyContin and other prescription opioids.”

Chapter 15, “Antipsychotics,” in my book NO ONE CARES ABOUT CRAZY PEOPLE, covers the era of Big Pharma from the introduction of Thorazine in 1954 through our present time. The saga is one of proliferating medications, global expansion of companies, almost inconceivable profits, false claims, hidden or downplayed side-effects, and a corporate culture whose manifest amorality was damningly characterized by a former insider, quoted in the chapter, as fulfilling “the criteria for crime in U.S. law.”

Given the details that I have amassed, in this essay and in NO ONE CARES, covering the nearly 70 years of depredations that make up the worst of Big Pharma, it may seem surprising that I do not, out of hand, dismiss the introduction of digitalized Abilify. And the entire universe of antipsychotic pharmaceuticals along with it.

The reason I do not is at once simple and complex: many of them work. Or work for some patients, if not others. Or work in spite of their problematic side effects. Or work until they don’t work. Our vexed universe of care for the seriously mentally ill, even at its best, remains enshrouded in mystery, incomplete science, and human failing.

I believe that until the day that an infallible cure arrives, the advocates of intervention (including conditional support for new products such as digital Abilify, and strong support for laws that ease intervention’s barriers) must acknowledge that we take our stands in a world of risks. Some of the risks we advocate might result in more harm than good, or in harm, period.

But I also believe this: that the biggest risk of all is doing nothing. For this way lies madness.

Demand Justice-Virginia Gave Mentally Ill Teen Two Life Sentences For non-Capital Crime!

Chris Sharikas at a young age started suffering from paranoid schizophrenia and ended up committing a violent crime, a crime where his sentencing guidelines called for a 7 to 11 year sentence.  The state knew that Chris suffered from a mental illness and sent him to a hospital for a short period with the hope that he would become competent to stand trial.  The State returned Chris to Arlington County for sentencing.  The county jail determined that Chris did not need the medications prescribed for his mental condition and decided to use a different approach.  Chris’ mental state deteriorated to the extent that he was no longer capable of showing remorse.  This angered the Judge and he gave Chris maximum sentences.

At a Writ of Habeas Corpus hearing the Judge verbally confirmed the long sentences because he did not believe that Chris could recover from his illness.  As a result Chris is serving multiple life sentences in a system of punishment because he is ill.  Chris who never killed anyone has a longer sentence than the sniper who killed 22 people.

Since when in the United States do we sentence someone to prison simply because they are sick?

Please sign this petition to Governor Terry McAuliffe and ask him to pardon Chris so that he can receive care from a mental health care facility and not suffer a lifetime of punishment because he has a mental illness.

Visit: Change.org

A Father’s Cry From the Heart

Ray Weaver is a singer/songwriter whose daughter is afflicted. With his permission I am reposting his recent message on the private Facebook site CCAC. Never have I seen the many griefs and agonies of a parent expressed so compactly and so bursting with truth.

Ray’s words remind us, among many other things, that far too many Americans remain uneducated about the nature of serious mental illness. It is a genetic brain disease, beyond the control of the sufferer. Yet its effects can be stabilized by medications, therapy, and a loving environment.

Thank you, Ray, and peace to you and to her.

When you have a sick child, there is never a day off. Never. Every day. Waiting for the phone to ring. Trips to the hospital. Fear. Fear. Fear. Sadness. Regret. And yeah, anger. At them. At yourself. At the fucking world. My daughter tried to kill my own mother. Demons. She tried to stab them out to save mom-mom’s life. And so, my own family, my own sisters have washed their hands of her, and, because they cannot understand the sickness, the illness, they have turned their backs on me as well,

I understand. I am not angry.

I am just tired. So very, very tired.

My Interview With Molly O’Brien

While in Providence to give a talk to the powerful advocacy group,  the Mental Health Association of Rhode Island I stopped in for an interview with Molly O’Brien, a young and talented host for the innovative public-affairs webcast GoLocalProv. Here is the clip:

Read the full story here: http://www.golocalprov.com/live/pulitzer-prize-winning-journalist-powers-on-mental-health-in-america

Tyler West is Viciously Assaulted in Jail AGAIN!

Tyler West photo courtesy Kimmy West

I have posted several blogs about the unconscionable jailhouse ordeal of Tyler West, the 18-year-old mental-illness sufferer who has been held in the Muskegon (MI) County Jail since February (!) while awaiting trial on a felony charge of breaking and entering. (He committed this offense early this year, walking into a neighbor’s house and falling asleep on a sofa while in a psychotic state.) Last week Tyler was beaten up by a violent inmate in a cell. It was the second beating he has endured.

Tyler has suffered unthinkably: deprivation of his medications for periods, stints in solitary confinement for no discernable reasons, and the one previous beating by an inmate. I cannot recall a case in which so much punitive state power and so much negligence for well being has ever been visited upon an ill and essentially peaceful young man. His adoptive parents, Dan and Kimberlee West, have held themselves together with remarkable fortitude as they have pleaded again and again for humane treatment and public recognition of Tyler’s torment.

Tyler West photo courtesy Kimmy West

The futility of finding help for Tyler–legal or through mass-media sources–rivals his ordeal itself in surreality. Together with many of you who read this blog, I have alerted media outlets in Michigan and an NPR program dedicated to investigative reporting. I am–we are–met with silence.

Kimberlee West herself updates the story in the message below, which I reprint with permission from the Circle of Comfort and Assistance Community website.

Please read it, and the letter she sent to the Muskegon County sheriff, and follow your conscience.

Wish with all of my being, I had nothing to post. Unfortunately, that is not the case. Our son Tyler was assaulted again, last week in jail. Tomorrow I will email another letter to Sheriff Poulin. Also I will bring forensic psych report into jail medical and to CMH. It is overwhelming. It is hard to carry on, when it has been one fire after another for the last 3 years. So hard to work like this. Ty has had struggles, but, this is a completely different matter. Admire all of you, who have been doing this year after year. This may be a ridiculous question because I already know the answer. How do ya all do it!? Hope one day we will have real choices! We told the sheriff several months prior, “Ty can’t protect himself”. Please do not place him with violent offenders. They are NEVER proactive! They mentioned placing him in security. What does that mean? Isolation!? The last week it has been hard to have a real conversation with Ty. He seems scared. He will barely talk to us. He fears he will be a snitch. Then someone else will get him. We found out during his video visit. We also noticed he had lost weight. Just wanted to reach through that computer and hug him, never letting go. Daddys and Mommys, if your kids and adult children are with you physically, hug them like there is no tomorrow. It is precious to have them near you! Even if you have rough days. Prayers ya all! Ty has a target on his back. Below is the letter to the sheriff. Hope I get it right?

Hello Sheriff Poulin,

We appreciate your quick response last time we emailed.
This is to inform you as of 10-31-2017, Tyler Daniel West,#131395, continues to be in your care at the Muskegon County Jail. We are Dan & Kimberlee West we are his parents, guardians and advocates. Should anything else happen to our son we hold you responsible for the damage/ or loss of life. We seek, for Ty to be moved to the appropriate pod. He was assaulted last week. Tyler is not violent. He has black eye and his neck, snapped back. He does not know how to fight. The last week he has has had a flat affect. Currently he does not feel safe? He is now a target in this unit. He is not street smart.

Sheriff Poulin,

Ty was also, assaulted March 11, 2017. Ty has traumatic brain injury as he has sustained, several serious concussions. Tyler has Healthwest,(CMH) Dan Scanlan is his liason. Ty cannot protect himself, which means he is a danger to himself. Should he not be, in either a disabilities, medical/mental or handicap pod? His previous pod, he was safe. Tyler is autistic, and has a neurocognitive disability. He also has a Serious Mental Illness. He has intrusive auditory command hallucinations. Sensory integration disorder and ADHD. We will also send his recent Psychiatric report, from Dr. Harris. Tyler is only 18.
We thank you for your help and hope you have compassion to do the right thing for Ty.

Cheers,

Dan and Kimberlee West
6712 Northpoint Drive
Fruitport, Michigan 49415

Update on Jack Greene

Greene, whose impending Nov. 9 execution I condemned in my previous post, is likely suffering from one of serious mental illness’s most insidious and common “companion” affflictions, anosognosia. (The term is Greek for lack of insight, and is explained here: http://www.treatmentadvocacycenter.org/key-issues/anosognosia.) I have seen anosognosia at work in both my schizophrenic sons, and can attest that its victims can make very convincing cases that they are “normal”–because that is what they believe. Greene appears to be another example.

The violent mentally ill comprise a small percentage of those afflicted. Yet they are among the most feared and despised of society’s scourges, and many people mistakenly equate schizophrenia with homicidal tendencies. http://depts.washington.edu/mhreport/facts_violence.php Very often, they have descended into a violent state because their brain disease has gone unmedicated, and thus worsened over time.

The Arkansas prison administrators who may soon exercise their power to kill Jack Greene appear to be equally clueless about the general nature of brain diseases such as Greene’s. They are physical genetic flaws that cannot be cured. Their effects can be modified by proper medication. Untreated, their victims lose all power to understand reality or control their actions.

If the November 9 execution goes forward, Jack Greene will die, but the real culprit–the disease that destroyed his reason–will live on, doing unspeakable human damage. It will continue to operate under the cloud of ignorance that still obscures justice for the mentally ill.

Take Action

Please watch the video below to learn more about Mr. Greene and share his story with friends.

Click here to sign the petition to grant mercy to Jack Greene initiated by the Arkansas Coalition to Abolish the Death Penalty.

Arkansas poised to execute man amid fight over mental health
His lawyers want doctors to have a greater say in determining his mental competency.
In this on Oct. 4, 2017, frame grab from video, Arkansas death row inmate Jack Greene appears before the state parole board at a prison in Varner, Ark. Greene is scheduled to die Nov. 9, 2017, but his lawyers are arguing that he is severely mentally
In this on Oct. 4, 2017, frame grab from video, Arkansas death row inmate Jack Greene appears before the state parole board at a prison in Varner, Ark. Greene is scheduled to die Nov. 9, 2017, but his lawyers are arguing that he is severely mentally

via ABC News

Jack Greene’s lawyers say he’s severely mentally ill. The Arkansas death row inmate says they’re lying.

As Greene approaches a Nov. 9 execution date, his lawyers are raising questions about who should determine his mental competency. Arkansas gives considerable weight to its prison director’s opinion in deciding whether a condemned inmate has the mental capacity to understand his execution; Greene’s lawyers want doctors to have a greater say.

“The system is really quite antiquated,” John Williams, an attorney for Greene, said in an interview. “(Prison director) Wendy Kelley is an arm of the state. She doesn’t have the expertise to make that determination.”

Greene was convicted for the 1991 killing Sidney Jethro Burnett after Burnett and his wife accused Greene of arson. At least one court this week will take up Greene’s case.

The inmate hasn’t always made it easy for his attorneys. While pleading for clemency, he told the Arkansas Parole Board this month that his lawyers are wrong to call him “delusional” and that courts have routinely found him competent. He also told the board, “I knew what I was doing to him,” when he tortured Burnett for an hour before shooting him. When a doctor testified that Greene has done headstands during examinations and even in courtrooms, Greene told the panel that he does yoga to remain “functional.”

Williams says the seemingly lucid moments mask severe mental illness.

“A lot of people who are mentally ill don’t think they’re mentally ill,” the lawyer said.

The case has drawn the attention of both the American Bar Association and a collection of 28 mental health professionals, who wrote to Gov. Asa Hutchinson saying it would be “morally and ethically wrong” to execute Greene.

“Mr. Greene’s illness manifests itself in extreme physical contortions, in self-mutilation, and in delusional beliefs he holds about a conspiracy against him between his attorneys and prison officials,” the mental health professionals wrote.

Greene stood throughout his Oct. 4 appearance before the Parole Board, fidgeting and fumbling through documents that, he says, promised him a transfer to his home state North Carolina, where authorities say he killed a brother days before killing Burnett. Bloodied, rolled up strands of tissue stuck out of both ears and his left nostril; his lawyers say that is a symptom of Greene’s mental illness.

“If I could go back to North Carolina and get medical treatment, that would be great, but if not, let’s come on with this execution,” he told the panel.

Williams says Greene believes he’s being executed because he uncovered a purported (and to Greene, successful) conspiracy among guards and lawyers to torture the inmate and dissolve his central nervous system and spinal column.

“He thinks that the Department of Correction cannot send him back to North Carolina because he knows too much about what has happened to him in prison,” Williams said. “They won’t send him back to North Carolina, so they have to execute him.”

Baloney, state lawyers say. North Carolina sent Greene to Arkansas for his murder trial on the condition that he would be returned if he received any sentence other than the death penalty. Greene knows a transfer is a lifeline, Assistant Attorney General Kathryn Henry said.

The governor said Friday that he was still reviewing Greene’s file after Parole Board members recommended that he not spare the inmate’s life.

Greene’s execution would be Arkansas’ first since it put four men to death in an eight-day period in April.

http://abcnews.go.com/US/wireStory/arkansas-poised-execute-man-amid-fight-mental-health-50794313

An Insane Consequence, and a Monstrous Violation-in-Progress

Unless a national petition sponsored by an Arkansas social-justice group succeeds (see the bottom of this blog), the life of a hopelessly insane man will be extinguished by the Arkansas Department of Corrections on November 9, less than two weeks away at this writing.

Jack Greene was convicted of murder in 1991. Greene’s lifelong history of suffering abuse, organic brain damage, psychotic disorder, and intellectual impairment amount to traditional grounds for being spared the death penalty. That history cries out for psychiatric attention and, yes, perhaps lifelong confinement. But not death. Yet, as this essay by Jessica Brand of Injustice Today reveals, Greene’s legal representation has been spectacularly clueless and negligent. The jury in his capital murder trial never received evidence of the manifold damages to his brain.

Jack Greene is the embodiment of what can (and often does) happen when a state criminal-justice system loses its fundamental sense of justice. But he is also a maimed human being who does not deserve to die for the violence impelled by a deformed brain.

Please sign the petition below, and repost this–and help in the effort to ward off what Brand rightly calls “a stain on our country’s moral conscience.”

Commentary: “It Is So Loud Inside My Head”
The words of a mentally ill man the state of Arkansas hopes to execute on November 9th

via Injustice Today

Photo: Arkansas Department of Correction
Photo: Arkansas Department of Correction

It is so loud inside my head. It feels like electrical impulses are going through my head all the time. If you took that pen and tapped it on the table I can feel it all the way down my spinal column. It is so loud inside my head.”

Those are Jack Greene’s words. He is the 62-year-old man that the state of Arkansas hopes to execute on November 9th for the 1991 killing of Sidney Burnett. Greene suffers from crippling psychiatric deficits, a possible intellectual disability, and a mental illness so severe that there are questions about his competency. He received such grossly inadequate representation at trial that the jury that sentenced him to death never heard of his devastating mental illness — a refrain all too familiar in capital cases. The state is aware of the glaring problems in Greene’s case, but it still hopes to execute him next month.

Greene, for example, regularly stuffs his ears and nose with paper “to alleviateperceived (but delusional) injuries.” Sometimes he intentionally causes his nose to bleed, and guards discover his face covered with blood. He eats out of his sink; his toilet is his desk. He thinks his central nervous system is totally destroyed, caused by, in his words,

[t]he prolong and repeated injuries on me . . . by staff of the Ark. Dept. of Corrections with the deliberate permanent destruction of such vital bodily functioning organs that’s caused injuries so severe and traumaticly [sic] inflicted to my brain, head, left inner ear, etc. . . . for all of which is so painfully torturing and inhumane I can no longer humanly function properly and live with.

He believes that his ex-attorney, the prison warden, a nurse, and a prison guard have conspired together (in that “chronological order”) to destroy “these vital functioning organs,” and that they are also preventing him from being extradited to North Carolina, where he could receive adequate medical care. He thinks his looming execution is part of this conspiracy.

Doctors believe Greene has organic brain damage. He has had a serious head injury in the past, and neuropsychological testing reveals damage to his frontal lobes. Several experts who have examined him have diagnosed him with a psychotic disorder, and his current lawyers are certain he is not competent to be executed. He also might be intellectually disabled, a status that, like incompetence, would render him categorically ineligible for the death penalty.

Then there is the trauma and the familial mental illness visible in many of Greene’s relatives. Greene’s father killed himself when Greene was an infant. His mother would later overdose on pain pills, and his brother later shot himself. Greene’s grandfather physically abused him and his siblings, sometimes rubbing salt in the wounds he caused. Greene lived in a house with no running water, electricity, or plumbing. At eleven, his grandfather handed him over to a notorious state-run training school for boys. While there, Greene was sexually and physically abused.

The evidence described above is the type that often causes juries to spare someone’s life, according to the findings of the Capital Jury Project. But at Greene’s sentencing trial, his attorney did not put on a mental-health expert and he presented no other mental-health evidence, although the signs of his illness were readily apparent. Instead, to convince the jury to spare Greene’s life, his lawyer presented a measly 46 pages of testimony, 33 of which were read from a cold, emotionless, transcript from a prior proceeding.

What happened next is equally disturbing. During post-conviction proceedings, an expert found that Greene might be intellectually disabled but stated that he needed to do additional testing to confirm. Greene, insistent that his lawyers were conspiring to torture him, asked the district court to withdraw the claim. He accused the Federal Defender’s Office of “making [him] out to be some kind of incompetent retard to get their office appointed to [his] case and try and cover up crimes of inhumane injuries maim and torture.” The judge found Greene competent to abandon this potentially life-saving claim and withdrew it. No court has ever heard it.

Perhaps the most shocking thing in Mr. Greene’s case is that, with a little more than two weeks until the scheduled execution, he has yet to receive a hearing to determine whether he is competent for execution under U.S. Supreme Court precedent that bars the execution of persons who lack a rational understanding of the punishment they are to receive. Arkansas’s unusual statute gives the Director of the Department of Correction sole discretion in making competency determinations. This means that the same person who is in charge of carrying out Mr. Greene’s execution also gets to determine –without a fair and independent court hearing — if he is competent for execution.

If the state has its way, Jack Greene will join a group of four other men executed by Arkansas in 2017, a group that to a man suffered from the most debilitating illnesses and trauma and received the worst lawyers. Ledell Lee, who might have been intellectually disabled, had lawyers who tried to withdraw from his case, citing a “gross [ethical] conflict,” a drunk lawyer, a mentally ill lawyer, but never, until it was too late, a competent lawyer. Marcel Wayne Williams had a mother who pimped him out for sex at ten and who tortured him by pouring boiling water on him and covering him with tar; Kenneth Williams may well have been intellectually disabled; and Jack Jones suffered from extreme physical abuse, was brutally raped by strangers, and suffered from bipolar disorder. Juries never heard these stories because of ineffective lawyering.

What is happening in Arkansas is a stain on our country’s moral conscience. Under the Eighth Amendment, the death penalty is supposed to be reserved for the worst of the worst, society’s most culpable. The prosecutors’ continued push for death in the face of severe illness and trauma, never heard about by juries, flouts that constitutional promise. And each time a court allows a state to carry out the harshest of punishments on the most impaired and least represented, it mocks the promise of justice. Will a court finally recognize this reality and intervene? Or will Greene become another tragedy in a system that is completely and utterly broken?

Take Action

Please watch the video below to learn more about Mr. Greene and share his story with friends.

Click here to sign the petition to grant mercy to Jack Greene initiated by the Arkansas Coalition to Abolish the Death Penalty.

The (Continuing) Education of a White Writer Regarding Black Americans and Mental Illness

This post is for two of the best women I know, the New York actor and activist Madeline McCray and her close friend Terrie M. Williams, the author of BLACK PAIN: IT JUST LOOKS LIKE WE’RE NOT HURTING.  

Terrie Williams and Madeline McCray

Madeline and Terrie, you tried to put me wise to the special challenges of African-Americans who suffer from mental illness. You reached out to me as I began research on NO ONE CARES ABOUT CRAZY PEOPLE.

You provided me with sources. You tried to educate me. I promised you that I would look deeply into this topic in my book. But in the end, I did not look deeply enough.

Recognition of this truth arrived, appropriately enough, on Mental Health Day, October 10. It arrived in the form of a young woman in Cleveland, an African-American service-staff employee at the Intercontinental Hotel. It arrived just minutes after I’d finished addressing an exemplary civic group on—well, on the topic of education. Education about mental illness. How important this kind of education is.

(from left) David E. Weiss, board chairman; Honoree Fleming; Ron Powers; Elizabeth Newman, president and CEO at The Centers for Families and Children Benefit Luncheon 2017.

It took a three-minute conversation with this soft-spoken young woman to make me realize that my own education has been incomplete.

This is a rich irony—or a well-deserved comeuppance, depending on your point of view. I wrote NO ONE CARES essentially as an effort at education. After schizophrenia invaded my family and attacked both my sons, triggering the suicide of one of them, my wife and I realized that we’d become citizens of a “sub-nation”: the largely opaque nation of the afflicted and their families. Years later, when I recovered my willpower, I decided to write the book as an attempt to widen public understanding (and my own) about the nature and the reach of serious mental illness. That, and to illuminate the gross deficiencies in the American systems of mental health-care, criminal justice, and political willpower in addressing the problem.

As I’d hoped, writing the book educated me—but incompletely, as I now understand.

It is not as though the book ignores the particular ordeal of mentally ill black Americans. At least the public symptoms of that ordeal. It covers the epidemic of fatal shootings, by police, of unarmed and psychotic black men on the street. It portrays the overcrowding of the nation’s jails by juveniles, mostly black, who have been charged with crimes but not yet tried; and the violence visited on them by wardens and guards.

All of this is important. Yet in merely evoking these familiar abuses, I failed to cross an elusive border: the border that defines the daily realities of a sub-nation within a sub-nation. The lives of African-Americans struggling with mental illness amounts to unknown territory—unknown, at least, to most white Americans, of which I am one.

Ron Powers – keynote speaker at The Centers for Families and Children Annual Benefit Luncheon

I was ushered across that border in Cleveland on Mental Health Day.

My guide, the young service staff member, approached me just minutes after I had finished speaking at the annual luncheon of the Centers for Families and Children at the Intercontinental. (I am withholding her name. It’s a sad possibility that in these hair-trigger times, her employment could be jeopardized by the very fact that she spoke up to me about a racially charged public issue.)

Woodlawn Avenue, East Cleveland

The Centers deserves a moment of illumination here. It is a sterling civic institution. A nonprofit with an annual budget of $55 million, it reaches out to the poor, the hungry, the under-educated, the sick, and the troubled—some twenty-five thousand clients—in a city striving to overcome chronic post-industrial poverty entrenched racial tensions. The racial stress is burned into the city’s history along lines of segregation in its housing patterns: most of its black and poor population is concentrated in the near East Side, and most of its white population farther west. Cleveland’s incidents of fatal police gunplay in recent years, highlighted by the shooting of the 12-year-old Tamir Rice in 2014, have deepened black Cleveland’s distrust, bordering on paranoia, toward the mostly white police department.

David E. Weiss

Amidst these overwhelming challenges of poverty and racial unease, the Centers for Families and Children persists as a national model of enlightened civic service and hope. Its board chairman, the lawyer and businessman David E. Weiss, ranks among the most socially engaged civic leaders in the country. Its new director, Elizabeth Newman, has re-ignited its six hundred volunteers with her own passionate sense of mission: to help people find job opportunities and early-education conduits for their children, provide food for hungry families, dispatch pharmacists to households to help manage nutrition and medications, find treatment for substance abuse, and summon emergency services in crisis situations.

And to co-ordinate intervention and help in the crises of the mentally ill. Elizabeth Newman explained this cornerstone service to me in detail:

Elizabeth Newman

“The Centers is equipped to support people with serious mental illness, this skill set actually sets us apart in the community. We routinely assist people living with schizophrenia. We have psychiatrists on staff, in addition to relationships with the local/regional hospital systems and emergency rooms. In terms of onset of psychosis, we are outpatient providers but work in partnership with inpatient providers, so it really depends on the level of severity.  Another agency in town runs the mobile crisis unit, but we receive referrals and connections to clients directly from that unit.”

Which brings me (in my round-about way) to the topic of this blog.

Ron Powers

As mentioned, I had completed my remarks and was standing amidst the departing luncheon attendees when she emerged from the mix of people. She wore the brown uniform of the hotel’s service corps, and her manner was hesitant; yet it was clear that she had something she wanted to say.

What she said was, “Thank you for speaking about schizophrenia.”

I sensed the urgency behind this polite comment and asked her: “Is there a history in your family?”

She hesitated for a moment, as if trying to decide whether she could trust me with an answer, and then:

“My mother. And my brother.”

There is no way to prepare for a response like this, no matter how much you expect it, no matter how often it comes. One rule of thumb is to avoid “condolences.”

I asked her the only questions that seem fitting, and necessary:

“Are they getting treatment? Are they on medications?”

She smiled just a little before answering; and the smile should have told me everything I needed to know. But she spelled it out anyway.

“Black folks don’t like to get treatment. Black folks see it as a white man’s disease.”

While I was digesting this, she added: “Black men don’t like to talk about mental illness. They see it as a sign of weakness.”

And then, as if recognizing the need to explain the obvious to a blockhead (accurate, I suppose, in this instance): “So, no. They aren’t getting any treatment.”

And there it was: a key to the inner realities of a sub-sub-nation. The culturally learned set of attitudes that makes it all the harder for doctors and psychiatrists to intervene in the mental-illness crises of African-Americans. African-American men in particular, who routinely suffer violations of their self-respect, their safety, their very humanity, at the hands (and guns) of those who view them as inherently alien, dangerous, unworthy of inclusion in society.

Which, when you think about it, is exactly the same way that many people view the mentally ill in general.

 

I left the Intercontinental Hotel in Cleveland as the educated educator. I thought of my friends Madeline McCray and Terrie Williams, and about the exasperation they must have felt at my failure to cross that border. Felt silently, without rebuke, in the way many African-Americans experience the myopia of their white friends.

Back home, I sought to verify the viewpoint of the young service-worker at the Intercontinental in Cleveland. Below are some samples of what I came up with. There are more, many more, as a Google search of “African Americans mental illness” will show.

–That African Americans are 20 percent more likely to experience serious mental health problems than the general population, owing in part to the exceptional stress they experience just living their lives. The problems include major depression, attention deficit hyperactivity disorder, recourse to suicide, and post-traumatic stress disorder (this last because African Americans are especially likely to be victims of violent crime).

–That many black Americans misunderstand what a mental health condition is and don’t talk about it. Many thus believe that a mental health condition is a personal weakness punishment from God.

–That stigma—which knows no color lines—triggers especial reluctance among African Americans to discuss mental health issues and seek treatment.

–That a pervasive deficit of information—education—causes many African Americans to have trouble recognizing the symptoms of mental illness and to underestimating its dangers. Some may think of depression as “the blues” “or something to snap out of.”

(The above examples are taken from https://www.nami.org/Find-Support/Diverse-Communities/African-Americans)

–That black Americans’ distrust of doctors has some factual justification: Blacks are “over-diagnosed with schizophrenia, frequently misunderstood by their psychiatrists, and largely disenfranchised,” in the opinion of William B. Lawson, the distinguished African-American professor and chair of psychiatry at the Howard University College of Medicine. (https://www.medscape.com/viewarticle/768391#vp_2)

 

A Closing Thought

This has been far from an easy blog entry for me to write. No one likes to own up to failures of understanding, especially in the fraught arena of of racial relations. As with NO ONE CARES ABOUT CRAZY PEOPLE itself, I at first resisted writing it at all. Then I decided I had to write it because it was the truth. I hope that it is read with an understanding that writers are often fallible—just like ordinary people.

________

The full recording of the interview with Elizabeth Newman and Ron Powers is available here: http://www.ideastream.org/programs/sound-of-ideas/finding-the-cure-for-aids-book-no-one-cares-about-crazy-people.

Additional coverage of the Luncheon in The Plain Dealer, the daily newspaper for Cleveland: http://www.cleveland.com/healthfit/index.ssf/2017/10/putting_a_renewed_focus_on_men.html

Is the Tide Starting to Turn in the Battle for Mental Healthcare Reform?

“This is not the end. It is not even the beginning of the end. but it is, perhaps, the end of the beginning.”

These were Winston Churchill’s words to the British people after General Montgomery’s forces turned back the formidable German army under General Rommel at Alamein in November 1942.

Readers of this blog know that I see our present struggle to eradicate the terrible abuses of mentally ill people in terms of a war: a war against entrenched ignorance, apathy, denial, and abject cruelty within the institutions that exist to protect all citizens, especially the most helpless. Too many caregivers, jail wardens, and state governments (among others) remain clueless or unwilling to reform the atrocities that they perpetuate.

And yet hope endures. It is important to amplify and celebrate any example of enlightened hope overcoming dark chaos.

Here are three stories, linked below, that offer hope.

The first covers the efforts of lawyers in Illinois, representing a total of 12,000 mentally ill patients, demanding from a federal judge that Illinois face up to its “state of emergency” in Illinois prisons and move to eradicate poor psychiatric care amounting to “cruel and unusual punishment.” https://goo.gl/yaSvtq

The second addresses a barbaric practice that is near the top of my personal list for drastic action, solitary confinement. Written by the executive director of the Colorado department of corrections, it explains why the state recently ended the practice of long-term solitary confinement for prisoners. Colorado now limits stays in solitary to fifteen days. In my opinion, that is fifteen days too long; but it is a significant improvement over the state’s average length of two and a half years “and sometimes for decades.” https://goo.gl/c6SqTf

 

Elizabeth Newman, President and CEO of The Centers for Families and Children

The third focuses on the Centers for Families and Children in Cleveland, a nonprofit group that has existed for years but has accelerated dramatically in its outreach under its young new executive director, Elizabeth Newman. I visited the Centers on Tuesday to give a talk at their annual luncheon. My typic skepticism burned away as I experienced the Centers’ zeal, the intelligence, and the broad scope of outreach, exemplified by the remarkable Ms. Newman. I will return to the topic of the Centers in an upcoming blog. https://goo.gl/Jczmsk

For now, let us celebrate what may be the end of the beginning.