Please carve out a few minutes and listen to these powerful, articulate advocates discuss the most overlooked social and moral blight of our time.
You can find Debbi Anderson’s wrenching cry from the heart farther down this post. I have left the two parts exactly as I found them on a private Facebook discussion site. They are long and messy. That’s the thing about mental-illness narratives. They don’t clean up well. They shouldn’t clean up well. “Polishing” them, “editing them down,” “trimming” out “wordiness,” “sprucing up” bad diction—these are forms of murder within this genre. This kind of sanitizing leaches out the violated humanity in the original words. It distills the raw passion down to journalese.
And that is a core problem with writing about mental-health issues, whether quoting from a frantic mother or composing expository prose about the nature of brain disease: it comes out either too long or too sterile.
Here I am going to risk both the former and the latter. I’m going to give you the context of Debbi’s two messages. (There is some repetition.) And then I am going to turn things over to Debbi, who has given me her permission. In a later post, I will examine some of the public-policy roadblocks to relief for her and her stricken son.
Set aside some time. But please try to read every word of Debbi’s stream-of-consciousness burst of despair. At a minimum, it will (re-)introduce you to a world that most people shrink from even thinking about. If a miracle occurs, it might infuriate you into joining the ranks of the reform advocates.
Debbi Anderson is a working-class woman who lives in Wichita, Kansas. Her son Devin has spent 18 of his 36 years in a fog of severe schizophrenia, and the voices in his head have driven him again and again to the streets (see the “missing” poster link below), to addiction, to jail, and to at least ten suicide attempts: “dangerous” behavior. Dangerous “to himself and others,” as the bloodless bureaucratic bromide has it.
Debbie, whose photographs show a blonde woman with large, penetrating eyes, has stood with her son all this time, tortured with worry as he has shuttled in and out of “care centers”—another bloodless bromide. (Some work well; others—well, read Debbi.) She has divorced his father and remarried, to a man who means well for Devin yet understandably lacks a clue as to how to maintain a bond of trust with him.
Things have hit rock bottom. Devin has been evicted from his latest hovel, a “rat drug infested apartment” in Debbi’s description, that his latest caseworker found for him. Why? Because he is uncontrollable. He is uncontrollable because the voices in his head ordered him to go off the stabilizing medication that once worked for him. The bloodless bureaucratic bromide-term for this condition is “anosognosia”—lack of insight. The bedraggled bailiwicks of American mental healthcare are suffocated under bureaucratic jargon and acronyms. And this is probably one big reason that no one cares about crazy people.
Here is Debbi:
I have attempted to post something about three times on here and every time I deleted it! I have ADHD, so if I jump around on here you’ll know why LOL I feel like you need to know that before you read this! My son was diagnosed with schizophrenia at the age of 18 is 36 now most of my family was worried about what the neighbors would think! My mother was extremely ￼narcissistic ￼ so I know I get no support there! It has been 18 ￼years of hell! he has a severe case! When he was diagnosed I was relieved in a sense I could finally put a name to what was attacking my son!! But I went from saving him from himself to having a gun pulled on me trying to get him out of a motel I was young and stupid back then that isn’t gonna happen again! but phone calls at night needing a ride because got beat up dont know how many times going out on the streets panhandling staying in the worst dirt bag place you could find. He had at least 10 suicide attempts when he goes off his medication the voices just torture him! Constantly went missing here in Wichita Kansas and then got so delusional and manic he thought that $.50 the rapper stole his lyrics He tried three times to make it to California and the third time’s a charm! Made it to California went missing for over a year. I searched every day it was hell! I was not sleeping throwing up malnutrition losing my hair (I’m sure some of you have been thru this!) After the year was up my mind was taking over like it was trying to prepare me for that awful phone call or knock on the door we all dread! And then a phone call came in, from a hospital in south-central LA it was my son finally someone called me and asked me if I had a son named DEVIN! How he ever survived that i’ll never understand it had to be a God thing! He wanted to stay there! So in order for me to get the help that he so desperately needed I had to give up my rights so we could be a ward of California by the way one of the hardest decisions I ever had to make doing that! He started the revolving door in California just like he did here in Wichita Hospital group home run away hospital group home you know the routine for years and until he met a doctor that really helped him! Who would’ve thought an old-school drug like haladol would help him so much one shot monthly XR! So he’s in the same group home for quite a while he started making phone calls to me back home in Kansas and he sounded more like MY SON!! than ever since the day he was diagnosed!!! Still had attitude problems but nothing like it used to be not going out on the streets and doing God knows what and doing things that I wish I never new about! He was somewhat stable so he decided he wanted to come back home! Everybody else was thrilled I was scared don’t get me wrong I miss him so much! But the thought of having him back here in my face and going through hell again I wanted to believe that everything was gonna be OK so desperately! deep down inside I knew it wouldn’t be! I have been with an amazing man going on eight years he is my support system he is my world he just could not understand why I wasn’t so excited I felt guilty don’t get me wrong I want to see him so bad I really missed him it had been over seven years since I saw my son! so I set up a meeting with his group home and we had a plan the team met and we had an exit strategy I laid down my boundaries and my rules you know nothing too terrible no drinking in my house and no drugging and you will let me know where you’re at! Because I have worried enough through the years to last one person 20 lifetimes! But the first several months went really well I’ve bonded with my son since the first time he’s been diagnosed we were getting close he still had some issues but like I said nothing like before! Then when he got comfortable back home he started getting Like he had ants in his pants!
When ever he had money in his pocket the streets with Would call him! countless nights talking him out of using drugs the voices telling him to stop taking his shot then he meets a girl that’s an alcoholic and all goes downhill from there starts taking off I have no clue where is that then he decided to ask his case worker for an apartment and they put him in the most rat drug infested apartment they could find he got evicted because he can’t even take care of himself he’s so delusional because he’s been off of his shot for quite some time now which should’ve already been in the case file at the mental health place that he goes through I know there’s like a huge file on him but nobody bothers to look at that it’s already been proven he can’t live alone he can’t shower now he doesn’t even know he needs to! he barely eats! out on the streets living homeless panhandling for money and doing other things on the streets I don’t even want to talk about they are so horrible! This is what happens when the voices told MY SON not to take his monthly shot The mental health services here has told me they’re going to quit him if he doesn’t make contact with them and work on his goals. My son is out of his mind right now! he doesn’t even believe I’m his mother! How can an irrational person do what their supposed to do?!
I need help before the suicide attempts start again! By the way I am off his release so that makes it twice as hard! I know that we all have different issues and that we’re all on different levels my son is on an extreme level right now he’s very sick! He puts himself in the most dangerous situation he can find! I call that a danger to yourself I still can’t get him hospitalized! He’s been back for a year and a half and stayed on his medication for probably half the year since he came back and he’s only been hospitalized twice and never got to stay they sent him home and he was still delusional well they didn’t send him home they dumped him off at a shelter!! The system is so broken they have nothing to protect our severely mentally ill!!
Yes! I was on the website today advocates for the mentally ill on Facebook and I read the blog with the sister that had a mentally ill brother and when I read it it was like I was reading about my sons life! I posted on there several times about my son and I think you even commented on one of the posts my son is 36 he was diagnosed with severe schizophrenia When he barely turned 18 so I have been doing with this hell for 18 years! When I read that she said she’s been doing this for 33 years i was like oh my god that’s gonna be me! I have been told has been the worst case of voices a doctor in California told me that several years ago! I’m from Wichita Kansas and my son was delusional and off meds several years ago thought the rapper 50cents stole his lyrics, so he tried three times to make it to California It scares me to think what he would’ve done if he did find him he was missing for over a year I searched every day he was found over a year later in south-central LA how he made it that long alive I will never know!! so anyway he decided he wanted to stay in California which they have a better mental health system than Kansas and more funding for the mentally ill so he stayed there a few years and decided he wanted to come back home because he was stable finally found medication that would work Every month he is supposed to take a shot of haldol XR it is The most lucid I have ever seen my son! But eventually those damn take over and they tell him not to take the medication! We have done revolving door run away , state hospital group home Rinse and repeat! you know throw in a couple jail times in there! I have spent his entire life practically saving him from himself I have had a gun pulled at my head shot at trying to get him out of a dangerous situation with gang members! Did that when was when I was young and stupid LOL that won’t happen again! I’m just blown away he got that far Wichita Kansas to south-central LA On Greyhound bus But he was manic and full of energy as he’s gotten older his illness so much worse! Attempted Suicide at least 10 times he gets off his meds for a long period of time voices are going to take over and literally torture him he will shoot anything in his veins there any kind of drug because he’s convinced it makes the voices go away when in reality it makes it amplified! He has a CaseWorker I’m not on any release he refuses to sign it! Years ago I wouldn’t be able to get him talked into going to the hospital as he’s gotten older he acts like I’m not his mom and he literally tells me you’re not my mom I don’t know who you are he doesn’t know who I am he’s so far gone he told my daughter the other day several months ago that he was an alien and he can’t ever take a shirt off because he has a hoses all over his body! He says he doesn’t even know his name he said he is black when reality he’s white The Services here we have for him are horrible They been just been letting him fend for himself he has met criteria for a danger to himself several times over but here it’s not actually trying to commit suicide they don’t think it’s a danger to himself when in reality he’s doing a slow methodical suicide he doesn’t care if he lives or dies! If he was walking down the street and there was a bunch of mean guys with guns and on the other side it was a bunch of nuns wanting to help him he would go over to the bad guys with them every time! Straight now he doesn’t shower and clean he was living in filth downstairs to meet her but he left the door unlocked one day and it was ungodly the mental health passivity here in Kansas has hardly any funding so they find a cheap drug infested apartment the last place in today well he got evicted there and now he’s on the streets hustling money running around with murderers prostitutes and drug dealers They all take advantage of him he won’t let any of us near him he runs from a course I am like the devil because I’m the one that wants to get him help when you’re that ill anyone who wants to get him help is the enemy! It’s heartbreaking he gets worse every day anyway there’s so much more but I’ll stop there I know it’s rambling and confusing I’m sorry also that’s why I want to him on the shot because he wouldn’t take his regular tablets but now he won’t even show up to get a shot it’s time for his shot this month again he has not been on it for four or 5 months The voices in his head Literally torture him! If he stays off his meds for too long he starts contemplating suicide! it’s been 18 years of hell! But I’ll never give up! The mental health care facility here where his caseworker is told me yesterday that if my son doesn’t start taking his medication and working towards his goals and if he doesn’t stop missing all his appointments they were going to take him ofc there caseload and he will no longer be a part of their agency they are worried about liability because he’s out there on the streets if something happened! unbelievable! I am so upset about that it seems like the more severe they get the worse they’re treated legally community wise and everything else! No so he can’t think rational how would he even know to go to his appointments he doesn’t even think I’m his mom! So tired of everyone thinking that they’re capable of talking or thinking rationally at this point! Thank you again for letting me share it’s good to get the stuff out of me I cry a lot I feel so defeated!
If you follow this blog, you know that I’ve written many times about the tragedy of Mark Rippee of Vacaville, CA. Here is a powerful essay by one of his two indefatigable sisters, written in May 2020 and reposted by her today, that says it all, and better than I have: https://www.catsvisions.org/post/no-apologies-by-catherine-j-rippee-hanson
Yes: I did.
I cited this barbaric penalty in my previous blog post, which was a plea for Ashley Biden to join her father’s Administration and co-ordinate federal policy regarding mental healthcare reform. Solitary confinement in our jails is one of the scourges that most needs reforming–obliterating, actually–if we are to call ourselves civilized. Solitary works horrors on the human brain. It drives mentally ill prisoners deeper into madness, and can afflict the sanity of those who have not shown symptoms of brain disease. And it does no good whatsoever–corrective, societal, or moral. That is the widespread theory. Here is the latest glimpse of the widespread practice.
The ravages of mental illness continue to flood every corner of society. Coverage of this atrocity has improved in quantity and sophistication in the last quarter-century–but to what end? Policy-makers, law enforcement and public opinion remain largely indifferent to meaningful education and reform. Mis-diagnoses, non-diagnoses, incarceration, hospital indifference, and violent deaths of people in psychosis surge on, gathering speed. And no one is at the wheel.
This strongly observed and written story by Hannah Dreier of The Washington Post throws light into an especially neglected precinct: Poor black families, and the mentally afflicted children within those families. It provides a glimpse of the day-to-day crises of a divorced Black mother, Kelli, and her two sons–one of whom, the 11-year-old Ahav, is diagnosed with schizophrenia.
You may read Dreier’s piece as simply a searing journey into the wilderness of one family’s mental-illness misery, and of the heroic efforts of Kelli to keep Ahav safe. A closer reading reveals a miasma of bureaucratic obstacles, therapeutic failure, option-choking poverty, and the constant dread of trigger-happy law enforcement that imprison tens of thousands of families such as Kelli’s in the rusted chains of our failed mental healthcare system.
Not really. It has quietly infiltrated and normalized aberrant public behavior in our deranged national landscape.
It is now front and center in the streets.
And in the ravings of pre-eminent news personalities.
In the 1960s the breakaway Scottish mystic/psychiatrist R. D. Laing was prominent among many emerging voices proclaiming that mental illness does not exist. His aphorisms such as “Insanity [is] a perfectly rational adjustment to an insane world” and “Madness need not be all breakdown. It may also be break-through . . . ” made him a charismatic figure among the counter-culture. His work placed him in the company of the greatest denier of them all, Thomas Szasz, whose 1961 book, The Myth of Mental Illness, crippled the status of psychiatry for generations.
In that time, neuroscientists and psychiatrists worked patiently to rebuild the legitimate acceptance of mental illness and its destructive properties. Breakthrough advances in microcomputer technology established, for instance, that schizophrenia is a genuine disease of the human brain, and not just a synonym for “nut job”: it leaves lesions–tiny traces–in the brain; its clusters of flawed genes are genetically inherited and, to date, incurable.
Yet even as science (that fake mumbo-jumbo!) has steadily clarified the properties of mental illness at the top levels of discourse on the subject, its work is being rapidly undermined again where it counts: in the chaotic maw of popular culture, where malign ideology, semi-literacy, and poisonous cynicism threaten to nullify reason. Including reasoning about unreason.
Thus when the ineffable birdbrain Ann Coulter tweet-tweets, as she did on August 27, that she wants the deranged teenaged lethal shooter Kyle Rittenhouse to be her president (above), we may think of her as the hideous drum majorette at the head of a long malign parade, marching directly toward a new Dark Age.
. . . And perhaps more than a year before reviews of the Linden Cameron shooting by Salt Lake City police are completed. (Linden, a 13-year-old victim of Asperger’s syndrome, absorbed eleven bullets from a policeman’s service pistol on the night of Sept. 4, yet survived and remains in serious condition.)
The link below, to the latest update on Linden’s story, discusses this likelihood. The story was reported and written by Heidi Hatch and Mackenzie Ryan of KJZZ television in Salt Lake City.
Months. Perhaps more than a year.
Months? Why months?!
Mundane reasons. Case backlogs. Scant resources to investigate them. That sort of thing. Since January of 2011, the Salt Lake City area has seen one hundred four shootings by police. Of these, only eight have been ruled “unjustified”–a fair microcosm of the national picture. Charges were filed in just three of the eight “unjustified” shootings, Hatch and Ryan report.
All three of those cases were dismissed.
Nine other unreviewed cases are piled on top of Linden Cameron’s.
And so Linden and his mother Golda Barton will wait. And wait. And wait. The state of waiting and its attendant stress, for one bureaucratic reason or another, is familiar to thousands of families trying to safeguard a mentally ill loved one, or to seek justice for that victim.
Below my September 22 blog on Linden’s case, a reader posted: “I will wait to see all the evidence.” I respect this reader’s sense of fairness. Yet we may never “see all the evidence.” That blog included a murky 36-second excerpt of body-cam recording released by the Salt Lake City police department. It shows a wandering pool of harsh light (presumably the camera light) surrounded by darkness. Linden can be glimpsed walking away from the camera before he disappears into the dark. We hear gunshots when the pool of light finds him again, he is writhing on the sidewalk. Then he turns over onto his left side and stops moving. We can hear him say,
“I don’t feel good. Tell Mom I love her.”
The body-cam footage below apparently covers the full length of the police video. It lasts 1 minute 40 seconds, some of the extra length showing police leaving their patrol car and yelling at Linden before the gunfire. It was posted on YouTube by the website RAW.
This footage also shows that Linden broke into a run after walking a few paces. The police pursue him in a 45-second footrace, yelling for him to “Get on the ground.” Then the shots and the boy’s moaning voice as he lies wounded on the sidewalk.
And that’s about it.
So: Linden Cameron and his mother, not to mention the police officers involved, probably will have to wait for up to a year, and maybe longer, before the investigative bureaucracy gets around to this case.
The great 19th-century British prime minister William Gladstone is credited with the maxim, “Justice delayed is justice denied.” Gladstone should have stuck around.
In a year’s time, pending investigations often lose their initial urgency. Public opinion and news coverage dissipate. The indignation of civic leaders cools. The cop shooting of a mentally ill boy, which initially drew international attention, grows stale in the files. The investigative bodies–in this case, they include an outside police department and the Salt Lake City department as well–tend to lose whatever incentive they may have had to render judgment against their own. The Linden Cameron case becomes something of an abstraction. Besides, it was dark. The camera dances around. Who, really, can say what happened? (Who, really, by this time, cares?)
“I will wait to see all the evidence.” A reasonable and honorable suspension of judgment.
Bring a book of crossword puzzles or something.
I almost wrote, “the mentally ill people of America lost a hero on Sunday,” but that would not have been nearly adequate to contain this giant’s significance to our country.
Dj Jaffe, who succumbed to leukemia and other cancers at age 65 after stoically battling them for fifteen years, was a human beacon of hope and guidance and enlightenment to those who suffered from chronic brain diseases (“chronic” meaning genetically inherited and incurable). And to their caretaking relatives, mostly mothers, in practice; to their often overmatched doctors and therapists; to uninformed policymakers and corrections officers.
Dj was among the three most influential advocates for the mentally ill in the brief history of that calling, along with the author and blogger Pete Earley and the pioneering statesman of advocacy, E. Fuller Torrey, author of many books and the founder of the Treatment Advocacy Center. The TAC website is the largest, most diverse compendium of m.i. information online.
Dj Jaffe was a skinny force of nature the likes of which the cautious mental healthcare world had never seen, and not everyone liked him. He walked away from an obscure career in advertising after the sister of his wife, Rose, was stricken with mental illness thirty years ago. Razor-sharp and pugnacious when he had to be, he transformed himself into an expert on the nosology, neuroscience, politics and policy issues surrounding the disease. Wearing his unrepentant bluejeans, ponytail, and oversize glasses (and a wrinkled suit when he had to), Dj mastered libraries of information, then cycloned through public hearings, press interviews, and panel discussions, rising to challenge the dignitaries who did not know what they were talking about—or didn’t care. He delighted in getting thrown out of hearings. Opponents were infuriated by his refusal to back down from a stance or a demand. Truth to tell, he was not always right.
He was right often enough. Boring in on our slipshod structure of criminal justice for the insane, he was instrumental in pushing the act known as Kendra’s Law, which allows courts to order treatment for certain mentally ill and perhaps dangerous patients even if they resist it. He worked with the Pennsylvania Republican congressman Tim Murphy to achieve the Helping Families in Mental Health Crisis Act. He demanded, and largely achieved, a long-delayed recognition that “chronic mental illness”—genetically inherited and incurable brain afflictions such as schizophrenia and bipolar disorder—differs on a quantum level from such lesser complaints as depression, alienation, alcoholism, and drug abuse.
In 2017 Pete Earley distilled the reasons why this distinction is essential:
“The problem, according to Jaffe, is that the focus, money and attention in our nation is focused on helping nearly everyone but those ten million [with chronic m.i.] and the result is at least 140,000 SMI Americans being homeless, 392,037 in jails and prisons, 755,360 on probation or parole and at least 95,000 who need hospitalization unable to find a bed.”
His politics were less doctrinaire than fluid, tuned to the needs of the dispossessed who consumed his passions. He founded the nonpartisan Mental Illness Policy Organization. As an adjunct fellow at the conservative Manhattan Institute, Dj spoke at a White House summit on mental illness in December 2019. His countless articles and appearances across the media spectrum testify that he was a zealot not for ideology, but for enlightenment and hope.
Dj joined Fuller Torrey and TAC in 1998. He drew on Torrey’s collaborative expertise and on TAC’s informational and advocacy riches for his important 2017 book, Insane Consequences: How the Mental Health Industry Fails the Mentally Ill (Prometheus Books). Torrey acknowledged his friend and disciple’s stature in a statement released this morning:
“Since 1998, when we first started making plans for what became the Treatment Advocacy Center, Dj has been the single most effective advocate I have worked with and a close personal friend. His dedication to improving the treatment of people with serious mental illness, based on his experience with his sister-in-law, has been extraordinary. The amount of time and energy he has invested in this mission, first at TAC and then at Mental Illness Policy Org, is legendary. Even as he knew he was dying, DJ said nothing and continued his advocacy efforts.”
On a personal note:
It took me a while to get comfortable with the idea of meeting Dj Jaffe. His reputation as a controversial know-it-all firebrand put me off. But when we did meet, the rapport was instant. We discovered that we could make one another laugh. (I nearly lost it in a hotel coffee house in New York when my friend got embroiled in an argument with the waiter. This was no ordinary waiter-customer spat: the waiter was yelling at Dj!) Over several breakfasts, dinners and drinks in New York, Washington, and in the Powers home in Vermont, and in many lively emails, we kept up a bantering style that could segue seamlessly into explorations of our passions and ideas.
His just-beneath-the-surface humor proved the key to Dj: The firebrand was a necessary tactic, not a character flaw. In fact, Dj Jaffe was an extraordinarily loving man, as his career shift after his sister-in-law’s illness demonstrates. He enjoyed a longstanding marriage to his wife Rose, a lovely, laughing woman whom he adored. When Rose died two years ago, his friends expected that Dj would be devastated with grief. He may have been, but he was back to his advocacy work in a day or two. He never mentioned his feelings.
He met a woman named Paula about a year and a half ago, via a dating app. She was the one who reached out to him, friends say. Dj probably knew at the time that he was dying. Paula and Dj were married on Friday in his hospital room. Paula wore white pajamas and stomped on a Styrofoam cup. By all accounts, the marriage was a happy one. Because that’s the kind of guy Dj Jaffe was.
The voices of the growing grass-roots movement to reform mental healthcare are at last rallying to demand justice for perhaps the most dispossessed victim in America.
In a town in America, here in the Twenty-first century, a man has been left to die. A maimed and blind and deeply mentally ill man.
He has been left to die in this town for thirteen years. Right out in public, on the city streets, where everybody can see him. And beat him and rob him when they feel like it. And nobody with any statutory power over his predicament seems to give a damn.
A technical clarification: this man is not on the streets of Vacaville as I write these words. He is in critical condition in a hospital, bandaged and splinted and broken after being struck by a car at a traffic intersection at dusk on February 12. (It is the second time this man has been hit.)
His injuries include a fractured skull and bleeding from the brain, facial lacerations, lung contusions, a dislocated shoulder, a shattered elbow, a decimated leg, and bruises that blanket his body.
But it’s a safe bet that after the surgeons have him all fixed up—it could take months—he will be ushered back out onto the streets, where the cars he can’t see and the thugs whom he cannot fend off will help him resume his accustomed existence.
The man has a name: (James) Mark Rippee. The city has a name: Vacaville, California. The situation has a name: depraved indifference to the survival of a human being.
I just made that name up. Actually, I borrowed it from legal parlance. Its definition: “Conduct which is so reckless, wanton and deficient and lacking in regard for the lives of others as to warrant the same culpability as the individual who actually commits a crime.”
Here is the crime that Mark Rippee has committed: the crime of existing while crippled, blind, and insane. Are there any questions?
I’m sure there are lots of questions. I have lots of questions myself. Or I used to. I have written so often about Mark Rippee since I became aware of his plight that the words I write about him seem to turn to dust. I have written blog posts about him here and here and here. I have written speeches to mental-health reform groups in which I summarize his story. I have written directly to media outlets, to lawmakers, and to civic leaders in Vacaville and elsewhere. And the streets still claim Mark Rippee.
The bare-bones story—as it were—is that Mark Rippee was involved in a terrible motorcycle crash in June 1987, at age 24, that left him nearly dead, with bits of his brain scattered near the site, his eyes and his right leg destroyed. You can read the details in my links.
Somehow he survived. But over the years, his traumatic brain injury (TBI) has morphed into schizophrenic-like thoughts and behavior. His power to reason vanished. His mother and his twin sisters Linda Privatte and Catherine J. Rippee-Hanson tended him in the family household for eighteen years, until his deformed brain turned him into a raging menace. He left the household and has made his way on the streets, where his sisters—both of whom have developed serious illnesses of their own—bring him food, clothing, canes. Vandals keep stealing all of it, and often also the money given him for food and other needs.
Why doesn’t somebody rescue Mark Rippee? Why doesn’t some agency . . . why doesn’t . . .
Those are very good questions, and I’m glad you asked them. But the answers are buried within the folds of incoherence that comprise so much of the American mental healthcare system. Or systems. Or “systems.”
Mark Rippee is a victim of a perfect storm of gothic bureaucracy. The pertinent bureaucrats at Solano County and California state levels have exhibited no discernible interest in finding any way to counter the bureaucratic snafus with a humane solution that would get this man into supervised care and treatment.
One might even say that they are hiding behind a “humane solution” that actually exists. This solution would begin with a declaration from a psychiatrist that Mark Rippee’s accident left his brain with “diminished capacity.” This ruling would permit Mark’s family to place him in an appropriate facility and/or to establish a conservatorship that would give them discretion over his affairs, including psychiatric care.
No dice: hospital psychiatrists have consistently, and weirdly, denied that Mark Rippee has “diminished capacity.”
And the reasoning behind this confounding denial? Well, it’s none of your business what the reasoning is. The hospital is protecting Mark Rippee’s rights, you see. Protecting them by way of the cartoonish Health Insurance Portability and Accountability Act. HIPAA was designed to ensure a patient’s “privacy.” “Privacy” that prohibits even family members from learning the medical procedures and condition of a patient. There’s an irony there, in case you missed it.
Catherine and Linda have fought tooth and claw, over parts of three decades, to tear through the self-serving laws and policies that keep Mark in a near-feral state. Two years ago, Catherine plunged into work on a petition in support of a California bill known as AB 1971. AB 1971 would have expanded the existing definition of “gravely disabled” to include medical treatment for a patient if the lack of treatment “may result in substantial physical harm or death.” It would have secured treatment for Mark Rippee. Catherine collected 82,000 signatures in favor of the petition.
In April 2018, the Disability Rights Education and Defense Fund, one of several lobbies that oppose conservatorship and deny other needs of the mentally ill, signaled that it disapproved of AB 1971. The California Hospital Association also weighed in on the negative side.
AB 1971’s sponsors pulled the bill.
The sisters’ determination would be the stuff of heroic legend, if we lived in a country that valued heroic legend. In the wake of Mark Rippee’s second brush with death by an oncoming car he couldn’t see, Catherine has released a new petition. It demands intervention from California Governor Gavin Newsom to rectify this travesty of public policy. It reads in part: “While we hold the County of Solano and many officials, departments and agencies responsible for not preventing this second tragedy that we told them would happen – We also demand that the State of California and in particular – Governor Gavin Newsom – whom we have previously attempted to contact – PAY ATTENTION TO THIS SITUATION and ACT accordingly!”
Here is a link to the petition.
Moreover, thanks to the sisters and the Internet, word of Mark’s ordeal is spreading at the grass-roots level. Activists around the country, alerted to the nightmare, have begun writing letters demanding justice for Mark.
Here are two. Their tone of indignation and urgency is echoed by many more.
From Donna Erickson of Massachusetts:
“Hello, I’m writing to voice my concern, in regard to a homeless individual named James Mark Rippee. As you probably know, he is severely disabled both mentally and physically. Being blind only further complicates his poor condition. The real tragedy here is that none of this is his fault. Severe mental illness is a disease nobody chooses. Many who are afflicted are unaware of how sick they are, because of anosognosia, which is lack of insight, a condition that is a manifestation of the illness itself. It is not his fault that he repeatedly walks into traffic.
“His brain is broken, and he cannot see. Someone in this condition should never have been put on the street. So now he is hospitalized for another accident, resulting in critical injuries, including a skull fracture, brain bleed, and broken bones. He will need many surgeries.
“His family is devastated, because they tried so hard to get him off the streets. But the laws get in the way. This poor man requires a hospital, rehab, and eventually a long-term residential facility. If he is an elopement risk, then there are locked facilities. Mark’s value as a person is no less than any of us on Earth. He has fallen through the cracks of a very broken system.
“How would you feel if this was your family member? Mental illness can strike anyone. He is not a nobody. He is a family member of caring individuals who have tried everything in their power to help. The tragic part is that this all could have been avoided, if only someone had truly cared and listened. Keeping someone on the streets in his condition is disgraceful. And it shouldn’t matter what he says. He is unable to make a rational decision, which is in his best interest, due to his illness.
“The system has failed him, because no one intervened, even though the family had begged and pleaded. I had to voice my concern, because this could have been my son. This could have been anyone’s son, and we need to start taking care of our most vulnerable citizens!”
And from the Maryland advocate Laura Pogliano:
“My friend [Catherine] Hanson and her sister Linda Rippee have been trying to help their brother Mark for 13 years; a motorcycle crash left him with no eyes, a severe brain injury, broken bones all over his body, a metal rod in his leg, and as a result of TBI, schizophrenia. He’s been on the streets for years, being victimized, robbed, beaten and neglected. They’ve been denied help for him over and over by the county they’re in, by hospitals.
“He’s been admitted to, by group homes, by every support service you can think of. He was hit by a car a few months ago and while inpatient, one sister’s medical power of attorney was revoked, and the psychiatrist sided with his delusional raging patient, that he was capable of making his own medical choices and caring for himself (blind and floridly psychotic). He was discharged to a group home and lasted about a week.
“Now, living on the streets, Mark’s been hit by a car again! Only this time, he was thrown into the air and smashed his face against the driver’s windshield. He’s in bad shape, has another brain injury, the leg with the metal rods is shattered, his shoulder is dislocated and he might lose what’s left of his teeth.
“He’s going to need months of hospitals, multiple surgeries, and extended care. And guess what? He’s in the same damned hospital that battled back against his family and discharged him to the streets.
“Mental health care in America. You stand a slight, very slight chance of making it, if you’re healthy enough to ask for help and participate in it. If you’re really, really sick, you’re screwed.”
In a city in America, here in the Twenty-first century, a man has been left to die. But in America, the voices of reclamation are arising to insist on his right to live.
An open message to Bernie Sanders:
Bernie, you represent me in Congress. I am a constituent of yours who has voted for you regularly. We know one another a little. (In Vermont, everybody knows one another a little.) I have followed your political career with admiration. I have defended you against my Democrat and progressive friends who insist that you are prohibitively doctrinaire, headstrong, and abrasive/dismissive in conversation. (Who, knowing you, could possibly believe these things?!)
I applaud your decades of consistency in holding large corporations to account for their greed, deceptions, and perversions of economic and social justice. I feel inspired by your support of the American worker even as many American workers, including many in your home state, are blinded to your support by your self-identification as a “socialist.”
And so, when I make the urgent request that I am about to make, I hope you will not reject it out of hand as the trolling of a political opponent. I’m asking you to reconsider your stands on three critical elements of U.S. mental health-care policy. Singly and as a group, these elements in their present form contribute to the ongoing national crisis in the care of our most helpless citizens.
Your problematic proposals are as follows: to defend the oppressive “IMD exclusion” that disallows Medicaid funding for those hospitalized with mental illness; to maintain the so-called HIPAA rule; and to keep in place the highly problematic civil commitment laws (laws that bar hospitalization of a person in a psychotic episode, unless it’s demonstrated that person is a danger to self or others).
Senator, each of these policies has caused untold and needless frustration, and often financial loss, to sufferers and their families. Each of the reform proposals you oppose amounts to a common-sense solution. Yet each, and all, of these laws are defended by lobbying groups within the anti-psychiatry community and by mental-illness deniers, despite breakthroughs in neuroscience and brain-scan technology dating to the 1980s.
To examine each of them:
- The IMD (Institutions for Mental Diseases) exclusion bars federal Medicaid financing for patients in psychiatric facilities with more than sixteen beds. It was enacted in 1965, the new Bronze Age of mental-health care, when large, decrepit, and often brutally run asylums brooded over the landscape. In 2020, IMD is a destructive artifact that stands athwart the enlightened trend toward smaller, efficient community-based care centers with professionalized staffs.
Case in point: The venerable Brattleboro Retreat—Vermont’s largest psychiatric hospital—emblemizes the creaking policy’s noxious legacy: in January, the private nonprofit Retreat warned that a funding crisis might lead to its shutting down. Not until crisis negotiations a few weeks later between the governor and Vermont’s Agency of Human Services did the state grudgingly consent to cough up $2 million in emergency funds to keep the Retreat going. Its future remains precarious.
Meanwhile, Vermont’s shortage of acute care beds for the mentally ill has grown even more dire. In the words of the reform advocate DJ Jaffe, “It is hard for Senator Sanders to argue in favor of ‘healthcare for all’ while embracing the federally sanctioned discrimination embedded in Medicaid that is causing hospital beds for the seriously mentally ill to close.”
- The cumbersome HIPAA is similarly a counter-productive policy that calls for scrapping, not defending. The Health Insurance Portability and Accountability Act was signed in 1996 to accomplish many things, most notably, to restrict the personal and medical data of hospital patients from scrutiny by insurance companies, employers, other care providers—and also from the patients’ family members.
The unintended consequences of HIPAA thrust mental patients’ families, into an abyss of anxiety and frustration. Denied any scrap of information—Is our child resting? Screaming? Lashing out at doctors? Improperly medicated? How can we help him/her?—parents can only rage against the curse-upon-curse that HIPAA imposes. My wife and I experienced this torture when our son Kevin was hospitalized with schizophrenia. We wanted desperately to know what medications he was being given. We had seen the horrifying effects on him from meds that did not suit his biological system and wanted to share what we knew.
Kevin was eventually released from the hospital. He took his life during an episode of psychosis a week before his twenty-first birthday in 2005.
Surely the HIPAA laws can at least be modified to include a sufferer’s loved ones in the information loop without releasing sensitive data to all and sundry. Yet, Senator Sanders, you have stated your opposition to any amendments whatsoever. Please—and I ask on behalf of desperate parents everywhere—please reconsider.
- As for your intention to stand by the existing civil commitment laws: These laws changed the history of confronting psychotic behavior by raising, for the first time, legal obstacles to what had been intended as purely medical decisions. Most of these civil commitment laws were enacted by states in the 1970s, a period of passionate civil-rights activism and also fervent skepticism about the very existence of mental illness. The laws have bedeviled advocates and judges ever since. They address questions that have no clear answers, yet can determine the life or death of a person in a state of crisis, and of anyone nearby. Is this agitated person capable of self-harm or harm to others? Should such people be treated against their will, or should their civil liberties be prioritized above the risk of mayhem? And most critically, how is risk, or lack of it, ascertained in the emotionally charged moments of crisis? How is psychosis determined?
The commitment laws essentially allow the person in crisis to give the answers—a genuflection to the principle of civil liberties. These privilege the law above psychiatric/medical judgment. Given that civil liberties are among America’s most cherished ideals, this direction makes sense. Or it would make sense, if the person in psychosis is capable of reasoned thought.
Psychosis by definition is a break with reality, an inability to think in a rational way. In a large number of cases—up to 50%, according to most estimates—the affliction is accompanied by a condition called anosognosia, the inability to comprehend that one has a psychotic illness.
Given such overpowering impediments to clear thought, how can a sufferer possibly be expected to rule on his or her own need for psychiatric intervention?
DJ Jaffee, executive director of Mental Illness Policy Organization, offers one trending alternative: the use of assisted outpatient treatment (AOT). Jaffee writes, “AOT is a procedure that allows judges— after full due process— to commit the few seriously mentally ill who are historically and potentially dangerous to stay up to one year in outpatient treatment, often including medications, while they continue to live uninstitutionalized in the community. Outpatient commitment is less expensive and less restrictive than inpatient commitment.”
I’m not suggesting that any of these remedies is simple. Nothing about mental illness is simple. It remains a unique curse, defying cure, reclamation, policies without pitfalls. All who attempt to seriously tackle these challenges must brace for unintended consequences. Yet these hurdles are no excuse for allowing patently bad policies to continue unopposed.
We in the advocacy movement are grateful for your political leadership in the struggle for justice and thoughtful reform in our broken mental healthcare system, Senator Sanders. Please consider these suggestions for critical refining of your policies in your campaign.