Without Care

If you’re psychotic and you don’t want treatment it’s no problem.  At least until you harm or kill somebody.

Navy veteran and computer contractor Aaron Alexis killed twelve people at the Washington Navy Yard.  By all evidence he had been psychotic for weeks or months.

He told his friends and neighbors that their cat was secretly going into his refrigerator to steal his food.  When he started screaming at a family in the Norfolk airport that they were “laughing at him,” spouting obscenities while at the gate, the police talked with him till he “calmed down.” He got on his flight.   After hoteliers went nuts trying to respond to his endless complaints about horrible noise only he could hear, the Newport, Rhode Island police listened to his calls about the “microwave machine” sending those voices through walls. They marked the call in their ledgers. Why bother telling him he should seek treatment?  He probably wouldn’t go anyway.  And think of all that paperwork.

The mass murderers of Aurora, Colorado, Virginia Tech and other sites quickly learned an important lesson – if you want to prepare for a massacre, stop seeing the doctor.

Aaron Alexis probably had been psychotic on and off for months.  His one known foray into treatment – going to a VA emergency and telling them he had a “sleep disorder.”

Murder and sleeplessness have more than a few connections.

Secrets of Florida

A few years ago lawyers in central Florida contacted me about a murderer.  They thought they had the cause for their incarcerated clients’ unjustified attack on a neighbor – sleep deprivation.

The client claimed “sleeplessness” made him do it.  The attorneys described an intelligent man who made his living as a “really smart investor” who drove expensive cars to expensive bars and enjoyed a sybaritic life.

I duly arrived at the jail. There I was shunted by overhead intercom from empty corridor to empty corridor , three series of gates closing behind, until I reached an empty room and watched the murderer walk alone up the steps.

Cameras were present, but I never saw a corrections officer at any time – anywhere.

The man was huge, bearded and friendly. He  shook my hand and quietly told me his story.

He had been sleepless for years.  Voices and music spewed through the walls of house and garage.  There was no place to hide.  His neighbor kept diligently sending the electronic signals, trying to drive him mad.

His retired police chief father with whom he lived duly tape recorded the garage and house spaces.  There was no music, no talking on those tapes.  His son did not believe that evidence.  He knew the neighbor was constantly sending him electronic messages.

One morning he had had enough.  He put on his nailed boots, went over to the driveway, and killed his elderly neighbor.   “I stomped the **cker to death” he proudly told the police.

When I told the lawyers that their client was not suffering from sleep apnea but from psychosis they were unimpressed.  Getting a “not guilty by way of insanity” plea through a Florida jury was close to impossible, they said.  He had confessed to the police.  He had to admit guilt.

The client agreed. His work as a “smart full time investor” had consisted of occasionally buying Treasury bills.  His life consisted of watching TV and driving his father’s car over to titty bars where he would nurse a coke or a sprite through the night. He said the whole show would only cost him four bucks, plus gas.  He had no friends.  His father was now dead.

He said he was glad to stay in jail.  A plea bargain would get him maybe 10-15 years behind bars.  He didn’t miss home much, and they were giving him medications that got rid of the voices.

That what happens in most prisons.  The state hospitals are gone.  Tens of thousands suffering from psychosis reside inside prisons, the new form of “community treatment.”

For if you are forcibly hospitalized today, the community mental health centers that “replaced” state hospitals in the 1960’s and 1970’s may give you an appointment – in three or four months. When hospitalized you might only stay a few days, wherehoused to a ward where therapy consists of quick interviews with a nurse or doctor, drugs and television.

That’s one reason police don’t want to bring “crazies” into the “loony bin.”  The “crazies” can become dangerous when you “move them out.”   If hospitalized they are often rapidly discharged.  Unless their families work very hard, treatment options are often thin. And, as police tell me, “people don’t want to go to treatment.”

It’s their right.

Politicians, especially those opposed to increasing coverage for the poor and chronically ill, are quick to tell you that medical care is “very costly.”   In Florida, counselors who’d explain the Affordable Care Act are banned from state and county community health centers.  The governor and legislature don’t want many people to know how and when they might seek care.

It’s the same game – no treatment, no problem.  Until somebody dies – and there’s a media story.

The Future

Aaron Alexis had treatment options. Many with psychiatric illness don’t.

We treat people with diabetes – even if they don’t want treatment.  Medicare will pay for dialysis.  Medicaid will treat coronary artery disease and heart attacks.

The cost to communities of not treating psychosis include the immense economic cost of unemployment (yes, there are plenty of schizophrenic doctors and lawyers and accountants;  periodically crazy people often like to work hard); the destruction of patient’s families; fear of “what the insane might do” by the public; and the intense, godawful suffering of those who live with psychosis.

Yet the public debate about insanity is presently about “getting those people registered” so that they will not easily be able to obtain guns.  Recent massacres are regarded as a “failure of mental health treatment,” not of our “sacred rights of freedom.”

Since 9/11, 364,000 Americans have died of firearms.

So who are the crazy ones?
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