tag:blogger.com,1999:blog-183000981898072892024-03-22T05:17:53.819-04:00Mental Health ResolutionMental health blog mixing policy and treatment issues with personal stories. Each week is a short story.
Posts by diagnosis:
Schizophrenia
6/17/11- 6/29/11- 7/6/11- 8/18/11- 8/30/11- 9/7/11- 9/14/11- 9/30/11
11/2/11- 1/10/12
Schizoaffective disorder
7/14/11
Bi-polar disorder
8/10/11-9/21/11-10/14/11
Bi-polar depression
7/26/11
Depression
8/25/11
Dementia
10/6/11
Dissociation
10/22/11Terry Garahanhttp://www.blogger.com/profile/18066569365497313232noreply@blogger.comBlogger31125tag:blogger.com,1999:blog-18300098189807289.post-70302723625135347722023-08-03T11:25:00.002-04:002023-08-03T11:25:39.100-04:00<p> Stay tuned for future posts.</p>Terry Garahanhttp://www.blogger.com/profile/18066569365497313232noreply@blogger.com0tag:blogger.com,1999:blog-18300098189807289.post-64418700261845068972012-01-10T17:57:00.000-05:002012-01-10T17:57:10.125-05:00Illness can take control!<span style="font-family: "Calibri", "sans-serif"; font-size: 11pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-tab-count: 1;"> <span style="font-size: large;"> </span></span><span style="font-size: large;">There are times when everyone who is involved in mental health treatment tries their best to resolve problems.<span style="mso-spacerun: yes;"> </span>The patients work as hard as they can to feel better and to do better.<span style="mso-spacerun: yes;"> </span>The helpers, both family and professionals, use every resource available to make things work.<span style="mso-spacerun: yes;"> </span>The illness, however, can conquer all.</span></span><br />
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<span style="font-family: "Calibri", "sans-serif"; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-size: x-large;"><strong>The Story </strong></span></span><br />
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<span style="font-family: "Calibri", "sans-serif"; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-size: x-large;"><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">“There’s nothing up here. It’s really dusty and from what I can see nothing is disturbed.” The young cop was on a step ladder, his hat off, his upper body squeezed through a small square hole in the celing of the closet of my client’s bedroom. “The attic is really well insulated.” he said as he carefully made his way down the ladder, adding his flashlight to the gear on his belt. His partner gave him back his hat and they both stepped into the small bedroom. “I suppose there could have been squirrels, but I don’t think so. I didn’t see any light from outside and they have to have some way to get in.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">Gwen looked at me and softly said, “They were here.<span style="mso-spacerun: yes;"> </span>I’m not lying to you. They really were here.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">I walked the cops to the door. “Thanks guys, I really appreciate you coming. You’ve been a big help.” The older cop rolled his eyes at me and said, “Give me a call when you’re done.” I closed the door and returned to the living room. Gwen was sitting on her sofa. Her tall thin body was swallowed by the soft cushions. Her graying brown hair was matted. The sweat pants and tee shirt that served as pajamas were wrinkled. She stared at her hands folded in her lap. I’d only seen her neat and prim in nice clothes and makeup. She looked up at me, eyes pleading.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">“They were here. They really were here. I don’t know how they do it and I don’t know how they get in, but they were here.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">She was referring to the aliens that had been visiting her on a regular basis for a month or more. Her therapist had brought it up in one of our regular clinic staff meetings a few weeks earlier.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">Alicia, her therapist, told us, “This is new. She’s had delusional materiel before, but nothing like this. It came up almost as an aside in a discussion about other problems that she’s had with neighbors in the building, loud noise and stuff like that. She said that aliens have been in her room at night. The first time was in the last few weeks. Two or three of them just stood at the end of her bed. When she first told me about them, they were unformed, a presence. As time has gone on they have become more substantive. They look like TV or movie aliens, a child’s height with light bulb shaped heads, their bodies a greenish color.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">The room gave a collective sigh. Gwen was a favorite. She was a woman in her forties who had returned to Ithaca last year after many years in and out of mental hospitals throughout the country. She’d grown up here and had a strong and supportive family who were willing to assist in any way possible without being intrusive. They’d helped her find an apartment and scoured garage sales and second hand stores to furnish it. More than twenty years earlier Gwen had left Ithaca to go to college in the Midwest. She’d earned an undergraduate degree in English literature and had started a doctorate program. Then she became symptomatic with signs of schizophrenia. After a few hospitalizations she hit the road trying to escape the various demons that made up her illness. She’d tried cities: Denver, Austin, and Portland Oregon. She’d tried rural: southern Ohio, eastern New Mexico, even Lancaster Pennsylvania in hopes that the Amish lifestyle would somehow rub off on her. Illness combined with poverty always led her to hospitalizations. I’d looked at her record a number of times and saw the all too familiar patterns.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">“Have her make an appointment to see me,” her psychiatrist said. “Maybe we can find a way to resolve this before it becomes too bad. Squeeze her in after lunch tomorrow.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">Gwen would only agree to a minor medication adjustment when she met with the doctor. She’d been given a variety of medications over the years, but we all knew that many of our clients did not take medication as prescribed and at times the medications did not work. When Gwen came to our clinic, accompanied by a cousin, we’d been impressed by her knowledge of her illness and her level of commitment. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">“I am sick of that life!” she told us when she arrived a year earlier. “A young person can wander the country and do all sorts of crazy things. I’m not a young person anymore.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">She was the kind of individual who continued to be very well read, often showing up at appointments with arms filled with books from the library. She went to the library every day, spending hours reading papers and magazines. She often engaged other clients in the clinic waiting room with discussions of current events or politics. Her employment history was the counterpoint to her hospitalizations. She presented very well, and according to her and family members, she’d been able to support herself waiting tables, stocking shelves, answering phones and with every other entry level job imaginable. When she moved home, she needed public assistance to survive and the Department of Social Services looked at her record and insisted she apply for disability. Even with more than twenty hospitalizations, Gwen did not view herself as disabled. Soon after she was settled, she began to volunteer at the soup kitchen. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">Gwen had lived in a variety of rooms, apartments, motels and shelters over the years.<span style="mso-spacerun: yes;"> </span>She had nothing of value. At different times over the years she’d return to her residence to find her few belongings stolen. Her current apartment was in a building on the edge of college town, where at least ten thousand students and hangers on lived. Most people felt physically safe, but break-ins were common, with practiced local thieves looking for laptops, jewelry and other easily fenced items.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">The first few times she’d called the police, it was to report strange noises or possible intruders. The officers had responded quickly and professionally, making sure that doors and windows were secure, writing detailed reports. A crime prevention officer had even come during the day and helped her make an assessment of risk. I was made aware of the calls by the Records Sargent and stopped by Gwen’s on a regular follow up visit. We had only met once before at the clinic and she was polite, but not forthcoming.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">Later in the day, after the inspection of the attic, I went to the police department to follow up on the older officer’s request.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">It was near the end of the day shift and the officer had that careworn look that cops get when retirement is near but not close. He had a couple of years left.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">“Terry, she is clearly a code 88,” he said, referring to the designation police give to mental health calls. Since I couldn’t talk with him about her case, I went to a general discussion.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">“When these sorts of things happen, we try to add medication and keep close track of what’s going on.” </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">The officer knew the limits of our discussion, but added, “When we first got there, she said the aliens “probed” her. I asked what that meant and she got sort of angry and said that they looked inside her. I didn’t bring it up at her house because she had calmed down and I didn’t want her to get upset again and I knew I’d talk to you today.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">I called Alicia and let her know about the “probing”. Working with clients that are often the victims of crime, we felt the need to rule out sexual assault as a possibility.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">Alicia called me into her office later that week. Gwen was sitting across from her. As I sat Gwen looked at me, silent for a moment as she tried to gather herself and control her anger before she spoke. “Look, I was probed, not raped. I’ve been raped before, once in Denver and once when I was hitch-hiking. What happened in my apartment was <strong>not </strong>rape. There was nothing violent or sexual about it. Somehow they controlled my mind. They made it so I couldn’t move. Then they poked and prodded and looked inside. And not just my private parts. They looked in my ears and mouth and even my nose. See what they did?”<span style="mso-spacerun: yes;"> </span>She leaned towards me and touched a sore on the bottom of her nose. “They did that! They pulled too hard on the nostril and it tore a little.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">“That sounds really unpleasant,” I said</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">“You don’t believe me! You people act like you’re trying to help and when I really need help, you don’t help.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">“I was there with the cops when they looked in the attic. When you call, we respond. It doesn’t make any difference whether I believe the specifics or not. I believe that you are upset and I’m trying to help.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">She shook her head and mumbled, “No one believes me, and they think I’m crazy. It’s getting bad, really bad.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">“Would you like to go to the hospital for a few days? You’ll be safe there. No one will bother you. You can catch up on sleep then decide what you want to do. Alicia can meet with you there to sort things out,” I suggested.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">Gwen gathered her coat and purse and slowly stood up. “I know you think I’m crazy, or I’m lying, but I’m not. This is really happening. I don’t want to talk about it anymore. I’ve got to meet somebody for coffee.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">After she left, Alicia and I reviewed our very limited options. Fortunately, she didn’t leave while she was angry. We felt there were still opportunities for help.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">It was two nights later, about one in the morning when I was called to Gwen’s apartment. I could see the flashing lights as I came down the hill to her street. The fire trucks filled the space in front of the house, ladder lifts on either side of the house. Hoses were directed at the roof where a few flames were still licking at the sides of a large hole. A small crowd of residents and neighbors gathered across the street. Beyond the firefighters was a police car. Gwen was in the back seat. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">“I’ll sign the papers for the hospital,” I told the cop sitting in the front seat.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">He lowered the driver’s side back window a few inches so Gwen and I could talk.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">She was wrapped in a soft white blanket, quietly crying. “They came to take me with them. I heard them in the attic talking and I didn’t know what to do. So I rolled up a newspaper and set it on fire and pushed it through the attic hole to drive them out.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">“I’m glad you’re safe,” I said as the officer rolled up the window and put the car in gear.</span></div><br />
</span></span>Terry Garahanhttp://www.blogger.com/profile/18066569365497313232noreply@blogger.com14tag:blogger.com,1999:blog-18300098189807289.post-10231941738018838142012-01-01T16:47:00.000-05:002012-01-01T16:47:31.187-05:00Break Almost Over<span style="font-size: large;">As many of you know, I have been promoting and giving readings of my new book, When Truth Lies, A Journey with Schizophrenia </span><a href="http://whentruthlies.com/"><span style="font-size: large;">http://whentruthlies.com/</span></a><span style="font-size: large;"> I will continue promotions and tours throughout the spring and summer. I will resume posting this week, continuing to share true stories from the world of mental health.</span>Terry Garahanhttp://www.blogger.com/profile/18066569365497313232noreply@blogger.com2tag:blogger.com,1999:blog-18300098189807289.post-32542280470558634262011-11-02T17:36:00.000-04:002011-11-02T17:36:28.956-04:00Communities need characters!<span style="font-family: "Calibri", "sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Neighborhoods and small towns all have their characters.<span style="mso-spacerun: yes;"> </span>We often view them in a one dimensional way and assign our judgments to them. <span style="mso-spacerun: yes;"> </span>In my neighborhood, growing up, it was “Moose”, a big guy in his mid-thirties with intellectual limitations, a Yankees cap and a beat up baseball glove. Our responsibility as a society is not only to ensure the safety of our characters, but to try to <span style="font-family: "Calibri", "sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">make them a part of our community. They are a part of, not apart from our world. </span></span><br />
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<span style="font-family: "Calibri", "sans-serif"; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "Calibri", "sans-serif"; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><strong><span style="font-size: large;">The Story</span></strong></span></span><br />
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<span style="font-family: "Calibri", "sans-serif"; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "Calibri", "sans-serif"; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">He came out of the post office with a handful of flyers, ads and junk mail. He’d probably been attractive as a young man but time, mental illness and psychiatric medications had taken a toll on him. He was at least forty, just under six feet tall and had long dirty blonde hair. He was clean shaven and you could tell his face wanted to be long and narrow, but ended up puffy and jowly from weight gain. He had on a Motley Crue t-shirt that barely covered his protruding belly. The spandex pants and lace up boots had never really been in style, and no one had worn anything like them for twenty years. I knew it would take him about ten minutes to walk home so I went to a convenience store for a cup of coffee and sat in my car listening to talk radio. The little town Jim lived in was a strange mix of run down Victorian homes, empty storefronts and a new “super” drugstore that sold everything.<span style="mso-spacerun: yes;"> </span>This community had been Jim’s home his entire life and he’d become a local character. “The Rock Star” was what the locals called him.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">I went to the door of his basement apartment and gave the secret knock:<span style="mso-spacerun: yes;"> </span>Tap- tap,tap,tap, - tap,tap. I could hear him behind the door looking through the peephole. He cautiously opened it and I quickly entered. The smell of cigarettes was overpowering. The white walls and ceiling were a light tan from twelve years of exhaled nicotine. The long, narrow living room was built just below ground level with windows at shoulder height. When other residents of the building entered or left you could only see their legs and feet. However, most of the day, the curtains were drawn, as they were this day. The bare bulbs of the fixtures made it brighter than it was outdoors. The sparse furnishings consisted of two lounge chairs facing a small TV and a kitchen table. Dolly sat at the table, she wore a floral print dress that went just below her plastic knees. “It’s only Terry,” Jim said to her. Dolly’s surprised open mouth <span style="mso-spacerun: yes;"> </span>expression never changed. Jim had purchased her at the dirty book store in Ithaca almost ten years earlier and she’d been his companion ever since. Jim softly smiled at her.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">The radio was playing hits from the past. “Classic 99” the voice from the radio said and Jim echoed “Classic 99.” He sang along with his favorites as they came on.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">“I saw you walking back from the post office. It’s great to see you getting out,” I said.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">“I never get anything anymore, just junk mail. I keep writing and nobody sends me anything. I think the interweb makes it so people don’t write except with that e-mail stuff. The last thing I got was a picture of Bon Jovi and that was almost a year ago.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">He lit a cigarette and waved his arm towards a wall of photographs, each sent and signed by his favorites: Kiss, White Snake, Alice Cooper, Def Leppard and many more of the genre know as Glam or Hair Bands. “Classic 99,” the radio said “Classic 99,” Jim repeated, laughing.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">“The zombies pooped on my front step again first thing this morning. I went up to the door and cursed them. It smelled real bad. But they cleaned it up by the time I went out. They’re going to get in trouble. They can’t do that can they, Terry?” He asked.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">“I’m sorry your day started out so badly,” I said. “Maybe tomorrow will be better. Have you seen your folks?”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">“My mom came over yesterday and brought me groceries. I got Fruit Loops. Me and Dolly love Fruit Loops. Mom took the garbage with her too. I told her about the zombies and also I’ve been having a problem with ghosts. They keep flying around when I’m watching TV. They don’t really bother me, but they get in the way of the TV and sometimes they get together and make this buzzing sound, like there’s bees in the room. If I yell they’ll usually stop.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">“That sounds terrible, but you usually can deal with bad stuff,” I said.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">“Where’s your med box?” I asked. Jim went into the bedroom and came out with a plastic box that was divided into seven long slots for each day of the week and further divided into four for morning, mid-day, dinner and evening doses. A nurse came every Friday to fill his medication box and he also had a two day emergency supply in case of bad weather. “Things look good here,” I said, handing the box back. “Any problems with the medications?”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">“Just a little dry mouth, nothing too bad,” he answered.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">“Mr. Cooper upstairs keeps cursing me. Dolly heard it too. I’ve never done anything to him. I can hear him curse at me. But I haven’t been banging on the ceiling.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">I looked up, seeing the marks where Jim had banged the broom handle earlier in the month. Jim’s caseworker had spent time with both the neighbor and the landlord reassuring them that Jim was not a danger to them. “Remember what I said? If anyone is bothering you while you are in the apartment you can take another pill to make you relax. Make sure you let me or your mom know. And if anybody is bothering you in town remember what I told you?”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">“Yep, I can go to my mom’s or I can go to the police station.” Jim had been bothered a number of times in the street by local teens. The police chief had gone to high school with Jim and felt very protective of his former football teammate. “Chief Billy always watches out for me.” “Classic 99”, the radio said. “Classic 99”, Jim repeated.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">“When I was at the post office yesterday, I heard people say I had AIDS. The people in line and the people behind the counter all said I have AIDS. I don’t have AIDS, do I, Terry?”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">“When you hear people stay stupid things what can you do, Jim?” I asked.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">“Just ignore them. That’s the best way to do it, right Terry?”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">“I’ve got to get going. It’s really good to see you, and Dolly too. Tell your mom hello when you see her.” I got up and Jim unlocked the door and I slipped out. Behind the door I could hear, “Classic 99”.</span></div><br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">The Stories</i></b></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><i style="mso-bidi-font-style: normal;">The stories are my remembrances. Each of them is based on a true event in my work for Tompkins County Mental Health. I have changed the names and identifying information of every client, patient and co-worker except for Beau Saul, of the Ithaca Police Department, who I was fortunate enough to have as a partner. When confidentiality demanded it, I have changed details. The dialogue is my reconstruction of what was said at the time.<span style="mso-spacerun: yes;"> </span>I have felt honored to be let into the lives of so many individuals over the years. Their stories are a gift I have been given.<span style="mso-spacerun: yes;"> </span>Please enjoy them in the spirit with which they were written; to educate and inform.</i></div></span></span>Terry Garahanhttp://www.blogger.com/profile/18066569365497313232noreply@blogger.com1tag:blogger.com,1999:blog-18300098189807289.post-85814714548623788482011-10-22T12:57:00.000-04:002011-10-22T12:57:26.727-04:00Difficult lives can create challenging problems.<div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: 12pt; line-height: 115%;"><span style="font-family: Calibri;">There are some people who live such difficult lives it is hard for us to imagine.<span style="mso-spacerun: yes;"> </span>Pain and suffering are joined with fear in ways that produce unusual patterns of behavior as a way of coping. We can pathologize those behaviors if we are willing to help. But we must be careful about judging them.</span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><br />
</div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="line-height: 115%;"><span style="font-family: Calibri;"><strong><span style="font-size: large;">The Story</span></strong></span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><br />
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</div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="color: #222222; font-family: "Arial", "sans-serif"; font-size: 12pt; line-height: 115%;"><span style="mso-tab-count: 1;"> </span>Her face had been sliced and cut at least fifty times. She looked like she’d been in a horror movie. The razor blade was still in her hand. “Would you please put that down?” I asked. “What? What?” she whispered back at me. “The razor is in your hand. Could you please put it on the table behind you? Can I come in?” “Yeah, sure. Come in.” As she backed into the house, I picked up a book from the same table and placed it on top of the razor, hiding it. “What do you want?” she asked, irritated that I had entered her world. “I need to make a call, give me a minute.” I said as I dialed the house phone to central dispatch asking for an ambulance and a deputy. “Shit”, she said, “Not the cops, there’s really no need for the cops. I’m not going to do anything stupid.” I remembered some time earlier that year when she had threatened suicide and made the same promise. While she and I were walking to the car, she pulled a piece of broken glass from her pocket and slit her wrist. I wasn’t taking any chances this time.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="color: #222222; font-family: "Arial", "sans-serif"; font-size: 12pt; line-height: 115%;"><span style="mso-tab-count: 1;"> </span>I went to the kitchen and got some paper towels. ”You’re bleeding!” Many of the cuts were superficial, but some looked deep. There was blood in her hair and down the front of her shirt, on her jeans and splattered throughout the house. Her hands looked like they were covered in rust. I doubted she had even looked at herself since she’d started cutting. When she cut, it was usually slow, a process that could take hours, something she could savor like a fine meal.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="color: #222222; font-family: "Arial", "sans-serif"; font-size: 12pt; line-height: 115%;"><span style="mso-tab-count: 1;"> </span>“What are you doing here?” she asked. I replied, “Dave called me and told me that you’ve been having a rough time. When he left to go to work, you promised that you would answer the phone. But you didn’t. I see the answering machine has eight messages on it. Two are from me. I had to come out this way for a home visit and I thought I’d stop by.” “You have no right to be here,” she said. “When I knocked on the door, you opened it and invited me in,” I replied.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="color: #222222; font-family: "Arial", "sans-serif"; font-size: 12pt; line-height: 115%;"><span style="mso-tab-count: 1;"> </span>She had bunched the paper towels into a ball. She sat and stared at them. “I need my glasses. They’re in the kitchen, can you get them?” I went to the kitchen and found the glasses on the table next to a box of Cheerios. The dishes were done, the counters were clean. I was sure that after Dave went to work she’d fed Maggie, then fixed her lunch and sent her off to school. I went back to the living room and gave LeeAnn her glasses. “What time is it?” she asked. “Almost two. What time does Maggie get home?” I asked. “The bus comes at two thirty.” she answered. “Is there anyone who can stay with her until Dave comes home?” I said. LeeAnn picked up the phone and called a neighbor who agreed to meet her daughter and have a play date with her own child until Dave got out of work. She then returned to her chair and the ball of paper towels returned to her hand.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="color: #222222; font-family: "Arial", "sans-serif"; font-size: 12pt; line-height: 115%;"><span style="mso-tab-count: 1;"> </span>“Do we really have to do this? I’m okay, I really am?” she said, pleading with her eyes for me to just disappear. I was tempted to have her look in the mirror. But her appearance was so shocking, I was afraid of her emotional response. Her history of dissociation had begun in childhood with daily physical and sexual abuse. She’d described to me how horrible her life had been. I was aware of her extended family, with generations of sexual abusers and victims, men and women, taking on both roles. The families poverty had been spread out over two rural roads with broken down trailers and roughhewn cabins, most of which had no running water and were heated with wood or kerosene heaters. The children who lived there were dirty and strange, almost feral. They existed on canned goods from food pantries and school lunch programs. The adult men seemed always to be working on rusted out trucks in the yard, small groups of them under the hood or searching for tools. The women were inside watching talk shows on small old televisions.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="color: #222222; font-family: "Arial", "sans-serif"; font-size: 12pt; line-height: 115%;"><span style="mso-tab-count: 1;"> </span>LeeAnn had escaped. She’d graduated from high school and worked at Cornell in food service. She’d gotten her rotten teeth fixed and been presentable enough to become a supervisor. She met Dave when he made a delivery of paper goods for the restaurant supply company he worked for. They only dated a short time before they were living together and got married after she became pregnant. Somehow she was able to keep her cutting a secret for most of their early years together. She explained her dissociation as being “spaced out”. As a young mother she was able to juggle job and home as well as anyone. When her younger sister died she went off the rails. Her sister had tried to follow in LeeAnn’s footsteps and might have succeeded if she hadn’t gotten involved with a man who was like all the men in her family. He threatened and bullied and abused. LeeAnn’s sister found the only way out; she took her life.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="color: #222222; font-family: "Arial", "sans-serif"; font-size: 12pt; line-height: 115%;"><span style="mso-tab-count: 1;"> </span>The death brought back all the feelings of fear and helplessness and guilt. “I go away! I just go away.” was what LeeAnn had told me when I asked her about what she described as “missing time” each day. “You know when you’re driving on the interstate, and you realize you’ve passed three exits you didn’t notice. It’s like that.” LeeAnn’s therapist had been working hard, using a variety of therapeutic approaches to help LeeAnn. I supervised treatment and we agreed that LeeAnn needed to retain a high level of functioning to be able to stay in her marriage and raise her child. It was difficult to tell how successful we were.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="color: #222222; font-family: "Arial", "sans-serif"; font-size: 12pt; line-height: 115%;"><span style="mso-tab-count: 1;"> </span>I could hear the diesel engine of the ambulance as it pulled in front of the house. I went to the door and opened it. “You don’t need the gurney. I’ll walk her out.” LeeAnn continued to stare at the balled up paper towels. “LeeAnn, they’re here. Will you walk out with me?” She stood up and stared at me and I followed her out the door.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><br />
</div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-size: small;">The Stories</span></i></b></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><i style="mso-bidi-font-style: normal;"><span style="font-size: small;">The stories are my remembrances. Each of them is based on a true event in my work for Tompkins County Mental Health. I have changed the names and identifying information of every client, patient and co-worker except for Beau Saul, of the Ithaca Police Department, who I was fortunate enough to have as a partner. When confidentiality demanded it, I have changed details. The dialogue is my reconstruction of what was said at the time.<span style="mso-spacerun: yes;"> </span>I have felt honored to be let into the lives of so many individuals over the years. Their stories are a gift I have been given.<span style="mso-spacerun: yes;"> </span>Please enjoy them in the spirit with which they were written; to educate and inform.</span></i></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"></div></span></span></span>Terry Garahanhttp://www.blogger.com/profile/18066569365497313232noreply@blogger.com1tag:blogger.com,1999:blog-18300098189807289.post-4145114923524707392011-10-16T16:18:00.002-04:002011-10-16T21:22:45.925-04:00When Truth Lies available as an eBook<div class="separator" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8ayK2V9PXjuiYOB509PH0pOUstaJ9xSoWP6zUua-UXcX2MJ3KYZi47IuExju-vfPc3yz9OZInumKBI0j6m4DWvDQg3V_DDfYN9Ex5IOkNs_Tsp69z4R9CAA05Q5UT9iuW342_ELEOnyc/s1600/cover_2.jpg" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" oda="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8ayK2V9PXjuiYOB509PH0pOUstaJ9xSoWP6zUua-UXcX2MJ3KYZi47IuExju-vfPc3yz9OZInumKBI0j6m4DWvDQg3V_DDfYN9Ex5IOkNs_Tsp69z4R9CAA05Q5UT9iuW342_ELEOnyc/s200/cover_2.jpg" width="129" /></a></div><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none;"><br />
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</div><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none;">When Truth Lies, the first real novel about schizophrenia, is available today as an ebook. Print copies will be available for purchase beginning October 24, 2011. To find out more, or read an excerpt, go to <a href="http://www.whentruthlies.com/">http://www.whentruthlies.com/</a>. <br />
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Praise for When Truth Lies from Dr. E Fuller Torrey-<br />
[Garahan] "writes clearly and well, and the subject is certainly appealing." -Dr. E Fuller Torrey, author of Surviving Schizophrenia and the Insanity Offense</div>Terry Garahanhttp://www.blogger.com/profile/18066569365497313232noreply@blogger.com0tag:blogger.com,1999:blog-18300098189807289.post-83460780374293318992011-10-14T15:08:00.000-04:002011-10-14T15:08:29.213-04:00Context can create understanding<div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: 12pt; line-height: 115%;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>There are actions that people describe as “crazy” that really aren’t as crazy as they seem.<span style="mso-spacerun: yes;"> </span>Rather than saying what someone is doing is crazy, I often start with, “I don’t understand what that person is doing or why they are doing it.”<span style="mso-spacerun: yes;"> </span>The action, in and of itself, is most often neutral. When we call it crazy there is a judgment attached that may or may not be true.</span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><br />
</div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="line-height: 115%;"><strong><span style="font-size: large;">The Story</span></strong></span></div><span style="font-size: 12pt; line-height: 115%;"><span style="font-family: Calibri;"><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">The first calls started about eight thirty in the morning. The initial call was from a friend of a friend who was driving through a small town about seven miles from Ithaca. “There’s a guy walking down the road with a yak. He’s got it on a rope like a dog on a leash and he’s got a big dumb smile on his face. I thought you should know.” I often got calls like this; updates on unusual happenings where someone saw something and they just needed to call someone. The next call was from the lone officer on duty in the town. He was running radar on the edge of town when he noticed an unfamiliar sight in his rearview mirror. “This knucklehead is walking up behind me with the strangest animal I’ve ever seen. I got out of my car and waved him over to the sidewalk. It turns out that he was at the livestock auction at the other end of town and bought a cow or steer or something called a Scottish Highlander. Damn thing has horns that are about six feet wide, and hair like bigfoot. When I asked him what he was doing with it, he said he was going to go to Ithaca and set up a petting zoo. He didn’t have ID or anything except a receipt for the cow. I called the Sheriff’s department and they knew him. His name is Keith Taylor. He’s been picked up a few times, all petty stuff, mostly noise complaints, disturbing the peace and some weird motor vehicle charge. He seems pretty harmless. He was on his way out of town, so I told him to stay off the road and be careful. I was glad to see the back of him. Sheriff’s dispatch said that you had been called a couple of times on him. Good luck!”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">A year earlier I’d been called to the Sheriff’s department to help them with a man they had in custody. He’d been pulled over for driving 45 miles an hour in a 20 mile an hour school zone. When the deputy approached his car, the man began with “Do you know who I am?” The deputy was expecting a tale of local fame or high level connections. Instead he got an incoherent monologue that he referred to as “arble-garble.” At the time there was a suspicion of substance abuse. The police report stated that, “Mr. Taylor declined to take a field sobriety test and became quite agitated. When I suggested that he come with me to the sheriff’s department, he began to kick my car and curse. I then took him into custody.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">The deputy was frustrated. He met me at the sheriff department’s front door saying, “The guy can’t calm down. Maybe you can do something. All he’s got is a traffic ticket. I could charge him with harassment, but that is a huge pain in the ass for me. See if you can calm him down and get him out of here. I go off shift in a while and I don’t want to leave him behind.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">Keith was being held in a small corner interview room with glass on two sides. There was a rectangular metal table attached to the floor with a pair of metal chairs facing each other on either side. Keith saw me coming and stood near the door. The deputy pointed at the chair, “Sit!” Keith sat. The deputy unlocked the door and let me in. “I’ll come get you when you’re done,” he said and left.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">Keith was a tall, thin white man, with a narrow face and crooked teeth. Even though he was only in his mid-thirties, he had a haircut like a fifties rock and roller, swept back on the sides with a big curl on the top of his head that hung over his forehead almost to the bridge of his nose. He had on jeans and boots and a western shirt with decorated pockets. “I’m Terry Garahan from the county mental health department. The deputy said you were pretty upset and thought I might be able to help. What can I do for you?” Keith gripped the table top with both hands, gritting his teeth. “Now I’m crazy! I can see where this is going. I’m Keith Taylor. I’m the man who is going to decide whether you keep your job or you move on. Understand? I might not decide your fate, but your fate will be decided by me. There are things that I know and things that you know, but I don’t think we know the same things or things that are the same. Understand?” The monologue continued for about twenty minutes with my few interjections of: “That sounds pretty difficult” or “I’m sorry to hear that.” I occasionally nodded my head in response to, “Understand?” with recognition of the fact that in listening to him, there were many things I did understand. I tapped on the glass for the deputy, and said to Keith, “We need to figure a way to get you out of here.” “Good stuff!” he replied.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">After an hour on the phone, I had a story and a resolution. Keith was a local guy who was born and raised on a nearby farm. He’d joined the army right out of high school and was given a medical discharge for bi-polar disorder during his first year of service. He’d stayed in Texas, where he’d been stationed, until recently when he decided to return home. His dad said the Veteran’s Administration had been slow to transfer his case and he’d stopped his medications. Within half an hour his dad showed up and the deputy was happy for Keith to leave with him.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">During the following months I got several calls about Keith from his dad. He either refused to take his medication or he took it and spit it out or took it and threw it up. Keith’s mom and dad had a small dairy farm a few miles from town and had their hands full. Keith was their only son and while they wanted to help him, they hadn’t really spent much time with him as a mentally ill adult. He’d been in Texas for fourteen years.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">One early spring morning I drove out to the farm after an exasperated call from Mr. Taylor. I found Keith in a shop under the hood of an old, beat up Porsche with Texas plates. There was the number 11 formed by two long strips of duct tape on each of the doors of the car. The car was as loud as a jet plane with him revving it by pulling on the throttle. He looked over his shoulder at me. “This car, after I finish, will be the fastest car in the world.” “Your dad is worried about you!” I shouted. He replied, “The 11 is for the number of letters in my name.” He reached in and turned off the ignition, then leaned against the car, looking at me, saying, “A lot of people don’t believe in numerology. But if you think about it, it really makes sense.” I asked him, “Your dad doesn’t think you’re taking your meds. Are you?” He replied, “There is a lot of misinformation going around. Excuse me.” With that he got in his car and drove away.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">About midnight that night, I got a call from the state police. Keith Taylor had been arrested and taken to the county jail. A trooper had been having a coffee break in a diner just outside the city limits when he heard the sound of a very loud car. He turned on his stool in time to see a flash of metal go by at high speed. He raced to his car and got on the radio looking for other available troopers or deputies in the area. Another trooper pulled over “number 11” about ten miles away after clocking it at one hundred and three miles an hour. “What is your problem?” Keith had asked the trooper when he tossed his license and registration at his feet.<span style="mso-spacerun: yes;"> </span>Unfortunately, the problem was Keith’s; losing his license, car and spending nearly a week in jail.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">Now, months later, I was preparing to see what new plan Keith had concocted.<span style="mso-spacerun: yes;"> </span>I stopped to see one of the psychiatrists I consulted with. “Petting zoo! Really! He wants to open a petting zoo? Danger to self or others might be able to be met with the cow,” he said, “but I doubt it. Maybe you could trade the cow for three magic beans.”</span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbkinIvIefLeY7z99xTOPNQxn-0duTvaQR3vFj20JuqDhTGUz9gHkrJ9ieiLYaDpPRt6biKONSfpstbr7avCVeJwiApRfTmzPD9dgEuelM2N_4krN62BE5xvc-gbuKqhpwsUWt_9OiZow/s1600/Scottish+Highlander.jpg" imageanchor="1" style="clear: right; cssfloat: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" oda="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbkinIvIefLeY7z99xTOPNQxn-0duTvaQR3vFj20JuqDhTGUz9gHkrJ9ieiLYaDpPRt6biKONSfpstbr7avCVeJwiApRfTmzPD9dgEuelM2N_4krN62BE5xvc-gbuKqhpwsUWt_9OiZow/s320/Scottish+Highlander.jpg" width="228" /></a></div><div class="MsoNormal" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">I saw Keith about five miles outside of town. He was sitting in the grass on the side of the road. The cow was tied to a mailbox, grazing on the thick grass surrounding the wooden post. It was a beautiful animal, a movie star of cows. I drove past and turned the car around in order to be on the same side of the street. “Keith, how are you doing? What’s going on?” I asked. Keith lay back on the grass and closed his eyes. “The world is in turmoil. All I want to do is bring a little joy into the world. I grew up with cows. Kids should be able to see cows. But I’m so tired.” I stood over him blocking the sun. “Keith, you don’t look well. You are really pale and you’re sweating. Are you faint?” “I don’t feel so good,” he responded. “I think you need a doctor to take a look at you. I’m going to call someone to come get you.” The ambulance and the deputy showed up together. The emergency medical technician, after looking at Keith, conducted a simple test, pulling on the skin on his wrist. “He’s really dehydrated. No wonder he feels so lousy.”</span></div><div class="MsoNormal" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: 12pt; line-height: 115%;">The Scottish Highlander was tied to the rear bumper of my car when the deputy pulled away. “I’m glad I’m not you,” he called out the window. It was almost six in the evening when the livestock truck came to get the cow. They came shortly after I received a call that Keith had voluntarily admitted himself to the mental health unit at the hospital.</span></div><div class="MsoNormal" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; margin: 0in 0in 10pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">The Stories</i></b></div><div class="MsoNormal" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; margin: 0in 0in 10pt; text-indent: 0.5in;"><i style="mso-bidi-font-style: normal;">The stories are my remembrances. Each of them is based on a true event in my work for Tompkins County Mental Health. I have changed the names and identifying information of every client, patient and co-worker except for Beau Saul, of the Ithaca Police Department, who I was fortunate enough to have as a partner. When confidentiality demanded it, I have changed details. The dialogue is my reconstruction of what was said at the time.<span style="mso-spacerun: yes;"> </span>I have felt honored to be let into the lives of so many individuals over the years. Their stories are a gift I have been given.<span style="mso-spacerun: yes;"> </span>Please enjoy them in the spirit with which they were written; to educate and inform.</i></div><div class="MsoNormal" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; margin: 0in 0in 10pt;"></div></span></span>Terry Garahanhttp://www.blogger.com/profile/18066569365497313232noreply@blogger.com1tag:blogger.com,1999:blog-18300098189807289.post-37445948715784252632011-10-06T19:58:00.000-04:002011-10-06T19:58:43.116-04:00Dementia, when ignored, may have deadly consequences.<div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">Mental illness and mental health are part of our overall health concerns throughout our lives.<span style="mso-spacerun: yes;"> </span>As our society becomes more fragmented, we must remain aware of those who have few relatives or friends. It is estimated that in the United States there are over five million people with Alzheimer’s and many more who have other forms of dementia. How we help them says a lot about our society.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><br />
</div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;"><strong><span style="font-size: large;">The Story</span></strong></span></div><span style="font-family: Calibri;"><span style="font-size: large;"><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="mso-tab-count: 1;"> </span>Muriel Davis was 78 years old when her husband Ray died. They had been married 60 years. Ray had spent his entire work life at a company that made timing chains for car engines. His cancer had been a long drawn out affair that caused heartache and cost a good deal of their savings. Muriel acknowledged the pain of her husband’s death by being constantly reminded of their only son’s death in an automobile accident many years earlier.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="mso-tab-count: 1;"> </span>Muriel didn’t experience loneliness in any specific way. She and Ray had lived a fairly quiet life.<span style="mso-spacerun: yes;"> </span>She’d spent nearly twenty years serving food at the hospital cafeteria. Her work friends had never been to her home and when they gave her a retirement party at a local restaurant, it had been Ray’s first time meeting them. When Muriel and Ray were in their forties, after Ray Jr.’s death, they’d attended church and joined a bowling league. The demands of both proved too much. One winter they “forgot” to join the league and also avoided the phone calls of a pushy pastor. When retirement came at age 65 they focused on their home. Ray built a garage and made small repairs. Muriel worked in her garden and made preserves. Winter months were spent in front of the TV.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="mso-tab-count: 1;"> </span>The house was a small white farm house a few miles outside of the city of Ithaca. When it was built in the 1850’s, it sat in a grove of trees 100 feet from a dirt track where people walked, rode horses<span style="mso-spacerun: yes;"> </span>or drove wagons, beginning their decent into the valley where Ithaca and Cayuga lake lay. When I first visited, it was seven years after Ray’s death. The house was thirty feet from a busy highway where cars and trucks roared by at sixty miles an hour. Sumac and other scrub trees hid most of the front of the house, while a partially dead maple tree threatened the detached garage. I climbed the uneven front steps to a six by eight foot enclosed porch. Battleship grey paint chipped and peeled under my feet. Ripped plastic, an earlier attempt at winterization, snapped in the fall breeze all around me. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="mso-tab-count: 1;"> </span>I rapped with my knuckles on the door. “Mrs. Davis, Mrs. Davis? It’s Terry Garahan. I’m from the county and I need to talk to you.”<span style="mso-spacerun: yes;"> </span>My voice was raised to overcome the sound of traffic and what I assumed was a TV blaring in the living room. No response. “Mrs. Davis, Mrs. Davis. Can you come to the door please; I need to talk to you.” My voice was just short of a yell.<span style="mso-spacerun: yes;"> </span>I could hear movement in the room behind the door. “I’m sleeping. What do you want?”<span style="mso-spacerun: yes;"> </span>A scratchy older woman’s voice said.<span style="mso-spacerun: yes;"> </span>“Mam, I need to speak to you, can you come to the door please?”<span style="mso-spacerun: yes;"> </span>“Hold on, hold on, I’m going to be a minute. “ Moments later the door opened to reveal a short broad woman with thinning white hair. She had on a faded, flowered housedress, orthopedic stockings and bedroom slippers. I tried to peer around her, but her body blocked most of my view.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="mso-tab-count: 1;"> </span>“What do you want?” she said cautiously. “I’m from the county and I need to talk to you, do you mind if I come in, it’s awfully noisy out here,” I said referring to the trucks passing by. “I don’t know. This isn’t really a good time,” she replied. “It’s really important that I talk to you today,” I continued. “Oh all right,” she said, pulling the door open. “Come on in, but be careful, I haven’t had time to clean.” I held the door and watched her wade through knee-high trash to a fake leather recliner.<span style="mso-spacerun: yes;"> </span>She turned and sat, pushing back hard to elevate her swollen legs. Oprah spoke loudly from the television three feet in front of her. The door slammed behind me and I found myself in a swamp of Styrofoam containers, paper cups, plastic lids, brown paper bags and bits of food.<span style="mso-spacerun: yes;"> </span>I took a step and noticed movement along the floor under the mess. Things scurried for a moment and then stopped. I took another step and it happened again. “I suspect you’re here about the plumbing. I knew somebody would finally show up. The bathroom is there,” she said, pointing to a partially opened door where the tide of trash seemed to dissipate.<span style="mso-spacerun: yes;"> </span>I steeled myself for my brief passage across the room. Ripples of movement preceded me as I carefully raised my feet above the rubbish seeking a safe place to step. As I got to the bathroom door I turned and took in the scene. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: small;">Standing on the edge of this sea of trash I was able to confirm the call I’d gotten earlier in the week. A young Hispanic man had called to tell me about an older woman he was worried about.<span style="mso-spacerun: yes;"> </span>He was the delivery man for a pizza and sub shop downtown. He’d worked there for about a year and delivered to Mrs. Davis four or five times a week. She’d also made a separate arrangement for him to pick up wine for her at the liquor store once or twice a week. “I’m worried about her. She seems to be really losing it and her house looks like a horror movie.<span style="mso-spacerun: yes;"> </span>I tried talking to social services and they told me to call you. They think she might be crazy.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: small;">The assault on my senses reached a peak with the smell of the bathroom. Feces and urine filled the toilet to the brim. The seat was smudged and cracked. The sink was a brown stain of iron from the well water. The bathtub was filled with dirt and dust. I tried the sink faucet. Nothing came out. “Mrs. Davis, there’s no water in here.<span style="mso-spacerun: yes;"> </span>Do you know why?” “The well pump broke a while ago. Aren’t you here to fix it?” she responded. “Do you mind if I look in the kitchen. I want to check the sink in there.<span style="mso-spacerun: yes;"> </span>Is that all right,” I asked. “Sure, help yourself,” she replied. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: small;">The counters and sink in the kitchen were filled with dirty dishes, pots and pans.<span style="mso-spacerun: yes;"> </span>Empty wine bottles littered the floor and pantry. Near the back door was a five gallon paint bucket with a toilet seat on top.<span style="mso-spacerun: yes;"> </span>It was nearly full. I peeked out the back door and determined that Mrs. Davis had dumped many other bucketsful onto the back steps.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: small;">I went back to the living room to see what else I could learn. I waded through the mess trying to ignore the critters under foot. “Could you turn off the TV for a minute? There seems to be a real problem with the plumbing,” I said.<span style="mso-spacerun: yes;"> </span>“Ray’s going to fix it when he gets home.” Mrs. Davis answered, clicking off the TV with a remote. Up close, I noticed the sores on her legs and the immense swelling around the ankles.<span style="mso-spacerun: yes;"> </span>There was also a rash on her arms and what looked like blisters on her chin that appeared to be filled with pus. “Mam, you have some sores there”, I said pointing at her arm.<span style="mso-spacerun: yes;"> </span>“Do you have a doctor? Has anybody taken a look at those?” “I see Dr. Spanger. She’s always treated me real good.” She replied.<span style="mso-spacerun: yes;"> </span>“Mrs. Davis, I know you live alone here, but does anyone come in to help?”<span style="mso-spacerun: yes;"> </span>“Her watery blue eyes stared at me. “Why in god’s good name would I need help?<span style="mso-spacerun: yes;"> </span>I’ve lived in this house almost seventy years and I think I’ve done all right by myself. I forget, why are you here?<span style="mso-spacerun: yes;"> </span>The cable’s fixed, see?”<span style="mso-spacerun: yes;"> </span>She clicked on the TV just in time to see Oprah giving things away. “Mrs. Davis, I’m going to leave now.<span style="mso-spacerun: yes;"> </span>I’ll be back in a little while. Are you going to be OK?” “Could you get me some of that Lambrusco wine when you come back?” she asked.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: small;">I went back to my office and called Dr. Spanger.<span style="mso-spacerun: yes;"> </span>She said her office had been trying to get Mrs. Davis in for at least six months. She’d even arranged transportation.<span style="mso-spacerun: yes;"> </span>When the appointment time came Mrs. Davis hadn’t answered the door. When I explained things, the doctor let out a sigh. “I knew she was demented, but I hadn’t thought it was that bad.” I signed the paperwork and arranged for the Deputy Sheriff and ambulance to meet me at a gas station nearby and informed them of our goal.<span style="mso-spacerun: yes;"> </span>“She’s a nice old lady, but spirited. The best thing we could do is walk her out. Believe me; you don’t want to drag your gurney through that mess.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: small;">The EMT’s and the deputy waited on the lawn.<span style="mso-spacerun: yes;"> </span>I went up on the porch by myself and banged on the door a couple of times. The TV was still blasting. “Mrs. Davis, it’s me, Terry Garahan. I was here a few hours ago.” I pushed open the door and started to enter.<span style="mso-spacerun: yes;"> </span>Mrs. Davis was leaning back in her recliner. In her right hand was a pistol. “What do you want? Get the hell out of my house.<span style="mso-spacerun: yes;"> </span>I don’t want to have to shoot you!”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: small;">I pulled my head back behind the door. “Mrs. Davis. I’m from the county. I was looking at the plumbing. Remember? Could you put the gun down please?"<span style="mso-spacerun: yes;"> </span>Behind me, the Deputy unholstered his weapon. Mrs. Davis waved the gun around for a minute and then set it on a table next to her. “Judge Judy’s on.<span style="mso-spacerun: yes;"> </span>I like her!” she said to the TV. Moments later the small room was filled with the Deputy and two Emergency Medical Technicians. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: small;">When I visited her at the nursing home the next week she sat on a soft sofa next to another old woman watching an episode of Judge Judy.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-size: small;">The Stories</span></i></b></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><i style="mso-bidi-font-style: normal;"><span style="font-size: small;">The stories are my remembrances. Each of them is based on a true event in my work for Tompkins County Mental Health. I have changed the names and identifying information of every client, patient and co-worker except for Beau Saul, of the Ithaca Police Department, who I was fortunate enough to have as a partner. When confidentiality demanded it, I have changed details. The dialogue is my reconstruction of what was said at the time.<span style="mso-spacerun: yes;"> </span>I have felt honored to be let into the lives of so many individuals over the years. Their stories are a gift I have been given.<span style="mso-spacerun: yes;"> </span>Please enjoy them in the spirit with which they were written; to educate and inform.</span></i></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"></div></span></span>Terry Garahanhttp://www.blogger.com/profile/18066569365497313232noreply@blogger.com5tag:blogger.com,1999:blog-18300098189807289.post-58400015420444832432011-09-30T10:34:00.000-04:002011-09-30T10:34:16.447-04:00Mental patients are more often prey then predator.<div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>The popular media version of the mental patient is the crazed killer who is a danger to the community. In my experience, it is</span><span style="font-family: Calibri;"> more likely that people with serious psychiatric illness are preyed upon by bad people. Living in poverty in unsafe housing and </span><span style="font-family: Calibri;">marginal neighborhoods, the few belongings they have are always at risk. Many times, when people are hospitalized, their </span><span style="font-family: Calibri;">belongings are lost and stolen and when they are released they have to start from scratch. The risk of physical harm is also great. </span><span style="font-family: Calibri;">Those with psychiatric illness are not viewed as reliable reporters of crime. They can be victimized not only by the people who prey </span><span style="font-family: Calibri;">upon them, but by law enforcement and a criminal justice system that has difficulty understanding their needs.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><br />
</div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><strong><span style="font-size: large;">The Story</span></strong></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><br />
</div><span style="font-family: Calibri;"><span style="font-size: large;"><div class="MsoNormal" style="line-height: 150%; margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: small;">Gil was the sort of guy that when you met him, you couldn’t help smiling. This happened as a reflection of his smile, almost a permanent fixture on his face. It was genuine and welcoming and slightly amused as if he had a private joke he was about to share with only you. The tobacco stains on his teeth and mustache didn’t deter you from smiling back. Nor did his torn jeans and flannel shirt. Part of the joy that Gil relished was his secret knowledge that he was of royal blood. This idea had come to him when he was a second year student at Cornell. Having spent a good part of the year as a history major studying European history, he’d realized that the reach of the Hapsburgs went far and wide. They had many offspring and branches that entered every royal house in Europe. During winter break, visiting his parents in Delaware, he’d quizzed them extensively on their lineage. His father’s father had come from Germany as a child in the late 1890’s. A family story was told about his great grandfather working in the Kaiser’s kitchen. In the following spring semester Gil proclaimed during a seminar that he was of royal blood, most likely a prince. The professor ignored him until he became very insistent and disruptive. Gil’s roommate could only ignore him until a chair on a platform, decorated in red velvet, appeared in room they shared. Gil sat upon it dressed in a gold bathrobe with a crown made from wire coat hangers. The other students on the floor were more frightened than amused and when campus security came, Gil meekly agreed to go to the hospital. Gil’s dad, who had an uncle and several cousins with schizophrenia, wasn’t surprised by the call, just saddened that his only son had joined what he’d viewed as a family curse.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: small;">At the time, in the middle 1970’s, claims of royal blood combined with upsetting behavior could land you in the state hospital. Gil was a model patient, cooperating with all treatments, helping other patients and participating in groups and vocational programs. Unfortunately, he never gained “insight” into his illness and it took him several years to understand that there are some things that you just need to keep to yourself.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: small;">When Gil got out of the hospital, he found living in Ithaca more pleasing than his parent’s home in rural Delaware and stayed on. During his decades here, he thought of himself as an “alternative” sort of guy and Ithaca suited him fine. Much of the time he spent here was on our downtown pedestrian mall or “commons” as we call it. Summer or winter, he’d hang out with friends, sometimes playing his guitar or joining in a chess match. His apartment was nearby and well maintained, primarily through his caseworker, Helen. </span></div><div class="MsoNormal" style="line-height: 150%; margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: small;">Helen was very upset when she came into my office on a Monday morning. She plopped down in a chair and said, “The McCabe brothers have moved in on Gil.” Unfortunately, I knew exactly what that meant. The McCabe brothers were a real problem. Their primary occupation was to prey on the elderly and the disabled. The local cops had trouble deciding who was a bigger troublemaker, Danny or Davey. Danny was an alcoholic and substance abuser who would drink, smoke, snort or shoot anything he could get his hands on. He was a liar and a thief and worst of all, he was a bully. He always found someone weak and frightened to threaten and intimidate. At age 42, he was a little less than six feet tall with thin blond hair, cracked, broken and missing teeth, and a pitted lined face. His arms and legs were filled with bad ink from jail. He had a mean streak that could lead him to hitting and hurting anyone who didn’t give him what he wanted.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: small;">Davey was a runt. At a little over five feet tall, he was prone to wearing cowboy boots with lifts in them, except when he was working and then he wore Converse All Star sneakers. His work was stealing, and he maintained a specialty. He stole women’s purses off the backs of chairs and floors in bars and restaurants. He was good at it. I once went into a college bar at about 11:00pm and at least a dozen women were lined up to give statements to the uniformed cop. The purses were discovered the next day floating in a creek two blocks away. Money, credit cards and all other valuables had been removed.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: small;">Bar owners and bouncers knew Davey and what he did. But he somehow managed to get past them and ply his craft. Occasionally, he was caught, but the charges never gave him more than a month in the county lockup.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: small;">When I got to the apartment, Gil answered the door. “It’s not a good time.” He half whispered. “I need to talk to you,” I replied as I entered the room. Davey was lying on the couch smoking a cigarette. Danny was asleep in Gil’s bed. A pillow and blanket were on the floor where Gil had spent the night. I banged on the bedroom door. “Danny! Danny! Hey! Rise and shine. I have to talk to you.“ I heard him curse under his breath as he pulled on his jeans and got out of bed. “What’s the problem?” “Look Danny, you know the deal. Gil has an agreement with us and the landlord that he won’t have overnight guests. If you guys crash here, he’s going to get evicted.” “He asked us to stay,” Davey said from behind me. “Yeah, I know. Gil is a really good guy. He’s always ready to help somebody out,” I said.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: small;">Fifteen minutes later the McCabe’s were gone. “Terry, I’m sorry that I got Helen so upset. I was out on the street last night and those guys didn’t have a place to stay and we got a twelve pack and I told them they could crash here.” He was smiling that winning smile. “You know those guys,” I said. “They act like your friends, but they just use people. Did you give them money?“ “Just twenty bucks. But Danny said it was a loan, he’d pay me back.” “How long have they really been here?” I asked. “About a week,” he replied.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: small;">I received a call from Helen just before the work day ended. Gil had shown up at her office in tears. He reported that a watch his grandfather had given him and a coin collection (that was hidden in his closet) were gone.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: small;">The next day I was joined by a police officer and we found the McCabes hanging out in front of the Department of Social Services. “Look guys, there’s some stuff missing from Gil’s apartment. We’re not saying you took it but you may know where it is. It might be best if it was returned,” I said. Davey replied, “Hey, there were a lot of people in and out of that place. Anybody could have taken that stuff.” “It would be <i style="mso-bidi-font-style: normal;">really</i> good if Gil got his grandfather’s watch back,” I strongly suggested.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0in 0in 10pt 0.5in;"><span style="font-size: small;">The next day Helen called to tell me Gil had found his watch. “He said he misplaced it,” she said.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: small;">Over the next several months Helen called multiple times to tell me about the McCabes and Gil. She took over managing Gil’s finances and transferred the lease from his name to his elderly parents. She got their power of attorney, in an attempt to control the apartment. She and I tracked down the McCabes one Friday afternoon and Helen gave them a written notice stating that they were not allowed in Gil’s apartment under any circumstances. The next Monday Gil showed up at Helen’s office with stomach pains. When Helen pursued the cause of his distress he lifted his shirt to show multiple bruises all around his mid-section. She called me, and an officer and I met with Gil to get his story. The McCabes had shown up late Friday night and gave Gil a beating. They stayed at his apartment all week-end, having a party that got so big that the police had been called with a noise complaint.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: small;">Gil went to the police station and wrote out a statement to file charges against the McCabes. We met with an Assistant District Attorney and reviewed the charges. Trespassing was an easy one because of the documentation, including the police report from the noise complaint. Aggravated harassment was as high as they could be charged for the beating. “It’s a ‘his word against theirs’ kind of thing,” the ADA advised us. Beat cops brought the McCabes in later that day and they were both taken to the county jail, neither having bail money.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: small;">Helen called me to her office later that week. “Gil’s staying at the shelter in Rochester and they’re going to get him an apartment up there. He says that the McCabes will kill him when they get out.”</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: small;">A year later, Danny’s body was found in an abandoned house.<span style="mso-spacerun: yes;"> </span>He'd died of natural causes but nobody missed him for a week. Last month I saw Davey in a bar I frequent. When he saw me staring at him he made a quick exit. I never saw Gil again.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-size: small;">The Stories</span></i></b></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><i style="mso-bidi-font-style: normal;"><span style="font-size: small;">The stories are my remembrances. Each of them is based on a true event in my work for Tompkins County Mental Health. I have changed the names and identifying information of every client, patient and co-worker except for Beau Saul, of the Ithaca Police Department, who I was fortunate enough to have as a partner. When confidentiality demanded it, I have changed details. The dialogue is my reconstruction of what was said at the time.<span style="mso-spacerun: yes;"> </span>I have felt honored to be let into the lives of so many individuals over the years. Their stories are a gift I have been given.<span style="mso-spacerun: yes;"> </span>Please enjoy them in the spirit with which they were written; to educate and inform.</span></i></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"></div></span></span>Terry Garahanhttp://www.blogger.com/profile/18066569365497313232noreply@blogger.com0tag:blogger.com,1999:blog-18300098189807289.post-64826093073504125492011-09-21T19:30:00.000-04:002011-09-21T19:30:51.483-04:00We all seek community, some more successfully than others.<span style="font-family: "Calibri", "sans-serif"; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"> Many people with serious psychiatric illness live in isolation.<span style="mso-spacerun: yes;"> </span>Their behaviors can drive away family and friends. When they are symptomatic, many of their actions are misunderstood. Because of the perception of the mentally ill as dangerous, the way they conduct themselves may be viewed as threatening or menacing.<span style="mso-spacerun: yes;"> </span>Landlords, neighbors and acquaintances fear that interactions may bring on negative consequences. When they are stable, the person with mental illness may have little understanding as to why they are shunned by those around them. In seeking companionship, they may compound the fear their behavior has created. <span style="mso-spacerun: yes;"> </span>Most of us want to be part of a community, either the geographic community we reside in or the community of interest that makes our lives fuller. My experience suggests that even those with the most serious illness are well intentioned in their hope to make their lives better. </span><br />
<br />
<br />
<span style="font-family: "Calibri", "sans-serif"; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><strong><span style="font-size: large;">The Story</span></strong></span><br />
<br />
<span style="font-family: "Calibri", "sans-serif"; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="mso-tab-count: 1;"> </span>I stood behind a column, peeking around it at the café that occupied the public space between stores. <span style="mso-spacerun: yes;"> </span>A short woman with dark hair in her late forties was moving from table to table, a coffee pot in her right hand and a large pad of paper in her left hand. <span style="mso-spacerun: yes;"> </span>She reached over and around patrons, pouring coffee in cups, bowls and glasses. <span style="mso-spacerun: yes;"> </span>Behind her an elderly woman began to rise from her chair, pushing herself away from her finished meal. <span style="mso-spacerun: yes;"> </span>“Sit down! You sit down!” the younger woman screamed as she turned, facing the tables behind her. <span style="mso-spacerun: yes;"> </span>“Don’t get up until I tell you to get up. <span style="mso-spacerun: yes;"> </span>Do you understand me?” <span style="mso-spacerun: yes;"> </span>The elderly woman regained her seat, clutching her purse in her lap. It was late morning. <span style="mso-spacerun: yes;"> </span>The café’s twenty tables were only half full. <span style="mso-spacerun: yes;"> </span>The rest were set for lunch. I could see two cooks and two waitresses crowded together in the small kitchen. <span style="mso-spacerun: yes;"> </span>They had closed the kitchen door and were staring at me from behind the pass through, one cook clutching a large knife.<span style="mso-spacerun: yes;"> </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;">Directly across from me and down the hallway, a police officer gave me a thumbs up.<span style="mso-spacerun: yes;"> </span>I held my hand up motioning him to wait and walked slowly toward the woman with the coffee pot.<span style="mso-spacerun: yes;"> </span>She put it down as I approached and turned to fully face me. <span style="mso-spacerun: yes;"> </span>“Rosa,” I said. “What’s going on?”<span style="mso-spacerun: yes;"> </span>“So they called you? <span style="mso-spacerun: yes;"> </span>Why is it that every time I get things straight in my head, every time I get my life together you show up?” <span style="mso-spacerun: yes;"> </span>She was an unattractive woman with a big nose, bulging eyes peering through large black framed glasses and hair that had not seen a comb in months. She had on a flowered knee length skirt with a dungaree shirt jammed into it. Over this she had a bright vest that someone had bought at a tourist shop in Central America. <span style="mso-spacerun: yes;"> </span>A backpack rested on her back, a paisley bag on her left shoulder, a waist pack cinched around her stout middle. <span style="mso-spacerun: yes;"> </span>A pair of torn black hightop sneakers without socks completed her outfit. <span style="mso-spacerun: yes;"> </span>“Why don’t you go away? <span style="mso-spacerun: yes;"> </span>Why don’t you just mind your own damn business and get the hell out of here?” she screamed. <span style="mso-spacerun: yes;"> </span>“Somebody called me. <span style="mso-spacerun: yes;"> </span>They were worried about you. <span style="mso-spacerun: yes;"> </span>When they call I have to come, you know that.<span style="mso-spacerun: yes;"> </span>Why don’t we go someplace else to talk? <span style="mso-spacerun: yes;"> </span>Everybody doesn’t need to know your business.”<span style="mso-spacerun: yes;"> </span>I could sense movement behind me as people began to leave their tables. <span style="mso-spacerun: yes;"> </span>“I hope you’re happy?”<span style="mso-spacerun: yes;"> </span>Rosa said as she leaned on the table closest to her, palms down, her notebook under her arm.</div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;">I looked over my shoulder to find the police officer escorting people down the hall. <span style="mso-spacerun: yes;"> </span>When I turned back, a mass of cheese, avocado and sprouts on toast exploded in my face, the small fat hand rubbing it into my nose and eyes.<span style="mso-spacerun: yes;"> </span>Moments later, Rosa was on the ground screaming at the cop wrestling her one cuffed hand behind her to join under the backpack with the other hand waving in front of his face.</div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;">I’d known Rosa for many years.<span style="mso-spacerun: yes;"> </span>I’d first met her in the 1970’s, when I coordinated programs for mental health patients being discharged from Willard Psychiatric Center during the late stages of deinstitutionalization.<span style="mso-spacerun: yes;"> </span>Rosa was a revolving door patient who would become briefly stable and discharged and never keep appointments or follow up with treatment. <span style="mso-spacerun: yes;"> </span>As she got older, she cooperated with treatment more often, but still had periods of bothersome bi-polar symptoms. <span style="mso-spacerun: yes;"> </span>Several months earlier Rosa had visited the psychiatrist in our office stating that she no longer needed medication.<span style="mso-spacerun: yes;"> </span>‘I’ve been doing some research”, she had told the doctor, “And I believe that I have aged out of my illness.” <span style="mso-spacerun: yes;"> </span>She then presented copies of journal articles to support her proposition. <span style="mso-spacerun: yes;"> </span>She had a master’s degree in city planning and was able to use her academic background to articulate her case. <span style="mso-spacerun: yes;"> </span>What she presented was her decision. <span style="mso-spacerun: yes;"> </span>It was not open to discussion. <span style="mso-spacerun: yes;"> </span>When the doctor had me join them, she said, “He may be in charge here, but he is not the boss of me.”</div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;">The calls started to come in shortly thereafter: her grown daughter pleading “Isn’t there anything you can do? <span style="mso-spacerun: yes;"> </span>Can I sign a paper? <span style="mso-spacerun: yes;"> </span>Do we have to go through this all again? <span style="mso-spacerun: yes;"> </span>We know what’s going to happen. <span style="mso-spacerun: yes;"> </span>I’m the one who has to clean up her mess.”<span style="mso-spacerun: yes;"> </span>Her ex-husband stating, “If she shows up again I’m going to press charges. <span style="mso-spacerun: yes;"> </span>I don’t care how crazy she is, she can’t just show up at my house threatening my new wife. <span style="mso-spacerun: yes;"> </span>If she goes to jail, so be it.”</div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;">Rosa owned a beautiful home in a neighborhood of small ranch houses on a hill overlooking the city.<span style="mso-spacerun: yes;"> </span>I’d been there in the previous year to drop off a prescription that the doctor had forgotten to give her.<span style="mso-spacerun: yes;"> </span>The small inheritance she’d used to buy the house had also been spent on some nice antiques that she had restored. <span style="mso-spacerun: yes;"> </span>At the time she’d asked me in to take a tour and be dazzled by the views of Cornell and the valley below. <span style="mso-spacerun: yes;"> </span>“What do you think?” she’d asked, smiling.<span style="mso-spacerun: yes;"> </span>“I’m jealous,” I replied. <span style="mso-spacerun: yes;"> </span>Having seen Rosa years earlier stripped to her bra and panties on a foam pad in the isolation room at Willard, screaming and banging on a concrete wall, I was pleased to see the life she made for herself.</div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;">I visited again, after the calls began. <span style="mso-spacerun: yes;"> </span>When she opened the door, it appeared that a giant had picked up the house and shaken it like a snow globe. <span style="mso-spacerun: yes;"> </span>The rug was bunched up, the furniture overturned. <span style="mso-spacerun: yes;"> </span>Books pulled from bookcases, dishes dirty everywhere. <span style="mso-spacerun: yes;"> </span>“It took me a while, but I found it.”<span style="mso-spacerun: yes;"> </span>In her hand was a binder containing her master’s thesis. <span style="mso-spacerun: yes;"> </span>“Look at this,” she said guiding me to the kitchen table where a large piece of poster paper was unrolled.<span style="mso-spacerun: yes;"> </span>Books were piled on one corner; duct tape held the other three. <span style="mso-spacerun: yes;"> </span>A slide rule, protractor and plastic ruler, educational instruments long abandoned by academics, were at the bottom of the drawing. Her work showed a crude illustration of the valley as seen from her window. <span style="mso-spacerun: yes;"> </span>Near the top were wavy lines indicating the multiple rivers, streams and creeks flowing down the hills and into the lake. <span style="mso-spacerun: yes;"> </span>Each of them was well marked. <span style="mso-spacerun: yes;"> </span>At right angles to these lines were broad strokes made by magic markers that seemed to enter buildings erected on the top of the hill. <span style="mso-spacerun: yes;"> </span>“Well! <span style="mso-spacerun: yes;"> </span>What do you think?” she asked. <span style="mso-spacerun: yes;"> </span>“I don’t know what I’m looking at,” I replied. <span style="mso-spacerun: yes;"> </span>“Are you stupid? <span style="mso-spacerun: yes;"> </span>It’s the valley. <span style="mso-spacerun: yes;"> </span>See these?” she said indicating the wavy lines. “This is all water and water is power. <span style="mso-spacerun: yes;"> </span>You move the water from the streams and rivers, through the pipes and into the generator buildings. <span style="mso-spacerun: yes;"> </span>The wheels spin and the water falls downhill into the lake. <span style="mso-spacerun: yes;"> </span>The people who first lived here understood that. <span style="mso-spacerun: yes;"> </span>That is why they settled here. <span style="mso-spacerun: yes;"> </span>For the last 100 years we’ve ignored it.<span style="mso-spacerun: yes;"> </span>I’m the only one who understands it.” <span style="mso-spacerun: yes;"> </span>She walked over to the picture window. <span style="mso-spacerun: yes;"> </span>“Look at that! <span style="mso-spacerun: yes;"> </span>Ithaca doesn’t need to have one once of electricity come from the outside. <span style="mso-spacerun: yes;"> </span>I’ve solved it. <span style="mso-spacerun: yes;"> </span>That smelly coal plant up the lake can be torn down. <span style="mso-spacerun: yes;"> </span>It’s time for old to be new again.” She began to sing and dance. “It’s time for old to be new again; it’s time for old to be new again.”</div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;">“Rosa? <span style="mso-spacerun: yes;"> </span>Rosa, I need to talk to you. <span style="mso-spacerun: yes;"> </span>Your daughter called and…?”<span style="mso-spacerun: yes;"> </span>“Get out!” she yelled, not touching me, but moving me toward the door. “That little bitch is an ingrate. <span style="mso-spacerun: yes;"> </span>Her father raised her to hate me. <span style="mso-spacerun: yes;"> </span>He has always been jealous of my success and he can’t wait to see me fail. <span style="mso-spacerun: yes;"> </span>When people see what I’ve accomplished, what I’ve given back to this community, then he’ll have to apologize. Now get out and don’t come back and don’t tell anyone about my plan. <span style="mso-spacerun: yes;"> </span>I want to have an unveiling at City Hall when it’s all complete. <span style="mso-spacerun: yes;"> </span>If you tell anyone, anyone at all, I’ll sue you. <span style="mso-spacerun: yes;"> </span>Don’t think I won’t. <span style="mso-spacerun: yes;"> </span>The house shook when the door slammed.</div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;">Two days later I was at the city engineer’s office, a police officer at my side. <span style="mso-spacerun: yes;"> </span>“I’m going, I’m going.” Rosa said, gathering her things. “But you haven’t heard the last of me.” <span style="mso-spacerun: yes;"> </span>That afternoon, her ancient Volvo wagon was spotted parked sideways at the food co-op. <span style="mso-spacerun: yes;"> </span>Later, when I’d responded to the convenience store at the edge of town, the woman behind the counter said, “I don’t know what her problem is, but she better not bring it in here again.” <span style="mso-spacerun: yes;"> </span>Eventually I got a call from the woman who owned the café. <span style="mso-spacerun: yes;"> </span>She’d called just before Rosa had taken over her restaurant. “I don’t want her to get in trouble,” she’d said.</div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;">I sat across from Rosa at her hospital discharge meeting nearly a month later. “Sorry”, she said. “I know you’re trying to help. <span style="mso-spacerun: yes;"> </span>But sometimes you’re really a pain in the ass.”</div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">The Stories</i></b></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><i style="mso-bidi-font-style: normal;">The stories are my remembrances. Each of them is based on a true event in my work for Tompkins County Mental Health. I have changed the names and identifying information of every client, patient and co-worker except for Beau Saul, of the Ithaca Police Department, who I was fortunate enough to have as a partner. When confidentiality demanded it, I have changed details. The dialogue is my reconstruction of what was said at the time.<span style="mso-spacerun: yes;"> </span>I have felt honored to be let into the lives of so many individuals over the years. Their stories are a gift I have been given.<span style="mso-spacerun: yes;"> </span>Please enjoy them in the spirit with which they were written; to educate and inform.</i></div></span>Terry Garahanhttp://www.blogger.com/profile/18066569365497313232noreply@blogger.com1tag:blogger.com,1999:blog-18300098189807289.post-47424111888457144182011-09-07T17:34:00.000-04:002011-09-07T17:34:52.823-04:00Fifty years from now, we will look back in shame! How could we let the mentally ill be treated like this?<div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>History will judge our actions harshly.<span style="mso-spacerun: yes;"> </span>We closed the hospitals and placed the impossibly high burden of “danger to self or others” as our treatment criteria.<span style="mso-spacerun: yes;"> </span>Meanwhile millions who are seriously ill either live on the streets or are incarcerated.<span style="mso-spacerun: yes;"> </span>It is estimated that there are as many mentally ill in jails and prisons now as there were in hospitals at the beginning of deinstitutionalization; almost 500,000.<span style="mso-spacerun: yes;"> </span>We have protected their rights:<span style="mso-spacerun: yes;"> </span>the right to be ill without treatment, the right to live in poverty or in a cage.<span style="mso-spacerun: yes;"> </span>We have returned to a time before the asylum movement where the serious mentally ill were left to fend for themselves until their behavior interfered with our lives.<span style="mso-spacerun: yes;"> </span>Shame on us and the choices we have made. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><br />
</div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><strong><span style="font-size: large;">The Story</span></strong></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><br />
</div><span style="font-family: Calibri;"><span style="font-size: large;"><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="mso-tab-count: 1;"> </span>He was standing next to our billing administrator screaming, “My brame, my brame. Turn that off, it is hurting my brame.”<span style="mso-spacerun: yes;"> </span>His left hand was banging on the computer screen on her desk; his right hand was pressed against his head above his ear.<span style="mso-spacerun: yes;"> </span>“Stephan!” I called. <span style="mso-spacerun: yes;"> </span>“Stephan, what’s the matter?” <span style="mso-spacerun: yes;"> </span>He turned toward me, his narrow face contorted with pain, his eyes moist.<span style="mso-spacerun: yes;"> </span>His eastern European accent was thick. <span style="mso-spacerun: yes;"> </span>“The computer!<span style="mso-spacerun: yes;"> </span>It is hurting my brame!<span style="mso-spacerun: yes;"> </span>Ronald Reagan first put the radioactive isotopes in my skull and now he is trying to control me with this computer.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="mso-spacerun: yes;"> </span><span style="mso-tab-count: 1;"> </span>“Karen, could you shut the computer down and I’ll get Stephan downstairs?”<span style="mso-spacerun: yes;"> </span>The frightened woman had already shut it off and was grabbing her purse from under her desk moving toward another office.<span style="mso-spacerun: yes;"> </span>I led Stephan to the elevator and we went down a few floors to my office. Colleagues stationed themselves near my door as I directed the yelling man to a chair. A nurse mimed a call to the police as we passed her. I shook my head no, but left the door open. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="mso-tab-count: 1;"> </span>Stephan was the strongest person I’ve ever met. He wasn’t tall, less than six feet. But he was so broad he had to turn sideways to walk through most doors. When he’d emigrated from the Ukraine twenty years earlier he’d gotten a job on the loading dock at a local factory. When the fork lift broke, he loaded barrels by hand.<span style="mso-spacerun: yes;"> </span>I once watched him pick up the back of a small American car.<span style="mso-spacerun: yes;"> </span>He was psychotic most of the time. The only time I saw him stable was after an extended hospitalization. Even then, he was symptomatic but not agitated.<span style="mso-spacerun: yes;"> </span>He drank and smoked pot and most likely used other substances.<span style="mso-spacerun: yes;"> </span>He also screamed and yelled and frightened almost everyone he met, including me.<span style="mso-spacerun: yes;"> </span>He’d recently grabbed his file from a nurse who was treating him and ran out the door into the street.<span style="mso-spacerun: yes;"> </span>I’d needed the police to get the file back. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="mso-tab-count: 1;"> </span>However, there was a sweetness about him that would emerge when he realized how fearful he made people.<span style="mso-spacerun: yes;"> </span>“Ok, ok! Don’t worry,” he said smiling. “Maybe the computer is only to get money for mental health.<span style="mso-spacerun: yes;"> </span>That lady was a nice lady. She wouldn’t hurt me.<span style="mso-spacerun: yes;"> </span>But Ronald Reagan <i style="mso-bidi-font-style: normal;">did</i> put isotopes in my brame!”<span style="mso-spacerun: yes;"> </span>In the clinic, we held his prescription for an anti-psychotic medication that had a sedating effect. I offered it to him. He swallowed two and said, “I need some beer.”<span style="mso-spacerun: yes;"> </span>Then he got up and left. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="mso-tab-count: 1;"> </span>Waiting for him in our reception area was Jane, his girlfriend.<span style="mso-spacerun: yes;"> </span>She was a tall, thin woman with stringy black hair.<span style="mso-spacerun: yes;"> </span>She’d met Stephan in the state hospital when they were there on a long term admission.<span style="mso-spacerun: yes;"> </span>She’d found him exotic and interesting and had attached herself to him.<span style="mso-spacerun: yes;"> </span>Ten years later she still followed him around, helping and supporting him and cleaning up his messes.<span style="mso-spacerun: yes;"> </span>One of her main roles in the relationship was to find apartments. <span style="mso-spacerun: yes;"> </span>Landlords would never rent to Stephan, but when Jane went to rent a place, she was neat, clean, pleasant and cooperative. <span style="mso-spacerun: yes;"> </span>She’d never had a problem finding a place. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: small;">Jane’s first hospitalization was at age 17.<span style="mso-spacerun: yes;"> </span>Voices told her that her father was evil so she’d attacked him.<span style="mso-spacerun: yes;"> </span>She’d been taken directly to the state hospital where she spent several years. <span style="mso-spacerun: yes;"> </span>As a consequence she’d taken medication most of her adult life. Every few years she would stop taking medication and become catatonic, entering a world that only she knew. Unfortunately, she would stop eating and taking care of herself and eventually agree that she needed to be hospitalized. Even when she was stable, she still was psychotic in a quiet, internal way that, for the most part, gave her pleasure. She called it “active dreaming”. <span style="mso-spacerun: yes;"> </span>She created a world in her mind where many millions of people lived. <span style="mso-spacerun: yes;"> </span>She controlled them consciously, but they lived in what she described as a “wide awake dream state.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="mso-tab-count: 1;"> </span>Jane would work with her caseworker to secure an apartment, pretending that she would live there by herself.<span style="mso-spacerun: yes;"> </span>The caseworker would join in the fiction, imploring Jane to keep Stephan out. <span style="mso-spacerun: yes;"> </span>Jane would agree, but within hours of moving in, Stephan would be there.<span style="mso-spacerun: yes;"> </span>He was a presence. <span style="mso-spacerun: yes;"> </span>Even in his most stable moments he was three times louder than any other person.<span style="mso-spacerun: yes;"> </span>He occupied space with constant movement, walking to and fro; arms flailing with a lit cigarette dropping ash. <span style="mso-spacerun: yes;"> </span>Soon after moving in, the apartment was a mess, with empty beer cans and liquor bottles strewn about.<span style="mso-spacerun: yes;"> </span>Fast food containers would fill the trash cans and burn marks would appear on the furniture and rugs. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="mso-tab-count: 1;"> </span>The first complaints would come from neighbors, those unfortunate enough to share walls, ceilings or floors with Jane and Stephan.<span style="mso-spacerun: yes;"> </span>Often, the inexpensive housing was occupied by graduate students who would tap on the door requesting that Stephan please quiet down.<span style="mso-spacerun: yes;"> </span>Drunk or sober Stephan would explain that he had been made into a nuclear weapon by Ronald Reagan. Once I was called by a student’s roommate and went to the apartment to find Stephan sitting on a coffee table yelling at his frightened neighbor trapped on the couch in front of him.<span style="mso-spacerun: yes;"> </span>Stephan was wildly gesticulating, bits of ash and trails of smoke everywhere.<span style="mso-spacerun: yes;"> </span>“Look in my eyes!” he yelled at the young man. “See the bits of gold? <span style="mso-spacerun: yes;"> </span>They always use gold when they place the isotopes.” <span style="mso-spacerun: yes;"> </span>The student nodded in agreement.<span style="mso-spacerun: yes;"> </span>“Terry, my friend! Tell him this is true!<span style="mso-spacerun: yes;"> </span>I’m not lying about this,” he said, turning towards me and standing up.<span style="mso-spacerun: yes;"> </span>I replied, “Stephan, you’ve certainly had some very difficult and frightening things happen to you.<span style="mso-spacerun: yes;"> </span>But I need to talk to you.<span style="mso-spacerun: yes;"> </span>Is it okay if this guy leaves?”<span style="mso-spacerun: yes;"> </span>The student was out the door before Stephan turned around. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="mso-tab-count: 1;"> </span>“This is a nice place,” I said looking around. “You and Jane can make this work for you if you settle down. “<span style="mso-spacerun: yes;"> </span>Jane came out of the kitchen where she had been reading a book. “Don’t worry, we won’t screw it up.<span style="mso-spacerun: yes;"> </span>Stephan promised to stay away when he gets drunk. That should help.”<span style="mso-spacerun: yes;"> </span>“A few drinks is not drunk,” he said.<span style="mso-spacerun: yes;"> </span>He then proceeded to touch his nose, stand on one foot and walk a straight line, replicating a police field sobriety test. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="mso-tab-count: 1;"> </span>Jane’s caseworker came to my office the next day.<span style="mso-spacerun: yes;"> </span>“Other tenants are already threatening to leave if Stephan keeps coming around. Just thought I’d let you know.” <span style="mso-spacerun: yes;"> </span>When I stopped at the police station later that morning I was presented with three separate complaints about noise from Jane’s apartment. One included a question about domestic violence with the officer concerned about Jane’s safety. <span style="mso-spacerun: yes;"> </span>It was something I often wondered about, but the only time I had seen Stephan get physical with Jane was out on the street in front of the mental health building. <span style="mso-spacerun: yes;"> </span>He had grabbed her head and put her ear next to his ear.<span style="mso-spacerun: yes;"> </span>He’d been screaming, “Hear them, they are cursing me. <span style="mso-spacerun: yes;"> </span>They are laughing at me. They are trying to kill me.” <span style="mso-spacerun: yes;"> </span>When Jane agreed that she’d heard the voices, he let her go.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="mso-tab-count: 1;"> </span>The eviction notice came the next week.<span style="mso-spacerun: yes;"> </span>The caseworker tried to get them someplace else, wanting to stay on good terms with the landlord.<span style="mso-spacerun: yes;"> </span>Weeks and then months passed as the eviction proceeded, and no living alternative presented itself. <span style="mso-spacerun: yes;"> </span>Stephan’s drinking got worse and he spent most days on the street downtown, yelling at passers by.<span style="mso-spacerun: yes;"> </span>When the police told him to stop or move on, he quieted down and left. I had numerous conversations with the psychiatrists and nurses and social workers I worked with to try to figure out a way to resolve the situation. I met with the Commissioner of Mental Health and the head of the hospital psychiatric unit.<span style="mso-spacerun: yes;"> </span>Although Stephan put himself at risk by yelling at people and menacing them, he did not meet the criteria for “danger to self or others”. <span style="mso-spacerun: yes;"> </span>Finally, the day arrived when they had to leave. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="mso-tab-count: 1;"> </span>Jane came to my office with her few possessions in a garbage bag. “I stopped taking my meds three weeks ago.” she said. “I want to go in the hospital.<span style="mso-spacerun: yes;"> </span>I’m having difficulty knowing what’s real and what’s not.”<span style="mso-spacerun: yes;"> </span>With Jane in the hospital, Stephan became a bigger problem.<span style="mso-spacerun: yes;"> </span>He began living outside, staying in the parks and gorges that are plentiful in Ithaca. <span style="mso-spacerun: yes;"> </span>His caseworker prevailed upon a shelter in a nearby city to help.<span style="mso-spacerun: yes;"> </span>Stephan only had the clothes on his back when he left. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="mso-tab-count: 1;"> </span>The Ithaca police department Deputy Chief called me at my office several months later.<span style="mso-spacerun: yes;"> </span>“Stephan was shot and killed last night.<span style="mso-spacerun: yes;"> </span>The duty officer in ____, found out he was originally from here and called me. They wanted information to justify the shooting. Apparently, he’d had a small fire in his apartment, probably from unsafe smoking.<span style="mso-spacerun: yes;"> </span>When the fire department came, he wouldn’t let them in. <span style="mso-spacerun: yes;"> </span>When officers arrived to assist, he jumped out of a window and ran down the street. <span style="mso-spacerun: yes;"> </span>When they finally cornered him he had a kitchen knife. <span style="mso-spacerun: yes;"> </span>He wouldn’t put it down so they pepper-sprayed him, and then shot him with a bean bag round. <span style="mso-spacerun: yes;"> </span>You know Stephan, that would only piss him off.<span style="mso-spacerun: yes;"> </span>In the end, he came at them with the knife and they put four rounds in him. <span style="mso-spacerun: yes;"> </span>Sorry to be the bearer of bad news.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="mso-tab-count: 1;"> </span>I go to the library every week. <span style="mso-spacerun: yes;"> </span>Each time I visit, Jane is in a comfortable chair reading a book.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="mso-tab-count: 1;"><span style="font-size: small;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-size: small;">The Stories</span></i></b></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><i style="mso-bidi-font-style: normal;"><span style="font-size: small;">The stories are my remembrances. Each of them is based on a true event in my work for Tompkins County Mental Health. I have changed the names and identifying information of every client, patient and co-worker except for Beau Saul, of the Ithaca Police Department, who I was fortunate enough to have as a partner. When confidentiality demanded it, I have changed details. The dialogue is my reconstruction of what was said at the time.<span style="mso-spacerun: yes;"> </span>I have felt honored to be let into the lives of so many individuals over the years. Their stories are a gift I have been given.<span style="mso-spacerun: yes;"> </span>Please enjoy them in the spirit with which they were written; to educate and inform.</span></i></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"></div></span></span>Terry Garahanhttp://www.blogger.com/profile/18066569365497313232noreply@blogger.com2tag:blogger.com,1999:blog-18300098189807289.post-27876072283332457962011-08-30T13:01:00.000-04:002011-08-30T13:01:06.908-04:00Say “person with schizophrenia”, not schizophrenic!<div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>When someone is called a schizophrenic, the word tends to describe them as a mass of symptoms that defines them.<span style="mso-spacerun: yes;"> </span>Saying a person has schizophrenia better describes a complex person who is diagnosed with a disease. I have met thousands of people with schizophrenia. They are brothers, sisters, sons and daughters, mothers and fathers. They are liberal and conservative, Jewish, Catholic Protestant, Hindu and Buddhist. They are smart and stupid, interesting and dull. They are never the same although they often have symptoms that are similar.<span style="mso-spacerun: yes;"> </span>They have hobbies and interests, hopes and dreams.<span style="mso-spacerun: yes;"> </span>Most importantly they love and are loved. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri; font-size: large;"><strong>The Story</strong></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">Her young son stood behind her when she opened the door. He was 9 or 10, with jet black hair and big brown eyes. “I.D,” she demanded. <span style="mso-spacerun: yes;"> </span>When I handed it over, she looked closely at the picture and at me, and then examined the lamination to make sure it had not been tampered with. <span style="mso-spacerun: yes;"> </span>“We’ll talk outside. <span style="mso-spacerun: yes;"> </span>You stay here and lock the door,” she said to the boy. She was a tall white woman 5’9” or 10”, with long brown hair. <span style="mso-spacerun: yes;"> </span>Her face was thin, pinched and with a small mouth. <span style="mso-spacerun: yes;"> </span>“I don’t know why the cops came, I wasn’t bothering anyone. <span style="mso-spacerun: yes;"> </span>I was just talking to my son.”<span style="mso-spacerun: yes;"> </span>“I guess the neighbors thought maybe somebody was bothering you or hurting you or your son,” I said. <span style="mso-spacerun: yes;"> </span>“Also, you gave the police a false name and your son hasn’t been to school.” <span style="mso-spacerun: yes;"> </span>“I told them that I had to escape my ex-husband who is trying to kill me. He has access to all FBI and CIA records and if I use my real name he can easily find me. <span style="mso-spacerun: yes;"> </span>He’s found us in Flagstaff, Arizona, Rockford, Illinois and last month in Charleston, South Carolina. <span style="mso-spacerun: yes;"> </span>He even had me raped in Charleston,” she replied.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">The officer, who alerted me to Kristen and her son Adam, had contacted the Charleston police for information. They’d had a dozen difficult contacts with Kristen in the six months she lived there and confirmed the sexual assault had taken place about a month earlier.<span style="mso-spacerun: yes;"> </span>They had a suspect in the case, who was also being investigated for other rapes, but they did not have enough for an arrest.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">Kristen claimed her husband was a member of the Noriega family and had been working as a CIA informant and as a drug runner and was part of the “Miami Mafia”. <span style="mso-spacerun: yes;"> </span>“He has a long reach! People think I’m lying or crazy, but I know it’s true. <span style="mso-spacerun: yes;"> </span>Look at the things that happen to me. How else can I be followed all over the country?<span style="mso-spacerun: yes;"> </span>There are things that go on that we can see that are on the surface, and there are things that go on under the surface.<span style="mso-spacerun: yes;"> </span>The things on top are controlled by the people underneath. I’ve been working for a number of years on a book that will expose the connections between corporations and the mafia. <span style="mso-spacerun: yes;"> </span>There are great libraries here at Cornell and I’m going to spend time doing research so I can expose the system that nobody sees. <span style="mso-spacerun: yes;"> </span>I hope I can hide out long enough to do my work.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;"><span style="mso-spacerun: yes;"> </span>“It sounds like you have really been through a lot,” I said.<span style="mso-spacerun: yes;"> </span>“We keep our information strictly confidential.<span style="mso-spacerun: yes;"> </span>The records we keep are only paper records. <span style="mso-spacerun: yes;"> </span>We don’t keep any computer records at all. We won’t for at least a few years.<span style="mso-spacerun: yes;"> </span>There is a woman I work with named Anne who specializes in helping women who have been oppressed by the men in their lives. <span style="mso-spacerun: yes;"> </span>She also helps women who have been sexually assaulted. I’d love for you to meet her. <span style="mso-spacerun: yes;"> </span>Would you do that? <span style="mso-spacerun: yes;"> </span>And your son has to go to school. I’ll talk to them about securing his records.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">The psychiatrist who presented her case at our intake meeting was not optimistic. “This 36 year old woman had an onset of symptoms of paranoid schizophrenia at about age 22, shortly after her college graduation. We have received hospital records from her home town, Baltimore. <span style="mso-spacerun: yes;"> </span>She was reluctant at first to sign a release, but after much discussion and prompting, she agreed that it would be helpful for us to confirm facts as she states them. <span style="mso-spacerun: yes;"> </span>She is a traveller.<span style="mso-spacerun: yes;"> </span>The only region she hasn’t been in is the Pacific Northwest and not for want of trying. She says that she was in Salt Lake City at the bus station with a ticket to Seattle when she saw her husband at the ticket office talking to the agent. Kristen says that she is happy to talk to Anne, but is unwilling to take medication. <span style="mso-spacerun: yes;"> </span>I also saw her son and spoke to him with her present and by himself. <span style="mso-spacerun: yes;"> </span>He is a nice young boy. <span style="mso-spacerun: yes;"> </span>Mostly, he’s worried about his mom, who can go on rants about various delusions she has. <span style="mso-spacerun: yes;"> </span>That was what the original call was about. <span style="mso-spacerun: yes;"> </span>As far as the ex is concerned, I don’t know if he’s a good guy or a bad guy. <span style="mso-spacerun: yes;"> </span>At the moment, we have no reason to look for him. <span style="mso-spacerun: yes;"> </span>What I do know is that she has had some very bad things happen to her and for the sake of her son; it would be nice to try to engage her and have her want to stay here so her son can have a life. <span style="mso-spacerun: yes;"> </span>But if she’s still here six months from now I’d be surprised.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">I heard the piano when I came down the stairs. Anne had called me and asked that I come down to the day treatment program. <span style="mso-spacerun: yes;"> </span>It was late in the afternoon, the program was over and when she said it wasn’t a crisis, I’d been relieved.<span style="mso-spacerun: yes;"> </span>The old upright was in a corner and usually it was subjected to unending versions of “Chopsticks”. <span style="mso-spacerun: yes;"> </span>The sounds that came from it now were melodic and sweet. I recognized the song as an old standard, <i style="mso-bidi-font-style: normal;">What a Difference a Day Makes.</i><span style="mso-spacerun: yes;"> </span>When I was able to look over the top of the piano I was shocked to find a little boy with ink black hair and brown eyes. <span style="mso-spacerun: yes;"> </span>His small hands moved easily over the keys, his gaze intent on the sheet music in front of him.<span style="mso-spacerun: yes;"> </span>He picked up the tempo and the song took on a different flavor.<span style="mso-spacerun: yes;"> </span>“I heard it played faster once,” he said, looking up at me.<span style="mso-spacerun: yes;"> </span>An hour later, after preforming songs from <i style="mso-bidi-font-style: normal;">West Side Story</i>, some ragtime, and then Bach and Chopin, Kristen came in to get him. <span style="mso-spacerun: yes;"> </span>“He’s good, isn’t he?”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">Anne told me that Kristen recognized Adam’s talent early on. <span style="mso-spacerun: yes;"> </span>In each community they had lived, Kristen had arranged piano lessons. <span style="mso-spacerun: yes;"> </span>She’d scrimped and saved and traded labor and bartered belongings for the lessons. <span style="mso-spacerun: yes;"> </span>What was clear was that this very charming and pleasant young boy had exceptional talent that needed to be developed.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">Kristen’s agitation, including yelling, continued to cause problems. <span style="mso-spacerun: yes;"> </span>The psychiatrist had given her a prescription for anti-psychotic medication that he said would “calm her”. <span style="mso-spacerun: yes;"> </span>He told her that she was in charge of her treatment and she should take the medication if she felt an episode coming on or if the neighbors complained or the police showed up. <span style="mso-spacerun: yes;"> </span>“It does take the edge off,” she told him at their next meeting.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">After about eighteen months passed, Adam was nearing the completion of his first entire year in one school. <span style="mso-spacerun: yes;"> </span>Kristen had joined our day treatment program and was a regular, cooking and serving lunch to some severely disabled clients. <span style="mso-spacerun: yes;"> </span>She came to my office one day in April to brainstorm about ways to finance a summer arts camp for Adam in a nearby city.<span style="mso-spacerun: yes;"> </span>I directed her to some local charities that I knew could help. <span style="mso-spacerun: yes;"> </span>When she came up a few hundred dollars short, we took up a collection and I told her it was from a special charity.<span style="mso-spacerun: yes;"> </span>It took three buses and a mile walk for her to take him there. <span style="mso-spacerun: yes;"> </span>She’d spent the night on a bench in the bus station before returning the next day. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">The regional orchestra that Adam performs with now is a five hour drive away. <span style="mso-spacerun: yes;"> </span>I saw him just after he graduated from college. <span style="mso-spacerun: yes;"> </span>“My mom’s crazy, but she loves me,” he said.</span></div><span style="font-family: Calibri; font-size: large;"><div class="MsoNormal" style="margin: 0in 0in 10pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: small;"><em>The Stories</em></span></b></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-size: small;"><em>The stories are my remembrances. Each of them is based on a true event in my work for Tompkins County Mental Health. I have changed the names and identifying information of every client, patient and co-worker except for Beau Saul, of the Ithaca Police Department, who I was fortunate enough to have as a partner. When confidentiality demanded it, I have changed details. The dialogue is my reconstruction of what was said at the time.<span style="mso-spacerun: yes;"> </span>I have felt honored to be let into the lives of so many individuals over the years. Their stories are a gift I have been given.<span style="mso-spacerun: yes;"> </span>Please enjoy them in the spirit with which they were written; to educate and inform.</em></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"></div></span>Terry Garahanhttp://www.blogger.com/profile/18066569365497313232noreply@blogger.com1tag:blogger.com,1999:blog-18300098189807289.post-36381605819500089672011-08-25T10:28:00.000-04:002011-08-25T10:28:41.275-04:00If you have a serious mental health problem, find a skilled helper!<div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">There are many different kinds of mental health professionals. <span style="mso-spacerun: yes;"> </span>Often they claim a broad knowledge base and are willing to see anyone who comes through the door.<span style="mso-spacerun: yes;"> </span>If you have a serious mental health problem, check around. Contact your local mental health association or the local affiliate of the National Alliance for the Mentally Ill, (NAMI).<span style="mso-spacerun: yes;"> </span>Have a brief phone or face-to-face consult, which should be free.<span style="mso-spacerun: yes;"> </span>Make sure the person is skilled and knowledgeable.<span style="mso-spacerun: yes;"> </span>Talk about cost and insurance. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">The professional should be helping you set goals and objectives early in the process.<span style="mso-spacerun: yes;"> </span>Avoid “chit-chat” therapists who don’t have a plan and talk to you like an interested friend.<span style="mso-spacerun: yes;"> </span>You ought to know where you are going in treatment and how you are going to get there.<span style="mso-spacerun: yes;"> </span>You should be learning skills and be able to apply them in the real world. <span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Insight is not enough! <span style="mso-spacerun: yes;"> </span></b>Change needs to take place. <span style="mso-spacerun: yes;"> </span>A skilled mental health professional should know about “talk” and “non-talk’ treatments and be open to at least discussing all possibilities.<span style="mso-spacerun: yes;"> </span>If, after three months, change is not taking place, find another professional.<span style="mso-spacerun: yes;"> </span></span></div><br />
<br />
<strong><span style="font-size: large;">The Story</span></strong><br />
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">The smell of gasoline was frightening. It enveloped the entire space.<span style="mso-spacerun: yes;"> </span>The empty gallon can was next to her on the concrete floor as she sat there sobbing, her hair and clothing covered, soaked with the fuel that was slowly evaporating. In her hand was a shiny zippo lighter. Its reflection sent splashes of light throughout the two car garage.<span style="mso-spacerun: yes;"> </span>I sat on an overturned five gallon bucket near a side door to the room. The cars were parked in front and I could see the lights of the police cruisers flashing against the leaves of the trees in the early autumn afternoon. She was a thin, small white woman in her mid-forties. Her damp hair may have been blond. Her white sleeveless blouse and grey sweatpants were saturated, her feet were bare. The garage was silent except for the buzz of the florescent bulbs overhead.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">The therapist had come running down the hallway waving a folder in her hand about two hours earlier. “Terry, Terry, you’ve got to help me. She’s going to kill herself. This time she’s really going to do it.”<span style="mso-spacerun: yes;"> </span>I sat her down and had her tell me the whole story. Her client had a long history of depression. She had been seeing her for eight or nine years.<span style="mso-spacerun: yes;"> </span>Our new psychiatrist had recommended medication for this patient and Diane, the therapist, had not only resisted, but had poisoned the person’s attitude regarding medication. She was an old school therapist who was taken to saying, “People have to work through their issues. Medication is just a short cut, a band aide that doesn’t solve the problem. They need insight and understanding into the reasons they are depressed. They need to take responsibility for their part in their depression.”<span style="mso-spacerun: yes;"> </span>This particular therapist had a caseload of depressed women who she had been seeing for years and none of them ever seemed to get better. Her notes always indicated that her clients were “gaining insight” or on the verge of having a “breakthrough”.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">When we had reviewed this case a few months earlier, we had noted the length of time the patient had been in treatment without real progress. Our recommendation was to begin a trial of Prozac, a medication that had only been available for a short time. I understood the resistance to the older antidepressants, the tricyclics, like Elavil and <span lang="EN" style="mso-ansi-language: EN;">Imipramine.</span> Those medications were very useful except for a major problem. A month’s supply would kill you. Prescribing the means to end your life to a depressed, suicidal person was risky business and in the thirty years they were in use, these medications killed many.<span style="mso-spacerun: yes;"> </span>Prozac did not have this problem and was a game changer. Professionals had to be convinced, but many didn’t have an interest in rethinking the way people with serious depression might be helped.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">The therapist was rocking back and forth in her chair saying, “Hurry, you’ve got to hurry.” <span style="mso-spacerun: yes;"> </span>I scanned the folder in front of me and called the sheriff’s dispatcher. The response was: “We’ve got a car out on the lake road. He can meet you and you can follow him out.” </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">The initial call had come from the woman’s boyfriend. Lenore had been having increasing suicidal thoughts and had been fighting an impulse to kill herself for an entire week. The boyfriend had locked his rifle in the car, hid all the sharp knives and cleaning products and hoped Lenore would make it to her next appointment. That morning they had argued about something minor and he had gone to the store. When he returned, she was in the garage covered with gasoline. “Stay away from me,” she had screamed at him, and he called her therapist. He went to the door of the garage and told her someone was coming out to talk to her and proceeded to the end of the driveway to wait.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">I pulled up next to the deputy’s Crown Victoria and briefed him on our call.<span style="mso-spacerun: yes;"> </span>“Follow me. Stay close,” he said smiling, and then his wheels spit gravel at me as he took off, his big lights flashing. <span style="mso-spacerun: yes;"> </span>My official county car was perhaps the worst car ever made, the Ford Escort. It was small and cheap and when you stepped on the gas the engine made a roaring noise and the car hardly moved. We had a twelve mile run into the country and even though I repeatedly called on the radio to slow down, the deputy kept us moving at about eighty. The front end shook, the doors rattled, wind made the hood lift slightly as if it would fly into the windshield. We passed semi’s from the salt mine and school buses full of kids and when I realized my life depended on it, I got about six feet behind that cruiser and stayed there. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">The boyfriend was leaning against a fence having a smoke when we got there. “I can’t take this crap much longer,” he began, and I had him fill me in on recent events. The deputy said, “I called an ambulance. I’m going to wait out here. If you need me call me.” I replied, “Get the fire department too, and remind them both to approach silently.<span style="mso-spacerun: yes;"> </span>I don’t want to have to yell over the sirens. And tell them to stay out until I call them.”<span style="mso-spacerun: yes;"> </span>“You’re the mental health expert!” he responded.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">The adrenaline from my drive was beginning to dissipate when I opened the door to enter the garage. The smell was overwhelming. “Lenore?” I asked, as I observed the figure on the floor. “Don’t come near me,” she yelled, flipping open the lighter. “I’m going to stay right here. Do you mind if we talk?” I asked, introducing myself. “I think we met once in the waiting room, can I open the window? The fumes are making me a little dizzy. I’m going to sit on this bucket.” “Ok, but just stay away,” she replied. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">“Tell me what’s going on?” I asked. I want people in crisis to tell me their story and she did. It was a sad story, a difficult story, one that had no simple resolution. It included a problematic childhood and the betrayal of friends. She spoke of missed opportunities and unfortunate decisions that created unpleasant consequences she had to live with. There was a sadness that permeated everything. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">“I’m so sorry. That sounds awful,” were my responses to the pain she expressed. <span style="mso-spacerun: yes;"> </span>“Why now, why today?” I asked.<span style="mso-spacerun: yes;"> </span>“There was nothing special. When I woke up I just felt like I couldn’t deal with it anymore. There is no end in sight and I’m so tired.” She began to cry, first tears running down her face, then sobs that shook her body. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">“How about this? Clearly you are overwhelmed and can’t see any resolution to the problems you’ve described, but you’ve also told me about good things in your life.<span style="mso-spacerun: yes;"> </span>What if we get you some place where you are taken care of, where the worries can be put aside and you can try to focus on the few things that have taken you to this point?”<span style="mso-spacerun: yes;"> </span>She slid the lighter across the floor to me. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">When she was discharged a month later on Prozac, I assigned her to a new therapist. Three months later Diane resigned, wanting to devote herself full time to her private practice.</span></div><br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;"><em>The Stories</em></span></b></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;"><em>The stories are my remembrances. Each of them is based on a true event in my work for Tompkins County Mental Health. I have changed the names of every client, patient and co-worker except for Beau Saul, of the Ithaca Police Department, who I was fortunate enough to have as a partner. When confidentiality demanded it, I have changed details. The dialogue is my reconstruction of what was said at the time.<span style="mso-spacerun: yes;"> </span>I have felt honored to be let into the lives of so many individuals over the years. Their stories are a gift I have been given.<span style="mso-spacerun: yes;"> </span>Please enjoy them in the spirit with which they were written; to educate and inform.</em></span></div>Terry Garahanhttp://www.blogger.com/profile/18066569365497313232noreply@blogger.com3tag:blogger.com,1999:blog-18300098189807289.post-7393150801315304082011-08-18T09:31:00.000-04:002011-08-18T09:31:38.416-04:00Unconditional support provides positive outcomes<div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Schizophrenia is a very isolating disease. The positive symptoms; hallucinations and delusions, are not shared experiences. The expression of these symptoms<span style="mso-spacerun: yes;"> </span>tend to frighten and drive away those closest to the person experiencing them.<span style="mso-spacerun: yes;"> </span>The negative symptoms: lack of interest in the world and a diminishment in the ability to experience pleasure, further separate the person from their surroundings.<span style="mso-spacerun: yes;"> </span>In order to be successful in treatment, an individual must have someone on their side. This unconditional support is often the basis for positive outcomes in treatment.<span style="mso-spacerun: yes;"> </span>Families should be natural allies, but may end up being seen as enemies as a result of symptoms.<span style="mso-spacerun: yes;"> </span>Friends are hard to maintain and professionals who may be caring have to maintain a distance.<span style="mso-spacerun: yes;"> </span>However, support must come from somewhere.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>As we recognize schizophrenia for what it is, a brain disease, we must also recognize that we can’t abandon people because they have symptoms that are difficult or unpleasant.<span style="mso-spacerun: yes;"> </span>This story speaks to the kind of support that creates a successful outcome.</span></div><br />
<br />
<strong><span style="font-size: large;">The Story</span></strong><br />
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">“The kid is just standing there in the main library, not moving, not really saying anything. When I try to get him to come with me or do anything, he just looks at me sideways with a smile on his face. </span><span style="font-family: "Times New Roman", "serif";"><span style="mso-spacerun: yes;"> </span>When he says something, it’s just gibberish.<span style="mso-spacerun: yes;"> </span>The sergeant says you need to come up and take a look at him. He’s not really causing any problems, breaking the law or anything, no danger to self or others, just out of it.” I put down the phone and drove to Cornell.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: "Times New Roman", "serif";"><span style="mso-tab-count: 1;"> </span>He was halfway down an aisle in the stacks. He was moving his head up and down slowly, in a jerky motion, the way a parrot does. The cop had gone to the other end of the aisle to try to control the situation if things turned to crap. Another cop was behind me. No one knew the young man’s name, but he looked like a student.<span style="mso-spacerun: yes;"> </span>White kid in his early twenties, 5’10” short brown hair, average build, wrinkled jeans and a tee shirt.<span style="mso-spacerun: yes;"> </span>His hands and arms were also moving in a slow jerky motion almost like Tai Chi. “Hey”, I said walking up to him, but not within arm’s reach. “I need to talk to you. What’s your name?”<span style="mso-spacerun: yes;"> </span>He looked at me and smiled. <span style="mso-spacerun: yes;"> </span>I continued, “People are a little concerned about you. You’ve been standing in this same spot for about five or six hours and you don’t answer when people try to talk to you.”<span style="mso-spacerun: yes;"> </span>He didn’t look at me but began to speak, “You or not you, to be or not to be.” When he finished he started laughing, then tilted his head up and to the side, obviously listening to voices that only he could hear. “I’ll be right back,” I said as I went to the cop behind me to make a request. I returned to the young man and attempted to engage him in a variety of ways while I waited. Nothing worked. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: "Times New Roman", "serif";">Ten minutes later an EMT showed up with a gurney. I rolled the gurney between the shelves and parked it next to the young man, locking the wheels with my feet.<span style="mso-spacerun: yes;"> </span>I pulled down the top sheet and said, “It is very important that you lie down on this. Your legs are sore and you are very tired. Your back must be stiff too.<span style="mso-spacerun: yes;"> </span>If you lie down on this, you will feel much better. Take two steps and climb up on here”, I said, patting the bed. The jerky motion stopped and he took one big step and settled his rear on the gurney, then turned to lie flat, his arms at his side, eyes staring at the ceiling. I pulled the sheet over him and buckled a belt over his chest, pinning his arms. The cops and EMT’s took over, adding more belts and rolled him out the door.<span style="mso-spacerun: yes;"> </span>Before they put him in the ambulance, an officer patted him down and got a wallet from a front pocket.<span style="mso-spacerun: yes;"> </span>His name was Louis and he was a junior at Cornell. Before I left campus I went with a cop to his dorm to talk to his roommate. I wanted to get as much information as I could to give to the hospital for assessment. The emergency room folks could call his parents.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: "Times New Roman", "serif";"><span style="mso-tab-count: 1;"> </span>“I haven’t seen him for a couple of days. We’ve been roommates for two years. He’s a good guy, English major. But lately he’s gotten really strange. Sometimes he just stares into space or he’ll disappear for a day or two. At first I thought maybe he had a girlfriend, but I don’t think so. We really hang out with different people. As a matter of fact, he doesn’t really hang out much at all. The first couple of years he was doing club volleyball, then that stopped. I don’t know how he’s doing in his classes, but he did pretty badly last semester. I hope he doesn’t flunk out.”<span style="mso-spacerun: yes;"> </span>He went on to say he didn’t think that Louis used drugs and that he hardly ever drank. “He always worked hard and kept to himself. You were more likely to find him in the library on Saturday night than at a bar. But one thing he does do is attend that little church on the edge of college town. I went with him once, not holy rollers, but sort of fundamentalist. It wasn’t for me, so I never went again.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: "Times New Roman", "serif";"><span style="mso-tab-count: 1;"> </span>Louis was from Queens, in New York City and it seemed that this was not the first time he appeared to be having a psychotic break. The previous summer he’d been sent to the hospital after walking among traffic on a major roadway. At the time, his parents were convinced that someone had “slipped something into his drink.” According to the record they were unaware of any mental illness on either side of their families although on the husband’s side there was strong evidence of substance abuse. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: "Times New Roman", "serif";"><span style="mso-tab-count: 1;"> </span>He was referred to our clinic from the hospital after a two week stay. Mental health services at Cornell are very good, but they tended to defer to our greater experience and services when a person has a chronic psychiatric illness. <span style="mso-spacerun: yes;"> </span>When we first met, Louis was somewhat coherent. However, it was clear he was very symptomatic with what are known as positive symptoms like hearing voices or feeling controlled by others. Much of our initial conversation was interrupted by Louis cocking his head to one side, concentrating on the words the other voice spoke to him.<span style="mso-spacerun: yes;"> </span>He was a very smart, articulate and pleasant young man who agreed that he needed a medical leave from the university.<span style="mso-spacerun: yes;"> </span>He described a family situation that was less than ideal and decided to stay in Ithaca. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: "Times New Roman", "serif";"><span style="mso-spacerun: yes;"> </span><span style="mso-tab-count: 1;"> </span>Louis took medication like many other patients at our clinic. As the unpleasant symptoms began to diminish, the unpleasant side effects of the medication began to be a problem. Feeling better often made things worse. He started to take medication on an “as needed” basis and it did not work very well. Missed appointments became common. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: "Times New Roman", "serif";">I saw him walking slowly down the street one day and approached him. “I want you to come and see me,” I said. “I see you and I see beyond you,” he replied laughing. As we walked, he made eye contact and bowed slightly to the people walking by.<span style="mso-spacerun: yes;"> </span>“My subjects,” he explained. In fact, his contagious smile and nodding elicited a similar response from everyone we passed. “You need to start taking medication again!”<span style="mso-spacerun: yes;"> </span>I stated emphatically.<span style="mso-spacerun: yes;"> </span>“That’s right,” he exclaimed pointing in front of him. “That’s right!” he said again. It took me a moment to understand that he was pointing at a line of three or four cars in a turning lane in front of us, their <i style="mso-bidi-font-style: normal;">right</i> blinkers on.<span style="mso-spacerun: yes;"> </span>That afternoon he started an injectable medication that he responded well to.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: "Times New Roman", "serif";"><span style="mso-tab-count: 1;"> </span>Two weeks later, Louis showed up at my office with a middle-aged man dressed like a golf pro. “I’m Pastor Johanson, Gary Johanson. Louis belongs to my church.<span style="mso-spacerun: yes;"> </span>He’s been a member for two years. He’s told me a little bit about his problems and told me about you. Last Sunday during service he spoke about some of the things on his mind. Not all of it made sense. I wonder if there is a way we can help.” I asked the pastor to leave the room for a moment to make sure Louis wanted this man involved.<span style="mso-spacerun: yes;"> </span>When the Pastor came back in, I said to him, “Louis has been having a difficult time following through on his treatment. He certainly needs encouragement to be fully engaged in the process.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: "Times New Roman", "serif";"><span style="mso-tab-count: 1;"> </span>On Sunday, a month after meeting with Louis and his pastor, I found myself at the podium in the front of their church. Nearly eighty people had stayed to hear my talk about mental illness and treatment. Pastor Gary had purchased ten copies of <u>Surviving Schizophrenia</u>, by E. Fuller Torrey, and people agreed to read it and pass it on. <span style="mso-spacerun: yes;"> </span>Louis sat next to the pastor in the front row. His smile was less infectious, but more genuine. When my talk ended, Pastor Gary offered juice and cookies in the church basement. But first he asked us to bow our heads, “Merciful God, let us join together to help and heal each other.”</span></div><div class="MsoNormal" style="background: white; line-height: normal; margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><em><b style="mso-bidi-font-weight: normal;"><span style="color: #222222; font-size: 10pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;">The Stories</span></b><span style="color: #222222; font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: "Times New Roman";"></span></em></span></div><div class="MsoNormal" style="background: white; line-height: normal; margin: 0in 0in 10pt; text-indent: 0.5in;"><em><span style="color: #222222; font-size: 10pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"><span style="font-family: Calibri;">The stories are my remembrances. Each of them is based on a true event in my work for Tompkins County Mental Health in Ithaca New York. I have changed the names of every client, patient and co-worker except for Beau Saul, of the Ithaca Police Department, who I was fortunate enough to have as a partner. When confidentiality demanded it, I have changed details. The dialogue is my reconstruction of what was said at the time.<span style="mso-spacerun: yes;"> </span>I have felt honored to be let into the lives of so many individuals over the years. Their stories are a gift I have been given.<span style="mso-spacerun: yes;"> </span>Please enjoy them in the spirit with which they were written; to educate and inform.</span></span><span style="color: #222222; font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: "Times New Roman";"></span></em></div>Terry Garahanhttp://www.blogger.com/profile/18066569365497313232noreply@blogger.com0tag:blogger.com,1999:blog-18300098189807289.post-58442089465635389682011-08-10T12:56:00.000-04:002011-08-10T12:56:19.499-04:00Bi-polar disorder can be a lifelong illness<div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">Bi-polar disorder can last a lifetime. Although, there are often periods that are symptom free, bi-polar disorder is a recurrent illness. It is estimated that 90% of those who have a manic episode will go on to have future episodes. Often, episodes of depression and mania can follow quickly, at times caused by the medication used for treatment.<span style="mso-spacerun: yes;"> </span>In my experience, it was common to see patients become manic after a depressive episode as a result of the introduction of antidepressants. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">Bi-polar disorder is viewed primarily as a mood disorder.<span style="mso-spacerun: yes;"> </span>But it is common for people with serious bi-polar disorder to have some symptoms of thought disorder associated with difficult episodes. Psychosis that may include hearing voices or paranoia may be part of the symptom pattern. These may occur during the extreme phases of mania or depression. Whether the symptoms are primarily mood symptoms or thought symptoms, the person’s ability to have good judgment is impaired.<span style="mso-spacerun: yes;"> </span>The incident I recount is an example of <span style="mso-spacerun: yes;"> </span>how the illness can be a lifelong problem.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"> </span><br />
<strong>The Story</strong></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">The woman with the knife to her throat was shrieking at me through the door, “I’m going to kill me! There’s nothing you can do to stop me.” When I peered through the glass I saw the big kitchen knife, the largest in the set, clasped in her right hand, the sharp edge against her throat. Four dogs surrounded me on the small deck in front of the trailer, barking furiously and nipping at my legs.<span style="mso-spacerun: yes;"> </span>All of them were old and tired, but could not ignore their master’s screams.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>Mrs. Johnson must have been in her mid-seventies. She’d had a lifetime of bipolar disorder and had spent from her early twenties through her forties at Willard Psychiatric Center, a big old fashioned state hospital in farm country along Seneca Lake in upstate New York. <span style="mso-spacerun: yes;"> </span>She’d had several hundred electro convulsive therapies (ECT) also known as shock treatment. She’d had insulin shock treatment that involved insulin injections that made her comatose. In the late 1950’s she’d been scheduled for a lobotomy, but had improved enough to escape that procedure.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>She was a patient at the county outpatient clinic for twenty years and like everyone who had treatment there I’d looked at her records, including volumes from Willard that filled four three ringed binders. They didn’t tell me much about her, but they did tell me what happened to her; the treatment they provided, the long years she’d spent “improving”. Her family information introduced me to a rural extended family that lived along a few roads in a deep valley a dozen miles from Ithaca.<span style="mso-spacerun: yes;"> </span>Their ancestor was one of the original settlers of the Finger Lakes who’d fought in the revolutionary war and received a land grant. <span style="mso-spacerun: yes;"> </span>He’d then purchased more grants to create a homestead of a couple of thousand acres. Now days the family has a broad reach of education and vocation. They are dirt farmers, shade tree mechanics, college professors, nurses and every other sort of person a family can produce in over 200 years.<span style="mso-spacerun: yes;"> </span>What they had in common was the land that the family inhabited in every form from mcmansion to broken down trailer.<span style="mso-spacerun: yes;"> </span>It appeared that no family member ever left.<span style="mso-spacerun: yes;"> </span>When you reached 18 or got married or returned from college, they cut out a piece of land and it was yours.<span style="mso-spacerun: yes;"> </span>That was how Mrs. Johnson got her two acres. A cousin drilled a well, someone else brought in a backhoe to dig the septic system and after the electric pole was put up her brother brought in a ten year old trailer and set it on cinder blocks. It was a single wide, long and narrow, surprisingly pleasant and comfortable on the inside.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>In recent years, Mrs. Johnson had been doing very well, taking her medications, having her blood work done and eating and sleeping on a regular schedule. She was an avid gardener. The flowers that lined her path and surrounded the base of her trailer began to bloom in early spring with daffodils and ebbed and flowed throughout the summer and fall, a riot of color that reflected many of Mrs. Johnson’s moods.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-spacerun: yes;"> </span><span style="mso-tab-count: 1;"> </span><span style="mso-spacerun: yes;"> </span>This latest episode had begun almost two months earlier, when at a regular clinic appointment she announced to her psychiatrist that she had stopped taking her medications. <span style="mso-spacerun: yes;"> </span>When the doctor presented her case in a meeting, he described a failed attempt at reminding her that two thirds of her life had been taken from her by illness and that she currently had a terrific existence that she was putting at risk.<span style="mso-spacerun: yes;"> </span>Her response, read from his notes stated: “I don’t care one damn bit about your opinion. I feel fine, better than I felt in my whole life and I don’t need your pills.”<span style="mso-spacerun: yes;"> </span>Our crisis team had one more name added to out “hot” list.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>From that time until my visit, it had been like watching a slow motion train wreck. First her brother called, heartbroken but resigned, he described her coming to his house at two in the morning to renew a family dispute from a decade earlier. Her family doctor called me the following week to say that she’d shown up without an appointment demanding he give her a prescription for birth control pills because she was going to become sexually active. Next, was a State Trooper who had written her a ticket for speeding and passing a school bus. “She was really crazy. I don’t know what you can do, but you better do something because she’s going to hurt someone.”<span style="mso-spacerun: yes;"> </span>I’d visited her at home twice and she yelled at me through the door. Two days earlier she’d hung up on me when I called. Her mania had moved into an agitated depression that had her lashing out at anyone she had contact with. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;"><span style="mso-spacerun: yes;"> </span>That morning her brother called as soon as I got to work. “She is out of control. You need to bring the cops with you when you come.” I walked away from the door when I saw the deputy’s car stop near the edge of the property. When I waved, he pointed his thumb backwards and reversed the car, hiding it behind a row of bushes.<span style="mso-spacerun: yes;"> </span>When I got to his door he got out, unfolding himself to a height of 6’6”. He was as broad as he was tall. We’d known each other for a while and I was happy he’d been the one on duty. “What have we got?”<span style="mso-spacerun: yes;"> </span>He asked. When I told him, he said, “Oh yeah, I dealt with her before. She can really get going, but otherwise she’s a nice old lady. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">He went to the trunk of his car and got a pry bar. “Anybody else coming?” I asked. “Nope! Sorry, but there was an accident up at the airport and the trooper from this side of the lake is up there. I called an ambulance; they’re about three minutes out. It’s just us playing cowboys and Indians by ourselves. Here’s the plan: If she knows I’m here that will make it worse. So, I want you to go to the door and see if she’s still screaming with the knife. I’m going to sneak up along these bushes and get in next to you. Try to get the dogs behind the screen door when you open it. <span style="mso-spacerun: yes;"> </span>I’m going to pop the door with this bar and land on top of her. You get the knife.” </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;"><span style="mso-spacerun: yes;"> </span>As I walked past her car I opened the rear door and three of the dogs jumped in. That got me a thumbs up from the deputy. Approaching the trailer, I could hear that the screaming was louder. Up on the porch I wrapped my jacket around my right hand and got in place while the deputy, who’d come up behind me, placed the bar between the door and frame. “Go!” He yelled. The door hit her when he banged through it and he was on top of her trying to hold her arms. I put my coat on the knife and pushed it to the floor. I then carefully pried her fingers off the handle and pushed the knife away.<span style="mso-spacerun: yes;"> </span>He rolled her and cuffed her and called the EMT’s on his radio to come and get her. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;"><span style="mso-spacerun: yes;"> </span>Her brother was walking down the road towards us while they were loading her onto a stretcher into their rig. “Hey Andy”, the deputy called,<span style="mso-spacerun: yes;"> </span>“good to see you. When you come over next week, bring your boys, we’ve got some new dirt bikes.”<span style="mso-spacerun: yes;"> </span>He turned to me, “Andy’s married to my wife’s cousin.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><br />
</div><span style="font-family: Calibri;"><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;"><em>The stories are my remembrances. Each of them is based on a true event in my work for Tompkins County Mental Health in Ithaca New York. I have changed the names of every client, patient and co-worker except for Beau Saul, of the Ithaca Police Department, who I was fortunate enough to have as a partner. When confidentiality demanded it, I have changed details. The dialogue is my reconstruction of what was said at the time.<span style="mso-spacerun: yes;"> </span>I have felt honored to be let into the lives of so many individuals over the years. Their stories are a gift I have been given.<span style="mso-spacerun: yes;"> </span>Please enjoy them in the spirit with which they were written; to educate and inform.</em></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><br />
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</div></span>Terry Garahanhttp://www.blogger.com/profile/18066569365497313232noreply@blogger.com1tag:blogger.com,1999:blog-18300098189807289.post-2338660165157861362011-08-07T14:54:00.000-04:002011-08-07T14:54:39.575-04:00A recovery treatment modelA New York Times article describes a hybrid approach to managing schizophrenia. There are ways that people can manage the stress that brings on symptoms, but also use medication as needed. What's missing in this article is a look at the course of illness. For some people, as they get older, the symptoms get more manageable. Below is the link to this August 7, 2011 article:<br />
<h6 class="kicker">Lives Restored</h6><h5><a href="http://www.nytimes.com/2011/08/07/health/07lives.html?hp"><span style="color: #666699;">Learning to Cope With Schizophrenia</span></a></h5><h6 class="byline">By BENEDICT CAREY </h6><div class="thumbnail"><a href="http://www.nytimes.com/2011/08/07/health/07lives.html?hp"><img alt="Among the approaches Joe Holt uses against schizophrenia are moments of self-conversation." border="0" height="75" src="http://i1.nyt.com/images/2011/08/07/us/07lives-span/07lives-span-thumbStandard.jpg" width="75" /><span style="color: #666699;"> </span></a></div><div class="summary">Joe Holt spent years trying to determine the cause of his problems, before deciding to find a way to live with them. </div> Terry Garahanhttp://www.blogger.com/profile/18066569365497313232noreply@blogger.com0tag:blogger.com,1999:blog-18300098189807289.post-29214195029471067802011-08-03T09:56:00.002-04:002011-08-03T10:05:58.102-04:00Obsessive Compulsive Disorder - Rituals in Control<div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">Obsessive Compulsive Disorder commonly known as OCD can be one of the most debilitating problems one can face. The National Institute of Mental Health describes it this way: “People with OCD have persistent, upsetting thoughts (obsessions) and use rituals (compulsions) to control the anxiety these thoughts produce. Most of the time, the rituals end up controlling them.” The thinking is very hard to control and it drives the behavior which can be treated with therapy as part of a difficult process. Medications may also help.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">All of us have rituals. They help us get through the day, from morning coffee to evening prayers. Many of us check multiple times to make sure the stove is off or the door is locked. It is when these rituals take over and interfere with our lives, that there is cause for concern. We are unsure about the causes of OCD and the symptoms can ebb and flow. It’s often accompanied by other anxiety disorders and depression. The following story gives an extreme example, but not as uncommon as people would think. </span></div><br />
<strong><span style="font-size: large;">The Story</span></strong><br />
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<div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>He sat cross-legged on the floor, dressed only in his bright, white underwear. Tears ran down his face. Next to him on the floor was a bucket filled with water, a sponge and a scrub brush. Folded neatly in his lap was a pair of bright yellow rubber gloves. He shook his head from side to side in disbelief that I had entered his house. I had removed my shoes and put on surgical gloves that I got from a box I always kept in the car. “My God”, he said, “now I don’t know where to begin.” </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>His ex-wife had called to say she had not been able to reach him on the phone. “I’m concerned, not worried really,” She told me. “He could be standing next to the damn thing while it’s ringing, but if it isn’t cleaned properly or if he hasn’t performed the proper ritual, he won’t answer it.<span style="mso-spacerun: yes;"> </span>I’ve seen it happen a hundred times. <span style="mso-spacerun: yes;"> </span>Another thing that happens is he’ll sort of get stuck, like he is overwhelmed with what he needs to do and he’ll forget what he’s cleaned and he is immobilized. Maybe you could stop by and see if he’s ok.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>Elliot’s ex-wife was the person who introduced him to me two years earlier. He’d moved to Ithaca from Newark, New Jersey, after things fell apart for him. He’d been a mechanic for the New York City subway system for twenty six years when his obsessive compulsive disorder got the best of him. He’d taken early retirement and picked Ithaca because a high school friend lived here and he’d visited a number of times and liked it.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">His ex-wife was also his best friend. They’d married young, both of them just 20. He’d been discharged from the army less than a week. She got pregnant on their honeymoon and again a year later while nursing her first daughter. <span style="mso-spacerun: yes;"> </span>He took the skills he learned in the service and was offered a position with the Transit Authority.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>When her youngest daughter went to college, Amy told Elliot she wanted a divorce. She moved out of their house and into an apartment. She told me why when we first met. “He was driving me crazy. Not only the cleaning thing, but everything.<span style="mso-spacerun: yes;"> </span>It was classic!<span style="mso-spacerun: yes;"> </span>Checking the stove and checking the locks on the doors and windows and being afraid to go anywhere in the car because it might break down. I started to think I might lose my mind.”<span style="mso-spacerun: yes;"> </span>Elliot had not disagreed with this assessment when I met with them both. He also agreed that things got a whole lot worse when Amy was gone. He hadn’t realized what a moderating factor she’d been in his life until she left. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>“A geographical cure!” the psychiatrist had said after seeing Elliot. “It rarely works.” Elliot had refused to take medication at that time. “It makes me feel drugged. I can’t get anything done.” Later, he’d agreed to have some medication in the house for those times when he felt completely overwhelmed. His effort to integrate himself into life in Ithaca was limited. The old friend got tired of him fairly soon and Elliot became as isolated here as he’d been in Jersey.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>“Can you get up?” I asked, offering my hand. “My legs are pretty cramped. What day is it?”<span style="mso-spacerun: yes;"> </span>He asked as I pulled him up. When I told him, he determined he’d been on that spot on the floor for about eighteen hours. “I got to pee!”<span style="mso-spacerun: yes;"> </span>He announced and went down the hall to the bathroom. When he returned, I handed him a pair of pants and a tee shirt and we went outside to his front steps.<span style="mso-spacerun: yes;"> </span>He and I had been through this a couple of times before and we both knew the routine. Essentially, I had contaminated the entire apartment and when I left, he would start again from the doorknob inward. In the past, he’d allow me to visit and knock only if I had on rubber gloves and then we met on his steps.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>He was tall and thin with graying hair in tufts on the front of his head. I started to explain, “I’m sorry, Amy called and was worried. When you didn’t answer the door I got a key from the landlord.” “No problem,” he said, “there were guys in to replace the stove two days ago. I told the landlord that the old stove was fine, but he insisted and finally got sort of pissed and sent his guys over. I started cleaning after that. And the new stove is really nice.<span style="mso-spacerun: yes;"> </span>When I got to the second bedroom upstairs I cleaned myself into a corner. The floor was wet all around me, so I thought; I’ll just let it dry and go downstairs. After it dried I didn’t really know where I’d cleaned so I stayed put. The phone rang about a dozen times. I knew it was Amy or one of the girls and they’d understand.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;"><span style="mso-spacerun: yes;"> </span>I always found it interesting that when Elliot and I ended up on the steps together, how utterly normal he could be. It was like he was taking a break from his psychological problems. We’d chat and joke and make small talk as if his life had not been ruined by his condition. “What do you think about seeing Kevin again,” I asked, referring to the psychologist he’d worked with in the past. Kevin had used a form of classic exposure therapy with Elliot, having him make contact with various objects that others have touched. Elliot had once walked through the entire building touching doorknobs. He ended the session with both hands on the handles that opened the front doors of our building which hundreds of people touch each day. It appeared that Elliot was making progress, getting out, keeping appointments and attempting to make a life for himself when all of a sudden he stopped. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>“I don’t think so,” Elliot said, referring to my question about treatment. “I like Kevin, but that stuff wasn’t really working for me.” I tried a different tack, “How about if he came over here and worked with you here? You could try some small things, like how to deal with the phone or people coming to the door. Also, you have to figure out a way for your caseworker to help you buy food. She can’t spend the whole day with you, she has other clients. Kevin might be able to help with that.” <span style="mso-spacerun: yes;"> </span>He replied, “I really appreciate what you’re trying to do and I know that exposure helps some people. It just didn’t seem to help me. It made me more anxious. Besides, now when I’m doing real bad I take the pills, they help a lot. I just didn’t have them with me this time. I’ll make sure I keep them close so this doesn’t happen again.”<span style="mso-spacerun: yes;"> </span>He held up his red, raw hands, palms up near his shoulders, blending surrender with goodbye. “Thanks for coming by.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>The U-Haul with Jersey plates was almost full. Amy and two young, attractive women were putting plastic bags of clothing on top of the furniture, before pulling the door down and locking it. Elliot sat in the front seat, his eyes closed, his head resting comfortably on a clean white towel covering the headrest. “It’s for the best.” Amy said to me, shaking my hand. </span></div><br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span></span><b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;"></span></b> </div><div class="MsoNormal" style="margin: 0in 0in 10pt;"></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">The Stories</span></b></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">The stories are my remembrances. Each of them is based on a true event in my work for Tompkins County Mental Health in Ithaca New York. I have changed the names of every client, patient and co-worker except for Beau Saul, of the Ithaca Police Department, who I was fortunate enough to have as a partner. When confidentiality demanded it, I have changed details. The dialogue is my reconstruction of what was said at the time.<span style="mso-spacerun: yes;"> </span>I have felt honored to be let into the lives of so many individuals over the years. Their stories are a gift I have been given.<span style="mso-spacerun: yes;"> </span>Please enjoy them in the spirit with which they were written; to educate and inform.</span></div>Terry Garahanhttp://www.blogger.com/profile/18066569365497313232noreply@blogger.com1tag:blogger.com,1999:blog-18300098189807289.post-414371649730933172011-07-28T10:56:00.000-04:002011-07-28T10:56:37.792-04:00Depression/ Not Depression<div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">Depression is an illness, a series of symptoms, not your life.<span style="mso-spacerun: yes;"> </span>The worst cases of depression I saw were people who had bi-polar disorder that was mainly expressed in depressive rather than manic states.<span style="mso-spacerun: yes;"> </span>The few episodes of mania they experienced were rare and often brought chaos and then regret into their lives.<span style="mso-spacerun: yes;"> </span>Mostly, they lived with depression. “Like a giant hand is holding me down,” said one client.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">One of the ways to look at depression is a very simple behavioral approach I refer to as, depression/not depression. <span style="mso-spacerun: yes;"> </span>This is a concept I got from trainings with Bill O’Hanlon (http://www.billohanlon.com/), a great speaker and trainer.<span style="mso-spacerun: yes;"> </span>In this approach we look at the way a person spends the day as if we were observing it on a video. <span style="mso-spacerun: yes;"> </span>We then describe the activities in terms of depression or not depression. <span style="mso-spacerun: yes;"> </span>This is an example of a patient I saw for many years:</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">Depression - “I wake up and get a cup of coffee and sit on the couch. <span style="mso-spacerun: yes;"> </span>I turn on the TV, light up a smoke and proceed to watch Today, Regis, The View and intersperse it with CNN and whatever else is on.<span style="mso-spacerun: yes;"> </span>I’ll eat cereal or a bagel, not get dressed, not get washed and have my jammies on when the midday local news show comes on.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">Not depression - “When I wake up I get into the shower, and then brush my teeth. <span style="mso-spacerun: yes;"> </span>If I have to have coffee, I have it while I’m getting dressed. <span style="mso-spacerun: yes;"> </span>I leave the house. <span style="mso-spacerun: yes;"> </span>Even if it’s for a walk around the block, I get outside. <span style="mso-spacerun: yes;"> </span>I try to have an activity for the afternoon. <span style="mso-spacerun: yes;"> </span>I try to plan meals and have good food in the house. <span style="mso-spacerun: yes;"> </span>I make sure I talk to someone every single day.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">For a depressed person, not depression is difficult. <span style="mso-spacerun: yes;"> </span>However, even those with the worst depression can do something, one thing different every day. <span style="mso-spacerun: yes;"> </span>What I am suggesting is not meant to replace medication or other talk therapy. <span style="mso-spacerun: yes;"> </span>It is meant to add a way to maintain success with small measurable goals.<span style="mso-spacerun: yes;"> </span>The outcome can be significant.<span style="mso-spacerun: yes;"> </span>Read the story.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><br />
</div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;"><strong><span style="font-size: large;">The Story</span></strong></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>She set down the shoebox on the table between us and rifled through some photographs, “I don’t think you believe me, so I brought some pictures. <span style="mso-spacerun: yes;"> </span>Here, look at this,” she said handing me a cracked color photo of a group of women with big hair wearing mid-seventies vintage clothing. <span style="mso-spacerun: yes;"> </span>In the center of this group of five women holding their drinks up toasting the camera, I recognized a thinner, younger Hanna Berg. <span style="mso-spacerun: yes;"> </span>“I was something, a real hell raiser, and I made good money too.” <span style="mso-spacerun: yes;"> </span>In another image she sits on a barstool, her back to the bar, legs neatly crossed, her hands folded in her lap, the beginning a of a smile on her face.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>I’d been seeing Hanna for over five years. <span style="mso-spacerun: yes;"> </span>Her bi-polar disorder was diagnosed shortly after these pictures were taken.<span style="mso-spacerun: yes;"> </span>“I covered the area from Syracuse to Albany. <span style="mso-spacerun: yes;"> </span>In the springtime I was always on the road,” she continued, describing her work taking and selling school pictures. <span style="mso-spacerun: yes;"> </span>“We did class pictures and individual pictures and all the stuff that went in the yearbook.”<span style="mso-spacerun: yes;"> </span>Although I’d heard this all before, Hanna felt the need to display proof of her normalcy. <span style="mso-spacerun: yes;"> </span>The manic episodes, worsened by self-medication with alcohol and drugs, made her young life a shambles.<span style="mso-spacerun: yes;"> </span>There were a series of episodes that saw her arrested, and then hospitalized. <span style="mso-spacerun: yes;"> </span>After a high speed car chase and crash, she was sent to the State hospital and been one of the last long term patients before it closed.<span style="mso-spacerun: yes;"> </span>She’d fought the mania with medication and as she got older she found that the manic episodes were few and far between. <span style="mso-spacerun: yes;"> </span>She mourned her mania like the death of a loved one and had no choice but to accept the depression that overwhelmed her like dark grey clouds filling the sky for months or even years at a time.<span style="mso-spacerun: yes;"> </span>Anti-depressants gave some relief, but not much. Early on she’d had electro convulsive therapy, known as ECT or shock treatment. <span style="mso-spacerun: yes;"> </span>She said of it, “You know, it made me feel better, but my short term memory was shot. <span style="mso-spacerun: yes;"> </span>Then I’d get anxious that I’d forgot something important and that would make me feel depressed.” <span style="mso-spacerun: yes;"> </span>At times, she had great trouble getting out of bed, not because she was tired, but as if a giant hand were holding her down. <span style="mso-spacerun: yes;"> </span>When I first met her she used to cry a great deal, but later she seemed to have less emotion attached to her illness.<span style="mso-spacerun: yes;"> </span>Her diet had gotten worse and she sometimes would eat a month’s worth of groceries in a week. <span style="mso-spacerun: yes;"> </span>She was now a pale, overweight woman in her late fifties with a halo of dyed blonde hair framing a puffy pale face. <span style="mso-spacerun: yes;"> </span>Her occasional smile could brighten a room and I could imagine how she’d been a heartbreaker as well as a hell raiser.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>Hanna was always at a high level of lethality for suicide and we’d been through at least seven attempts in our time together. <span style="mso-spacerun: yes;"> </span>“Look at my crappy life. <span style="mso-spacerun: yes;"> </span>Is there really a reason to go on?” she’d said to me in the emergency room after she’d slit her wrists and been found by her boyfriend. <span style="mso-spacerun: yes;"> </span>“Bill is a jerk. <span style="mso-spacerun: yes;"> </span>He doesn’t love me and is only my boyfriend because it gives him a free place to stay when his mom gets sick of him. <span style="mso-spacerun: yes;"> </span>He also knows I’ll feed him.<span style="mso-spacerun: yes;"> </span>If I died he’d have to find a job.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>When her elderly mother became ill, Hanna moved her into an apartment in Hanna’s building and cared for her or arranged for her care until her mother died.<span style="mso-spacerun: yes;"> </span>Hanna also, somehow, found money to help her disabled sister who lived in a group home. <span style="mso-spacerun: yes;"> </span>She almost always made an effort to see her sister on Sunday afternoons. <span style="mso-spacerun: yes;"> </span>Other residents of her complex depended on her daily phone contacts even when she was in the hospital. <span style="mso-spacerun: yes;"> </span>Few days passed when she did not have advice or a kind word for someone.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>A good friend of hers called me and asked me to go to Hanna’s apartment after not hearing from her for a few days. <span style="mso-spacerun: yes;"> </span>She tried calling and had even knocked on her door without getting a response. <span style="mso-spacerun: yes;"> </span>She’d tried to contact Bill, but he did not return her call. <span style="mso-spacerun: yes;"> </span>No one came to the door for me either, so I called the landlord who came over and let me in.<span style="mso-spacerun: yes;"> </span>Hanna was lying on the sofa, her features flat, the person gone. <span style="mso-spacerun: yes;"> </span>Above her head was a white poster board taped to the wall. <span style="mso-spacerun: yes;"> </span>In magic marker, it said: “<b style="mso-bidi-font-weight: normal;">Do not resuscitate</b>.” </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>Several hundred people attended her funeral service. <span style="mso-spacerun: yes;"> </span>Many said they didn’t know what they’d do without her.</span></div>Terry Garahanhttp://www.blogger.com/profile/18066569365497313232noreply@blogger.com0tag:blogger.com,1999:blog-18300098189807289.post-83070913592867933232011-07-21T13:04:00.005-04:002011-07-27T21:44:05.483-04:00Lives Interrupted! Photos by Emil Ghinger<div class="separator" style="clear: both; text-align: center;"><br />
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</div><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtneAM2EcyGNP0uzGgYQkYw_mw3amlxEVWaC6TaOx_jX28HV7_DRz5yHgJkUsKEYAPO3idC_3-Rq6fIVoXLa9K2jYrOTQp7_HXNr7OhKt4Ps_OsgJOph4C8vy_GtGYQgA2Lc3VcfDAZqY/s1600/Photo+%25234+001.jpg" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtneAM2EcyGNP0uzGgYQkYw_mw3amlxEVWaC6TaOx_jX28HV7_DRz5yHgJkUsKEYAPO3idC_3-Rq6fIVoXLa9K2jYrOTQp7_HXNr7OhKt4Ps_OsgJOph4C8vy_GtGYQgA2Lc3VcfDAZqY/s200/Photo+%25234+001.jpg" t$="true" width="138" /></a>I worked at Meadow House, a day treatment program in Ithaca, NY from 1975-1979. The mission of the agency was to reintroduce people to the community who had been institutionalized for years. My friend Emil Ghinger, a portrait photographer, took pictures of some of the clients in 1976. This is a sample of some of the work that Mr. Ghinger produced. I am very pleased to share them.<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8Oe6jAdj2Cc-dcUbdNm1pq95YyvSkdfeTVMcJyHHxwuZBLPdBKyorLXii4Bejl8EDSVQbW-gkLCbeBymwczfv8EBwLhbxu4UoK-VT91Bro1t3IuZqt_EEAe4AsPeyluPE-RjW4E4w0KA/s1600/Photo+%25233+001.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="146" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8Oe6jAdj2Cc-dcUbdNm1pq95YyvSkdfeTVMcJyHHxwuZBLPdBKyorLXii4Bejl8EDSVQbW-gkLCbeBymwczfv8EBwLhbxu4UoK-VT91Bro1t3IuZqt_EEAe4AsPeyluPE-RjW4E4w0KA/s200/Photo+%25233+001.jpg" t$="true" width="200" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1rZkfciIJuB9EwJei610PDxEfaFFvQrn94HC4MqRZoIlzh_f0JZTIikUiLGuk_dXlbQeqydQ47bK3nmbbO4N0qvbOaPo4KhWALmxRIlA0JFStQnaTtgM3jg3cSW6wB29kUJMPAr8kne8/s1600/Photo+%25232+001.jpg" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1rZkfciIJuB9EwJei610PDxEfaFFvQrn94HC4MqRZoIlzh_f0JZTIikUiLGuk_dXlbQeqydQ47bK3nmbbO4N0qvbOaPo4KhWALmxRIlA0JFStQnaTtgM3jg3cSW6wB29kUJMPAr8kne8/s200/Photo+%25232+001.jpg" t$="true" width="145" /></a><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbW9AJIG9lJW3zLvFzviWrxrFGf9LwMYFQz7F3iPBgyocMzUkT47d6nk8p6ihY000Ug7HWVyzEYyWDbeKMnKG21aj34GP-yP3M9wskktTfpZnqaSVRWOPCPZ2z9DpEWDqzhcb0OlYV_Rc/s200/Photo+%25231+002.jpg" t$="true" width="145" /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4VnKZjlSKPrFPPCSaIk0BQh3ArySerbm7fBoMt39-zF5vN9FIuvW-Z8vjSwc4t0jrzy4vqgyNV2tLrohxcGmskjJ5fAf-KJTEZ2YAC0_tkQEsz-tuLFnhwh6af1TutJaT29S3rvwdb2A/s1600/Photo+%25236+001.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4VnKZjlSKPrFPPCSaIk0BQh3ArySerbm7fBoMt39-zF5vN9FIuvW-Z8vjSwc4t0jrzy4vqgyNV2tLrohxcGmskjJ5fAf-KJTEZ2YAC0_tkQEsz-tuLFnhwh6af1TutJaT29S3rvwdb2A/s200/Photo+%25236+001.jpg" t$="true" width="145" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9vOR5fyk9lM4yGywPMDptbD2NDlblJvlfg_I-9UtmJRS-QdMXBSnQmJLHzCuvOT5nyIt3UAezLWOZVIUp6XeSPPaG0MbQRzb8sfotfs3RdoklW-Y5aRVUTPm-UBLyNEZiK7ogDzlC8PE/s1600/Photo+%252312+001.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9vOR5fyk9lM4yGywPMDptbD2NDlblJvlfg_I-9UtmJRS-QdMXBSnQmJLHzCuvOT5nyIt3UAezLWOZVIUp6XeSPPaG0MbQRzb8sfotfs3RdoklW-Y5aRVUTPm-UBLyNEZiK7ogDzlC8PE/s200/Photo+%252312+001.jpg" t$="true" width="141" /></a></div>Terry Garahanhttp://www.blogger.com/profile/18066569365497313232noreply@blogger.com1tag:blogger.com,1999:blog-18300098189807289.post-37078293759440932152011-07-21T10:05:00.022-04:002011-07-21T19:49:26.372-04:00The hard lessons learned from two deaths.This front page article in the New York Times fairly describes the work I did with Beau Saul from the Ithaca Police Department. There are many other aspects of our work that are not covered, including our founding and co-leading a regional hostage negotiation team. I will post stories about those events in the future. The title of this feature is based on a series of articles that studied 100 rampage killers in the United States over 50 years. Many of those killings were carried out by people who were mentally ill. This story is a response to letters that asked, "What is being done?"<br />
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<strong><span style="font-size: large;">New York Times</span></strong><br />
<strong>September 6, 2000 </strong><br />
<strong> Trying to Prevent the Next Killer Rampage</strong><br />
By LAURIE GOODSTEIN<br />
[I] THACA, N.Y. — It was nearly four years ago when the police climbed the creaky stairs to Deborah Stagg's apartment in response to calls from neighbors who had heard her screaming and raving alone in there. Ms.Stagg was known around town as a woman so disturbed that she had once delivered her own baby by cutting her womb open with a penknife. <br />
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This time, a steak knife in hand, Ms. Stagg bolted from her barricaded bathroom and stabbed Inspector Michael A.Padula in the neck, a fatal wound. The police opened fire, killing Ms. Stagg. <br />
<br />
The double deaths were a pivotal trauma in Ithaca, where Inspector Padula was the first police officer killed in the line of duty. In the grim aftermath, the police blamed the mental health department, and mental health advocates blamed the police.<br />
<br />
In the midst of the mourning and finger-pointing, a policeman and a mental health clinic supervisor who were distant acquaintances got together over beer to talk about whether they could prevent such occurrences, jotting down ideas on bar napkins. Out of it grew a collaboration between the Ithaca police and mental health departments that some policing experts say is unmatched anywhere in the country because of its focus on pre-empting problems in addition to responding to crises.<br />
Now, when the police department receives a call that someone is behaving bizarrely, making threats or talking of suicide, it is usually the two men who brainstormed in the bar — Lt. John Beau Saul of the police department and Terry Garahan, the mental health clinic supervisor — who drive to the scene together in a worn police van to assess the situation. They have paved the way for other police officers or county sheriffs and mental health workers to go out regularly on calls together. They intervene when the case is potentially dangerous, as when a young man threatened to kill the staff at a temporary-employment agency and then kill himself. But they also intervene when the case might appear frivolous, as when a woman called to report Martians invading through her ceiling.<br />
"We go out and find these people and try to get them to get the help they need," Lieutenant Saul said, steering the van down a leafy street to visit an elderly man who had called the police to report a jar of peanut butter stolen from his bed.<br />
"If you go to other places," he said, "people like this are avoided like the plague. We actually go out of our way to find these people and engage them."<br />
Mr. Garahan said, "The theory is, you solve problems even when they're not problems. "The unlikely team, one a clean- cut cop, the other a long-haired social worker, uses a carrot-and- stick approach, sometimes cajoling a person into mental health treatment or<br />
contact with other social services, and sometimes, where criminal behavior is involved, using the threat of arrest or imprisonment.<br />
The result is that even Ithaca police officers who were initially cynical about the approach now say they have seen a steep decline in the number of chronic phone callers tying up police lines and time, and fewer untreated mentally ill people out on the streets. In several cases, they succeeded in defusing emotionally disturbed people who were armed and threatening violence, prodding them into psychiatric care rather than prison.<br />
In a study of rampage killers conducted earlier this year by The New York Times, family, friends, and neighbors of killers repeatedly said in interviews afterward that they had observed the killers behaving strangely or making threats before the crime, and had tried to alert the police or mental health officials, to no avail. The police often say that they can intervene only after the person has demonstrated a danger to himself or others. Mental health services and hospitals in most places are stretched so thin that they too are not equipped to respond.<br />
The city of Ithaca has dared to move beyond this "hands are tied" response. A maverick university town, the home of Cornell, in upstate New York at the southern tip of Cayuga Lake, Ithaca has committed the resources of its police and mental health departments to respond even when there is no immediate crisis. It allows the sharing of information between the departments about past criminal and mental health histories, treading close to a line that could raise the hackles of civil libertarians and advocates for mental health patients.<br />
<strong>Approaching the Mentally Ill</strong><br />
The approach in Ithaca goes beyond that of other cities in which police departments have begun programs for dealing with the mentally ill. The model most commonly copied is from Memphis, where a specially trained police unit responds to crisis calls about emotionally disturbed people, referred to by the police as EDP's. Other cities, like Los Angeles and Birmingham, Ala., have paired social workers with police officers who respond to crises involving the mentally ill, said several experts who study policing.<br />
What is unusual in Ithaca is the emphasis on prevention, and the decision to devote police resources to following up on people with chronic problems who do not always want to accept help. Over the course of the summer, Mr. Saul and Mr. Garahan revisited several cases, including those of a mentally ill crack addict who was resisting drug treatment, an angry schizophrenic who had threatened his ex-wife and was making harassing phone calls to public officials at their homes, and a paranoid factory worker who wanted the police to investigate "mind intrusion machines" that he insisted were planted in his home and workplace.<br />
By August, Mr. Saul and Mr. Garahan had succeeded in steering two of those inddividuals into treatment and were still making weekly visits to persuade the crack-addicted man to enter a drug detoxification program.<br />
"That's pretty unique. I haven't heard of that type of follow-up before," said Melissa M. Reuland, a research associate at the Police Executive Research Forum, a Washington nonprofit group whose members include chiefs from the nation's larger police departments.<br />
"This really is problem-solving in action, identifying hot spots and partnering with service providers in your community who have expertise where you don't. If we could subject this to a really critical legal and ethical analysis, I think it's got some promise." But such aggressive police involvement has a risk, said Henry J. Steadman, the president of Policy Research Associates, which studies mental disorders and the criminal justice system. "There is a potential invasiveness there for individuals who would feel coerced into mental health services because the police are still checking up on them in the role of police officers," Mr. Steadman said. "If the person is simply seen as in need of treatment, then why should the police be hanging around forcing the person into treatment?" Ron Honberg, director of legal affairs at the National Alliance for the Mentally Ill, said,<br />
"I think it's great that Ithaca cares enough to do something creative. I just worry that if it's done the wrong way it conjures up images of Big Brother at its worst."<br />
The police are often on the front lines of mental health care in this country, like it or not. For instance, the Ithaca Police Department was called on Aug. 26, 1999, when the managers at Stafkings, a temporary-employment agency, arrived at work to hear two chilling messages on their answering machine from an unemployed man who said he was frustrated that he had not been offered a job.<br />
"I'll kill all y'all up in there. I ain't playing, man," he said, spitting out his words in the recorded message. "The day that I kill all you I'll probably kill myself because I'm upset enough."<br />
In many smaller police departments that have not been trained in threat assessment, the routine response would be to document the complaint and leave it at that. In Ithaca, the police department contacted Mr. Garahan, who, as supervisor of the county outpatient mental health clinic, knew the man who had left the message. Jason James, who is 21, suffered from psychotic episodes and had received a diagnosis of schizoaffective disorder at the clinic, but had quit treatment. The phone threats indicated he had reached a critical stage.<br />
Found at his house, Mr. James was charged with aggravated harassment but was told that he could avoid jail by committing to a program of counseling and psychiatric medication. Mr. James, accompanied by Mr. Garahan, appeared in court before Judge Judith A. Rossiter, who often works closely with Mr. Garahan and Mr. Saul to devise alternatives to prison for emotionally disturbed people. Judge Rossiter dropped the charge on the condition that Mr. James resumed treatment. One day last month, Mr. James rode his bicycle to Ithaca's mental health clinic, which he does daily to receive his daily medication. Soft-spoken and serious, Mr. James said that now that the voices had faded, he knew he needed the treatment. He said he still struggled, however, to explain his illness to his family and friends.<br />
"They just wave their hands and say, `He's sick,' `He's crazy.' I want people to see that I am getting treatment, that I am living a better life," he said, before riding off to a job interview.<br />
<strong>Emphasizing Persistent Vigilance</strong><br />
Often, however, people are far less compliant, even when facing arrest. All summer, Mr. Garahan and Mr. Saul worked on the case of Nicholas Celia, a 44-year-old man with a record of convictions for assaults on civilians and police officers, and a history<br />
of alcohol and drug abuse as well as psychiatric problems and hospitalizations — the three factors that experts say indicate a potential for future violence. Recent studies have found that the mentally ill are no more violent than other people, except when they are off their medications or have been abusing drugs or alcohol. Looking like a pirate in a blue bandanna and hoop earring, Mr. Celia wandered the Ithaca Commons, the city's open-air street mall, sometimes mellow and bumming cigarettes, sometimes screaming and menacing. He was repeatedly arrested on charges of harassment and assault, once on Mr. Garahan, who got an order of protection against Mr. Celia and began to carry pepper spray. Even some of Mr. Celia's friends at the regular Wednesday night dinner of the local mental health advocacy group said in interviews that Mr. Celia was starting to scare them and needed help.<br />
Mr. Garahan and Mr. Saul decided to use the newest, most aggressive tool they had to compel Mr. Celia into treatment: Kendra's Law, named for Kendra Webdale, who died after being pushed in front of a New York City subway train by a mentally ill man. They filed a petition asking a judge to order Mr. Celia into outpatient drug treatment and counseling.<br />
At his hearing, Mr. Celia interrupted a psychiatrist testifying that he had examined Mr. Celia and diagnosed bipolar disorder, or manic-depression.<br />
"I would just like to say, Your Honor, I am getting a little upset hearing these lies and innuendo, and this is what happens when I am under stress and this is a farce to me," Mr. Celia said, speaking loud and fast.<br />
The judge ordered Mr. Celia to report to the outpatient clinic for injections of Haldol.<br />
In his police car after the hearing, Lieutenant Saul volunteered that he was uneasy at the idea of forcing psychiatric drugs on someone.<br />
"I have a miniature soul-search about it, but then maybe if Deborah Stagg had been forced to take medication, Mike would still be alive," said Mr. Saul, who wears a small pin on his uniform in honor of Michael Padula, the dead policeman.<br />
Mr. Celia's response was to flee. He went to New York City, checked in to Bellevue Hospital's psychiatric ward, returned to Ithaca, was arrested, hospitalized again and released, returned to New York City, was arrested and sent again to Bellevue before<br />
being transferred to a county hospital for long-term treatment. In a telephone interview from Bellevue in August, Mr. Celia, now more subdued, insisted he needed no treatment, saying, "What's happening to me is an injustice."<br />
<strong>An Appreciated if Unenvied Job</strong><br />
Even in this politically liberal college town, however, it is hard to find a civil libertarian or mental health consumer who objects to the work of Mr. Garahan and Mr. Saul. Some do oppose the law stemming from the Kendra Webdale killing, but all said in interviews that they were glad there were officials with mental health experience to call in emergencies.<br />
Much of Mr. Garahan and Mr. Saul's work boils down to protecting emotionally disturbed people from hurting themselves or from being victimized by others. After months in which they tried to convince the woman obsessed with Martians to seek treatment, she set a fire in her apartment to exorcise the extraterrestrials. She walked to the police station and was hospitalized. And when Mr. Garahan and Mr. Saul responded to the elderly man who had reported a jar of peanut butter missing, they found him living in a basement apartment swarming with flies, with feces tracked across the floor and a bare light bulb that had burned through a lampshade. They called building inspectors, who condemned the place. They called an ambulance for the man, in keeping with their approach that "medicalizing" a mental illness is less threatening for the person.<br />
"I know it doesn't look like compassion, but it is for his best, and for the neighborhood's best," Mr. Saul said to neighbors curious about the ambulance. The landlord has since renovated the apartment, Mr. Garahan said.<br />
As to whether they have ever stopped a rampage killer, Mr. Garahan said: "You do this stuff and you don't know whether you prevented something or not. But I do know that the ability of the two disciplines, police and mental health, to work together has a<br />
tremendous effect on a lot of people's lives."<br />
<br />
<br />
Copyright 2000 The New York Times CompanyTerry Garahanhttp://www.blogger.com/profile/18066569365497313232noreply@blogger.com1tag:blogger.com,1999:blog-18300098189807289.post-43333690180444438102011-07-14T11:02:00.001-04:002011-07-18T14:40:19.613-04:00A few people with mental illness are very dangerous. There are better ways to keep us all safe.<div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">Why did Jared Loughner, a dangerous mentally ill man never get treatment?<span style="mso-spacerun: yes;"> </span>Teachers, friends, family members and others not only knew he was disturbed, his actions and words caused them to fear him. <span style="mso-spacerun: yes;"> </span>In my experience providing crisis counseling to people with mental illness who are dangerous, most people are afraid of becoming the target of aggression. <span style="mso-spacerun: yes;"> </span>I had become a target on a number of occasions over my twenty plus years in crisis work. <span style="mso-spacerun: yes;"> </span>I understand why others won’t want their names attached to a complaint. The question for many becomes who to call? <span style="mso-spacerun: yes;"> </span>In the end the police have to be involved. <span style="mso-spacerun: yes;"> </span>Had a mental health professional been contacted, he would have had to involve the police to facilitate the evaluation. <span style="mso-spacerun: yes;"> </span>Mr. Loughner created such fear that when the campus police went to his home to tell him he would no longer be able to attend college, they requested backup.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">The police are the primary providers of mental health services in the United States. <span style="mso-spacerun: yes;"> </span>They deal with the mentally ill at all times of day and in both private and public settings.<span style="mso-spacerun: yes;"> </span>At a time when the police are also being judged with regard to their actions in Tucson prior to the shootings, it is important to state that the actions taken by law enforcement regarding Jared Loughner were appropriate to the circumstances and consistent with actions taken by law enforcement agencies throughout the country.<span style="mso-spacerun: yes;"> </span>The consequence of those actions will be that Mr. Loughner will enter the prison system, joining the approximately 320,000 other mentally ill individuals currently incarcerated.<span style="mso-spacerun: yes;"> </span>If you add the 100,000 currently in mental hospitals, the result is almost the same number as those in state hospitals prior to deinstitutionalization.<span style="mso-spacerun: yes;"> </span>It is also important to state that most interactions the police have with the mentally ill are ineffective because the police are not part of the mental health system and have no regular access to it. <span style="mso-spacerun: yes;"> </span>When the call is finished and the records are written and the shift ends, nothing happens.<span style="mso-spacerun: yes;"> </span>The only way to resolve this and to create effective interventions that can stop incidents like what happened in Tucson is to have mental health professionals attached to police departments.<span style="mso-spacerun: yes;"> </span>One of the clients in the clinic I ran killed a police officer in 1996. <span style="mso-spacerun: yes;"> </span>As a result, I worked with police to form a partnership that would link mental health services with local law enforcement.<span style="mso-spacerun: yes;"> </span>Sharing information was a crucial aspect of our work within the limits of confidentiality.<span style="mso-spacerun: yes;"> </span>I opened cases that were appropriate mental health cases and transferred primary responsibility from law enforcement to mental health, often using mandated treatment with the cooperation of local judges.<span style="mso-spacerun: yes;"> </span>While many of our cases were driven by police reports, I would also open cases based on reports of family, friends, coworkers and landlords. <span style="mso-spacerun: yes;"> </span>Sadly, many went nowhere, because the person was not dangerous. <span style="mso-spacerun: yes;"> </span>The concept of dangerousness needs to be replaced by need for care. <span style="mso-spacerun: yes;"> </span>Anosognosia, the inability of the person to recognize illness in himself, made it impossible to help many very ill people.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">Crises take place on a continuum.<span style="mso-spacerun: yes;"> </span>Mister Loughner had multiple negative contacts with police, teachers, family and friends.<span style="mso-spacerun: yes;"> </span>At those times, if he had then been connected to mental health services, there could have been interventions.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>In this brief window between outrage and despair, there is a chance for action.<span style="mso-spacerun: yes;"> </span>Congress can begin by appropriating funds to have police agencies throughout the nation hire mental health social workers or caseworkers to attach to departments and precincts to move people with serious psychiatric problems from the criminal justice to the mental health system.<span style="mso-spacerun: yes;"> </span>Mental health courts could help facilitate this process. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><br />
</div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><strong>The Story</strong></span></div><span style="font-family: Calibri;"></span><br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;"> Mr. Jones was handsome and charming and extraordinarily dangerous.<span style="mso-spacerun: yes;"> </span>His good looks and charm got him pretty far along. <span style="mso-spacerun: yes;"> </span>Preppy was the term we used to describe him, which in a town with an Ivy League University is not a negative.<span style="mso-spacerun: yes;"> </span>Wavy black hair, soft blue eyes and a 100 watt smile gave him more second looks then he deserved.<span style="mso-spacerun: yes;"> </span>Women who should have known better suspended their judgment when they met him and would at least take the opportunity to know him better. <span style="mso-spacerun: yes;"> </span>I never met one who did not regret it.<span style="mso-spacerun: yes;"> </span>He never really participated in treatment, but my interactions with him, all of them in my role as crisis counselor, would lead me to believe he had schizoaffective disorder.<span style="mso-spacerun: yes;"> </span>This diagnosis combines the elements of a mood disorder like bi-polar with elements of a thought disorder like schizophrenia. <span style="mso-spacerun: yes;"> </span>What it produced in him was a manic mood that was like someone after 20 cups of coffee. Once started, he did not stop.<span style="mso-spacerun: yes;"> </span>That mood was wrapped around thoughts that were very disturbing; like he was the smartest man in the United States and the government was after him, torturing and punishing him because of his genius.<span style="mso-spacerun: yes;"> </span>Unfortunately, his actions played out these thoughts and moods in frightening and dangerous ways. </div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><br />
</div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="mso-tab-count: 1;"> </span>He lived in a rooming house downtown occupied by students and recent graduates. <span style="mso-spacerun: yes;"> </span>It was a building where there were shared spaces like kitchen and bathroom.<span style="mso-spacerun: yes;"> </span>He ate people’s food, he banged on the bathroom door, and he entered other people’s rooms and sat on their beds while they were sleeping, then waking them to tell them something.<span style="mso-spacerun: yes;"> </span>It was at that point that the winning smile became the frightening grin.<span style="mso-spacerun: yes;"> </span>If they disagreed with him, he would yell at them and curse them.<span style="mso-spacerun: yes;"> </span>I got a call from the police department one morning asking me to come see him.<span style="mso-spacerun: yes;"> </span>He was in a holding cell at the back of the station.<span style="mso-spacerun: yes;"> </span>“They locked up the wrong person! <span style="mso-spacerun: yes;"> </span>They screwed up! <span style="mso-spacerun: yes;"> </span>Get me out of here!” <span style="mso-spacerun: yes;"> </span>When I tried to ask what happened, he was out of control.<span style="mso-spacerun: yes;"> </span>“She’s the criminal, not me!” <span style="mso-spacerun: yes;"> </span>The overnight shift had gone home, so I read the report.<span style="mso-spacerun: yes;"> </span>At about 4 in the morning he had arrived at the police station with a young woman.<span style="mso-spacerun: yes;"> </span>Her hands were tied behind her back and she had packing tape over her mouth.<span style="mso-spacerun: yes;"> </span>He pushed her against the bullet proof window and shouted, “This is a citizen’s arrest.”<span style="mso-spacerun: yes;"> </span>The desk officer responded by putting him in cuffs and taking him to a holding cell. </div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="mso-tab-count: 1;"> </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="mso-tab-count: 1;"> </span>The woman reported he’d come in after the bars had closed and had been crashing around the kitchen and bathroom.<span style="mso-spacerun: yes;"> </span>He then had gone from door to door asking if anyone had cigarettes.<span style="mso-spacerun: yes;"> </span>She had been sleeping for a while before he came home and since it was a weekday she had school in the morning.<span style="mso-spacerun: yes;"> </span>She’d begun to yell at him and when she'd had enough of his antics she got very personal in her language.<span style="mso-spacerun: yes;"> </span>He grabbed her and put her face down on the bed and yanked out the phone line to bind her hands.<span style="mso-spacerun: yes;"> </span>When she’d screamed he pushed her face in the pillow, yelling at her to “Shut up!” The packing tape was put on before he pulled her down the hall.<span style="mso-spacerun: yes;"> </span>In her nightgown and bare feet he pushed, pulled and dragged her the four blocks to the police station.<span style="mso-spacerun: yes;"> </span>He wanted her charged with aggravated harassment for cursing at him and calling him names.</div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><br />
</div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="mso-tab-count: 1;"> </span>I tried to speak with him, to calm him down.<span style="mso-spacerun: yes;"> </span>He had no idea what he had done to be treated this way and as he stated to me many times, “I’m not crazy.”<span style="mso-spacerun: yes;"> </span>A few hours later when he got in front of the female judge, he was calm and charming, but the judge would have none of it.<span style="mso-spacerun: yes;"> </span>Before his arraignment the court officer had run his “sheet”, a list of previous charges and crimes.<span style="mso-spacerun: yes;"> </span>At the time, the computer paper was on a roll.<span style="mso-spacerun: yes;"> </span>His sheet was 14 feet long. <span style="mso-spacerun: yes;"> </span>I was in the court and the judge asked me if he would get mental health treatment in jail. <span style="mso-spacerun: yes;"> </span>“We’ll try,” I replied.<span style="mso-spacerun: yes;"> </span>“If I send him to the hospital there’s no guarantee they’ll keep him, is there? “ <span style="mso-spacerun: yes;"> </span>she asked, already knowing the answer.<span style="mso-spacerun: yes;"> </span>He went to jail and the student got an order of protection. </div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><br />
</div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="mso-tab-count: 1;"> </span>A few months later I got a call from an officer I knew quite well. “Terry, I’m in my car on Green Street and Mr. Jones is walking down the street pushing a shopping cart with a rifle in it.<span style="mso-spacerun: yes;"> </span>Is there any reason he should have a rifle?”<span style="mso-spacerun: yes;"> </span>A chill went through me, “No, absolutely not!”<span style="mso-spacerun: yes;"> </span>I did a short hand of mental hygiene law in my head.<span style="mso-spacerun: yes;"> </span>“Take him into custody, I’ll sign the papers.<span style="mso-spacerun: yes;"> </span>And please be careful.”</div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="mso-tab-count: 1;"> </span>Minutes later I met her at the police station with him in an interview room.<span style="mso-spacerun: yes;"> </span>I sat across from him at a desk and asked what the gun was for.<span style="mso-spacerun: yes;"> </span>He smiled smugly and said, “None of your business.<span style="mso-spacerun: yes;"> </span>I’m not crazy and I don’t have to talk to you.” <span style="mso-spacerun: yes;"> </span>An investigator went to the K-Mart where Mr. Jones had bought the rifle and nearly 1000 rounds of ammunition.<span style="mso-spacerun: yes;"> </span>There was no background check at that time and if there had been it would not have included psychiatric hospitalizations.<span style="mso-spacerun: yes;"> </span>On the form where it asked if the person purchasing the weapon had ever been committed to a mental hospital against their will, Mr. Jones had checked “No”.<span style="mso-spacerun: yes;"> </span>When asked about this, Mr. Jones had replied, “All of those hospitalizations were illegal, I don’t recognize them.”`</div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="mso-tab-count: 1;"> </span>Hours on the phone trying to get the Feds through the ATF (Alcohol, Tobacco and Firearms) to file felony charges for lying on their form were wasted.<span style="mso-spacerun: yes;"> </span>The local District Attorney’s office finally came up with the misdemeanor charge of filing a false instrument.<span style="mso-spacerun: yes;"> </span>We noted that Mr. Jones at the time was heading in the direction of the colleges. <span style="mso-spacerun: yes;"> </span>He never told anyone what the gun was for.<span style="mso-spacerun: yes;"> </span>He left town shortly after that, telling me and my police partner Beau Saul, “I can’t do anything here, I’m leaving.” <span style="mso-spacerun: yes;"> </span>Months later I got a call from a Sergeant in a police force in a nearby city.<span style="mso-spacerun: yes;"> </span>“I picked up this crazy guy with a shotgun. <span style="mso-spacerun: yes;"> </span>What can you tell me about him?”<span style="mso-spacerun: yes;"> </span>I replied, “Look at his sheet.”</div><div class="MsoNormal" style="margin: 0in 0in 10pt;"></div>Terry Garahanhttp://www.blogger.com/profile/18066569365497313232noreply@blogger.com3tag:blogger.com,1999:blog-18300098189807289.post-3757277411875742272011-07-10T19:49:00.000-04:002011-07-10T20:23:10.712-04:00Important change in addiction treatment<h1 class="articleHeadline"><span style="font-size: small;">The New York times has published an article that looks at changes in the way addiction is viewed. It has important implications for those with serious mental illness. The Link is below:</span></h1><h1 class="articleHeadline"><span style="font-size: small;"><h3><h3><a href="http://www.nytimes.com/2011/07/11/health/11addictions.html?hp"><span style="color: #666699;">Rethinking Addiction’s Roots, and Its Treatment</span></a></h3><h6 class="byline"><span style="color: #666699;">By DOUGLAS QUENQUA</span></h6></h3></nyt_headline></span></h1>Terry Garahanhttp://www.blogger.com/profile/18066569365497313232noreply@blogger.com3tag:blogger.com,1999:blog-18300098189807289.post-19321585069695098392011-07-06T12:19:00.000-04:002011-07-06T12:19:37.773-04:00Doing better can create danger!<div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 14pt; line-height: 115%;"><span style="font-family: Calibri;">Intense Insight</span></span></b></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><br />
</div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><br />
</div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">While many people with serious mental illness have no idea that they are ill, it can still be difficult for them to deny the evidence of their illness. Surrounded by poverty, ill health, repeated incarcerations and hospitalizations it is impossible to not know that something is wrong. <span style="mso-spacerun: yes;"> </span>There can be moments of extraordinary clarity that can be as frightening and dangerous as the worst symptoms.<span style="mso-spacerun: yes;"> </span>Getting the right kind of help during this time is a challenge for the patient and the helper.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><br />
</div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><br />
</div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">The Story</span></b></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><br />
</div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">I stood there in the harsh light of the morgue, walking around the body staring at the face.<span style="mso-spacerun: yes;"> </span>It looked somewhat familiar, but distorted in ways that made it difficult to discern.<span style="mso-spacerun: yes;"> </span>He had jumped from one of the higher bridges, almost 17 stories, nearly 170 feet into the gorge.<span style="mso-spacerun: yes;"> </span>When he’d landed, he’d<span style="mso-spacerun: yes;"> </span>hit his head, and the bruising, swelling and missing teeth combined with almost 24 hours in the water had altered his appearance in nightmarish ways. He looked shockingly like a Halloween pumpkin ready for display.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>He’d jumped in the early evening and only one person had seen him.<span style="mso-spacerun: yes;"> </span>If not for her, we may have never known what happened. He might have gone over the falls and into the lake without anyone knowing. As it was, he’d ended up in a small deep pool a half mile downstream.<span style="mso-spacerun: yes;"> </span>A uniformed cop with a long pole had found him. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;"><span style="mso-spacerun: yes;"> </span>“Could you help me roll him,” the investigator asked, “I want to see if there is anything in his back pockets.”<span style="mso-spacerun: yes;"> </span>I could feel the cold through the rubber gloves.<span style="mso-spacerun: yes;"> </span>I grabbed a belt loop on the jeans with my right hand and pushed hard with my left on his shoulders.<span style="mso-spacerun: yes;"> </span>We tipped him on his side and the second investigator carefully searched the pockets. We returned the body to its prone position and started to remove the clothing and bag it.<span style="mso-spacerun: yes;"> </span>It was driving me crazy! Who was it! I knew I knew him! <span style="mso-spacerun: yes;"> </span>He was a Southeast Asian or Hispanic male, early thirties to early forties without a damn bit of ID on him.<span style="mso-spacerun: yes;"> </span>When he was naked I left the room.<span style="mso-spacerun: yes;"> </span>Someone knew this man, loved this man, and he was dead and they didn’t know it. <span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">I went back to the clinic and talked to my colleagues.<span style="mso-spacerun: yes;"> </span>They were stumped.<span style="mso-spacerun: yes;"> </span>I went to the records department to try and jar my memory. Our records room was a big square room with tall metal shelves filled with three ring binders with names on the side. I started with the A’s going from top to bottom, left to right, walking slowly along the shelves.<span style="mso-spacerun: yes;"> </span>By the time I got to the end of the open cases, I was sure we weren’t currently treating him. I began to look at the names of the closed case binders and got to the second shelf and realized I’d found my answer. I pulled out the binder and started reading the notes.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">Doug was his Americanized name.<span style="mso-spacerun: yes;"> </span>He wasn’t born in the US, but had been raised here.<span style="mso-spacerun: yes;"> </span>His parents had attended Cornell as grad students and separated when he was about seven. His dad returned to Asia and his mom stayed, starting a small home based business that thrived. She and Doug moved in with a widowed man who also had a son a few years younger than Doug. The family was happy until Doug started to have psychotic symptoms just after high school graduation.<span style="mso-spacerun: yes;"> </span>Mostly he heard voices that called him names or cursed at him. He’d respond to the voices by yelling and cursing back. <span style="mso-spacerun: yes;"> </span>Sometimes he would break things in the house or imagine his step- brother was against him and make vocal threats against him.<span style="mso-spacerun: yes;"> </span>His actions made it impossible to stay in the family home, so he moved through a series of crummy apartments and rooms. <span style="mso-spacerun: yes;"> </span>He’d work washing dishes or shoveling snow or cutting grass.<span style="mso-spacerun: yes;"> </span>His threatening statements caused a string of hospitalizations that would be followed by periods of calm. Then he would stop taking medications, start smoking pot and the process would begin again. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">Each time he was hospitalized, he would be referred to our clinic for outpatient treatment upon discharge.<span style="mso-spacerun: yes;"> </span>He had little insight as to his illness, but he hated to be hospitalized and often the focus of treatment was our encouraging him to take the medication to avoid the hospital.<span style="mso-spacerun: yes;"> </span>Another consequence of his becoming stable was the onset of depression.<span style="mso-spacerun: yes;"> </span>His depression was the result of this clear, unobstructed view of his life, at least as he saw it.<span style="mso-spacerun: yes;"> </span>He was a loser, almost thirty and nothing good happening.<span style="mso-spacerun: yes;"> </span>He’d tell the psychiatrist, “Everybody I know has a better life than I do.<span style="mso-spacerun: yes;"> </span>Everybody I went to school with is a success. They have good jobs, wives and kids, houses and cars and I’ve got shit.”<span style="mso-spacerun: yes;"> </span>The doctor, of course explained that it was not true, not “everybody” he went to high school with was doing great.<span style="mso-spacerun: yes;"> </span>In fact we knew some, both personally and professionally, that were not doing well at all. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">Eighteen months earlier Doug’s father had come from Pakistan and after consulting with Doug’s mom took him home with him.<span style="mso-spacerun: yes;"> </span>We closed his case and went on treating the other five hundred and sixty patients.<span style="mso-spacerun: yes;"> </span>Doug had returned with his dad six weeks ago.<span style="mso-spacerun: yes;"> </span>His father had made an appointment with the doctor for a consultation.<span style="mso-spacerun: yes;"> </span>Although not uncommon, a parent requesting a doctor visit without the son, who was the patient, made me wonder, so I decided to sit in. <span style="mso-spacerun: yes;"> </span>“For almost a year now, I have been treating him.”<span style="mso-spacerun: yes;"> </span>Doug’s father began.<span style="mso-spacerun: yes;"> </span>“My cousin is a doctor and he has prescribed the very same medicines he was given here in the United States.<span style="mso-spacerun: yes;"> </span>Each day I have crushed up this medicine and placed it in his food. I have never seen him doing better.<span style="mso-spacerun: yes;"> </span>If you would just continue to prescribe this medicine, his mother has agreed to continue to put it in his food.”<span style="mso-spacerun: yes;"> </span>“Does he know he is taking the medication?” the doctor asked. <span style="mso-spacerun: yes;"> </span>The father replied, “Of course not, he would stop taking it like he always does. This is working so much better and all we need is the prescriptions and we’ll take full responsibility.”<span style="mso-spacerun: yes;"> </span>He left our office sad and dejected and not fully understanding why we could not and would not participate in his plan of deception.<span style="mso-spacerun: yes;"> </span>He went back to Pakistan telling his wife he would send the medications. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">Doug’s mom had called about a month ago, after the dad left.<span style="mso-spacerun: yes;"> </span>“I understand why you couldn’t do it, but his dad is a stubborn guy.<span style="mso-spacerun: yes;"> </span>Doug is really doing great.<span style="mso-spacerun: yes;"> </span>He’s applied to community college and says he will make an appointment with you guys.<span style="mso-spacerun: yes;"> </span>He’s got some money from his granddad and has rented an apartment in college town. I’ll give you the address.”<span style="mso-spacerun: yes;"> </span>I went to see him at one of the newer apartment houses, filled with Cornell students.<span style="mso-spacerun: yes;"> </span>“Nice place,” I remarked as I entered his apartment.<span style="mso-spacerun: yes;"> </span>It was easily the nicest apartment he’d lived in since he’d left home. It was neat and well cared for. He looked good; clean clothes, nice haircut. He said, “I thought since I was going to college, even community college, I’d try to live the part.”<span style="mso-spacerun: yes;"> </span>We talked for a little while and I set up an appointment for him and left.<span style="mso-spacerun: yes;"> </span>He never kept the appointment and when I returned he was not there or did not answer the door. <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>I’d spoken briefly to his mom and she said he was still doing Ok, but seemed stressed. “I’ll try to get him to see you.” </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">I put the binder back and walked over to the police department. When I got to investigations I looked at the pictures from the morgue. I knew the answer, but had to confirm my suspicions. <span style="mso-spacerun: yes;"> </span>It was him!<span style="mso-spacerun: yes;"> </span>I went with the investigator to Doug’s apartment and we got the landlord to let us in.<span style="mso-spacerun: yes;"> </span>The smell of rotting food in styrofoam greeted us. The place was a mess. No note or indication of his thoughts.<span style="mso-spacerun: yes;"> </span>I called his mom. “Have you seen Doug?”<span style="mso-spacerun: yes;"> </span>I asked.<span style="mso-spacerun: yes;"> </span>“No we haven’t seen him for a week.<span style="mso-spacerun: yes;"> </span>He had dinner with us Sunday and he was really depressed.<span style="mso-spacerun: yes;"> </span>Being around all those successful kids wasn’t a good idea. He just kept saying, I’ll never catch up.”<span style="mso-spacerun: yes;"> </span>I took a deep breath and said, “Are you going to be home for a while, I want to stop by and talk to you?”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt; text-indent: 0.5in;"><span style="font-family: Calibri;">The Lieutenant and I went to see her. <span style="mso-spacerun: yes;"> </span>He told her there were other means of identification they were pursuing; that the remains were unpleasant to view.<span style="mso-spacerun: yes;"> </span>“No mother should have to see their child like that,” he said to me as she entered the morgue. </span></div>Terry Garahanhttp://www.blogger.com/profile/18066569365497313232noreply@blogger.com3tag:blogger.com,1999:blog-18300098189807289.post-71580129206652979502011-07-03T09:20:00.000-04:002011-07-03T09:20:57.903-04:00Is this a good Idea?Cuts in services and programs! No food, no housing ; but at least they can get guns. If you have a few minutes read this from today's NYTimes. The link is below. <br />
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<a href="http://www.nytimes.com/2011/07/03/us/03guns.html?emc=eta1" target="_blank"><strong><span style="font-size: medium;">Some With Histories of Mental Illness Petition to Get Their Gun Rights Back</span></strong></a>Terry Garahanhttp://www.blogger.com/profile/18066569365497313232noreply@blogger.com1tag:blogger.com,1999:blog-18300098189807289.post-14622948122212932752011-07-03T09:11:00.000-04:002011-07-03T09:11:12.829-04:00Now they mandate treatment!This is from last weeks Washingtonpost. It is followed by a link from today's New York Times. I will write about violence, guns and the mentally ill in weeks to come. Unfortunately I have more stories than I want to remember. It is important to know that even among the most serious mentally ill there are only a small number who are prone to violence. <br />
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</script><!-- START MICHELE 2011 01 17 (Modified)--><!-- STOP MICHELE 2011 01 17 (Modified)--><div><div class="sidebar"><div class="top"><div class="title"><h1 class="entry-title">Jared Loughner forcible medication to continue, judge rules</h1><div class="blog-byline">By Elizabeth Flock</div><div id="entrytext"><span class="imgleft"><img align="bottom" border="0" src="http://www.washingtonpost.com/rf/image_296w/WashingtonPost/Content/Blogs/blogpost/201106/Images/loughnermed.JPG?uuid=1hIwLqNREeCxG385yZuJEA" width="228" /><br />
<span class="blog_caption"><span style="color: #333333; font-size: x-small;">This photo released Feb. 22 by the U.S. Marshal's Service shows Tucson shooting rampage suspect Jared Loughner. (AP) </span></span></span>A federal juge on Wednesday ruled that prison officials can forcibly give Loughner anti-psychotic drugs so that he can be mentally fit for trial. <br />
In May, doctors diagnosed Loughner with schizophrenia, and U.S. District Judge Larry A. Burns in May declared Loughner to be <a href="http://www.washingtonpost.com/politics/jared-lee-loughner-ruled-unfit-for-trial-in-tucson-rampage/2011/05/25/AG843YBH_story.html" target="_blank"><span style="color: #0c4790;">unfit for trial</span></a>. He has since been undergoing treatment. <br />
Attorneys for Jared Loughner filed an emergency motion on Friday asking Burns to stop officials from giving him drugs, but Burns said he deferred to the advice of doctors.<br />
<a href="" name="pagebreak"></a>According to the 1960 Supreme Court Decision Dusky v. United States, an individual must be able to communicate with his lawyer and understand the charges against him in order to be tried in court. Doctors who examined Loughner earlier said he could do neither.<br />
Loughner has several times thrown chairs around his cell and has spit on and lunged at his defense attorney. Staff at the Springfield, Mo., facility, where he is being held, said his behavior was “escalating” before he received medication.<br />
In its latest filing, the government said he is “<a href="http://www.courthousenews.com/2011/06/30/37817.htm" target="_blank"><span style="color: #0c4790;">tolerating the medication well</span></a>.”<br />
Loughner is charged with the Jan. 8, 2011 Tucson, Arizona shooting that injured U.S. Rep. Gabrielle Giffords and killed six others.</div></div></div></div></div></div></div>Terry Garahanhttp://www.blogger.com/profile/18066569365497313232noreply@blogger.com1