Thursday, July 27, 2006

Jail and mental illness

I used to be of the opinion that things in life were black and white. If you did something wrong, and it was against the law, you needed to accept the consequences of your actions. Then I went to work at Wishard, in the Psych ICU, where people would come from the bus station - or the police station, and stay until they could think clearly again.

We had some repeat patients during the 5+ years I was there. Nice thing about psych, your patients may come back a little crazy, but rarely are they dying. It was a good job - and taught me the habit of trying to see how much of my own she!t was causing problems in my perception of others - and what they said. It is a good habit, though I may never perfect it.

I remember vividly many of my patients. There was the urge to hurry to get them out of the "goldfish jar" in the ER where psychotic people were held until we could get them admitted. I remember watching officials, who didn't know the difference between mental illness and disrespect, shove patients, leaving marks on their wrists from the handcuffs. I have never believed that the best place for treating mental illness was jail, though there are maximum security mental health hospitals that do a pretty good job.

I remember the woman who couldn't take her antipsychotic while pregnant and didn't remember even having her baby - I saw her the next day and she had no recollection of even being pregnant. There were a couple of young men who came to us: One was so very handsome, and had just finished his masters in Biochemistry at a prestigious university. He was 25 - and then he became psychotic one morning and tore up a mall downtown. His family was beyond shocked. It was a long time before the diagnosis of Bipolar Disorder was something he could understand. The police eventually just had him do community service.

The other young man was not so lucky. He was in his thirties, worked as an engineer or an accountant, I can't remember exactly. He lived in an apartment complex, across the hall from his elderly father. One night, his schizophrenia showed itself, and he brutally murdered his father. That was his first indication there was something wrong - killing his father. He stayed with us for a long time, and when his mind cleared there was no more tortured man on the planet.

For many people who suffer from mental illness, there is the blessing of not remembering what happened when you were decompensated (crazy). I have to say I think this is a good system design, because in their right minds, these folks would be horrified to learn about how they had behaved, or what they had said. Some things are best left locked away in the subconscious.

I was thinking about this because I have been following the Andrea Yates case. Her husband spoke out today, saying he was very disappointed with the prosecutions handling of the case. No dispute about whether or not she did something wrong, but the push among prosecutors to prove that someone who is admittedly mentally ill did something psychotic just amazes me. When I followed this back in 2002, I kept wanting to send them a note - congratulating them for stating the obvious - people who are mentally ill and in the throes of their illness, do crazy things. I wonder why they think that putting a person with mental issues in a cage with a crack whore will help society. And here is the father of those sweet children, fighting for their mother - even though he has divorced her and started his life over with a new wife and stepkids. It seems that the victim's wishes are totally ignored - and if anyone had a right to ask for restitution, it would have been him.

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