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No Treatment? No Problem

Why do we look away from psychosis?

Who's Crazy?

 

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

Navy veteran and computer contractor Aaron Alexis killed twelve people at the Washington Navy Yard. By all evidence he had been psychotic quite a while. 

He told his friends and neighbors that their cat was secretly going into his refrigerator to steal his food. At the Norfolk Airport he started screaming at a family that they were “laughing at him,” spouting obscenities. Yet when airport security spoke to him at the gate he “calmed down.” Alexis got on his flight. After hoteliers went nuts trying to respond to his endless complaints about horrible noise only he could hear, the Newport, Rhode Island police listened to his calls about the “microwave machine” sending those voices through walls. They marked the phone messages in their ledgers. Why bother telling him he should seek treatment? He probably wouldn’t go anyway. And think of all that useless paperwork.  Even when they hospitalize him, he'll be out in hours or days.

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

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

Murder and sleeplessness have more than a few connections.

Secrets of Florida

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

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

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

Cameras were present, but I never saw a corrections officer.

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

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

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

One morning he had had enough. He put on his nailed boots, crossed his driveway, and "stomped the **cker to death.” Once they arrived, he proudly told the police.

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

The client agreed. His "work" as “smart full time investor” had consisted of occasionally buying Treasury bills. His life consisted of watching TV by day and by night and driving his father’s car over to titty bars where he would nurse a Coke or a Sprite for hours. He said the whole show would only cost four bucks, plus gas. He had no friends. His father had died.

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

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

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

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

It’s their right. They don't have to go.

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

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

The Future

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

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

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

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

According to The Week, since 9/11, 364,000 American civilians have died from firearms.

So who are the crazy ones?

Matthew Edlund, M.D. researches rest, sleep, performance, and public health; he is the author of Healthy Without Health Insurance and The Power of Rest.

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