What is your take on this story. Originally published in the Washington Post
A STATE OF OUTRAGE;
His Son Is Delusional, Paranoid, Psychotic -- But Cannot Be Forced Into Treatment.
A Father Grapples With Truth, Responsibility And A Confounding Virginia Law
By Pete Earley, Special to The Washington Post
My son is bipolar. It's a mental illness. It's trying to kill him.
"How would you feel, Dad," he asks, "if someone you loved killed
himself?"
It's not spoken as a threat in anger. Rather, his voice is tired, weary. It's
Friday and I am racing along the interstate, driving from New York to
Virginia. We're now just north of Baltimore. For the past several hours, I
have been begging him to take Zyprexa, his antipsychotic medicine. "Pills
are poison," he says. "Those doctors don't know what they're talking
about. I just think differently."
I'd first learned that my son was slipping earlier that morning.
"Something's wrong," his older brother telephoned from New York to say.
Since then, I have discovered that his dementia actually began surfacing
three days ago when he found a video on the sidewalk in Manhattan. It
was Oliver Stone's movie "Heaven and Earth." He watched it three times
and decided it contained a secret message just for him. He tried to
convince me of this as we drove. "Just watch it, then you'll understand."
I react by pressing harder on the gas pedal and urging him to take a
Zyprexa tablet.
"Okay, I'll take your damn pill," he finally says. But he pauses just before
slipping it into his mouth.
Please, God! I pray. Swallow it!
He pops it in and takes a drink of water, but I see him wipe his lips, drop
his hand down next to the car seat, and shake it. Was that the pill?
"No one dies unless God wants him dead," he says.
"Did Patti's first husband want to die?" I ask.
Patti is my wife, his stepmother. Her first husband died of cancer, leaving
her a widow with four children. The question irks him. His thoughts
bounce like a pogo stick, without reason. OutKast. Capitalism. Satan.
Comic books. Sex. Spontaneous laughter.
"Dog God!" Ha, ha, ha. "God Dog! Get it?" He sees a hidden message in
a bumper sticker on the blue sedan in front of us: "Believe In Him!"
Patti has alerted the emergency room at Inova Fairfax Hospital. It's
where I drove him a year ago when he suffered a similar psychotic
episode. Security guards had to wrestle him down that time. But a shot
of Haldol, a powerful antipsychotic, had quieted his mind.
By the time we reach the emergency room it's 8 p.m. The intake nurse
rolls her eyes as he talks. He has been admitted twice before into Virginia
mental hospitals, has suffered three previous delusional episodes, has
been diagnosed by four psychiatrists as being bipolar. What's happening
now shouldn't be a surprise.
Typically, bipolar sufferers stop taking their medicines. This time, he took
his pills for four months. They made him gain weight, turned his mouth
dry, made him sluggish, killed his sex drive. At age 23, those are high
prices.
One morning, he declared that he was done with all medicines. I'd
responded with tough love. "Take your pills or you can't live with me."
He'd walked out and eventually returned to Brooklyn to finish college.
For nine months, he was fine. But now he is slipping fast. At least this
time I got him help before he was too far gone, I think.
A nurse appears and escorts us into a separate room. While he babbles, I
explain that my son's first psychotic episode occurred during his final
year at the Pratt Institute. Some call bipolar, once known as
manic-depressive illness, the "artists' disease." Novelist Graham Greene.
Actress Patty Duke. Creativity. Despair.
My son invited two homeless men to a Brooklyn diner and bought them
breakfast. They assumed he wanted sex in return, but all he'd wanted
was to preach about politics. That night, he wasn't certain if it had been
a dream.
He called me. I suspected drug use and drove to Brooklyn. Patti found
him a psychiatrist. He went twice, then stopped. Too much schoolwork,
he said.
Five months later, a friend brought him home unexpectedly. My son
hadn't slept for seven nights. He'd walked 20 miles aimlessly through
New York's boroughs. He was fixated on a woman, Jen, but she didn't
know it. He had to save her.
"From what?"
"Evil."
I fed him, put him in bed and was calling a doctor when he bolted from
the house. An hour later, he'd come home and I'd tricked him into riding
with me to the hospital. "Jen's there," I'd said.
After he'd received the shot of Haldol, he'd voluntarily entered Dominion
Hospital in Falls Church.
Four days later, his insurance company had forced the mental hospital to
discharge him. Their computerized charts had convinced them that he
was mentally stable.
Two days later, he took a car, began driving, let go of the steering wheel
and shut his eyes. He struck a parked car. This time, the insurance
company let him stay in the hospital for 10 days.
After that episode, I'd asked him what he remembered. He said he'd
been aware of everything, that he had helplessly watched it unfold, but
that he hadn't been able to tell whether it was real or a dream, taking
place in the present, past or future.
Now, as we were waiting for help in the emergency room, I wonder: Are
you in there, son, watching your insane self? Can you hear me?
It has been two hours. No one has come to help us. My son is reading a
copy of The New Yorker that had been left on the examining table. He's
read the same page out loud to me four times.
Another hour passes and then another. Four hours! It's almost midnight.
"I'm leaving," he announces.
I call a nurse. The doctor arrives. He's young, clean-cut, all business. As
he enters the room, he raises both hands as if he is already frustrated.
"Sorry you've had to wait, but we're busy, and there's not going to be
much I can do for you," he says.
I think: You haven't even examined my son! A nurse has told him that
my son is convinced medicines are poison. The doctor asks him: "Do you
know who I am?"
"You're the witch doctor," he replies. "Ow-ee-ow-ah-ah."
"He's bipolar," I say and begin explaining his past. "On the drive down
from New York, he asked me how I'd feel if someone I loved killed
himself."
The doctor asks my son: "Are you going to hurt yourself or anyone else?"
"No!" he replies.
The doctor looks at me and shrugs.
I can't believe this is happening.
"He's delusional," I say. "For God's sake, he's been reading the same
magazine page for an hour."
The doctor turns back to him: "Who is the president of the United
States?"
"George Bush."
"What's today?"
Other questions follow: "Can you count backwards by sevens from a
hundred? What does the phrase 'Don't cry over spilled milk' mean? How
about the words 'a heavy heart'?" My son answers each question
correctly. Then he adds that he's indestructible.
The doctor tells me: "Virginia law is very specific. Unless a patient is in
imminent danger to himself or others, I cannot treat him unless he
voluntarily agrees to be treated."
Before I can reply, he asks my son: "Will you take medicines if I offer
them to you?"
"No, I don't believe in your poisons," he replies.
"He's bipolar, he's off his meds, he has a history of psychotic behavior!" I
say. "Please help him!"
But the doctor isn't swayed. "Your son is an adult, and while he is clearly
acting odd, he has a right under the law to refuse treatment."
"Then you take him home with you tonight!" I snap.
We are distracted. My son is screaming at his mother, who has joined us,
because she has told him that alcohol is a drug. "You drink beer, why not
take your medicine?" she'd asked.
The nurses are staring. Someone calls hospital security. My son walks
away swearing. I run after him. The doctor tells my ex-wife that it is not
illegal for someone to be mentally ill in Virginia. It's not illegal for anyone
to refuse medical treatment. But it's illegal for a doctor to treat someone
against his wishes.
"Even if he's psychotic?"
"Yes."
Afraid to take him home, where my wife and his step-siblings are
sleeping, I drive to my office, make my son a bed, bolt-lock the doors,
hide the keys. While he's taking a shower, I crush a Zyprexa tablet and
spike his drink. After he has fallen asleep, I put a chair in the doorway
and sit.
It's Saturday morning now and he insists I watch "Heaven and Earth."
"You'll understand then," he promises.
Patti comes and tries to reason with him. He begins sobbing. "There's so
much pain. I just want the pain to go away."
Patti has called his former therapist and the psychiatrist who last treated
him. Neither has seen him in months. They're no help. She's called the
police. Everyone gives her the same answer: Wait until he's more
psychotic, then try the emergency room again. Hope for a more
compassionate doctor.
A friend whose daughter is bipolar tells her: "I screamed at the doctors. I
said, 'Do I have to wait for my daughter to hang herself before you'll help
her?' "
It's 2 p.m. and during the past 24 hours, I have watched my son slip
deeper and deeper into insanity. He suspects that I'm spiking his drinks
and demands that I drive him to his mother's.
En route, I say: "You're sick. Please, please take your medicine."
"STOP TRYING TO F------ CONTROL MY LIFE!" he screams. Suddenly he
is out of control, spewing profanity, making threats. He reaches for the
door handle, I jam on the car's brakes and grab for his shoulder, but he
leaps out before the car comes to a full stop.
I hear the screech of brakes and expect to be rear-ended, but the car
behind me swerves and the driver flips me an obscene gesture as I
watch my son run away.
The call from the police comes Monday morning. The Reston dispatcher
leaves a message on my answering machine. My son couldn't remember
our home number.
He has been arrested and is now in handcuffs at the Woodburn Center
for Community Mental Health. It's less than a mile from the Fairfax
Hospital emergency room where I'd driven him Friday night. Fairfax
Police Officer Vern Albert is waiting for me outside the brick building. He
tells me that my son walked into a Starbucks that morning in the
neighborhood where he grew up, lifted a glass bottle shoulder height
and announced that it wouldn't break if he dropped it. When it shattered
at his feet, he grabbed another bottle and ran. The young clerk
recognized him from their high school days.
Minutes later, a residential burglar alarm sounded. My son had thrown a
potted plant through a glass door and broken into a house. He had
started smashing furniture. Luckily, the homeowners were away. He had
then run upstairs, turned on the water facuets and drawn himself a
bubble bath. Two days before, two Prince George's County sheriff's
deputies had been killed when they tried to apprehend a mentally
impaired man who had refused treatment despite his parents' pleas. The
Fairfax police didn't want to take any chances. They unleashed a police
dog. Its teeth ripped into my son's arm, biting him three times before he
was subdued.
Officer Albert, a father himself, offers me compassionate advice: "Even
though your son has committed several felonies, unless you tell them
that he threatened to kill you, they won't require him to get medical
treatment. He'll end up in jail."
I am outraged. I march in and tell the psychologist on duty that I want a
temporary detention order issued because my son has threatened my
life. She responds quickly and my son is taken by police to the psychiatric
unit at Mount Vernon Hospital. Under Virginia law, I must appear before
a special justice in 48 hours to explain why my son should be hospitalized
against his will.
The next day is a blur. I meet with lawyers and psychiatrists, and I call
everyone I know who has been through the process. The lawyer who has
been appointed by the state to represent my son's interests says my son
has agreed to voluntarily commit himself. My lawyer says that's good --
because in spite of everything that my son has done, it would have been
difficult for us to have him committed him against his will. The dangerous
part of my son's decision is that it means he will be kept in the hospital
no more than five days unless we can convince him to voluntarily stay
longer. The detention hearing will take less than five minutes, I'm told.
"It's all just routine paper-signing."
Routine? Five minutes! His life!
After I visit my son at the hospital, a nurse takes me aside. "Twenty
years ago, you could get someone committed just by accusing them of
being crazy," she says. "Now the law has swung so far the other way
that you can't get them help even though you know they will thank you
later."
"Why are you voluntarily committing yourself?" the special justice asks
my son. He is the fourth patient to appear at a commitment hearing that
morning.
"Because I am having a relapse, and my parents want me somewhere
safe," my son replies. I am shocked at how lucid he is since he has
agreed to take his medicine. The hospital psychiatrist, James Dee, has
marveled at how quickly my son is recovering but grimly warns that each
time he suffers another psychotic episode, it will be more difficult for him.
It's possible that eventually we may see an "unavoidable deteriorating
course." Simply put, we will lose his mind forever.
"Does anyone object," the special justice asks.
"I do!" I say, surprising him. "I understand there is nothing I can do
legally to stop you from releasing my son in five days," I say, reading a
prepared statement. "But my son told me last night that as soon as he is
released, he will stop taking medicine and not cooperate in any
treatment program." I can't continue. My voice cracks, tears well. The
justice says his hands are tied under Virginia law. I reply: "My lawyer has
told me that. But I'm speaking to you not as a judge, but as one father
to another father, please, don't release my son until he is mentally
stable."
In an compassionate gesture, the justice asks my son if he has heard
what I said. Then it's over.
It's my birthday. I'm 51. Patti and our children postpone the party. We
are all too busy scrambling to find a partial hospital treatment program
for my son. For the first time in days, I feel some hope when Penny
Hinckle, the director of the Northwest Center in Reston, agrees to help
him adjust back into the community. But she warns: "If his meds don't
kick in, he'll probably just walk away."
I bring a box of Kentucky Fried Chicken with me that night when I visit
him. He surprises me with a gift of his own: a hand-drawn birthday card.
He's written down past events we have done together.
"Remember when I fell off the cliff?" he asks.
We were fishing in the Black Hills of South Dakota. But 5-year-olds have
no patience and he had wandered too close to the edge of a ravine. The
dirt gave way and he tumbled a third of the way down before he
grabbed a bush and clung on, screaming, his chest scraped and
bleeding. I had climbed down, but he wouldn't let go of the bush until
I'd promised that I'd protect him. Over the years, the story grew. The
ravine became a hundred-foot-high cliff. In sixth grade, he'd written an
essay about how I'd saved his life. That was when I was still his hero.
That night, we hug before I leave. I've been warned that many bipolar
young men get stuck in a revolving door, going from hospital to
treatment center and back to the streets. They stop taking their
medications and end up hospitalized. They're the lucky ones. Many kill
themselves, others become alcohol and drug abusers.
Not my son, I tell myself. I can save him.
The next morning, his psychiatrists calls. A pill has been found on the
floor. My son had spit it out and tried to hide it. I'm told it takes up to
three weeks for the medicines to become fully effective. My son still
believes medicines are poison. He can be released in two days. If I
continue to think he is unstable, I'm told that I can accuse him of
threatening me again and seek another detention order. "Do whatever
you have to do to save your son," a nurse urges. "Just lie!"
I'm looking at a photograph of my children. Why him? An abiding
sadness comes over me. I rarely cry, but now I begin. I can complain to
Fairfax Hospital officials about how my son was turned away from the
emergency room. I can lobby my local Virginia legislators to change a
dumb-headed law that prevents bipolar patients from getting medical
help. I can hire teams of psychiatrists. But I can't scoop up my son from
this bipolar ravine and carry him to firm ground.
He must first reach out his hand.
The experts tell me that he must come to grips with his own illness, even
though part of that sickness robs him of his judgment. It's like
demanding that a man with a broken leg run a marathon.
The clock is ticking. Forty-eight hours are left. The demons are tugging
at his feet. And the law, in its zeal to protect my son's civil rights, is
doing everything it can to prevent me from getting him help in time. I'm
not sure what Patti and his mother and I can do.
My son is bipolar. It's a mental illness. It's trying to kill him. And the state
of Virginia is on the devil's side.*
The day after this story was written, the author's son agreed to remain in
the hospital voluntarily until his doctor discharged him. In total, he was
there 11 days and is now in an outpatient treatment program. The
author, a former Post reporter, lives in Fairfax.
******************************
pcami.org |
