Paranoid schizophrenics I’ve known

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Esteban Santiago in custody

Esteban Santiago, the lone gunman who killed five innocent strangers and wounded six more at the Fort Lauderdale airport on January 6th, had sought help from the government in November. He walked into an FBI office in Anchorage, Alaska, claiming that the U.S. government was controlling his mind and forcing him to watch Islamic State videos. Agents called police and he was taken for a mental health evaluation, but he didn’t appear intent on harming anyone, so he slipped through the cracks in the system. Two months later, he officially became a murderer.

His delusional claims brought back memories of my years working on locked wards with seriously ill patients at Hudson River Psychiatric Center in Poughkeepsie. With my hard-earned master’s degree in art therapy from New York University, I was embarking on my first full-time job in mental health, and I was especially fascinated by the elaborate delusions of those diagnosed as paranoid schizophrenic. The men on Ward 604 ranged in age from their late teens to early middle age and they were on the maximum-security ward because they were considered a danger to themselves or others. Some were assaultive, others had prison records, and there were a couple of murderers.

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Abandoned Rehab Center at HRPC. I led an evening Creative Arts Club here for those allowed to leave the wards.

This was the 1980’s, and like many state mental hospitals across the country, Hudson River was rapidly being downsized as patients were discharged into the community, presumably to be managed through outpatient services and medication. But some were deemed too dangerous for discharge, and others cycled in and out through the system’s revolving doors.

Some of the paranoid schizophrenics believed they took their orders from God or the government, while a few believed they actually were God or at least Jesus. One young man believed he had turned into a woman and had sex with John Lennon. (This was in early 1980, before John was brutally murdered.) I couldn’t resist replying, in my best nonjudgmental therapeutic manner, “Oh, do you want to tell me about that? What was it like?” Unfortunately I can’t recall his reply.

I encouraged the patients to get their visions down on paper, with pencils or paint, and to talk or write about what the images meant to them. As an art therapist, I’d been trained not to impose my own interpretations aloud, but I’d learned to analyze the pathologies revealed by their artwork, to record them in progress notes and to report disturbing content to their shrinks and treatment teams. Often the imagery was violent, replete with swords, guns, blood and dismemberment. Yet not once did a patient assault me or even verbally threaten me. I was their ally, there to foster their creativity and self-expression, not to impose controls on them.

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Abandoned day room, Cheney Building, HRPC–much like the one where I held art therapy sessions

Hudson River closed years ago, and I’ve often wondered what became of those patients who were incapable of adjusting to life in the community. Like thousands of others, many probably ended up in prison, homeless or dead. Deinstitutionalization hasn’t been the panacea it was touted as being, and there aren’t enough affordable community mental health services to go around.

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Esteban Santiago in Iraq

Esteban Santiago was receiving psychological treatment in Alaska, but his family wasn’t privy to the details. Clearly it wasn’t enough, but maybe nothing could have stopped his deadly rampage. Since he surrendered and survived, maybe he’ll be able to shed some light on his actions.

Two days after the shooting, I began this blog post as a potential op ed piece for the Albany Times Union, but then I realized that my viewpoint wasn’t sufficiently clear, so I put it aside. A day after that, the TU introduced a new, reduced format, with certain features shortened or omitted. The two Perspective pages, with their generous space for columns, both national and local, went on the chopping block. Now they might not have space for my essay in any event, so I decided to post it here. Since I’m no longer limited to 600 words, I can be a bit more freewheeling—if I were aiming for publication in the TU, I wouldn’t have mentioned the patient who believed he’d fucked John Lennon.

I have mixed emotions about hospitalization for the mentally ill, especially those who are truly a danger to themselves or others. Deinstitutionalization was supposed to be a good thing, and those enormous old hospitals were portrayed in the public eye as hideous snake pits. But Hudson River Psychiatric Center was a fairly benign and yes, therapeutic environment. If it weren’t, I could never have worked there for 13 years, enough to get me vested in the New York State retirement system that helps sustain me now.

The patients at Hudson River inspired me to embark on my first novel, then titled The Flip Side. It was good enough to win me some personalized and encouraging rejection letters, and eventually a good agent in Manhattan, but alas, she never sold it. It remains unpublished, but who knows, I may resurrect it one of these days.

Meanwhile, I sometimes wonder what became of those fascinating guys on Ward 604. Did they eventually get discharged and adjust to life in the community? More likely they died young or landed in prison.

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Main building at HRPC burning in May, 2007

Deja vu: Another troubled young man, another massacre

Back in July, I concluded my blog post about the horrific massacre in the Colorado movie theatre as follows: 

Social media and mass communications have become so overwhelmingly powerful, the images of violence and mayhem so inescapable, and powerful deadly weapons so readily available, it’s no surprise that for certain deranged individuals, the lure of deadly international fame will prove irresistible. Sadly, the massacre in Aurora probably won’t be the last.  

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I wish with all my heart that I’d been wrong, yet here I am, trying once more to make sense of a senseless act of violence. We don’t yet know what motivated Adam Lanza to kill twenty first-graders and six staff at the Sandy Hook school in Newtown, and the answers may have died with him. We do know that he spent countless hours closeted in his bedroom with his computer, but the authorities are saying he smashed it up so thoroughly that the contents may never be recovered.

Once again, in the wake of this tragedy, the pundits are pontificating about gun control and mental illness, and theorizing about what can be done to prevent future massacres. There are no easy answers, but one is painfully obvious: outlaw or severely restrict the sale and possession of semi-automatic weapons and magazines.

In January of 2011, after Jared Louchner opened fire in a Tucson parking lot, killing six and injuring 14 others, including Congresswoman Gabriella Gifford, I began writing the following blog post: 

Bacon Francis seated figureAs soon as I heard the first reports about the twisted thinking of the shooter in the horrific Arizona massacre, a snap judgment came to mind – I was willing to bet he was paranoid schizophrenic. As an art therapist, I’d worked for over a decade with patients who shared that diagnosis, and I knew the symptoms well. It was Jared Loughner’s creation of a “new currency” to rival the government’s that was the tip-off.

I knew quite a few paranoid schizophrenics who believed in complicated structures of world domination, often involving the government. Sometimes they thought they “controlled” these bizarre delusions, but of course it was the delusions that controlled them – that and the fact that they were confined to locked wards in a state psychiatric hospital.

That was back in the 1980’s – ancient history when it comes to the treatment of mental illness. At Hudson River Psychiatric Center in Poughkeepsie, deinstitutionalization was making rapid inroads, with more and more patients being discharged to the community, but there were still well over a thousand inpatients, many of them there for years on end. All were judged a danger to themselves or others, and many had done prison time. I worked with arsonists and murderers. It was almost inconceivable that some could ever be discharged, yet in the years that followed, most of them were. I don’t know what became of them.

Strangely enough, I wasn’t frightened. None of them ever assaulted or even threatened me. I like to think that was because of my charming personality or therapeutic skills, but more likely it was my role as a creative arts therapist. I didn’t wield the authority to change their medications or make crucial decisions regarding their privileges or discharge planning, so I didn’t constitute a threat. The options I offered – music, art, creative writing and role playing – weren’t required; patients could elect to take them or leave them. Then too, they were on heavy doses of medication.

One night a week, I facilitated a Creative Arts Club at the Rehabilitation Center for those approved by their doctors to leave the wards. In a mostly dark, deserted building, with only a therapy aide and sometimes an art therapy intern for backup, I helped them to create murals and to act out their issues in sociodramatic role playing. We held art shows in the community and staged cabarets for the other patients, with me as the piano accompanist. Years later, these events provided the inspiration for the climactic cabaret scene in my novel Mood Swing: The Bipolar Murders.

I never finished or published that blog post – in part because I couldn’t figure out what conclusions I wanted to make, in part because I was in the throes of profound depression at the time. I was barely able to get out of bed in the morning, and nothing, including blogging, seemed worth the effort. Yes, I too am one of the millions of Americans diagnosed with a mental illness. In my case it’s bipolar disorder, currently well controlled with medication.

It appears Adam Lanza may have had Asperger’s syndrome, technically a developmental disability rather than a mental illness. Perhaps with proper treatment, he might also have been diagnosed with an underlying mental illness and received appropriate help. In any case, people with Asperger’s are certain to be further stigmatized the way people with mental illness already are.

Should our society start locking up more of the mentally ill, the way we did in the good old days of Hudson River? Probably not, but these days millions of them are doing time in prison instead. The old-fashioned psychiatric hospitals were far more humane, and sometimes they actually helped. But of one thing I’m absolutely sure: those deadly semi-automatic weapons have got to go.

Bacon Francis carcass umbrella

 Illustrations for this post are all paintings by the British artist Francis Bacon (1909-1992), one of the biggest influences on my own art.