“The essential point here is that the thinking which mental health practitioners call delusional is simply an extreme case of a completely normal phenomenon – namely, the ability of human beings to construct thought patterns which serve our needs, and to consistently screen out information which threatens these patterns.”
— From “Delusions,” by Philip Hickey, PhD,
Featured MIA blog – August 20, 2015
“Case Note: ‘John Doe’ # 246765; Inmate seen today. No data on family, resources or history. He appears to be in his 30’s, odd manner of dress and hair style, mood is euthymic, speech WNL, memory poor or withholding information (?), presence of “delusional” content, possible abuse in cell (bruising) denies emotional/medical problems, court date (?), pub def (?) charge;602PC. Plan; Nursing consult. Obtain psycho social data, contact P.D.”
— True case from the Los Angeles Correctional System
One cannot be with other individuals without encountering their belief systems at some point. My work with individuals in locked in patient units, mental health clinics and the Los Angeles Jails has brought me into close contact with people who had diverse belief systems, some of which were cultural and life-long, others were trauma-induced or influenced by drugs and alcohol. These experiences taught me to approach belief systems without prejudice and with open receptivity to their meaning and importance to the person.
The development of a resilient sense of self, with a belief system that is protective, congruent with social mores and motivating is the ultimate task of maturation. For the vulnerable, marginalized person; the individual living in poverty surrounded by instability and conflict , victimized by abuse and indifference, the pathway to developing a functional sense of self is a minefield. The journey from childhood to adulthood often presents obstacles – not opportunities for self-realization, harmony and emotional balance. Harsh adverse experiences create depression, anxiety, and belief systems that make sense of a nonsensical world; belief systems that are not based upon “known” evidence. Known is the key word here, for many “delusional” thoughts and the emotions attached to them make remarkable sense when seen in the context of the person’s lived experiences.
In the jail system, an individual with “delusions” is at extremely high risk for abuse, as the following case illustrates. The environment is hostile and punitive, often mirroring the individual’s life experiences with abuse and dehumanization. The inmates and deputies are bored, angry and retaliatory. Within this environment symptoms of emotional distress become worse and these symptoms often provoke attacks upon persons who are defenseless.
The last time that I saw “john Doe # 246765 he was strapped down to a gurney on his way to Atascadero State Hospital. He was disheveled, dirty and thin as a rail. I was close to tears as he was wheeled out. He was frightened and pale, for the first time recognizing that this “release” was not going to be back to his “home” in the streets. I knew that a patient at the State Hospital had been murdered the week before and that this man would become a target – as he had been in the jail – with no one to look out for him. His delusions would make some people angry, others would use him because he was a gentle soul, and I hoped my case notes and documentation could shield him in some way.
John Doe (Mickey, as I found out later) was an inmate in Men’s Central Jail in downtown Los Angeles, and he was a frequent inhabitant of the correctional system. I met him when I joined the jail’s mental health staff as the first clinician on the JMET Team (Jail Mental Evaluation Team) that was a partnership between a deputy and a clinician who were tasked with identifying the “mentally ill” inmates in the jail. The cells were overflowing with inmates in Men’s Central; 12 men to an 8X12 foot cell meant for 4 adults. Each row of cells had 12 cells filled to capacity with “general population” inmates whose crimes ranged from trespassing to armed robbery and assault with a deadly weapon. Screening for emotional problems at the intake level was superficial and inmates who were in acute states of emotional distress were thrown in with the others if they were able to say they had no history of illness.
Mickey, when I first encountered him, was in the back of a filthy cell squatting against the wall as the other 11 men played cards and wrote letters. The cell was buzzing with the black flies that were everywhere and the smells of urine and stale food made breathing difficult. The only data that I had to go on was his “rap sheet” listing 15 incarcerations for trespassing, breaking and entering, loitering, failure to obey a police officer, possession of marijuana, and receiving stolen property. This was the usual list for many of the “mentally ill” incarcerated who are picked up by the police and taken to jail when they are not flagrantly out of control – and the jail was full of such individuals. My job was to find them and have them evaluated by a psychiatrist and possibly sent to “Twin Towers,” the mental health jail.
There was no private space in which to speak to Mickey, and when I called him over to the bars he kept close to the walls, his hands clasped as though he were handcuffed. Aside from telling me that he was called “Mickey” he told me that he was in jail by mistake because the police did not know that he was the owner of the house in Hancock Park where he was found, nor were they aware that he owned multiple homes and other property in Los Angeles. He was, by his account, a millionaire who “helped” people on the streets who needed money or places to live. He had “friends” but no family, and he couldn’t tell me where he was born, raised, or went to school.
Mickey seemed to be a pleasant, gentle fellow although when he started talking about his property his voice became louder and his speech was rapid and pressured. He sketched beautiful pictures for me upon envelopes and called me “Miss Margie.“ He consistently denied any contact with mental health in his past, and insisted that he was OK . I noticed bruises on his arms and a cut on his cheek. He said that he had banged into the walls and the cut was his “badge of honor” for having fought through many wars. In the background I could hear the other inmates joking about what he was saying, and one of the deputies habitually called him a “ding” (their word for “crazy”).
After this first encounter I meet with Mickey daily. He was evaluated and prescribed Haldol and Cogentin, but not moved due to problems at Twin Towers. Mickey became attached to me and welcomed visits throughout his 4-month stay, but he became progressively more lethargic with the medications. He seemed distracted and withdrawn and was less able to defend himself verbally or behaviorally. His delusions persisted and I had him seen by a nurse who uncovered multiple bruises on his chest and back; he was being assaulted in the jail. My contact with his public defender was disastrous; he had too many cases, he was busy, and my pleas for getting Mickey out of the cell – either to a hospital in-patient unit or to Twin Towers – were to no avail. With his increasing lethargy, followed by tremors and drooling, he was more vulnerable than ever, and I finally had him moved to a cell usually reserved for elderly inmates where he was a bit safer. Due to the 3-Strikes Law, the judge who finally heard the case sentenced him to State Prison because of his multiple misdemeanors, several of which had been upgraded to felonies. He would languish in prison for years given the lack of available family and his increasingly passive, withdrawn emotional state. This was work that I brought home with me, along with his sketches, and I think about him often.
Mickey was not the only delusional inmate that I encountered. Perhaps the saddest was a 76-year-old man who, several months after his wife’s death stripped himself naked and presented himself to a woman from his Church saying that she was his wife. He demanded entrance, became agitated, and when the police arrived and tried to handcuff him they found him to be “combative.” When they called emergency rooms they were informed that there was a long wait for evaluations so they booked him into jail. This elderly man was cleaned up by the nurses and sent back to the cell on medication. It took weeks before he was able to give me the names of family members who eventually came to his rescue. According to his cousin, he had been delusional for months after his wife died, saying that she was alive and that he had to find her. He had refused help but had been cooperative in every other way so that they left him alone and hoped he would “come to his senses.”
There is no positive ending to this narrative, but the way forward is to inform and educate more people about the meaning and the risks of “delusional” thinking. Context and resources (family and a safe environment) are of utmost importance in these situations. When they are unavailable the person is at high risk for unimaginable abuse.
My job has been to listen to Mickey, and many others. I have come to see “delusions” as nothing other than the expression of unmet needs – needs which if you were to listen long enough become utterly and completely understandable to anyone listening with a compassionate ear. Needs such as a safe place to live, or hope for the restoration of a lost – or future – love can take increasingly tortured forms when hope fades. What others view as delusional comes to seem, when we listen from our hearts, like the increasingly strident – and occasionally bizarre – expression of hearts as they break, or are broken. This is something we can all understand. As any one of us is really only a few short steps from being in that place ourselves, we are obliged to learn to listen. We all belong to a society that benefits some at the expense of others: we must honor our debt to those who find themselves – as we all might and probably will at some time – under the tail at the other end of the bell curve.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
Thanks so much for documenting this issue! I am surprised that they are even letting folks see what is going on! Thanks for your work. So hard to try to protect folks when you know they are in a system that is stacked against them. Sounds like the old asylums are alive and well. Wasn’t sure but not surprised. I liked your documentation of how the meds affected him. Yes! Didn’t have the eyes or the long term time to see it in the past. Now I know because of my own past.
There but for my white privlege go I. I could have easily ended up in this system. One more wrong word or sentence and I too could have been seen by you.
Thank you. Can you read my comment to Ted and if you have some suggestions, please let me know
Being naked and declaring someone your wife ( who doesn’t wish to be) is obviously a mental health issue, not a criminal case. This kind of person would not respond to the authority of the police who would be called when the problem was reported. Naked person would not obey the polices requests, so the police would naturally be angry that their authority is not respected. The police can’t tell by looking at someone if they are sane or insane. What happens then?
I can’t fault the police for doing their job.
Another story I read, a man(father) calls the police to report his car stolen. When the police find the car they accidental kill the thief- driver for not obeying (their) orders. The thief was the mans son. http://www.washingtontimes.com/news/2013/nov/7/iowa-police-shoot-teen-dead-after-father-calls-cop/
Any murder you find is usually an act of violence. Anger is typically irrational and can not be reasoned with. The opposite yet equal to being in love. Can you reason someone out of love?
Police have to assume someone is a criminal (for not obeying) rather than delusional.
The proper response to people who believe in creationism, rather than science, is to explain the science to them. Explain how the Sun is the center of the solar system, its size-mass in relation to Earths size-mass.
I would carefully try to confront the delusion-problem of property ownership of Mickey.
Assuming Mickey was well fed, clean, and had adequate sleep and all those details.
Mickey has to follow the rules, if he doesn’t , he goes to prison. Can he follow the rules? Still has to go to prison on the (mentally ill) assumption he is evil instead of good.
My experience of psychiatric hospital-prison is that it is worse than criminal prison.
Why? No right to face your accuser, what was I accused of being delusional about? No one tells you. You need to take this poison we call medicine.
They are worse.
“I can’t fault the police for doing their job.”
Yeah, you kind of can. Everyone keeps doing their jobs and we end up running a nice concentration camp. Everyone who participates in a system like this is guilty.
Right, one problem is that the wait time in the ER is hours long and police just don’t have time to await the ER triage procedure. Now, ER’s have cut staff in order to save money and the problem is worse. I found it profoundly sad to see police waiting their turn to get a person evaluated. If they book him or her into jail it is faster but then the individual will languish in jail due to the backload of court cases. It’s a no win situation due to economic forces and hospitals are streamlining to cut costs. Police should have priority in the ER but the ER is a medical domain and emotional issues are, believe me, not considered important.
Btw, I wonder if giving Mickey a safe place to sleep, food and clean clothes would not cure some of his “delusions”. Given his situations that just sounds like the most understandable defence mechanism his mind could have come up with.
Plus some of the rules we have are just plain stupid. there are too many nuisance crimes and poeple should not be locked up for loitering and mouthing off cops and sh*t like that.
A very empathetic article and I appreciate the compassion behind it.
But what can we or should we do about these situations? Of course, “more money for mental health” isn’t the answer. They already have enough money for “mental health,” a/k/a psychiatric drugs. It would be good to have more articles in MIA about activism.
What I am doing is following the Federal Investigation and gathering names and email locations for those who are involved. Also I have contact with jail clinicians and I am encouraging them to read the MIA articles on psychiatric drugs, withdrawal etc. In addition I am sending these works to Washington Post and other journals and as a writer on Psychcentral Pro I am working on articles for that site. I think that others might forward MIA articles on to these sites? The clinicians in the jail (I supervised masters level USC students) are completely uninformed about the harmful effects of psych drugs! I think this is a beginning but I am going ahead full steam at this point. Your encouragement is what I need now and so I thank you with all of my heart, Ted.
What about getting these people out of prisons where they mostly don’t belong (sorry but loitering and smoking pot should not be crimes to begin with)? What about solving homelessness and hunger and poverty? Maybe then one would not have so many “delusional” people to deal with.
Shipping them back and forth between “hospitals” and prisons is not an answer. Abusing them to no end in both of these institutions ain’t helping either.
Getting people out of the correctional system is a process that involves their public defender, the judge and proof that they would do well in another setting. This is something I have done many times; judges differ in their understanding of emotional distress, abuse issues etc. and so do public defenders. Some of them are completely biased, others are more informed. I always refer them to MIA for information and hope that they look at the site and read the comments. I often find the comment are more informative than the articles themselves. Such as yours. Thank you
Not trying to start an argument, Maggie, OK?….
The system IS the problem. Pres. Johnson signed the Federal “Community Mental Health Center Act” in 1964,
yet 50 years later, our prisons are filled with “mental patients”? And you think this is by “accident”, or “unintentional”?. Sorry, but I can’t see it that way….
Mass-incarceration, and mass-drugging, are 2 sides to the same coin. Both are inhumane, anti-freedom, and anti-human. We need to call out Pharma and the pseudo-science of psychiatry for the deliberate lies and means of social control which they are. I was almost literally beaten to death by the jail guards, in 1986, when in the throes of a toxic drug (“meds”) reaction.
There are too many blatant SADISTS in jail guard uniform. I’d be both GLAD, and GRATEFUL, if you, as a professional writer, can make something of my story.
I’m living proof of the lie of psychiatry. Thanks….
this is heartbreaking. I am hoping that your attempts to get the mainstream press to report on stories such as Mickey’s will help. The New York Times strike me as not too bad when it comes to reporting on mental health issues (it is all relative, I know) so I hope you can get them interested. Bless you for what you are doing. What do you suggest the rest of us can do to get the larger society interested? I am afraid of sparking the wrong knee-jerk response, as in “we need more ‘treatment,” knowing what that entails.
Thank you! I am thinking of ways that people who have been harmed, betrayed and dehumanized by the system can influence others and, for now, since I have some ways to get the message out in the correctional system I would just appreciate your support and links ( if you have them) to any informative information about side-effects or withdrawal problems etc. I use the MIA information but could use other resources while I pursue the jail issue. So thanks for your encouragement….believe me I have a lot of powerful influences that are obstacles in my path so I can use all the support that you and others give me! Thanks again, Margie
The scam is very clever. I’ve been “shrink-proof” for well over 20 years now.
What I couldn’t know then, but do now, is that ALL of my so-called “symptoms” didn’t appear until AFTER I was on psych drugs. Since being OFF psych drugs, my so-called “symptoms” have all DISAPPEARED. Easier said, than done, indeed….
And, having “played the game” for over 30 years in the same town, I have NEVER seen ANYBODY improve long-term from psych meds. Best-case scenario is some sort of stabilization at a marginal level of function. EVERYBODY ELSE shows clear, and dramatic decline over time, on psych meds, followed by an early death….
That’s beyond stupid. That’s too often willful sadism. Psychiatry & Pharma are institutionalized sadism. Did “Mickey” *NEED* to be in jail? Or does his incarceration merely serve as an excuse to scam more tax-money from the tax-payer. The problem with too many “bleeding-heart-liberals” is they are too kind to the truly evil oppressors. Mass Stockholm Syndrome. Which reminds me, google
“mass psychogenic illness”. That’s psychiatry, itself…..
Margie I can only give you some thoughts. You seem to be doing all you as one individual can do at this point. This narrative reminds me of Dickens” A Tale of Two Cities” excellent reading for all at his time. There was a movement there getting prisoners of the revolution released because they were there unfairly. Recalled to Life, I think, was the phrase they used. It seems that might be a seed for a movement. In the past, there was the AIDS Quilt, POW ID bracelets, Dylan’s “Hurricane Carter.”
The issue of fear is a double whammy here because these folks are the marginalized of the marginalized. In a different time, I would have looked to Churches to take on part of the movement. My hopes are not great for now but I do know there are priests and nuns ie Sr .Helen Prejean who minister and at the very least are somewhat aware. Medication perspectives are such a huge , huge barrier. Better living through Chemistry is now a fait accompli for even the most aware folks.
Back in the early eighties there was a poignant Australian documentary at a film festival in my city.
It was about as worker in a government institution who was overcome with dismay at the conditions for the Developmentally Disabled. She ran into great barriers with the staff who said it was so much worse earlier and they were okay with program and buildings as they were when it was clear to the worker things were bad. She was able to change some things not all.Her story, though I have forgotten all the facts and even the title, is still with me to this
I have found blogs to helpful but not great fantastic change agents. I think somehow face to face would help but I am not sure what is the best way. Those of us who are fearful of telling our stories also need to step up. I am working on it!
I admire your persistence it is hard to be “out there” and you do have to be careful and do what you can without sacrificing your personal safety and security
Margie, you have a wonderfully empathetic way of telling these stories of marginalized people who have been confronted with our no checks and balances required, inhumane, out of control, monster of an unjust and uncivil psychiatric “social control” system.
And, absolutely, “delusions” are a subjective subject, and according to my medical records, pretty much everything is a “delusion” or “psychosis” to our US “mental health” / mainstream medical practitioners today. According to my medical records, appropriate disgust at 9.11.2001 is a “delusion.” And a dream query regarding what it means to be “moved by the Holy Spirit” became a “Holy Spirit ‘voice,'” which was proof of “psychosis.” And the common symptoms of antidepressant discontinuation syndrome and the common ADRs of a “safe pain killer” / dangerous opioid are the “life long, incurable, genetic bipolar.” Really? Not according to the DSM-IV-TR. Such a misdiagnosis is blatent malpractice according to that psychiatric “bible.” Although similar US psychiatric malpractice has happened on an almost unfathomable scale to many, many US children. Thanks largely to pharmacutical industry and “second only to God,” Joeseph Beiderman, and his childhood bipolar epidemic.
All it takes in the US today to be railroaded into the psychiatric system is a PCP who is paranoid of a non-existent malpractice suit due to a “bad fix” on a broken bone. And / Or a pastor who wants to cover up child abuse for a wealthy parishioner. And an unethical “holistic, Christian talk therapist.” It can happen to anyone is right – even the daughter of the head of the investment committee of the board of pensions for the now apparently completely psychopathically controlled, unrepentant child abuse covering up ELCA religion (see the chapter on evil).
One must wonder how long it will take our society to realize we’d all be better off going back to a system of law and order, rather than one controlled by the rules of the jungle. Of course, big, bad psychopathic corporations, especially when aided by the scientifically invalid psychiatric defamation, tranquilization, and anticholinergic toxidrome creating system, can steal from and harm individual humans. But is doing so acceptable human behavior? No.
We are now living in the world in which Thomas Jefferson forewarned us. The evil banks and corporations who now control the US are legally required to behave as psychopaths, therefore, they do.
Is it truly in the best interest of humanity for us all to be ruled by psychopaths? The psychiatric system, and it’s unprovable terms such as “delusions” and “psychosis,” and it’s “bibles” of scientifically invalid disorders is at the root of our society’s problems today, just as the psychiatric system’s invalid “mental illnesses” were at the root of the injustices and problems in Nazi Germany and Russia.
Psychiatry’s unprovable “mental illnesses” have been repeatedly abused and misused throughout history by the same “warrior elite” families who own the “too big to fail” banks and corporations that control the US government today.
But, of course, according to today’s US psychiatric system, all my “insightful” “delusions” / concerns are a part of a “credible fictional story.” But it is bizarre that so many people now share my “delusions” / concerns, like the problem that Greenspan spanned the green to the point it’s now “irrelevant to reality.” Since so many others now share my “delusions” that 9.11 was disgusting, religions covering up child abuse is wrong, and that the bankers who have taken over this country from the ethical American banking families like mine are evil “banksters,” does that mean my “delusions” are no longer “delusions”?
Thank you for noting that “delusions” are subjective and that this word covers a multitude of experiences that occur with everyone. This is one of the terms that need to be eliminated from the vocabulary of anyone involved in the field of psychology or the social sciences.
A general and wholehearted thank you all for your comments and encouragement. I have just joined an organization for social justice and have offered my voluntary services in their on-line Q and A site or in writing articles for them.
Onward we go
I remember when Los Angeles county closed its community mental health centers like Santa Monica West. There was a belief that all that was needed was to place those suffering from Mental Illness on Meds, that they didn’t need anything else.
Unfortunately, that is still the belief held by many.
The police, are not equipped to deal with the enormity of this issue, nor are the jails. We expect them to deal with issues, that really can’t be address with current approaches by anyone. Often there are co occurring drug issues, and paranoia on the part of prisoners who don’t want the judicial system knowing about how they live or what the do.
Violence and brutality, may or may not be a mental health issues, but it is one of survival. Personality disorders, and sociopathy, help one survive in the streets, as does keeping your mouth shut. Often inmates, have a better understanding of what makes a person tick, and an intuitive sense of self, that is difficult to address from a psychological point of view.
If you don’t listen and try to impose some arbitrary judgment of who or what someone is you will find out the hard way, just how wrong you can be.
Disrespect or respect, its your choice.