by Harvey Widroe, M.D.
American Reporter Correspondent
October 16, 2007
KILLING THE DEVIL
ORINDA, Calif. -- That man lying in bed next to Janice was the Devil. God had warned her earlier that day, and now she knew it for certain.
"Be careful," God's voice had said. "He wants you to become his slave on earth."
Janice carefully sneaked into the kitchen. Then, armed with her longest and sharpest knife, she quietly stole back into the bedroom. With the voice she thought to be from God now screaming in her ears, she stabbed the man lying there, again and again and again. At last the Devil was dead.
It felt wonderful, doing what she believed to be God's work.
In a horribly psychotic state, Janice had murdered her husband. She was released from prison some seven years later, apparently free from all psychotic symptoms. Throughout her prison stay she had been treated with haldol, a powerful antipsychotic medication.
After her parole, though, she did not see a psychiatrist as recommended, and her parole officer hadn't seemed to care. But she did continue to take her antipsychotic drug for about six months before she felt safe stopping it altogether. She had always disliked the drooling and overall stiffness that she knew came from taking the medicine. She wasn't sure if it did any good, anyway.
Within a few weeks she began to hear God's voice talking to her again, softly at first, and then gradually increasing in frequency and intensity. The voice began to keep her awake and made her confused. When the police apprehended her for screaming threats at strangers in a supermarket, she insisted that she was there to do God's work, and that she was special in God's eyes. She attacked one of the officers while yelling that he was an agent of the Devil. Janice was bound in leather restraints and sent by ambulance to a psychiatric hospital where staff were specially trained in the care of violent patients.
At the hospital she confessed to a deep conviction that others were out to murder her unless she killed them first. Much of the time she didn't make much sense, and every sentence or two her thoughts jumped from one subject to another. She was more preoccupied with listening to hallucinatory voices than to the reassurances of the treatment staff.
Considered a menace to others because of her potential for extremely violent behavior, Janet was secluded and restrained as necessary to protect her, the other patients, and the treatment staff. Her doctor prescribed a newer antipsychotic medication, Risperdal, which seemed to have a much lower incidence of unpleasant side effects than haldol and other members of an older generation of psychiatric drugs. It has been proven that after discharge from the hospital patients with serious mental illness are more likely to keep taking those antipsychotic medications that produce fewer side effects.
Janice slowly improved over a period of a month. As she improved, she no longer required restraints, and she was transferred from a locked to an unlocked unit of the hospital. Her thinking became clearer, and she could engage in logical conversations. Her psychotherapy, at first focusing on helping her regain a grasp of reality, shifted to educating her about her illness, its incurable nature, and the need to take appropriate antipsychotic medication for the rest of her life.
She seemed to acknowledge that she had a serious mental illness. She recalled with regret that she had murdered her husband. And she pledged to take her new antipsychotic medication, much more tolerable to her than the medications she had been given in the past. She was discharged to live in a county board-and-care home for the mentally ill.
There, she and others, whose mental illnesses were under varying degrees of control, lived together with some minimal supervision. She was given responsibility for taking her medication, and for seeing a psychiatrist on an outpatient basis to continue her therapy and for medication monitoring.
So what happens next? Is Janice the evening-news headline trumpeting that a rampaging killer had been well known to have a history of serious mental illness, including a previous homicide? And that she had been "irresponsibly" released from a mental hospital within a year prior to her latest horrific killing spree.
Or does Janice live a very quiet life at the board-and-care home, attending a day treatment program, taking her medication, and seeing her doctor at somewhat irregular intervals for medication monitoring? These are the many mentally ill patients we rarely hear about. Many live in our communities. Some even move to a higher level of functioning. They may get jobs and come to live in their own apartments.
For these mentally ill patients the regular use of antipsychotic medication is as critical as it is for a diabetic to take insulin. Continued use of antipsychotic medication is essential to preventing a flare-up of the illness. And any decision by the patient to stop taking psychiatric drugs is almost always followed by a resurgence of symptoms of the psychotic illness in anywhere from a few days to a few months. For some patients an injectable antipsychotic medication that lasts anywhere from a week to a month may be the best approach, assuming the patient can be induced to appear at the clinic for the shots.
If a patient doesn't want to take antipsychotic medication, we may all be endangered as the illness-driven bizarre behavior ramps up. To a limited degree the prison system does a better job of protecting us than the hospital system. An estimated one-third of all prison inmates suffer from one type of mental illness or another. Many prisons are designated as repositories for the mentally ill who have been convicted of a crime.
At the present time the hospital system does all too little to protect us. Many patients become victims of the revolving door system of hospitalization. They are hospitalized repeatedly, each time for too short a period of time to enable them to recover enough to understand that medication compliance for life is a must to avoid new chapters of the illness.
Over time and repeated bouts of the illness, some patients come to realize that regular medication use is the only way they can lead even half way normal lives. Others fall through the cracks of society and live psychotic lives on the streets, where their behavior may be insufficiently frightening or troublesome to others to lead to jail or rehospitalization.
State hospitals incarcerate only a small number of chronically psychotic patients, and too few of the most dangerous mentally ill patients are actually committed for long term psychiatric institutionalization.
All in all, our system of providing adequate care to those with severe mental illness is far from adequate.
Harvey Widroe MD author The Smart Dieter's Cheating Guide (Outskirts Press, 2007) with Ron Kenner.