PARANOID KILLERS AMONG US? by Art Smukler, author & psychiatrist

Back in the flush sixties, the federal government provided millions of dollars to support community mental health programs. The eerie, dark, cavernous hospitals for the insane were bulldozed or turned into condos, and the care of thousands of mentally ill patients was shifted to local community mental health centers. Graphic visions of schizophrenics chained and screaming was now going to be a thing of the past.

Since Hahnemann (now Drexel University School of Medicine) had a terrific, community-based program and psychiatric residents had the opportunity to treat all forms of mental illness, I decided to do my residency there. My first six months were spent at Philadelphia General Hospital (PGH), an ancient psychiatric fortress with a unique treatment program. During the morning meetings everyone had a vote. Doctors, nurses, art therapists, psych techs and patients would vote on all sorts of things, including discharges. No chains, no demonic ECT toting psychiatrists, just young enthusiastic psychiatric residents wearing bell bottoms and colorful shirts.

It all sounded great except for one “little” problem; most of these patients were psychotic! They heard voices (auditory hallucinations), thought people were after them (paranoid delusions), and without medication were impossible to reason with. Some even became violent and very dangerous. Not a fun experience for a clueless 1st year psychiatric resident who was assigned to treat a violent paranoid man — but more about that in my novella, The Man with a Microphone in his Ear.

Fast forward fifty years to 2013. The government’s money stream has diminished from a mighty river to a trickling creek. Thousands of mentally ill patients have chosen to wander the streets of our cities begging for food, mumbling aloud to themselves, and pushing all their worldly belongings in a battered food cart. Like the patients I treated at PGH, they refuse medication and refuse help.

Most are just hungry and needy and mean no harm, but some believe, really believe, that they are under attack, and without provocation will attack first. They aren’t in psychiatric hospitals, but still suffer from a profound psychiatric illness. Now their illness is simply visible to anyone who takes the time to look.

Should the state hospitals be reopened?

I think so.

Very sick people need structure and treatment. Their impulses to attack, because they feel under attack, need to be treated. If they are too sick or too dangerous to be among us, they will at least have a safe, comfortable environment in which to live until they get better. It doesn’t have to be like in the primitive days of the screams and chains. New therapies, new medications, and an enlightened approach to mental illness is needed. Just because people have rights, doesn’t mean that mental illness will just disappear.

How many Cruise missiles will it take to rebuild our hospitals and care for our mentally ill street people? Would it really cost more to have this sick population in a hospital rather than all the money we spend on police work, social services, cleaning crews and a flawed community mental health concept?

Art Smukler MD is the author of Skin Dance, a mystery, Chasing Backwards, a psychological murder mystery, The Man with a Microphone in his Ear, and the blog, Inside the Mind of a Psychiatrist.

WHAT’S IT LIKE TO FEEL CRAZY? by Art Smukler, author & psychiatrist

A number of years ago, I was post surgery for a sports related injury. Woozy, they rolled me back to my hospital room and hooked me up to an IV drip, an EKG monitor, and a machine to give me morphine if the pain got too bad. As soon as the nurse left the room I needed to get up.

“What are you doing?” my wife said, startled that I was trying to stand.

“I have to get up,” I said.

“Stop it you’re being crazy. You’re going to pull the IV out.”

I ignored her, pulled off the EKG wires, pulled out the morphine drip, and started rolling the IV bottle towards the bathroom. I knew I was being crazy, but couldn’t stop it.

“Going to the bathroom,” I said, lying because I knew she was right, but I just had to get up and move around .

I stood in the bathroom and looked at my diaphoretic, unshaven face. I couldn’t just lay there. Something weird was happening to me. I waited 5 maybe 10 minutes and got back in bed.

“Are you okay?” my wife asked’

“I’m fine.”

Ten minutes later the same thing happened again, and ten minutes after that again, and again… It was a nightmare. It felt like I had lost my mind, and like a dog with a ball on the other side of a very high fence would never retrieve it. I begged my wife to go home. She wouldn’t leave. I didn’t want her to see me this way. The nurses didn’t know what was happening and kept suggesting that I take more morphine. Four long hours later, when the surgeon finally finished his next two operations and came in to see me, I was finally back to normal.

The next day I figured out what happened. The anesthetic, Droperidol, triggered an akithesia,  an abnormal, uncontrollable movement disorder that originated in the extrapyramidal part of my brain. Droperidol is from the same family as Haloperidol, a major tranquilizer to treat schizophrenia, bipolar disorders etc. Haloperidol can cause the same symptoms that I experienced. Until this happened, I never imagined the hell my poor patients were going through when they had side effects from the medication I was giving them.

Not being able to control oneself is a horrible experience. Imagine having voices that try to control you, or a delusion that people are trying to kill you, or panic attacks so bad that you’re sweating, your heart’s pounding, you can’t think straight, and you’ll do almost ANYTHING to get it to stop.

For anyone to ever minimize the pain of mental illness is a travesty, yet insurance companies almost always separate treatment for “medical” problems with treatment for “psychological” problems. For the millionth time, let me remind them that the brain is connected to the rest of our bodies.

Any thoughts about being out of control or how our medical care system works or doesn’t work?