A Troubled Mind
What it's really like to live with schizophrenia
Antipsychotic drugs are also tangled, inextricably, in the question of schizophrenia and violence. Until A Beautiful Mind became a box-office hit, schizophrenics made headlines only when they had done something ghastly. Andrea Yates, who was convicted last week of killing her five children, drowned them while in the grip of psychotic delusions. Ted Kaczynski built his lethal bombs with the false beliefs of paranoid schizophrenia. Rusty Weston, also a paranoid schizophrenic, killed 14 cats on his parents' Illinois farm before shooting up the U.S. Capitol, where he killed two police officers. Mental-health advocates often argue that people with schizophrenia are no more violent than the general public. But recent research shows that there is more risk. In any year, 2.3 percent of the non-ill public commit a violent act, while 7 percent of people with schizophrenia or a mood disorder do, according to data gathered by NIMH. Lunceford-Mikolajczyk says the violence is a product of the confusion created by the disease. "We're drawing conclusions based on things we've never seen before, and we don't know what to do."
Off track. The problem is compounded by the fact that about 40 percent of people with schizophrenia aren't receiving treatment at any given time and that people off medication are far more likely to be violent--and to be the victims of violence themselves. Many, like Weston, go off their medication because their thinking is so impaired that they don't realize they are ill. Others stop taking meds because they can't stand the side effects, are homeless, or don't want to be stigmatized. But the low rate of treatment is also the fault of a system so cumbersome that even a normal person would be hard pressed to prevail. "It's an incredible tragedy," says Marvin Swartz, a psychiatrist at Duke University. "We haven't configured treatment in a way that recognizes people's impairment." Swartz studies "outpatient commitment" programs, which legally require patients to take medication as a condition of being released from a hospital. His research has shown that these programs do reduce violence but need to be continued for at least a year to work. Some civil liberties groups vehemently oppose outpatient commitment, saying it unconstitutionally infringes freedom. Swartz argues that even very sick people understand the tradeoffs involved. "Folks with schizophrenia don't like outpatient commitment, but they value much more being safe and getting along with their families and staying out of the hospital."
But even staying out of the hospital and staying on medication don't necessarily make a person with schizophrenia feel safe. Rebecca Lewis adores her daughter Alyssa, now 10. But by court order she sees her only on supervised weekend visits at her mother's. "One day I accidentally spanked her too hard," Lewis says. Although the incident happened years ago, Lewis isn't ready to take a chance. "I don't know if I'd trust myself. I don't think I'd hurt her. But this lets me sleep with comfort."
To sleep with comfort--there's a goal that all too often eludes her. Lewis is proud of the fact that she has moved out of a group house into her own apartment, but she's often afraid there. Sometimes, at night, the visions return. She says she "has not a clue" what she's going to do with her life, other than help her daughter grow up to be a good girl. But she's found a haven at the Liberties support center, where she goes almost every day to hang out, shoot pool, and help organize events like the big St. Patrick's Day bingo party and corned beef feed. At Liberties she met Mary Smith, a 50-year-old former nurse with depression. She's now sponsoring Mary for conversion to the Catholic faith. They go to mass together on Sunday. When Rebecca gets too paranoid to stay home alone, she stays at Mary's. And it's at Liberties that she met her new boyfriend, John Fawcett, a 33-year-old with schizophrenia and a dry sense of humor who works nights at a BP Amoco station. Together they rent videos at Blockbuster or shoot some pool. John says, "Since I came down with this mental illness I've really mellowed out."
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