Why I Can't Save My Brother
My brother BJ has not killed anyone. Not yet. And I hope he never will. But in various disturbed, hyper-vigilant and paranoid states over the past 30 years, he has slashed screen doors, severed phone wires at the family home, tossed scalding coffee at our now-deceased mother, left bizarre or menacing messages on his siblings' phones and otherwise exhibited behavior that screams: "I am a danger to myself and others."
BJ also drinks or drugs himself into a stupor countless times a year and has spent the greater part of the past two decades in jail for drunken, disorderly or disruptive conduct. Two years ago, he created an hours-long hostage situation in the Southern California beach town where we grew up after threatening someone in a motel with a pellet gun. For this, he was thrown into Wasco State Prison near Bakersfield and charged with the felony of "threatening a crime with intent to terrorize," as well as several misdemeanors.
BJ is clearly ill. Yet the exact nature of his illness remains undiagnosed because in the decades that he has waged war against his demons, he has never had a full psychiatric workup.
That's right. Months, even years of jail time, all of it at taxpayers' expense, and not a single mandatory referral to a drug rehab or residential program with a strong mental health component. Sadly, BJ's experience reflects the true state of our country's health care system, especially as it relates to adults who are mentally ill and repeatedly incarcerated. It says even more about our society's unwillingness to provide the resources to diagnose and treat mentall illness.
This truth hit me again with the recent news of the death of Bethesda psychiatrist Wayne S. Fenton, whose body was found in his office on Labor Day weekend shortly after he had met with a severely troubled patient. It will probably be months before a clearer picture emerges -- if one ever does -- of what may have gone wrong with the fragile psyche of Vitali Davydov, the 19-year-old charged in the death. But the case is merely the latest tragedy involving individuals with a history of mental illness to scar the Washington area in recent years -- in May, a disturbed young man fatally shot two Fairfax County police officers before killing himself. And unless something changes in the way our society deals with the severely mentally ill, it won't be the last.
By all accounts, Davydov's family was trying desperately to get him the medical support he needed. But caring relatives often are not enough. Even if a family knows that one of its own is in dire need of medication or talk therapy or both, it is frustratingly difficult to get help for a mentally ill adult, especially one who refuses it. I know, because I have tried -- and failed.
My middle brother, BJ -- a bright and sensitive soul drawn to poetry and philosophy -- was the one most affected when our parents abruptly divorced in 1974, breaking up a 32-year marriage and the family we knew. BJ was a college graduate, but over time, his once erudite, witty letters became increasingly incoherent, tinted with delusions and paranoia. He held jobs irregularly while living with our mother: He fought forest fires, was a landscaper, a breadmaker, a beekeeper, a liquor store clerk. He even helped manage a shellfish company. But these jobs all ended suddenly, usually because BJ became abusive, picked a fight or inflated a perceived slight into an imaginary threat.
Like many people with undiagnosed mental illness, he self-medicated with alcohol and drugs to ease his anxiety and to quell his inner torment.
Over the years, my sister and I have tried to get BJ the help he needs: doctor's appointments, a place to sleep, rehab programs. We pleaded with him to take advantage of one of the good residential programs in California. All to no avail. Every time BJ is arrested, I write or call the presiding judge and beg him to remand my brother to a treatment center. If I find out BJ has been incarcerated, I call the jail's psych ward and have the same frustrating, ultimately futile conversation with staff counselors there. I urge them to do a psychiatric workup or to insist that BJ at least attend substance-abuse sessions while he is in jail and sober. I reason that even if he is not an active participant, a seed may be planted. I hope that BJ may see that he needs medical help and finally seek it.
Unfortunately, in California, as in many other states, even recalcitrant inmates cannot be forced to see a doctor, take antipsychotic drugs or attend individual or group therapy sessions, unless they consent to it. Yet once BJ is released, attendance at AA meetings is often a condition of BJ's parole; not surprisingly, his attendance is sporadic, half-hearted at best. Soon he is back in jail, on the public dole.
Prison counselors in California know that the current system is dysfunctional. The state prison at Wasco, one told me, is "nothing but a gigantic warehouse." He added that a typical counselor supervises at least 200 inmates and hence spends little time with any of them, and that the prison has many violent felons with "obvious mental health issues" who have never had a psychiatric write-up even after five or 10 years in the system. He said a rapid return to a life of crime and prison is typical of drug offenders or people with alcohol or substance-abuse issues with undiagnosed mental disorders.
"They do fine in our strict routine," he said. "We tell them when to get up, when to shower, exercise, what they can eat, even when to brush their teeth. But when they get out of here, many do not have the skills or the mental stability to function on their own in society, to hold down a job, to take care of themselves, to set up a support group they can call on."