Richard Longley rides buses. He sits in the rear of Metro buses four or five hours every day, smoking cigarettes, laughing and talking to himself.
"People, I guess, they wonder why don't I go get help or something like that," Longley says, embarrassed that he sometimes acts like a crazy person on the bus. "I'm there laughing and talking to myself and that's not the way to be."
For 19 years, as an inpatient at St. Elizabeths Hospital and D.C. General Hospital, as an outpatient at D.C. community mental health centers and now at the D.C. Institute for Mental Hygiene, Longley has been trying to find someone who can "snap me out of this thing."
This "thing" is called schizophrenia. Psychiatrists do not agree what causes it; there are no definitive tests proving that one has it. And it is often incurable. Symptoms include agitation, hallucinations, delusions and thought disorders. And schizophrenics often hear voices.
Longley was 14 years old, one of eight children in a fatherless family in Southeast Washington, when "god people" started talking to him. "They started telling me that they loved me," says Longley, now 33. "They started telling me they were going to give me all this gold and treasure and power."
In return, Longley must: "Kill people. Anybody, everybody I know. They mostly want me to hurt the people who like me."
Longley, a bearded, slow-speaking man who weighs nearly 300 pounds and wears size 15 EEE shoes, rents a room alone in Anacostia. He lives off food stamps and a $284.30-a-month Supplemental Social Security check. He says he has no friends, other than bus drivers.
Despite the savage voices in his head, as far as anyone knows he has never hurt anyone. Last summer, however, he threatened to kill his mother. She pleaded with him to see Dr. Harold Eist at the institute. After missing 15 appointments, he found his way, by bus, to the clinic last October.
"He was very tense. There was a certain awesomeness about him," Eist recalls. Eist found Longley "unusual in the sense that he was able to articulate so well" his delusions. The psychiatrist, who is a Freudian, found Longley's delusions "make Freud look like a genius. He doesn't say, 'I want to marry my mother and get rid of my father.' That is too lame and tame. He has stirringly creative, at times awesomely amusing ways of talking about this (Oedipal) drama."
Eist also found Longley unusual in that he kept asking for injections of more and more antipsychotic drugs. Many patients object to higher dosages because of the drugs' side effects, including weight gain, slurred speech and tingling fingertips.
Longley was placed in one-on-one psychotherapy once a week, and Eist began injecting him three times a week with increasingly larger doses of the antipsychotics. The drugs (which cost about $200 a week), the three sessions with Eist ($60 a week) and the once-a-week psychotherapy with a psychologist ($25) are paid by Medicaid.
Psychiatrists have found that some people can take 40 times as much of the antipsychotics as others while showing the same level of the drugs in their blood. Longley is an especially fast metabolizer of antipsychotics, and Eist increased his medication to levels as high as any reported in drug literature in the United States.
Longley's massive arms, after absorbing 12 shots a week for months, recently became swollen and achy. Injections caused bleeding. So Eist reduced the number of shots, giving pills instead. But Longley--who this winter, for the first time since he was 14 years old, went three months without hallucinations--doesn't believe in pills. The god people are back.
"The god people see these shots are helping me and they are making Dr. Eist stop," claims Longley, who says he is more discouraged than ever.
It's normal, Eist says, for schizophrenics to become depressed when they show improvement. "This guy was hallucinating almost on a moment-to-moment basis for 17 years. It was almost a foregone conclusion that the voices were going to come back," says Eist. "He hasn't been able to substitute enduring interpersonal relationships for them. So he is lonely. His voices are entertaining."
That's what Longley's psychotherapy is for, Eist says, to build psychic "structure" to replace the voices. "His therapist is telling him how his inner world works," Eist says.
Longley, however, wants shots, not talk. "You just messin' around if you say psychotherapy gonna snap you out of it," he says.
Many psychiatrists agree with this view, arguing that psychotherapy can actually harm some schizophrenics. As with so many disputes in psychiatry, however, there is no conclusive evidence dictating exactly how Longley should be treated.
Since Longley, for the time being, is Eist's patient and Eist believes that drugs must be combined with talk, Longley has no choice but to go along with the program.
Longley says he hopes the god people will stop threatening Eist, and allow the doctor to give him more injections.