Wednesday, January 23, 2008

Involuntary Commitment and the Mentally Ill

In 1969, when I was involuntarily committed, patients were at the mercy of the local courts and, sometimes, misguided or even greedy relatives who might have had a financial agenda in deciding to commit a parent, spouse, or child to a mental institution.

Fortunately, in 2008, there are protections in place, specifically two powerful Supreme Court decisions rendered during the 1970's:
  • Humphrey v. Cady, 405 U.S. 504, 509 (1972), which ruled involuntary civil commitment to a mental institution as “a massive curtailment to liberty.”
  • O’Connor v. Donaldson, 422 U.S. 563, 574 (1975), which ruled that there is “no Constitutional basis for confining such [mentally ill] persons involuntarily if they are dangerous to no one and can live safely in freedom” and that the presence of mental illness “does not disqualify a person from preferring his home to the comforts of an institution.”
Had these two rulings been in effect in 1969, this blog (and my memoir) would not exist, and my life would have been dramatically different. I doubt very much if I would be living in Pennsylvania; I probably would have remained in Iowa or returned to California. But my life is what it is because of my involuntary commitment, for after I was released from the hospital, I would have fled to Hell to escape my "captors": Woodbury County, Iowa, and my grandparents. So, at that point, Pennsylvania looked a great deal better than Iowa or Hell. As I saw it, I knew one person in Pennsylvania and that was enough to get out of Dodge and flee to this lone savior: Jeff Brown who later became my first husband and father of my son.

I clearly did not belong in a mental institution, but while I was in Cherokee, I met some other patients who needed to be there, but for very different reasons: Wolfie and D.J. (not their real names).

Wolfie, in his 20's, was a psychopath, who was allowed to interact with other patients, but only with two strong attendants close at hand. To this day, I don't know what Wolfie did that landed him in Cherokee, but he was extremely violent; he once attacked me at a social event (his two attendants had to pull him off me). He nearly attacked me at least two other times, but, by then, I had learned how to sidestep him and his homicidal tendencies. For the protection of society at large, he needed to be incarcerated--in my opinion, kept under lock and key for the rest of his life.

Wolfie has to be one of the scariest people I have ever met.

D.J., on the other hand, had been committed, at 17, by his dying mother (his father had abandoned his family years before); D.J. was mildly mentally challenged, but with help and training, he could have lived on his own. Unfortunately, by 1969, he had been incarcerated for 26 years, and he viewed Cherokee as his home; he had his routine and led a very structured institutional life. He loved Cherokee, its lovely grounds (see photo at the end of this page), and his job as an informal groundskeeper; he never wanted to leave. At the time, I could not understand why anyone would ever want to stay there. I had only one thing on my mind: ESCAPE! I just assumed that the other patients felt the same.

A scene from my memoir reveals how D.J., a simple man with a big heart, depicts a life painted in shades, not just black and white:

A middle-aged guy, carrying some two by fours, is tromping through a snowbank when he drops the boards to the ground, stumbles over them, and then falls flat on his rear.

I run over to help. “You okay?” I assume he’s part of the maintenance staff.

“No, no, I mean, yes, I’m okay.”

“Let me help you.” I grab his hand and help him up.

“Thank you.” Very formal.

“You’re not hurt?”

He laughs and brushes himself off. “Nope.” He sticks out his hand. “I’m D.J.”

He looks about 35, a big man but not fat, with dusky, reddish skin and slicked back shiny black hair, blue eyes, and thick lips. He wears a red knitted winter cap with ear flaps. No mittens or gloves.

I take his hand. “I’m Jennifer.” D.J. has the biggest hands I have ever seen, broad like paddles, with long thick fingers. His handshake is tentative, respectful.

He wears no winter coat, but he’s obviously layered in several shirts, the top one a gray flannel. A matching scarf wrapped around his neck. He’s clad in brand new overalls and old rubber boots, the kind with those lattice metal buckles that we all wore as kids. He looks a bit unsteady on his feet.

“You sure you’re okay?”

“Yeah, I’m always tripping over my own feet. I got a little bit of palsy.” Then he says, with a bit of a stutter. “I’m-m re-tard-ed.”

“I see.” I help him pick up his boards and walk with him to the maintenance shed, just to make sure he’s really okay. We rap–mostly, he raps–all the way to the shed.

D.J.’s kinda cool, and he’s only slightly retarded–if he hadn’t told me, I would’ve just thought a little slow. He works on the grounds, but he’s also a patient.

He’s been here for 26 years, since he was 17!

Oh-my-god! I can’t even imagine being here when I’m 43. I’ll be an old lady, one foot in the grave.

But D.J. seems happy. When I asked him, “Don’t you want to split this joint?”

He shrugged. “Not really,” he said. “I been here almost all my life. I got a job, my own room, and three meals a day.”

“But what about your freedom?”

“To do what?”

“Well, you could get an apartment, a job on the outside, an old lady–”

He shook his head violently. “Naw, no, I don’t think so. See, I don’t add and subtract too good, and I can’t read or write none too good either.”

“You like it here?”

“I dunno. It’s all right, I suppose. I don’t know any different.”

I hadn’t considered the possibility that someone would actually want to stay.

Maybe that’s what happen when you get stuck in the system and can’t get out.

D.J. clearly wanted to stay, but I often wonder how the 1970's Supreme Court rulings affected his life; what would have been my salvation might have been a nightmare for D.J. and other long-term patients like him. I lost touch with D.J., but I often wonder if he was given a choice whether to stay or leave Cherokee, or if he was simply given the boot?

I suspect the latter.

For D.J. that would have been tragic, simply because he had been entrenched in the system too long. The 1940's, when D.J. was still young, would have been the time to help him live on his own, but the times were different then, when mentally challenged people were routinely warehoused.

In this instance, the Supreme Court rulings might not have offered a good solution for the long-term mentally-challenged patient of the 1970's.

In the January 23, 2008, edition of the York Daily Record [York, Pennsylvania], a story about a mentally ill man who set fire to his own apartment in a suicide attempt reminded me of Wolfie; in the days before Humphrey v. Cady and O’Connor v. Donaldson, M.P. (not the man's real initials--if you wish to read the full story, you can Google it easily enough) would have been housed in a mental institution or structured halfway house; however, a local agency had placed him in an apartment of his own and without supervision. Unfortunately, his actions displaced about 46 other apartment residents. Fortunately, no one was injured, but a lot of people lost their possessions and homes.

Evidently, M.P. had second thoughts about suicide; he jumped out of his third-story window to escape the flames and landed in some bushes which broke his fall.

This very ill man was allowed to live on his own because of the 1970's rulings on involuntary commitment. Before yesterday's fire, this man had no police record of significance, so there was no reason to place him in an institution, and, legally, authorities could not place him there without proving that he was a danger to others and himself. Certainly, one can be mentally ill without being a being a danger to society, and proving future harm is problematic and nearly impossible.

Society is now safe from M.P.; he has finally demonstrated (in a rather spectacular fashion) that he is a danger to both himself and others. He has been charged with 231 counts of arson, 10 counts of criminal mischief, and 45 counts of risking catastrophe; he will be incarcerated in jail or a mental institution for a very long time.

A lot of people seem to be placing the blame on the social services agency that placed him in the apartment, but what else could they do? The law is clear. They were forced to follow the law and grant M.P. his freedom, even if social workers suspected that he was incompetent to run his own life.

The 1970's Supreme Court decisions were absolutely correct in righting serious gaps in mental health law, but they also resulted in unintended consequences in that the severely mentally ill and incompetent tend to fall through societal cracks; proving future crimes is impossible.

In my case, involuntary commitment was shockingly easy; trump up the right paperwork, find a crooked doctor to sign off on the case, and choose a senile lawyer to defend my interests--no need to prove anything. (I discuss this process in my memoir.)

Yes, 46 people were displaced yesterday by one crazy man's action, and last April 32 people died at the hand of a deeply disturbed young man who probably should have been committed.

Unfortunately, those random acts of violence are the price for living in a free society.

It would be so easy to enact draconian laws to help circumvent such tragedies; however, I wouldn't want to live in a country where I could be taken away and held against my will just because someone else says I'm "fit for commitment."

Been there, and done that already.


Jennifer Semple Siegel