Saturday, December 1, 2007


The tragedy that ended peacefully in New Hampshire today -- unlike those where mentally ill people get guns and end up killing others and/or themselves -- reveals much about our great difficulty in dealing with mental illness.

As Hillary Clinton said, he probably wanted to talk to her to ease his pain. We know the grimy details, a mentally ill man, going through a divorce (marriage apparently characterized by a lot of violence), drinking for 72 hours. He blew over the top.

The prominence of the location -- Hillary Clinton's local campaign office -- contrasted with the repeated pictures of police in counter-terrorist garb and guns together with the media frenzy, is a metaphore for how tragically limited our capability is to assess and deal with a man who went over his threshhold of pain. The word "overkill" doesn't begin to measure the gap between the ailment and the, our, response.

Many obviously don't achieve the heights of aberrational, dangerous and self-destructive behavior as that of Leeland Eisenberg. But the grinding contrast between their desire to reach out and touch and the dysfunctional ways in which those suffering from schizophrenias and bipolar disorders carrom from one failed interaction to another, all have the same pattern.

Intensities, deafness to others, lack of affect, lack of ability to connect, internal demons that at the least distract and at the most produce grandiosity, serious obsessions, impairments of all kinds, all spill over onto the caregiving and responsible families, doctors, caregivers and police.

The core understanding has to start with the knowledge that these manifestations of mental illness are not subject to will, punishment, redirection or any ouside or internal force other than the dis-ease itself. They can't help it. What such a person feels, thinks and does are impervious to control.

And, because in so many cases the person sees him or herself as not only normal but possibly gifted and only suffering from some physical ailment, he or she often refuses medication.

The definitions of behavior that trigger intervention by the law (commitment to a facility or in this case, jail) -- "a danger to himself or others" or a stronger formulation, do not give us a strong hold on helping either the person or the caregivers and restrainers.

The interpretation of "danger to self or others" focuses primarily on a physical danger. Police and hospital personnel will let a deranged person go back on the street if they aren't behaving wildly and can communicate just enough coherence to show a small hold on reality, in that immediate moment. The fact that it is predictable that he or she will proceed to binge on delusions and possibly harm themselves or others, again, doesn't enter into the evaluation.

We are constrained by our laws. But the laws only reflect the prevailing consensus of the society. And the fact is that in the face of intractable mentall illness, if the person (I hate to say victim) doesn't want help and doesn't want to be on medication, there is nothing we can do. Tragic as it is. Yes, we can nudge and try to convince. But the disease is too strong.

So, acceptance of the inevitable roller coaster built on a merry-go-round is the only real place to start. Accepting that society can't really respond if the person doesn't want help. And accepting, painful as it is, that they will continue to behave in dysfunctional ways that will weigh heavily on family or caregivers and sometimes end in tragedy.

Then the questions: what is the right reaction? how does one communicate or work with him or her? what is the right level of intervention? what will possibly be healing?

Was placing the man face down on the road and handcuffing him and then steering him from police car to police car and wheeling away with numerous commandos holding onto the van, the right response?

The answers are still out of reach. Our only tools are acceptance, understanding, patience, not judging, and being there, holding our ground. And hoping they will take their medication.

Can't we find better ways?