Imagine that you can hear what other people are thinking about you, or that you wake up each day but you can't turn off your dreams and nightmares.
In some sense these are the kinds of torments faced daily by many of the nation's two million or more schizophrenics, people such as Russell E. Weston Jr. -- a diagnosed paranoid schizophrenic, according to his parents -- who stands accused of the murders of two Capitol Police officers Friday.
Medical experts and relatives say schizophrenics are the victims of a nightmarish illness that is still only poorly understood. And while new drugs can help some patients quiet their delusions and fears, gaps in our social and legal systems often allow them to abandon treatment and spiral into isolation, homelessness, drug abuse, violence and suicide.
"We've been so concerned, and rightfully so, about their rights, that we've allowed them to get into trouble where they lose all their rights," said Carolyn Knight, president of the Maryland affiliate of the National Alliance for the Mentally Ill, an organization of families of schizophrenia victims.
Dr. Steven Sharfstein, president and medical director at Sheppard and Enoch Pratt Hospital in Towson, said "the numbers of untreated and undertreated patients with schizophrenia who are in the community and often homeless is a major public health problem, probably second only to the AIDS epidemic in the United States."
Weston's family said he was diagnosed in the mid-1980s but did not receive treatment until 1996, when he was committed for two months to a mental hospital in Montana. A few weeks after his release, he quit his medications.
He harbored delusions that he was a Secret Service or CIA agent, and that a radio tracking device was implanted in his teeth.
Dr. William R. Breakey, professor of psychiatry at the Johns Hopkins School of Medicine, said schizophrenia is a brain disease characterized by delusions, hallucinations and impaired thinking. It afflicts at least 1 percent of the U.S. population. About a third are "paranoid," convinced that people are persecuting them.
"It seems pretty clear there is a genetic predisposition," Breakey said, but other factors, including infections during pregnancy, may also play a role.
Symptoms typically show up during adolescence. Gradually, they become more intense and distressing. But "there is no evidence whatsoever that upbringing and parenting influence the course or onset of schizophrenia."
Victims live in a private world of fear. They eat poorly, drift into homelessness, illness, drugs and alcohol. Serious violence is unusual. The most likely targets are family members. About 10 percent eventually commit suicide.
Mental institutions were once the "mainstay" of treatment for schizophrenics who could not be managed at home, Breakey said.
The advent of anti-psychotic drugs in the 1950s quieted the delusions for many and helped begin a wave of deinstitutionalizations. New drugs even allowed some patients to have families and a job.
"The vast majority -- 99 percent I would say -- can be successfully and safely treated in community-based settings," Breakey said. Many continue to live at home. A minority live in group homes where they receive counseling and help in taking their medication and holding a job.
Unfortunately, "these programs tend to be overwhelmed," said Dr. John J. Boronow, chief of the in-patient psychotic disorders program at Sheppard and Enoch Pratt. "They are often very crowded. They could use a whole lot more staff." Only about half of all victims are in treatment.
The costs are high. The newest drugs run up to $3,000 a year. Some private insurance will cover the costs of drugs but rarely treatment. And most patients can't hold a job. Most end up on Medicare, Medicaid or Social Security disability programs.
The real problem is keeping patients in treatment. Most "don't seem to get the connection between taking their medication or staying in rehabilitation treatment, and avoiding the psychosis," Boronow said.
Many states, including Maryland, Boronow said, need updated laws to allow the courts to order "outpatient commitments."
When schizophrenics become a danger to themselves or others, Maryland courts can commit them to involuntary hospital stays, where they can be evaluated and stabilized on their medications. But once they're released, patients are free to quit their pills.
In some states, however, the courts can extend their jurisdiction beyond the hospital stay. If patients fail to comply with their outpatient treatment, they can be recommitted, taken into police custody and returned to a hospital.
"I imagine there are lots of civil liberties concerns, many of them understandable and appropriate, about such a set of laws," Boronow said. "But it does exist in some states."
Family members say such laws are vital. "I would rather that this man [Weston] had spent a month in hospitals each year, all his life, rather than be allowed to go down this road and lose the rest of his life, institutionalized," Knight said.
For information or assistance, call the National Alliance for the Mentally Ill, 1-800-950-6264.
Pub Date: 7/28/98