Americans deluded about mental illness

March 24, 2002|By Gordon Livingston

THAT WE are daily drowning in falsehood and misconception is usually harmless, so long as we see the world around us primarily as entertainment. Our twin obsessions with politics and celebrity ensure that we only occasionally confront anything resembling the truth. Lately, however, things have been worse than usual.

A Texas jury has now decided that Andrea Yates -- a woman described by one of her treating doctors as "one of the sickest patients I've ever seen" -- should get life in prison for killing her children.

According to the prosecution's psychiatrist, she believed that she was trying to save the children's souls from Satan by drowning them. Yet because she knew in some abstract sense that she was committing a crime, she was convicted.

This whole sorry spectacle underlines, as nothing else could, how inadequate is our understanding of mental illness. And no wonder. Look at two recent portrayals of schizophrenia.

In the much-celebrated movie A Beautiful Mind, Russell Crowe attempts to portray the travails of mathematician John Nash, who was plagued for much of his life by paranoid schizophrenia. At first blush, Mr. Crowe seems like the ideal actor for the job given the limited range of expressiveness that he has so far demonstrated in his work. In this inaccurate and dishonest film, however, the viewer is treated to a depiction of delusions and hallucinations that are as absurd as they are entertaining, a virtual second life featuring spies and car chases. This alternative reality not only is completely at odds with what the real John Nash experienced (auditory hallucinations) but also distorts the usual experience of those who endure this terrible disease.

Schizophrenia is a devastating illness of the mind of uncertain cause; it is a heritable biological abnormality. Those who suffer from it have intermittent, sometimes sustained, difficulty perceiving reality. About 1 percent of the population (2.5 million Americans) has the illness. While delusions and hallucinations are classic symptoms, the so-called negative symptoms (lack of emotional expression, apathy and social withdrawal) are equally or more debilitating. If you want to see someone in the grip of a schizophrenic illness, look at Andrea Yates.

The fundamental fraudulence of A Beautiful Mind is to play on the common misconception that creativity and intuition are somehow linked to madness. In fact, people with schizophrenia commonly find the most routine tasks -- shopping for food, holding a job -- monumentally difficult. Most of John Nash's contributions to game theory came before his illness was manifest.

Not to be outdone, television has now given us a portrayal of a schizophrenic. In a recent episode of The Practice, lawyers are defending a client who leaped out the window of a mental hospital while in the grip of a delusion that he was Superman and could fly. Unfortunately, he landed on and killed an unsuspecting passerby. We see him in the hospital, dressed in a Superman outfit and calling his wife "Lois."

With these images in our heads about what it means to be psychotic, is it any wonder that we cannot come up with a sensible social policy in dealing with the mentally ill?

We have, for example, over the last 40 years, decimated our inpatient public mental health system. Under the rubric of "deinstitutionalization," we have emptied our state psychiatric hospitals. Do you wonder what became of these chronically ill people? Not coincidentally, an estimated 20 percent to 25 percent of the current homeless population suffers from a diagnosable mental illness, often schizophrenia. The current lack of funding for outpatient mental health services in Maryland is a (virtually unnoticed) scandal.

And now a Texas jury has sentenced a mentally ill woman to life in prison. As is the case when profoundly retarded people have been executed, the law has shown again that it is unable to come to grips with how to deal with the most vulnerable and disabled of our citizens.

Until 1983, Texas law provided that someone could be judged insane if they knew they were committing a crime but could not stop themselves because of a mental illness. Andrea Yates might have met this test. When John Hinckley Jr. mounted a successful insanity defense after shooting President Ronald Reagan, a burst of public outrage caused legislatures in Texas and elsewhere to revert to the stricter "knew right from wrong" standard.

The movies we applaud and the laws we pass are both reflections of our dominant values. If we believe that Russell Crowe can marry Jennifer Connelly and win a Nobel Prize in spite of his schizophrenia, we are unlikely to cut Andrea Yates much slack.

An America Online poll before sentencing found 46 percent of the respondents in favor of killing her (the rest were evenly split between life in prison and hospitalization). If she is behind bars, will the children of other psychotic mothers be safer? And will our thirst for vengeance be satisfied if we call it justice? What delusional system are we operating under?

Gordon Livingston is a psychiatrist who lives in Columbia.

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