No One Cares About Crazy People

by Ron Powers

  The most repugnant reason for prison overcrowding can be found within the bureaucratic wisdom that “no one cares about crazy people.” It lies in the effects of the carelessly bungled experiment in deinstitutionalization.

  Since that era, the American system has been “criminalizing mental illness,” Thomas Dart, then Cook County sheriff, remarked to Nicholas Kristof of the New York Times in 2014.7 Kristof described the Cook County Jail as “the largest mental-health center in America,” and cited a 2006 Department of Justice study announcing that more than half of prisoners in the United States had a mental health problem of one form or another.

  For many among the incarcerated, a mental health “problem” leads not to treatment, but to problems that might cause Hieronymus Bosch to cover his eyes.

  Among the most gruesome and least forgivable forms of sanctioned torture by prison factotums is “punitive segregation,” as the delicate euphemism has it. The more familiar term is “solitary confinement.” Solitary confinement, even for brief periods—several days, say, with an hour’s respite each day—is known to trigger hallucinations and paranoia among sane and insane prisoners alike. For people already mad, it is a quick route to deep and lasting psychosis. The human psyche is essentially social and abhors isolation; enforced separation from others thus amounts to an act of sanctioned depravity.

  Solitary confinement has been used as a short-duration measure in the past. In recent decades, overwhelmed wardens increasingly have turned to it in a hair-trigger way, popping prisoners into tiny, badly ventilated cells, often restricting food, water, and medications as part of the bargain.

  Solitary confinement is a petri dish for the suicide impulse. Yet attempted suicide is a violation of prison rules. If an inmate is caught trying, or is discovered after having failed, he is often beaten within an inch of his just-rescued life, or worse.

  Solitary confinement ranks with batons and boot-tips as the punishment of choice at the most dreaded detention facility in America. Rikers Island opened in 1932—like Bedlam, on a fetid landfill of the same name in the East River, just north of what is now LaGuardia Airport. Its fifteen low-slung buildings command more than four hundred acres. Their cinderblock walls trap and exacerbate frigid air in winter and 100-degree heat in summer. Upkeep is minimal; the floors show large cracks that flood during rains. Unswept broken window glass provides handy shards for slashing faces and necks.

  Rikers’s designated holding capacity is fifteen thousand. Virtually none of the inmates are serving sentences for a crime. Mostly poor, overwhelmingly black and Latino, they are awaiting trial on one charge or another, their families too poor to supply bail money. It is widely estimated that about 40 percent of these inmates have some form of mental illness. Crazy people, historically, have proved irresistible targets for sadistic guards. Mayor Bill de Blasio, who has faced criticism for helplessness in the face of the near-daily brutalities at Rikers, announced in 2016 that the city will triple the number of PACE staffers (Program to Accelerate Clinical Effectiveness) under a program that by 2020 is estimated to cost more than $24 million.

  In the meantime, the ordained enforcers at Rikers continue to dole out “punitive segregation” when it suits them, which is often. News coverage does not seem to dissuade them, and there is virtually no public outcry. This may be what inspired the Times reporter Jim Dwyer to write, in 2013, that Rikers “is the basket into which society drops the disruptive mentally ill.”8

  In September 2013, as later reported by New York newspapers and television news groups and investigated by Jake Pearson of the Associated Press, a thirty-seven-year-old inmate at Rikers Island and schizophrenia sufferer named Bradley Ballard made an obscene gesture to a woman guard. Other guards locked Ballard in his cell and left him there. The guards withheld some of the man’s antipsychotic medication, as well as insulin injections that he needed for his diabetes. They also denied him many of his meals. They checked him through the cell door’s small window “dozens of times,” according to the AP report, but did nothing to intervene as Ballard grew progressively agitated, clogged his toilet so that it overflowed, stripped himself naked, and wound a rubber band tightly around his genitals. On the seventh day, a guard noticed that the inmate was motionless on the floor, smeared with his own feces, his genitals swollen and red. He died in a hospital a few hours afterward.

  One year later, Ballard’s mother, Beverly Ann Griffin, filed a wrongful death lawsuit against the city. The amount of the suit was not made public, and the suit has not been resolved at this writing. Ballard had been brought to Rikers from Texas in 2013 for the crime of changing his address without notifying his parole officer. He had been arrested for assault.

  In February 2014, careless mistreatment by Rikers staff resulted in the grotesque death of another inmate. New York City police had arrested Jerome Murdough, a fifty-six-year-old Marine with a history of schizo-affective disorder, for trespassing in a Harlem public-housing building. The AP’s Pearson, among others, reported that Murdough told the officers that he had been trying to escape the bitter cold. Unable to pay the twenty-five-hundred-dollar bail assessed for the misdemeanor, Murdough was placed in a six-by-ten cinderblock cell, in a unit designated for mentally ill inmates. Temperatures in the cellblock hovered around 100 degrees. Despite loud complaints, no one came to fix the heating system. Nor did the guards pay much attention to the Marine. It took a week for Murdough to bake to death. Before his family’s intended $25 million wrongful death lawsuit could be filed, the city quickly settled with them for a payment of $2.5 million.

  Kalief Browder did not commit suicide at Rikers Island, but it was there that he learned the technique he used to take his own life in 2015 at his home in the Bronx at age twenty-two. That is the conclusion reached by writer Jennifer Gonnerman in a New Yorker essay dated June 2, 2016.9 She also obtained documents of Browder’s deposition conducted by lawyers for the city. Gonnerman had interviewed Browder in 2014, after the charges against him had been dropped and he had been released from Rikers.

  Browder’s persecution began when he was arrested for robbery in 2010, at age sixteen. Browder and a friend had been falsely identified on a nighttime Bronx street by a man who said the boys accosted him. Police found no evidence on either of the two; yet, after a day of confinement, Browder found himself charged with robbery, grand larceny, and assault. Because he was on probation for a previous, nonviolent offense, the youth was ordered held over; his bail was set at three thousand dollars. The family, as is so typical in such cases, could not afford to pay. So a terrified Kalief Browder was placed on a police bus to Rikers Island.

  There he spent three years, nearly two of them in solitary confinement, in a seven-by-twelve-foot cell. He insisted on his innocence all the while. And he attempted suicide at least five times. He formed the idea of hanging himself after seeing a fellow inmate removed from his cell after a failed effort, the remains of a bedsheet still fastened around his neck.

  On one of his attempts, Browder told the lawyers deposing him, corrections officers walked into his cell as he was about to jump from the rim of a lavatory sink with a bedsheet threaded through holes in a ceiling vent and tied around his neck. Instead of lifting him down, the guards taunted him: “Go ahead and jump!” Browder, by now frightened of death, refused—at which point the guards cut the bedsheet, then threw the young man onto his bed and began beating him.

  (Jennifer Gonnerman cited the results of an investigation by the Times, published on July 14, 2014, which revealed “scores” of “brutal attacks by corrections officers on inmates—particularly those with mental health issues” inside Rikers.10 Among the facts revealed by the investigation: that 129 inmates had suffered serious injuries over an eleven-month period; that 77 percent of those injured had been diagnosed as mentally ill; that in 80 percent of the cases, the inmate-victims reported having been handcuffed; that none of the officers involved in the cases had been prosecuted or been brought up on formal charges as of the article’s publi
cation date.)

  After his release, Browder—who’d shown no previous symptoms of mental illness—enrolled at Bronx Community College and achieved a 3.5 grade point average. His achievements there included a scholarly research article on the dangers posed by solitary confinement to the human mind. “Instead of solitary confinement rehabilitating inmates there is evidence of it actually causing severe mental problems for inmates and in the long run leaving the mental disorders for their families to deal with,” Browder wrote.11 By that time, his own mind had been infected. He suffered from delusions and paranoia; tried again to kill himself; made three enforced visits to psychiatric wards. After enduring three depositions, one of them a five-hour grilling in May 2015 that probed his suicide attempts, Browder decided to try the bedsheet approach once again, less than a month later, and succeeded.

  Urban jails and prisons are not the only settings for the lethal abuse of the mentally ill, just as cities are not the only venues for police shootings of the mad. Atrocities by wardens and inmates can, and do, occur around the country, including in the Heartland.

  In October 2014, a thirty-nine-year-old man, Josh Francisco, the father of two children, hanged himself while in solitary confinement at the Farmington, Missouri, Correctional Center. As Blythe Bernhard reported in the November 8 St. Louis Post-Dispatch, Francisco suffered from a bipolar affliction, and “for four years, his family desperately tried to get the help he needed.”12 His mother, Anne Francisco, filled in the details of Josh’s life and of the reprehensible yet familiar bureaucratic cluelessness that dragged him inexorably beyond the reach of his loving and desperate family and into that cell. She composed those details on the day of her son’s suicide, in an essay of remarkable clarity and eloquence—and universality. She sent it to the blog13 of the distinguished journalist Pete Earley, himself the father of a mentally ill son and the author of Crazy: A Father’s Search Through America’s Mental Health Madness, a finalist for the 2007 Pulitzer Prize in nonfiction. Below are some edited excerpts, which Earley republished in 2015:

  My husband and I knew little about mental illness until four years ago, when we received a call from our daughter-in-law telling us that Josh’s behavior had changed and she needed our help to convince him that he should enter a hospital for psychiatric treatment. She explained that Josh… had become hyper-vigilant about national/government affairs and hyper-religious, praying in strange tongues.14

  Josh refused to seek treatment, believing he was sane—the classic symptom of anosognosia. His wife, alarmed at his behavior, obtained a restraining order against him. Josh persisted in trying to contact her. He was arrested for stalking. Arriving in Missouri from California, his parents “learned Josh was living in a storage locker.” They found a psychiatric facility. Josh balked. “The hospital admitted him only after I exaggerated his symptoms. It was the beginning of his resentment toward me.”15

  The divorce papers arrived while Josh was in the hospital. “He used a telephone there to call his wife and apologize.” He was released, and then immediately rearrested for making the call.

  Deprived of his medications for four days in a cell, Josh had an outburst when he was taken into the courtroom and his defense attorney wasn’t there. We later were told that outburst had angered the prosecutor. Josh’s bail was raised, and we were told that he couldn’t be released or return with us to California. We suddenly found ourselves fighting the criminal justice system as well as our son’s mental illness and our badly broken mental health system. It cost us upwards of $40,000 in legal and other fees to get Josh released and finally bring him home with us. My husband, a retired minister, and I would have preferred to spend our savings for Josh’s treatment.16

  Josh’s troubles were only beginning. In California, he himself aborted his first suicide attempt—by asphyxiation, in his mother’s car—and agreed to hospitalization. His older brother invited him to live with him and his family in Southern California. There, he found a new psychiatrist and got a job at a retail home improvement store. A photograph shows him posing proudly, a confident-looking young man in glasses, wearing the franchise store’s red vest, the fingers of one hand spread jauntily on his hip.

  Yet Josh continued to resist the notion that he was mentally ill, and he continued to suffer the consequences. He quit his job after four months. “Two days later,” his mother wrote, “his brother found him delusional in a hotel conference room, where he was waiting for people who he’d invited to sit on the board of directors of an international foundation he was forming.”17

  Not long after that, Josh hit the streets. “Soon he was stuck in a vicious cycle. He would be hospitalized and become stable, but would suffer horrible side effects from the medication and ditch the medications when he left the hospital. He would decompensate until he was hospitalized again.” Back with his parents in Northern California, he again tried a recovery regimen, but the anosognosia returned to delude him with the idea that he was well. He proclaimed that without his medication, he felt better than he had in years. He believed that the United States was about to fall under martial law.

  His mother found a respite and temporary hope in a local chapter of NAMI (National Alliance on Mental Illness). Yet Josh continued to refuse medication. In March 2013, his probation officer in Missouri directed him back to St. Louis, where, she believed, “he would get the help he needed.” Instead, he was talked into waiving his right to a preliminary hearing, and he embarked upon another ordeal common to sufferers in his situation: he spent two months, unmedicated, in the St. Louis County jail, awaiting an empty bed in a state psychiatric hospital. Six weeks later, he was issued a court order to resume medication because he had failed a mental competency exam. One night, he tried to contact his ex-wife, using the patients’ telephone. In doing so, he violated the terms of his probation. He spent nine more months in the hospital. “In January of this year,” Anne Francisco wrote in 2014, “we flew to visit him. He blamed us for his circumstances. The heartbreak we felt was indescribable.”18

  More jail time. Another hearing, delayed for months, resulted in his probation being revoked. A new, sustained refusal to take medications. Then, felony charges for using that patient telephone at the state hospital. He was sent to prison in early July to fulfill his original three-year sentence.

  Josh himself requested solitary confinement. He was paranoid about living amid the general jail population, his mother wrote. He remained in solitary for part of July into late October, without psychiatric supervision. HIPAA laws* forbade the authorities to give his parents any information about his condition—yet another source of anguish for relatives of the mentally ill.

  On October 22, a warden from the correctional center called to report that Josh Francisco had hanged himself in his cell. Apparently the HIPAA laws permit this sort of information.

  These stories make up but a small fraction of all reported and recorded accounts of murderous mayhem directed at the mentally ill in America by police officers and prison officials. They are drawn exclusively from the second decade of the twenty-first century, long after such encounters had drawn the vociferous interest of the press, television, sociologists, psychiatrists, clergy, coalitions of bereaved relatives, and even some politicians.

  Despite occasional promises of “reform” and actual initiatives such as New York City mayor de Blasio’s PACE plan for more psychiatrists at Rikers mentioned above, these patterns of mayhem by agents of the state against the state’s most abject citizens continue as though the perpetrators are convinced that they are acting with impunity. Thus far, this assumption is largely correct.

  It seems fitting to conclude this tour of atrocity with a stop in California, where the deinstitutionalization fiasco of the early ’60s begat the scourge of homeless and vulnerable mentally ill people, which in turn begat prisons as “the basket into which society drops the disruptive mentally ill.”

  In April 2014, the Federal District Court judge Lawrence K. Karlton reviewed the policies and prac
tices employed by the state’s Department of Corrections and Rehabilitation in dealing with mentally ill inmates, who make up 28 percent of the system’s population. The policies and practices included a profligate overuse of Tasers, pepper spray, forcible extraction from cells, and recourse to solitary confinement.

  Judge Karlton issued an order ruling that these practices were unconstitutional.

  11

  The Great Unraveler

  The 1960s, a decade of political explosion and social splintering, witnessed one masterful engineering project that has not received its due respect. That project involved the road to hell, which was thoroughly repaved with good intentions.

  If America’s social fabric was frayed by the idealistic revolutions of the ’60s, the subnation of the mentally ill was virtually dismembered. Its self-assured “rescuers” arrived in three distinct yet interrelated waves. One wave, actually a one-man tsunami, delivered a lingering wash of denunciation against psychiatry. Another wave, a joint production of laboratory science and marketing, drenched society with “wonder” medications guaranteed to make the mentally ill tractable and sociable, whose manufacturers and advocates promised would spell the obsolescence of traditional psychiatry—and nearly did. The merits and menace contained within these drugs remain under fierce debate to this day.