Dr. Xavier Amador, Ph.D., has devoted his life and his practice to understanding mental illness. He has a brother with schizophrenia and knows the trauma of mental illness firsthand. Amador’s book I Am Not Sick, I Don’t Need Help! outlines techniques to prevent involuntary commitments for people with psychiatric disorders. Among those techniques is a four-step process for creating a treatment agreement that keeps the patient out of the emergency room and out of an unwanted court-ordered hospitalization:
1.Listen.
2.Empathize.
3.Agree.
4.Partner.
“Finding common ground with a person with mental illness can be very difficult. She doesn’t think she needs medication or therapy. You think she does.” Amador says that common ground can exist even between the most entrenched oppositions. When faced with the frustration of trying to convince your loved one to get help, remember, “the enemy is brain dysfunction, not the person.”
Amador says there is no universal checklist you can use to tell you when you should call for help. However, there are certain circumstances that always warrant commitment. When someone is obviously about to hurt himself or endanger someone else, the imminent danger of harm signals the need to call in outside help. In fact, this is the most common legal standard for committing someone, against his or her will, to a hospital.
Then, there are three ways to seek a commitment for a loved one: go together to an ER, call your local crisis team, or call your local police. Many police departments and psychiatric emergency rooms work in partnership to keep mentally ill people who commit minor offenses out of jail.
Chapter Sixteen
The next morning, as on so many of these recent mornings, I dropped Sophie at school and drove home in a fog. My blood sugar felt perpetually low, my body heavy with fatigue, dulled to the piles of work all around me. The dogs were hungry; at least I could feed them. I pulled the huge bag of dog food from the bin, and it felt like it was going to overwhelm my body, crush me underneath it.
I sat in front of the bin and let grief wash over me. I forced myself to crawl to the hand-woven carpet David had given me for my birthday four years earlier, and I let myself lie down.
He’d bought the rug when we were in Costa Rica, and he tromped all through the streets with that thing lugged over his shoulder. We couldn’t locate a place to mail it, so he carried it everywhere, into little shops, to the beach, back to the hotel. We finally found a place to ship it home. It probably cost us more than if we’d bought it in the States. He was so headstrong in everything he did.
That reminded me of Jody, the divorce attorney. The divorce had been the last thing on my mind that week, but now I sat up and considered my list of “Crucial Things to Do.” Jody had told me to find a copy of David’s company charter. I dragged myself up from the carpet and willed myself upstairs. David’s office was on the top floor of the house, where the heat rose, and I stayed out of his space as much as I could. I couldn’t think straight with all his crazy piles, piles, and more piles. He never threw anything away. Sometimes, I’d find files that were fifteen years old, dated back to when he first started building.
“David,” I’d say. “Let it go.”
He’d shake his head. “Nope, not yet.”
His drafting board had a half an inch of dust on it; the first time I saw him standing at that board, I realized I’d fallen in love with him. I’d surprised him at his home, but he hadn’t heard me come in. I climbed the stairs to his office to find his back to me, deep in concentration, puzzling over a set of plans on his drawing board. He stood back from the plans, and then moved forward, interacting with the design as if he were an artist and it was his painting.
On that day, which now seemed like another lifetime ago, the window had been open to a view of the elementary school across the street. Sounds of children wafted into the room. He wore a white button-down cotton shirt with the sleeves rolled up, and his hair was typical, mussed, thick dark brown.
He turned to see me and didn’t jump or even act surprised. He put his drafting pencil behind his ear before he reached around to kiss me. I thought he was the one person I knew best, that the normal walls and barriers between human beings wouldn’t be there for us. He was different, yes. But I understood him. And I loved him so much.
Now, a decade later, I opened drawer after drawer of his chaos. I couldn’t find anything in this mess. In hindsight, I knew the disorganization was a symptom of the illness. I pulled open the bottom two drawers of his desk. Inside were dozens of white envelopes with his name on them. Strangely, they were unopened. I looked at the return addresses—Multnomah County Court, Clackamas County Court, Yamhill County Court.
Bills? Lawsuits? Worse?
My heart beat as if it were hooked to an electrical prod. I forced myself to focus on my breath, right now. I asked myself to survive the moment, just this one, and I’d never ask for anything again.
I tore into the envelopes, ripping them open one after another. At first, I thought they were misprints—how could David owe so much and not mention it to me? Clackamas County Court claimed he owed $2,600 for failing to appear in court for a ticket. Multnomah County wanted him on a $1,200 violation that had been ignored for eighteen months. How did I miss this going on? I ripped another envelope, and my index finger started to bleed. I opened letter after letter without stopping to find a bandage, leaving bright red stains on notice after notice about his seriously delinquent debt. One of the notices, from a roofing contractor, had both of our names on it.
How dare David hide these from me, hide my responsibility, take my good name from me! David had always retrieved the mail first since he worked at home. I thought it was polite that he sorted my mail from his and left mine in the foyer. I ripped open more envelopes. There was a warrant for his arrest. Jesus. My heart was going to explode. I’d never had a panic attack before. It was as if a stranger had entered my home and forced himself on me. I ran from his office to the garage, where he kept another old filing cabinet. I pulled open the top drawer and dozens more unopened envelopes fell out. This time there were thirty or forty. The second drawer wouldn’t budge; when I finally yanked it hard enough, dozens more envelopes fell onto the floor. The third drawer was also stacked full. I couldn’t swallow. I was covered in sweat.
The extent of his deceit now hit me hard, took the wind from my lungs. His business was tens of thousands, maybe hundreds of thousands of dollars in debt. I couldn’t breathe; I couldn’t get my breath under control. I threw the envelopes in a pile and cried. Some of the dates on the envelopes were three years old, a timeline to the worsening of David’s illness.
Now that day in the swimming pool last summer took on new significance. David probably had several bill collectors like the greasy-haired man with the gray suit and scuffed shoes. Our independent way of living had protected his secret. We had separate bank accounts, separate phone lines, separate lives. I had made sure the mortgage, the utilities, and Sophie’s school tuition were paid on time. I had trusted that David knew what he was doing with his business, that the juggle of construction credits and debits, although highly precarious, would work out in his favor.
The first time he asked for financial help with his business, I ignored my own internal warning system and bought his excuse that it was just a “bridge loan,” money he’d use just until his punch lists were complete and his many clients paid. A hundred thousand dollars was a lot of money. It meant taking out a second mortgage on the house. But I loaned David the money. The debt was in my name.
NEW BREAKTHROUGHS IN THE UNDERSTANDING OF PSYCHOSIS
At the University of Maryland, Dr. Robert Buchanan is testing anti-inflammatory action in schizophrenic patients using a combination of aspirin, omega 3 fatty acids, and fluvastatin. The trial is being conducted to determine whether psychosis might be caused by inflammation in the brain.
Researchers reporting in the journal Biological Psychiatry have observed the role inflammation plays in the onse
t of psychosis. Dr. Tyrone Cannon says, “Inflammation is increasingly recognized as a contributing factor to the emergence of progression of disease in every organ in the body.” In people who develop psychosis, markers of proinflammatory cytokines, or substance secreted by certain cells of the immune system, may predict the rate of gray matter loss among the individuals who convert to psychosis. The research suggests that activation of microglia, a type of cell that acts as the first form of active immune defense, is involved in tissue loss.
Neuro-inflammation may tip people over from an at-risk state into psychosis. The authors of a 2010 review of the literature suggested “it has been established that pro-inflammatory cytokines induce not only symptoms of sickness, but also true major depressive disorders in physically ill patients with no previous history of mental disorders.” There is even some evidence for a connection between inflammation and depression-related suicidality. Researchers don’t yet understand precisely how inflammation could lead to depression, but they are testing anti-inflammatory strategies in the hope of finding one or more that works.
A study reported in March 2015 linked psychosis in bipolar disorder to a gene variant associated with higher levels of a protein thought to play a role in cognition and psychosis. The protein is found at high levels in the brains of people suffering from infections. Scientists hope to develop anti-inflammatory drugs that can safely cross from the bloodstream into the brain and affect the pathways beneficially.
Chapter Seventeen
The radio station where I worked was in a relatively plain, older building and had been there for forty years. The station was a ratings blockbuster, with awards lining the hallways: best program director, best morning show, best reporting, best everything. You wouldn’t have known it by the look of the place.
A peace sign still hung above the receptionist’s desk. Every cubicle was littered with something irreverent or funny—off-color bumper stickers, photos with rock stars, recent articles clipped from Spin or Rolling Stone or Paste magazine. My cohost saw me walk in and said, “Welcome, mein Freund.” I’d managed to juggle David’s two weeks of hospitalization without missing more than a couple of days of work. But I had the foreboding sense that I would need more time off in the future.
I gave him a huge hug. He put his hands on my shoulders and squinted at me. “You okay?” he asked, tilting his head to one side.
“Nope,” I said, “but let’s pretend I am.”
We entered the studio together, a room filled with thousands of CDs, even though we ran the music off a computer hard drive. My cohost sat on one side of the studio; my desk and computer were on the other. We spoke with eye contact and hand signals, and it all sounded like two friends sitting down for an afternoon chat.
“We’re on in five,” he said, smiling, holding up all five fingers on his wedding band hand. No wonder his wife adored him.
The schedule, or “clock” as we referred to it, kept us on track. At the top of the hour, news and information. Then music. Commercial break. More music. More talk. The news. “Here are a few of the stories we’re keeping an eye on for you—on Wall Street . . .”
I finished the five-minute newscast, conscious of two clocks, the station’s and mine. I’d been piecing my life back together in off-air time, the five- to seven-minute intervals when I could call David at the hospital, or pay bills, or deal with the question of where Sophie and I might eventually live after the divorce.
“I’ll be back in four minutes!” I said, and then I ran next door to my production office, where I interviewed authors, artists, and politicians.
I punched in the number for James McCall, one of David’s oldest friends in Portland and one of Portland’s most brilliant defense lawyers. He wasn’t the ambulance-chasing type; he took big cases against corporations or government when people were harmed.
He’d know what I should do.
“Hey, Jim,” I said, taken aback by the energy in my voice. I’d slept so little lately, but adrenalin and fear are powerful drugs.
“Sheila!” He always sounded so cheery when we met, as if the weight of his clients’ problems never permeated his optimism.
“How’s the Hermiston case going?” I asked. Most recently, he’d been representing twelve workers from the Army’s chemical depot near Hermiston, Oregon, who were allegedly injured during a chemical leak. He hadn’t taken a penny and wouldn’t unless the government compensated the men for the injuries to their respiratory systems.
“Let’s just say they have the best attorney in town,” Jim said with a smile in his voice. “Hey, I’m so sorry to hear about David. My ex seems to get all the news before I do. I’d like to go see him, if it’s possible.”
“Sure thing, Jim. He’d like that.” I was conscious of the clock counting down the minutes until my next on air-break. “I’m at work, so I have to make this quick. David is in trouble, Jim. I found hundreds of unpaid bills he’s stuffed away. I don’t know how far the trouble reaches. And I don’t know if it involves me. I need someone who can help me get to the bottom of this.”
Jim paused, then exhaled loudly. “Well, this is tricky. I’m David’s attorney, or at least I was in the past. So I must advocate for him. But I understand your dilemma. You need to get a power of attorney from David so that you can understand what you’re up against.”
“It looks mostly like company debt.”
“Are you an officer of his company?”
“No.”
“Do you have check-writing ability, or have you ever taken a loan from the company?”
“No.” I looked through the window at my cohost holding up three fingers. Three minutes to air. “I’ve loaned David money, but I’ve never taken a loan.”
“I’ll draw up some papers and meet you at the hospital after work.”
Two minutes. I talked as I walked back into the on-air studio. “Jim,” I said, “I can’t thank you enough.”
“You take care of yourself, okay, kid, and that beautiful daughter of yours.” I wanted to stop, to acknowledge his caring and compassion. Instead, I offered a harried, “Thanks, Jim. A million ways, thanks.”
I punched in the phone numbers for Jody Stahancyk, the divorce attorney. Her secretary answered. “May I speak with Ms. Stahancyk?” I asked quickly, looking at the clock.
“She’s away from the office. May I take a message?”
“Please tell her to call Sheila Hamilton. It’s urgent.”
I sprinted to my seat and put my headphones over my ears. The clock ticked, and the red light went on. “There’s some new science on coffee—now it’s good for you!” I made it through the rest of the stories: A local hospital received a major donation. Two pit bulls were euthanized for attacks against humans. I introduced the sound clip for an interview with Robert Plant, the former lead singer of Led Zeppelin, and then we wrapped it all up with information about his new tour with a group of young musicians.
I took off my headphones and let out a big sigh. “Whew,” I said. “That was close.”
My cohost pulled one headphone off his ear and kept his fingers on the board. “Sheila,” he said smiling, “you’re a pro.”
“At some things,” I said. “And at others . . .” I made an “L” with my thumb and pointer finger and put it to my forehead.
He laughed a hearty laugh, his earring catching light as his head shook.
Jody Stahancyk had one of her younger attorneys call me back. I briefly told him the story of David’s hospitalization, the enormous debt I’d uncovered, the guilt of asking him to sign the divorce papers now that he was in lockdown.
The attorney sat quietly on the other end of the phone and then spoke in measured tones. “If you are still married, you will be responsible for his personal debts. And it will be very difficult, given the circumstances, to get a judge to grant a divorce now that he’s been institutionalized.”
So two of us were on lockdown now.
I thanked him for his time and told him I would be in touch.<
br />
When I returned to the hospital, the mental health visiting area was busier than I’d ever seen it. Alice was sitting with David, as was Jim McCall. Alice was wearing a gray wool dress with red ballerina flats and a red scarf around her neck. She smiled faintly when she saw me.
Jim was talking with David in soft tones about how to start sorting out his business trouble. Jim, always the gentleman, stood when he saw me. “How are you doing?” he asked, shaking my hand.
“I’m okay, thanks, Jim.” I turned to David’s mother. “Hi, Alice. Hello, David.” It was an awkward, formal moment, reminiscent of how couples must feel in the lawyer’s office before they divorce, trying desperately to be polite and functional while their worlds fall apart.
Jim had stacked the legal documents in the middle of the coffee table that separated the chairs. “Shall we begin?” he asked the group.
David turned to Alice. “Mommy, what do you think?”
I was stunned. I had never heard him refer to his mother as “Mommy.” I had never heard his voice so soft, or so lacking in authority. I wanted to stop the meeting right then and ask him what drugs he was on, or what had happened to destroy his confidence. Where was the strong, opinionated, brilliant man I had married? Where was the voice that would boom through the house when he called for Sophie or me? I bit my tongue as acid rose up in my stomach.
Alice nodded decisively. “I think we need to get a clearer picture of everything, David.”
His face looked soft and more rounded, like a child’s. The tremor that had affected his leg and hand seemed to be under control today, but he looked stressed by the number of people, the attention, and the decisions before him. He was still painfully thin for his size, even though the nurses reported that he was eating again. Was it the drugs or the illness robbing him of his manhood? I had heard about people who become mentally ill reverting back to childhood. If I hadn’t seen it myself, I would never have believed it was true.
All the Things We Never Knew Page 16