Paranoid schizophrenics I’ve known

Esteban Santiago, the lone gunman who killed five innocent strangers and wounded six more at the Fort Lauderdale airport on January 6^th, had sought help from the government in November. He walked into an FBI office in Anchorage, Alaska, claiming that the U.S. government was controlling his mind and forcing him to watch Islamic State videos. Agents called police and he was taken for a mental health evaluation, but he didn’t appear intent on harming anyone, so he slipped through the cracks in the system. Two months later, he officially became a murderer.

His delusional claims brought back memories of my years working on locked wards with seriously ill patients at Hudson River Psychiatric Center in Poughkeepsie. With my hard-earned master’s degree in art therapy from New York University, I was embarking on my first full-time job in mental health, and I was especially fascinated by the elaborate delusions of those diagnosed as paranoid schizophrenic. The men on Ward 604 ranged in age from their late teens to early middle age and they were on the maximum-security ward because they were considered a danger to themselves or others. Some were assaultive, others had prison records, and there were a couple of murderers.

This was the 1980’s, and like many state mental hospitals across the country, Hudson River was rapidly being downsized as patients were discharged into the community, presumably to be managed through outpatient services and medication. But some were deemed too dangerous for discharge, and others cycled in and out through the system’s revolving doors.

Some of the paranoid schizophrenics believed they took their orders from God or the government, while a few believed they actually were God or at least Jesus. One young man believed he had turned into a woman and had sex with John Lennon. (This was in early 1980, before John was brutally murdered.) I couldn’t resist replying, in my best nonjudgmental therapeutic manner, “Oh, do you want to tell me about that? What was it like?” Unfortunately I can’t recall his reply.

I encouraged the patients to get their visions down on paper, with pencils or paint, and to talk or write about what the images meant to them. As an art therapist, I’d been trained not to impose my own interpretations aloud, but I’d learned to analyze the pathologies revealed by their artwork, to record them in progress notes and to report disturbing content to their shrinks and treatment teams. Often the imagery was violent, replete with swords, guns, blood and dismemberment. Yet not once did a patient assault me or even verbally threaten me. I was their ally, there to foster their creativity and self-expression, not to impose controls on them.

Hudson River closed years ago, and I’ve often wondered what became of those patients who were incapable of adjusting to life in the community. Like thousands of others, many probably ended up in prison, homeless or dead. Deinstitutionalization hasn’t been the panacea it was touted as being, and there aren’t enough affordable community mental health services to go around.

Esteban Santiago was receiving psychological treatment in Alaska, but his family wasn’t privy to the details. Clearly it wasn’t enough, but maybe nothing could have stopped his deadly rampage. Since he surrendered and survived, maybe he’ll be able to shed some light on his actions.

Two days after the shooting, I began this blog post as a potential op ed piece for the Albany Times Union, but then I realized that my viewpoint wasn’t sufficiently clear, so I put it aside. A day after that, the TU introduced a new, reduced format, with certain features shortened or omitted. The two Perspective pages, with their generous space for columns, both national and local, went on the chopping block. Now they might not have space for my essay in any event, so I decided to post it here. Since I’m no longer limited to 600 words, I can be a bit more freewheeling—if I were aiming for publication in the TU, I wouldn’t have mentioned the patient who believed he’d fucked John Lennon.

I have mixed emotions about hospitalization for the mentally ill, especially those who are truly a danger to themselves or others. Deinstitutionalization was supposed to be a good thing, and those enormous old hospitals were portrayed in the public eye as hideous snake pits. But Hudson River Psychiatric Center was a fairly benign and yes, therapeutic environment. If it weren’t, I could never have worked there for 13 years, enough to get me vested in the New York State retirement system that helps sustain me now.

The patients at Hudson River inspired me to embark on my first novel, then titled The Flip Side. It was good enough to win me some personalized and encouraging rejection letters, and eventually a good agent in Manhattan, but alas, she never sold it. It remains unpublished, but who knows, I may resurrect it one of these days.

Meanwhile, I sometimes wonder what became of those fascinating guys on Ward 604. Did they eventually get discharged and adjust to life in the community? More likely they died young or landed in prison.