The Long, Lonesome Road
Fred Thomas is schizophrenic. Seven years ago he entered a state mental hospital. Ever since, his life has been a jumble of doctors and drugs, hospitals and halfway houses. But like so many others in Texas’ abysmal mental health system, he is not one bit better today.
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Despite his illness, Fred Thomas was easy to like. He was nearly six feet tall and had a gentle voice, a sly, funny smile, and a soft, almost delicate face. He was 23 years old and looked it; his chin was half-hidden by some facial hairs struggling to be a beard. His laugh, which came frequently (sometimes for good reason and sometimes not), was infectious. There was nothing at all threatening about him, and it later became clear that only in the presence of his mother did that side of him come out. Though he had a noticeable paunch, he was otherwise thin and even gangly. His eyelids drooped a little; that was from one of the side effects of his psychotropic medication—it made him drowsy. Other side effects were equally obvious. His skin and mouth were dry. There was numbness in his touch. His arms and legs always felt stiff, so he tended to shuffle. These side effects were experienced by almost all the patients to one degree or another; they could, and often did, lead to a twitching syndrome called tardive dyskinesia, which bears a resemblance to Parkinson’s disease.
We talked for a while longer about things that interested him—Prince’s latest record, a Richard Pryor concert he had seen in Houston, the black actress in The Facts of Life television show. Fred had an astonishing memory for the most arcane details about the lives of pop music stars and television personalities. Then, completely out of the blue, he said, “I know I’m a mental patient, man. I know it. I don’t like it. It’s a stigma, man.” He sighed. But a minute later he was off again on Joe Willie Namath and the birds and the bees, his moment of lucid sadness fleeting memory.
That April marked the beginning of Fred’s fifth stay at the Austin State Hospital. After his initial admission in 1979, he had managed to stay out of the hospital for four years. But between March 1984 and March 1985, he had been in three times. Upon Fred’s most recent release—on March 6, 1985, after a 43-day stay—Liz took her mother along to pick him up. When they arrived, Fred’s grandmother took one look at him and said, “Liz, this child’s in a worse fix than before. You get him right back in there, and you keep sending him back until they do something for him!” Liz held off for two days. Then Fred came after her with a broom, and she knew her mother was right. She called the authorities a few hours later to have her son recommitted to Austin. She had to wait a week for a temporary bed to open up at the Harris County Psychiatric Hospital. But finally two men from the county came to her house to pick up Fred. And after they left, Liz Thomas broke down and cried, just as she had in 1979. It hadn’t gotten any easier.
“Do You Think I Can Kill You With This?”
It’s 8 a.m. on a Thursday in early May: time for the “morning meds” in Ward B, one of the four male wards in the Harris K unit (there are two female wards). Ward B has been Fred Thomas’ home for more than a month.
The heart of an Austin State Hospital ward is the central dayroom, no larger than a bank president’s office; it is filled with beat-up chairs, a few card tables, and a television set that is constantly on. Plexiglas windows and locked doors separate the dayroom and a nurse’s station, from which the ward staff keeps watch over its charges. There are some 25 men in the Ward B dayroom this morning, at least 7 more than the ward was intended to hold. During the time I spent at Harris K, the dayroom was constantly overcrowded, which greatly increased the level of agitation and even danger. Fred, however, does not seem agitated. He is wearing a clean pair of short pants, a new T-shirt, and his ever-present basketball sneakers, unlaced. He is standing in front of a full-length mirror, mumbling to himself. No one seems to notice.
The two mental health workers sitting in the nurse’s station don’t notice Fred because, by their lights, he is being good. To such nonprofessionals, who make less than a good grocery clerk, a patient’s goodness is measured entirely on the basis of how little trouble he causes. Fred may be incoherent, but at least he’s not starting a fight. Besides, they are busy with their morning ration of paperwork, which is voluminous, as usual.
The other patients don’t take any special note of Fred because most of them are equally absorbed in their own private worlds. Very little is known about what causes mental illness; this is one reason why psychiatrists—and society—still can only guess at how best to treat mentally ill people. We also cannot even begin to comprehend their pain. Some schizophrenics hear voices commanding them to do things; others suffer from hallucinations, delusions, paranoia, or a combination of all three. Earlier this year, in an anonymous New York Times article, a woman who suffers from schizophrenia described her torment as “the fierce battle that goes on in my head.” She went on: “My mind can divide on a subject, and those two parts subdivide over and over until my mind feels like it is in pieces….At other times, I feel like I am trapped inside my head, banging against its wall, trying desperately to escape.”
You can get a small glimpse of that private torment in the dayroom this morning—or any morning. Three or four men are sitting stonily in chairs, grumbling angrily at the walls. Another man erupts into loud, incomprehensible laughter. A new patient tries to flick something off his shoulder, a motion he repeats again and again; there is nothing there. In the bathroom an extremely delusional, muscular man stuffs magazines down a toilet. The man’s parents conceived him (so the story goes) while both were patients at Rusk State Hospital. He has been flushing magazines down the toilet every morning for over a week, ever since someone sent dozens of old copies of the New Yorker to Ward B.
Although all the patients were roused out of bed two hours ago, the only things they have been required to do so far are brush their teeth, comb their hair, and make their beds, activities that exhaust no more than five minutes apiece. Thus the rest of their time has been spent doing what they’re doing now—milling about. When you’re confined to a state hospital ward, you’re forced to spend a lot of time with your thoughts, however terrifying they might be. This cruel fact cannot possibly help anyone get better, but that’s the way it is. Other than the television, there are very few distractions. Milling about is the basic activity in the ward.
In the middle of the low-level chaos, a nurse holding a carton containing the morning medication walks into the nurse’s station. Her name is Sue Dennison. “Okay,” she announces in a tone that is both firm and pleasant, “get in line for your morning meds.” The two mental health workers go into the dayroom to help the patients form a scraggly line. One by one the patients step up to the nurse’s station to receive their medication. The psychotropic drugs they take—with names like Thorazine, Navane, Prolixin, Mellaril, and Haldol—are the primary, indeed, the only, form of real treatment they will receive in the hospital. And while there is no doubt that most of the people in this dayroom need the drugs desperately, there is considerable doubt as to whether some of them might not also benefit from other forms of help—from therapy, for instance. The issue of alternative treatments, which is the subject of a fierce national debate, does not get addressed in Austin. It is drugs that can prop people up the fastest, and get them out the quickest, and soak up the least amount of money. So drugs are what is used.
The first person Sue Dennison sees on this Thursday morning is a short, shy, soft-spoken man who looks about fifty years old. He is a murderer. In June 1980, six weeks after being released from the state hospital, he shot his next-door neighbor. He had heard voices telling him the neighbor was about to shoot him. Every time the doctors think he is well enough to stand trial, he is sent to prison. But as soon as he gets to prison, he regresses and has to be returned to the state hospital.
“How are you feeling today?” Dennison asks him. A few days before, the man had asked a ward staffer if the attendant was going to kill him soon. “Oh, just fine,” he says meekly.
Next, a young black man steps up to the window. He has a little goatee and wears a baseball cap turned backward. When he sees Dennison, he puts his chin on the window ledge and stares at her salaciously. “Come on, Michael,” she says, “I can’t give you your medicine if you’re doing that.” He keeps staring.
Michael is retarded. He was committed by a probate judge in Harris County, thus making him Austin’s problem instead of Houston’s. Harris County washed its hands of him not long after he arrived by sending a letter to the hospital stating that Michael could not be returned to Houston because the city lacked an “appropriate placement.” But Austin doesn’t have any place for him either. He belongs in a state school for the mentally retarded, but he can’t get into one; the waiting period is about two years. Judge Sanders’ monitors have raised the issue of retarded people languishing in the state hospitals. But what can the staff on Ward B do? All they can do is wait.
Next in line is John Collins (not his real name), a tall, gaunt, 25-year-old with curly black hair and a terrible stutter. He is much better dressed than the others and much more scared: this is his first admission to the state hospital. After John comes a young Hispanic from the Valley who has serious brain damage, the result of sniffing glue. His face is pocked from self-inflicted acid wounds. And next is a tall, sardonic man who is suffering from manic depression.
Bringing up the end of the line is Donald Peterson (not his real name). He is the toughest patient on the ward; he has lived at least half of his adult life in an institution—either a mental hospital or Huntsville State Prison (for armed robbery). The other patients are afraid of him. The staff prefers to keep its distance too. Peterson, who looks old beyond his 44 years, hasn’t shaved or bathed in days. He smells of stale cigarettes and rancid sweat, and the other patients have been complaining about him. Eventually, staff will have to force Peterson to take a shower, but they’re not in any hurry. The last time they tried to make Peterson clean up—it happened about a week ago—one of the mental health workers wound up with torn ligaments in his thumb.
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