With painful clarity, Liz Thomas remembers when she first knew her only child was mentally ill. It was September 1979. Frederick, her son, was a seventeen-year-old senior at Houston’s Kashmere High. He had always been a good kid, a B student, and interested in the usual things: music and movies and girls. He got into the occasional scrape, but not often, for it was not in Fred Thomas’ nature to cause trouble.
The previous spring, Fred had begun to undergo a dramatic personality change. He started skipping school. He spent days in his bedroom, where he sat on his bed and stared at the walls, his door closed, his radio blaring. At night he wandered around his Fifth Ward neighborhood, smoking pot and drinking beer, and sometimes harassing the neighbors. He made lewd comments to women who walked by his house and became brusque and cold toward his mother. Whenever Liz tried to get Fred to come out of his room, her once-polite son would lash out at her with curses and threats, and push her out the door.
Liz Thomas has a younger sister who has schizophrenia, the most commonly diagnosed form of serious mental illness in this country. But Liz could not bring herself to contemplate the awful thought that her son was showing symptoms of the same disease. At first she ascribed Fred’s behavior to “a teenage thing.” Then in July, after a frightening outburst in which Fred ripped his bedroom door off the wall, Liz took him to Harris County Psychiatric Hospital, a forty-bed hospital—at the time, the county’s only short-term facility for the mentally ill—located on the third floor of one wing of Jefferson Davis Hospital. He was released after a few days of observation; the doctor told Liz that Fred simply wasn’t sick enough to be hospitalized. Although the doctor prescribed Navane, one of the array of so-called psychotropic drugs that are used to treat schizophrenia, his words greatly comforted Liz Thomas because they allowed her to cling to her most fervent hope for her son—that he was not mentally ill. “I guess you don’t want to accept stuff about your own child,” she says now. But then came that September day when Fred’s teacher at Kashmere High called Liz to say that her son was doing something scary and strange in class. He was barking like a dog, and the teacher had not been able to get him to stop. And that’s when Liz Thomas knew.
Liz also knew what she had to do. She had seen her own mother do it for her sister many times. She took Fred back to Jeff Davis and told the Harris County mental health authorities that her son needed to be committed. If a probate judge agreed with her assessment, Fred would be sent nearly two hundred miles away, to the Austin State Hospital, since the most populous county in Texas had no long-term facility of its own. Liz Thomas also knew she would have to sign legal documents alleging that her son, who until six months before had been her greatest source of hope and pride and joy, was “a danger to himself and others.” She read over the papers, occasionally wiping a tear from her eye. Then she signed them and went home, and let the tears pour out.
If Liz Thomas thought the Austin State Hospital was going to solve her son’s problem, she was wrong. In the time between Fred’s first commitment and when I met him six years later, he had been in the hospital five times. He had also been a client of out-patient clinics near his home; spent three months as a resident at a halfway house in Houston; been prescribed half a dozen drugs; and been seen by about forty doctors. Young schizophrenics are difficult to help under the best of circumstances, their conditions exacerbated by years of using dope and alcohol. But it’s fair to say that Fred’s experience with the Texas mental health system between 1979 and 1985, rather than making things better, had only made them worse. Fred continued to get sicker, more haunted by his private demons with every passing year.
The fact is, a real mental health system does not exist in Texas. Instead, a group of independent fiefdoms and power bases all operate under the loose rubric of the Texas Department of Mental Health and Mental Retardation ( MHMR). State hospitals are one power base, and local mental health authorities are another. Probate judges try to get mentally ill people into state hospitals, while hospital social workers try just as hard to get them out. There is even a federal judge involved in running the state hospital. As a result of a class-action suit brought a dozen years ago on the behalf of patients, federal district judge Barefoot Sanders is immersed in every aspect of hospital life, and although his intimidating presence has made the hospitals marginally better, the improvements have come at the expense of the local authorities. Part of the reason that everyone seems to be working at cross-purposes is that there is honest disagreement about how best to treat the mentally ill. But the chaos that reigns in the Texas mental health system also results from some of the worst reasons imaginable: bureaucratic infighting and turf battles, and a preference for the status quo over innovation or change.
Fred Thomas is in many ways typical of the people who populate that system. He is black. He is poor. He is unquestionably a tough case, partly because of the severity of his illness, but also because, as I discovered in the five months I spent with him a year ago, he lacks the motivation to try to make something of his life. Though instilling such motivation is perhaps the most fundamental goal of the modern mental health movement, the Texas system has seemed utterly helpless to change Fred. Instead, the system has been content to process him into the state hospital and process him out—always