July 24, 2014

Battling Back

Bill Mahoney was partying in a hotel room in the Keys the first time he telepathically entered the mind of another human being, what he dubbed a “mind-meld.” Then a freshman at the University of Florida, Mahoney was on spring break. During his first semester at school, Bill, a Naples native, had started smoking pot and then meditating. The combination had been transformative; his mind raced, it seemed, through planes of existence, seeking oneness with the universe. Enlightenment. In fact, by winter break, Bill was sure that he was akin to Buddha. But he didn’t tell his friends. That’s ridiculous, logic said.

However, that night in the Keys, amidst a throng of pot-smoking, alcohol-dazed college kids, Bill crossed his legs in the classic yoga pose and finally achieved the elusive Enlightenment. “Suddenly, I felt other people’s thoughts,” he says. “Emotions and thoughts intertwined into this sense that I could pick up on.” And why wouldn’t he trust it? His telepathy wasn’t solely in his mind; he felt it—physically. His skin tingled as it absorbed waves of thought. Spiders crawled across his body. His skin itched like crazy.

Back in Gainesville, the mind-melds increased. For many reasons, they were exciting. After all, Bill was the spiritual center of the universe. But there were drawbacks, too. The mental links worked as a two-way street, allowing friends and strangers to trespass in his thoughts. Bill, for example, had always been insecure about the redness of his nose. In psychology class, the professor (after Bill tried to hack his mind) put a picture of a nose on the front board and everyone laughed—at him!

So began Bill’s break with reality. What started as an adolescent dalliance with pot and philosophy, a young man’s search for something higher than himself, soon became a full-blown psychotic break. In the coming weeks, he crowned himself Jesus Christ, conversed with the devil and rebuked his mother for trying to sexually molest him, which she was not doing.

Until the 1970s, a break like Bill’s would’ve likely been treated by institutionalization (see below)—warehousing him in a state mental hospital. But thanks to 1971’s Florida Mental Health Act, or Baker Act, the mentally ill cannot be committed unless they are a danger to themselves or others. If someone is “Baker Acted,” authorities can hold them for only three days while they are examined by professionals at crisis stabilization units. This led to deinstitutionalization in Florida, with the state replacing its reliance on state hospitals with 104 smaller crisis stabilization units. These centers receive people who have been Baker Acted, and Collier County’s only facility is located at The David Lawrence Center in Naples.

Recent events, however, have led to a renewed conversation about the treatment of the mentally ill. Some blame deinstitutionalization for increasing the homeless population; others say that the stringent requirements for commitment keep violent people on the street. An examination of Bill’s descent, however, shows that current treatment methods work, but that maintaining mental wellness relies on a committed support system. For Bill, that backing came from parents who refused to give up on their son, even in his darkest hour.

But before Bill and his family could think about getting better, things got worse. Much worse.

 

Descent Into Darkness

On his way to the Keys for spring break, Bill stopped at home in Naples. He arrived at his parents’ door wearing jeans, a long-sleeved shirt and a toboggan. For a beach vacation. On one hand that was odd behavior. On the other hand, “that’s just Billy being Billy,” Claudia, his mother, says. Slight, with shaggy red hair and boyish good looks, Bill was a high school introvert at Palmetto Ridge until his senior year. Always a good student (he entered UF having completed 27 college credits), Bill shook off three years of isolation, placed a hiatus on his video gaming and reconnected with long-ignored friends. It was a beatnik crowd, sure, but they accepted Bill and his “ditzy” manner. “He’s very intelligent, but his common sense is zero. That’s why we call him the ‘Nutty Professor,’” Claudia says. 

Any fears Claudia had before the Keys trip were allayed when he returned home, his skin red with sun and his spirit seemingly refreshed. But two weeks later, back at UF, Bill began complaining to his father, Matt, about his roommates. “They’re sending me messages through my mind,” he told Matt. Worse yet, they were sexually explicit messages. First, there had been a wink. Then, it got worse; one of the roommates entered Bill’s mind and threatened to rape him. “You have to stop, man!” Bill screamed. “I can’t handle this!”

After Bill promised to spend the night at a friend’s, Claudia and Matt drove to Gainesville to check on their son. Again, Bill appeared normal. But when they went to lunch, before getting into the Mahoneys’ van, Bill let his parents in on the secret. He pointed to a woman jogging down the sidewalk. The jogger bent down and picked something up. “See! See!” Bill exclaimed. “I made her do that!” Another walker dropped a tennis ball, and Bill claimed credit for that, too. “He kept on and on,” Matt says. At lunch, it got worse.

“He was laughing,” Matt says.

“Yeah, like he was having a conversation with himself in his head that nobody else knew,” Claudia says.

Back on campus, Matt and Claudia talked to the dorm adviser about moving Bill into another room. No dice. Claudia entertained the idea of putting her job on hold and moving with Bill into a hotel room. But, again, just as these plans were rolling into action, Bill’s strange behavior subsided. “Don’t worry,” he assured them. “It’ll be fine. It’s just a matter of me growing up a little bit.” Hesitant but hopeful, Matt and Claudia drove home.

The next morning, Matt called Bill. The look Claudia saw on her husband’s face said everything. They jumped back into the car and headed to Gainesville, racing north on Interstate 75 at 95 mph.

 

Emergency Intervention

Bill was walking the streets, so Claudia called campus police during the drive. The officer who finally located her son, however, was black, as were Bill’s three roommates. Bill’s mind lumped them together, so that the cop was an extension of his roommates and their sexual threats. Eventually, his paranoia jumped from black people to cops in general. Suddenly, every cop at the station was mind melding. “They’re all in on it,” he told his mother on the phone. “It’s a conspiracy.” He wasn’t violent, so the police couldn’t keep him, and Bill left.

Bill stayed on the phone with Claudia, sobbing uncontrollably. His heart was racing. Bill knew he was dying. He told her, “I don’t want to die alone. I want you and dad with me.” She told Bill to see a movie. Each on their cell phones, she navigated him through buying a ticket, asked if he wanted food and told him to sit in the back row, where he could see everyone in the theater. “Mom, I’m going to be OK,” Bill finally told her. “I’m going to watch this movie.” Of course, when Claudia and Matt arrived, he wasn’t there. He was out back. In the woods. Hiding.

On the ride back to Naples, things deteriorated further. “I climbed into the backseat and told him it was going to be alright. He flipped out and said that I was trying to sexually abuse him,” Claudia says. She began to cry, too, before getting back into the front seat. “All the way back, that’s what he kept saying,” Matt says. “That she was trying to sexually abuse him. Then I was talking to him, mind-wise. He kept saying, ‘Stop. Don’t do that.’” 

The David Lawrence Center was full, so Bill went to another local treatment center that he was terrified of and that Claudia likened to a nursing home. One patient hollered, “Elijah! Elijah!” whenever he saw Bill, and the staff controlled the patients, he says, through fear. Bill faked normal, was released after three days and resumed his downward spiral. “At that point, he thought he was Jesus Christ,” says Claudia. “‘I am Jesus Christ. I am Him. And it is such a wonderful thing.’ And then he started in on how he wanted to get closer to me. Sexually closer to me.” Matt called 911. Bill refused to go with the Collier County deputies who arrived, however. He didn’t fight, but he struggled. So they shot him with a Taser gun. He stood back up, ripped the Taser prongs from his stomach and screamed. The deputies Tased him three times before Bill was subdued. He was taken to the DLC, but was out in three days.

 

Search for Answers

“We think stress is a component. Drug use, too,” David Lawrence Center CEO David Schimmel says, trying to explain Bill’s psychotic break. “The onset is biochemical and could be electrical, in the brain. There are neurons in the brain that when they fire, they tell us everything we need to do. Something happens to that process. And all of a sudden people start to hallucinate or they start to get paranoid or they hear voices.”

Schimmel says that pre-1970s patients, if not institutionalized, would almost certainly be cast aside by society. Today, thanks to better pharmaceuticals and counseling, places like the DLC are able to stabilize psychotic breaks in an average of three to four days, he says. Yet, the stigma of mental illness remains, with many people grouping every ill patient into the violent category. Schimmel is loath to use the term schizophrenic for fear of its stereotypes, while others get mad at him because by acknowledging the stigma, they say, he gives it credence.

The most important factor in a mentally ill person regaining his or her life, Schimmel says, is not stigma or prejudice, but remembering that mental illness, like diabetes, is a life-long ailment and must be treated as such. Of course, everything begins with the crisis stabilization unit, where medications squash fantasy, and the patient can see that he is mentally ill. But oftentimes, as in Bill’s case, the 20 beds available at the crisis unit are occupied, and incoming Baker Act patients must be turned away.

“Can you imagine suffering from a psychotic break, you’re out of control and you have to sit in an emergency room for a day or two because we can’t take you in?” Schimmel asks. “It’s a dilemma throughout Florida, and I don’t think it’s going to be solved in many counties because look at the situation the state of Florida’s [budget is] in right now. We’re talking about cutting. Not adding.”

 

Turning Point

In the end, Bill says, “I couldn’t accept that everything was going to work out well, so ... so flawlessly. There were so many things that didn’t add up, that didn’t make sense.” After his third Baker Act confinement, Bill surrendered to reality and checked himself into the DLC. His treatment, if not without obstacles, was at least tranquil. “A large part of it had to do with me and figuring out my issues,” Bill says. “The best thing David Lawrence did was show me reality in such a calm, peaceful way. They showed me that I didn’t have to be caught up in these thoughts.”

DLC’s crisis stabilization unit consists of three wards: adult, child and detox. All three are monitored from one long command center that looks directly into each area, thereby tripling the size of a typical staff. Each ward has couches, board games, wooden tables and TVs. It is Spartan, but comfortable. Most of all, as Bill said, it is calm and quiet, like a library.

However, there were periods of distress. The first medication contorted Bill’s muscles like a full-body cramp. Then, he refused to take his pills, often tonguing the meds and spitting them out. He didn’t think he needed them. “Typical Bill,” says Claudia. Finally, Matt and Claudia wore him down, and Bill began taking the pills. Even when they got his meds right, he complained to his mother that he felt “like a shell,” that he “was empty.” It took a long time, says Claudia, for those complaints to go away.

At the same time, Bill formed an immediate bond with his therapist. “He was a big part of helping him get back,” Claudia says. And after three weeks, Bill was released from DLC. Although the medicine made him lazy, both his mother and his therapist demanded that he return to school. (Well, his mother demanded and his therapist encouraged.) He took a class at Edison State in the latter part of the summer and continued there during the next school year. Still, his therapist and his parents worried when Bill announced that he would return to UF last fall.

“I got a lot of warning,” he says. “[Gainesville] is ground zero. Whatever may have caused [my psychotic break], I’d have to be aware.” How’d it go? “I rocked it.” At UF, he’s focusing on landing an internship, which will hopefully land him a job in the business field. He joined the model United Nations, where he currently represents Germany. He prefers small get-togethers over blow-out parties. He’s looking into becoming a counselor for mentally ill people. But the No. 1 goal on his list? “To meet the girlfriend I don’t have right now. That’s the biggest thing on my plate.”

Still, there’s no finite resolution to Bill’s break. “He ultimately had to come to the realization of, ‘I have an illness I have to manage now for the rest of my life,’ ” Schimmel says. “What we do here is help people manage an illness that there’s not a defined cure for.” And Bill doesn’t always battle well. Like the “Nutty Professor” of old, he forgets to take his pills sometimes.

To jog his memory, Matt taped a black “X” near the door of his UF dorm room. Bill can’t go outside without seeing it, and remembering his pills. Perhaps that “X” reminds Bill of something else, too; that he’s not the center of everyone’s universe, but in a very small orbit, Matt’s and Claudia’s, he is the sun. “I was so scared of them two years ago. I thought they were trying to do all this harm to me,” Bill says. “That power of family, that bond, that love, you can’t break that. Because two years later, I’m not thinking about any of those things, but I’m still thinking about how much I love my family.” 

 

The Case Against Institutionalization

Florida’s treatment of the mentally ill has a dark history. Few ever found it darker than Kenneth Donaldson, a patient at the notorious Florida State Hospital.

David Schimmel, CEO of the David Lawrence Center in Naples, toured Florida State Hospital in Chattahoochee in the late 1960s. “It was abominable,” he says. Originally constructed as a U.S. Army post in the 1830s during the Second Seminole War, it resembles an antebellum mansion. Through the years, it was accused of mistreating and ignoring its patients, and was the basis of the 1989 movie Chattahoochee, which depicted an abusive mental hospital.

By the late 1950s, it was a model of institutionalization, housing 6,689 patients, including, says Schimmel, Down syndrome patients. “In the ’50s, ’60s and even ’70s, so many people’s lives were just thrown away,” Schimmel says. “It was a concrete dungeon with a drain in the middle of the floor.”

In 1957, Donaldson was committed there after displaying signs of paranoia. He was never violent, held down a job and the Pinellas County judge who signed the order told Donaldson that he would be sent to the hospital for “a few weeks.” Donaldson was released in 1971—almost 15 years later.

While there, he lived in a large cell lined with 60 bunks that were stacked so close together it was impossible to fit a chair between them. During the night he was often wrenched from sleep by the screams of his roommates. Always present was “the fear, always the fear you have in your heart, I suppose, when you go to sleep that maybe somebody would jump on you during the night,” he said. One-third of his roommates were criminally insane. During a 10-year stretch he saw his doctor for an average of 14 minutes a year.

In 1975, the U.S. Supreme Court ruled in Donaldson’s favor, deciding that states could not commit individuals to an institution if they weren’t violent and could live on their own or with the help of responsible parents, relatives or friends. This, along with the Baker Act, led to deinstitutionalization in Florida. Today, Florida State Hospital boards 1,042 patients.

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