"Schizophrenia is to psychiatry what cancer is to medicine: a sentence as well as a diagnosis." A psychiatrist made this observation in 1985. Since that time, it's become less true about cancer, but even more accurate about schizophrenia. While billions of dollars have gone into cancer research, our community's response to schizophrenia has been a collective yawn and shrug of the shoulders. Because of that neglect, in addition to a lifelong battle for health, far too often a diagnosis of schizophrenia has come to mean a prison sentence, and in some cases, a death sentence.
In the last three months, two young men have been found dead in their cells at the Anchorage Correctional Complex. Just this month, on Mother's Day, Mark Bolus hung himself with bedsheets in an isolation cell. Only 24 years old, Bolus suffered from paranoid schizophrenia. According to his mother, Bolus asked to be placed in an isolation cell because he was scared out in the general population.
In March, an inmate named Davon Mosley, died in his cell at the Anchorage Correctional Complex. He was 20 years old and had been suffering from bipolar disorder and schizophrenia since his early teens, according to an article in the Anchorage Daily News after his death. The Department of Corrections uses a wall of bureaucracy thicker than any in its jails to conceal the details of these types of incidents. It has not yet explained what happened to Mosley, and probably will not unless Mosley's family can afford to hire an attorney to force it to by court order.
But these two events demonstrate that our jails and our jailors are particularly ill-equipped to keep people with severe mental illness safe.
According to Dr. David Sperbeck, the Director of Psychological services for the North Star Behavioral Health Hospital, Mark Bolus had reason to be fearful of the general prison population. Sperbeck, who has practiced at both the Alaska Psychiatric Institute and the Department of Corrections for years, has seen that inmates suffering from severe mental illness will often be targeted by predators within the prison population who try to extort privileges, services and property from them.
"As a consequence," he said, "chronically mentally ill individuals will often seek the very physical and social isolation that is a source of protection from predators, in spite of the fact that in the long run this is very harmful to them and can cause rapid decompensation in their emotional condition."
Turns out isolating someone with schizophrenia is a very bad idea. Among those who are trained to handle people with severe mental illness -- which prison staff are not -- it is well recognized that social and physical isolation is extremely destructive and counter-therapeutic. When sufferers are isolated, they have no distraction from their own delusional thoughts, which often overwhelm their perception of reality and emotional condition. This is why most psychiatric hospitals severely limit the degree to which patients can be isolated or left alone.
So in other words, when incarcerated, inmates like Mosley and Bolus have no option that will keep them safe: They either have to stay out in the general population and be victimized by predator inmates or chose isolation and be tormented by escalating delusions.
I know many people reading this will be unmoved by the suffering of Devon Mosley and Mark Bolus because of two labels attached to these young men, labels that evoke public apathy, even antipathy: They are prisoners, and they are mentally ill. I don't know why, but as a community, we still often treat severe mental illness -- which in a disease like schizophrenia involves an organic defect in the brain -- as a failure of character rather than biology. The equivalent would be telling someone afflicted with brain cancer that they have that disease because they made bad life choices. It is this type of societal scorn that often leads the severely mentally ill to acquire the second label, prisoner.
To manage a disease like schizophrenia takes effort we should all label as heroic. But many people succeed in doing just that: working, living independently, maintaining the trappings of normalcy. Meanwhile, they are coping with a disease that steals decades from its sufferer's lives: many die in their 40s or 50s from suicide, neglect, or medical conditions caused largely by the drugs used to control psychosis. Even the latest antipsychotic medications cause an average weight gain of 40 pounds along with other side effects like hypertension, diabetes and tremors -- all for minimal relief from psychosis much of the time. There is no cure.
And yet what support does our community offer when they stumble?
Consider another example, one that did not make the newspapers. Elaine (not her real name) is a woman with schizophrenia who for many years did just what society asked of her: She lived on her own and held down a job. But then she experienced a loss that unraveled her.
Elaine went to the Alaska Psychiatric Institute, where she was taken off her old medications and put on new ones. It can take weeks, even a month, for a person to respond to new medications. But API is only a short-term care facility and patients are discharged after 72 hours -- whether they are stable or not.
Alaska has no long-term care facility for the mentally ill. The only long-term care options are behavioral health assisted living homes. Receiving a license for an assisted living home requires no special training, experience or education. Anyone can open one up, and there is no guarantee of a spot for the severely mentally ill. Assisted living homes can refuse whomever they want.
Elaine was released from API before she was stable, without a place in an assisted living home. Her follow-up at Anchorage Community Mental Health Services was six weeks out because she'd never been there, and their new patient intake person was on vacation.
Elaine became fully symptomatic, wandered into an establishment downtown that didn't want her there, and was arrested for trespassing. She too was taken to the Anchorage Correctional Complex. After a day in jail -- where she was not provided with any medication -- Elaine was touched from behind in a sudden manner by a female corrections officer who had no training in dealing with severely mentally ill prisoners.
Paranoid and frightened, Elaine turned around and punched the woman. She was charged with a felony.
Let's give Elaine a more socially acceptable disease -- let's say she had a brain tumor that was causing delusional thoughts. Wouldn't you be horrified by her treatment? Thrown out of a hospital before she had recovered, denied outpatient care, taken to prison while still sick, and then denied the medication that would return her to health -- it seems unthinkable that we would allow someone afflicted with cancer to be treated in this manner.
One of the basic tenets behind the idea of community is that, collectively, we help those who -- through no fault of their own -- can't help themselves. Like anyone suffering from a debilitating illness, Elaine, Davon Mosley and Mark Bolus needed our help. Not only did we refuse the help they needed, but when they failed on their own, we put them in an environment guaranteed to promote their decline.
For Mosley and Bolus, our neglect had fatal consequences. Can't we as a community muster up the compassion to do better than that?
Marcelle McDannel earned a law degree from the University of Southern California, then made the life-changing decision to become a prosecutor in Bethel, Alaska. Several years later, she worked as an appellate lawyer with the state Office of Special Prosecution and Appeals and then as a prosecutor in the Anchorage District Attorney's Office. Now she is a criminal defense attorney statewide.
Author's note: A special thanks to Jill Ramsey, behavioral health training coordinator for UAA's Center for Human Development Trust Training Cooperative, for her contributions to this column.
The views expressed here are the writer's own and are not necessarily endorsed by Alaska Dispatch, which welcomes a broad range of viewpoints. To submit a piece for consideration, e-mail commentary(at)alaskadispatch.com.