Committed

In recent years, the mentally ill have made greater claims on their civil rights, including the right not to be treated. But what happens when part of your illness is not knowing that you're sick?

by Clea Simon

Ally's son has been talking to himself. He's been scaring people in their small town, wanting to chat in his particularly intense way, and pushing himself in the face of those who try to walk away.

Ally isn't surprised. She'd seen the signs that Greg, 38, was not taking his new drug, olanzapine, weeks ago.

Ally has been through this before, through more than 25 hospitalizations -- since Greg's schizophrenia was first diagnosed 20 years ago. After one such hospitalization, after the delusions and feelings of persecution faded, he stayed on one of the new miracle drugs, clozapine, for more than two years. That's when they were able to set him up in a subsidized apartment nearby, and when he first tried going back to school. But then he tapered off again -- one of the thousands of mentally ill people who do so, against medical advice.

Ally knows that trying to get her son back into voluntary treatment won't work. "If I say to him, `Why don't you talk to a doctor?' he just stares at me and says, `Why don't you talk to a doctor?' He has never accepted that he is ill."

Usually, having him hospitalized means calling the police and the fire department to have him involuntarily committed. Ally laughs with resignation and exhaustion at her own tales of household destruction: the flooding tubs in locked bathrooms, the filth and the broken glass. She talks about the time Greg pulled himself together and convinced the judge at his commitment hearing that he could take care of himself. And then took off on a cross-country odyssey that ended only when a relative retrieved him, barefoot and confused, from the Denver airport.

This time, Ally doesn't want to scare Greg, doesn't want him to bolt and turn up weeks later, dirty, even skinnier than he is now, perhaps beaten or abused. She is waiting until his decompensation -- his decline into another cycle of psychosis -- has gone far enough to be apparent to any judge, and then she will try to have him hospitalized again. She believes he isn't violent or consciously suicidal, and these are the only two legal reasons to hospitalize anyone against his will in Massachusetts, at least until he is so sick, so clearly ill, that his well-being is in danger. She knows she is pitting her wishes -- her desire to care for Greg and her fears for his safety -- against his legal right as an adult to determine how and where he will live. She worries too much to do otherwise.

For now, Ally waits until he is in such bad shape that it will be obvious that he cannot take care of himself. It breaks her heart to see him rail-thin, so dirty. It scares her to think of his delusions, his periods of catatonia -- of blank unresponsiveness -- particularly when she considers that one of these may occur as he drives his beat-up car around their small New England village. She no longer hopes for a cure; she just hopes that this time she pulls a good judge.

On to part 2

Clea Simon's Mad House: Growing Up in the Shadow of Mentally Ill Siblings (Doubleday) was named Book of the Year by the Alliance for the Mentally Ill (Mass.)