An ugly job, but it’s a living

Have you been taking your medication?

There’s a question I must have asked people a couple of million times.

The mentally disturbed are really not a police problem, but way too often cops wind up dealing with them.

Talk about a recipe for a fucking disaster.

Whatever you want to call them – emotionally distburbed, mentally ill, crazy as hell…they present a challenge to law enforcement that we’re not very well prepared to deal with. Sure, past tragedies (and resulting lawsuits) have forced police agencies to become better prepared, but the truth still remains that it’s just not our role in society to try and help folks who are mentally ill.

And still we get called.

We get called when someone’s illness manifests itself in dangerous ways. When nobody else can deal with them the police get the job. And when we show up we find ourselves stuck in role conflict hell.

When the police deal with someone who is acting unreasonably there are two basic routes to take: Logic or force. When you can’t appeal to someone’s sense of logic, i.e. “Stop doing that or you’re going to jail”, you resort to force “Okay, it’s time for the cuffs”.

But way too often, when we encounter the disturbed, we find people who are endangering themselves more than anyone else Their ability to sense logic or respond to force has gone haywire. It’s like a pack of chimpanzees has gotten loose in the wiring and are busily yanking out connections when they’re not randomly making new ones. Sometimes you can talk them into compliance, and other times you can force them into it. But there are uncountable occasions in which neither works very well. And good old option B, “do it my way or I’ll make you”, can be so ineffective with people who just don’t react to pain and seem to have incredible strength.

One night in the lobby of a private mental hospital, me and six other cops found ourselves fighting an older woman who stood 4’11” and would need lead weights in her pockets to tip the scales past 90. There was a point when we all thought we were losing.

It’s pretty damn sobering to realize that someone the size of an elf is kicking your ass.

It got really fucking serious when she started waving around the razor blade.

It wasn’t her first trip to the hospital. She been diagnosed years earlier and was on a regime of medication that let her lead something pretty damn close to a normal life. Not perfectly normal, I’m sure there were side effects, but it was close enough that she could enjoy freedom, her family, and all manner of things that beat the hell out of duking it out with the cops. Especially so when the reasoning was because the voices told her we were monsters intent on murder.

But she had gone off her meds. The thinking goes something like this: “I’m doing so much better on this medication. But only crazy people need medication, and I don’t want to be crazy. Hmmmm, if I stop taking my meds then I won’t be crazy anymore.”

It’s a scenario played out a thousand times a day. Right after hearing all about how the black helicopters have been using special rays on them, their spouse is poisoning their corn flakes, or there are a nest of snakes underneath the sofa; the first thing the cops want to ask is “Have you been taking your medication?”

The answer is always no. Because it’s only the ones who stop taking the damn pills that start doing weird shit that makes someone want to call the cops.

Whatever the outcome, you always want to know the answer to one question. “If the medicine keeps you from miserable instances of insanity like this, why would you ever stop taking it?”

And that is the subject of a profound and moving must-read article by Heather at Dooce, a woman who is one of the superior authors in the blogosphere.

But I don’t understand why being right is more important that being happy, why someone would go on living with a sick, nauseating swarm of junk in her stomach rather than trying to figure out how to fix it, because the act of even admitting that she feels this way is somehow a character flaw.

Heather is not just another concerned onlooker wondering “why won’t that crazy person take her meds?” Her medication saved her life and continues to do so every day.

Sometimes I have bad days, sometimes bad weeks, but the medication enables me to cope, to see a way out and over those times. I am not ashamed of any of this.

An absolute great read and one of the best uses of your browser today.

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4 responses

  1. If it makes you feel any better (which it won’t) we have the same problems over this side of the water.

    Police officers here have a power to detain people they find “mentally disordered in a public place” to take them to a place of safety. The act that covers this defines a place of safety as a mental hospital, ordinary hospital or police station.

    Guess where they end up 99% of the time? In some cases, we are expected to take them from a hospital to the station, even though the act specifically prevents people from being taken from one place of safety to another.

    Some criminals have mental illnesses – not all people with mental illnesses are criminals though. The fact that these people end up in police cells is a national disgrace.

    15 December, 2007 at 11:58

  2. The thing that really bothers me are the people that get killed when they become violent and dangerous. My now former employer bought first generation tasers in the 80’s partly because of an deadly force incident involving a mentally disturbed person who was off his meds. He showed up at the main police station at shift change, walked up to a group of officers at the front door and started waving around two martial arts swords. He wasn’t the first person whose illness sent him on a collision course the police, nor was he the last.

    Using deadly force to protect oneself is justified regardless of the mental state of the person who presents a credible threat. A couple of swords is definitely in the credible threat category. But realizing that the guy probably didn’t see his targets as police officers, but as demons from Hell or menacing aliens from the 10th dimension, has to make the officers involved want to know why such a situation was forced upon them.

    16 December, 2007 at 6:35

  3. foofoo5

    First, I can’t imagine how I find myself blogrolled on the sight of a real writer, but I am, indeed, honored.

    The issue of medication non-compliance is extraordinarily complex and holds its own as a significant area of research. I would note two things:

    The “efficacy” of psychotropic medications is measured by both the patient and the prescriber. The prescriber’s side is “easy” because it is simply based on the observation of improved functioning – and in many cases of the type of people that cross paths of law enforcement, improvement in functioning, rather than alleviation of illness, is the best hoped-for outcome. The patient’s assessment – guided by the prescriber – is to weigh positive versus negative symptoms. The research indicates that the majority of patients who stop taking medications do so because the negative symptoms outweigh the positive symptoms; specifically, side-effects. This can range from sexual (e.g. erectile and/or ejaculatory dysfunction), to metabolic (e.g. gross weight gain, medication-induced diabetes), to neurologic (e.g. ticks, twitching, stiffness, Parkinson-like syndromes). While the prescriber will try to compensate for side-effects (change dose, add or change a med), ultimately, the patient will determine if the “trouble” out-weighs the “benefit,” and far too many will stop taking the med. And ordinarily, without “consulting” the prescriber.

    Secondly, the article by Heather is written by someone who, at baseline, is functioning at a level significantly higher than the patients to whom you refer; greater “fund” of basic information & intelligence, etc. The “lucidity” (i.e. the logic of appreciation for mental stability, etc.) and capacity, Heather v. the persistently mentally ill, is disparate. One quick example: in psychosis, a frequent symptom is “concreteness.” The Parole Agent instructed the offender, “You be sure to take your all your meds,” emphasis mine and the patient’s. The guy went home and, following directions, took his entire 30-day supply in one gulp.

    I took the ass-kicking of my life in a brawl with a floridly psychotic man, off his meds, rescuing a (dumbass) intern. Fractured my skull, broke my ribs, bit me, and spit in my eyes & mouth before I got him to the ground and the police arrived. I had to be tested for HIV and Hepatitis C for a year. Lying in a trauma bay, an emergency response psychologist who accompanies the police asked me, “You don’t want to press charges, do you?” He got his “second strike” in CA because of me. And it was my pleasure.

    16 December, 2007 at 13:19

  4. Did you ever see the Three Stooges skit in which someone refers to them as “Gentlemen” and they all turn around looking to see who is being referred to?

    First, I can’t imagine how I find myself blogrolled on the sight of a real writer, but I am, indeed, honored.

    I keep looking behind me.

    Thank you for the compliment, but I tend to think of this thing I’m doing here as a combination of cheap therapy and a misplaced sense of self-importance that pours itself out onto the world thanks to a well-developed set of keyboard skills. A world class ability to bullshit and a good vocabulary have stood me in good stead for many years.

    I confess I have not read any of the research you mentioned. Some of the side effects certainly sound as if they could encourage a user to seek alternatives. When I first heard a commercial for a medication that mentions that the use of the drug comes with “No Sexual Side Effects!” my first thought to ponder was the exact nature of these side effects. After realizing they weren’t talking about an erection that wouldn’t quit but rather an erection that wouldn’t start – I made a mental note to never ever get any disease whose cure carried that side effect.

    My research was limited to personal field research. The kind conducted usually as I was huffing and puffing to catch my breath. With sweat pouring down my face, sometimes mixed with blood, arms aching, shirt ripped and firmly convinced that I had just survived hand to hand combat with a pissed off Yeti. Sometimes I would ask the patient/suspect, but if they were raving too badly I would ask the family – “why is this person not taking their medication?” Too often all I got in response from the disturbed was along the lines of: “imgoingotkillyouimgoingtokillyou!” Friends and family were usually no help and would just scream totally uninformative commentary: “Don’t hurt our Grandma – She’s 86 years-old!”

    Seriously, I managed to talk to a number of these folks and their families under less difficult circumstances, including times when the disturbed person was medicated and functioning. Many times the family didn’t have a clue why their loved one skipped his meds, but the disturbed themselves usually gave me some version of “I didn’t feel right” when they were medicated. Perhaps the devil was in the details and the side effects were unbearable – they never went into much detail with me.

    My inspiration for writing this post was only partly due to what Heather Armstrong wrote about her experiences. I’m halfway through John Grisham’s first nonfiction book, The Innocent Man, that tells one version of events as to how two Oklahoma men were wrongly convicted of murder. One of the two men had a long history of mental illness, and much of the story is devoted to his long downward spiral. Alcohol, as happens to many people, was an aggravating factor and contributed to his frequent trips off the meds and into a morass of trouble.

    I say I’m halfway through Grisham’s book because I had to stop reading at that point when my bullshit meter was pegged. So, as I am in the midst of independent research, I am not yet ready to say how far I think he may be off on some things, but his depiction of this man and his ups and downs with mental illness are horrifying. It’s good to be reminded of how good many of the things are that we have in our lives, and this week I’m super grateful for good mental health.

    Heather’s post at Dooce came right in the middle of reading The Innocent Man and my thoughts pondered the question that Heather asked and the same question most cops have asked, “Why did you stop taking your meds?”

    I’m going to devote some time to your commentary regarding people like Heather and those like the buzzsaw from hell that put you in the hospital. Comparing her history, which she is very open about and you can find much more detail in her archives, and someone like the guy I’ve been reading about in Gresham’s book, or the guy you ran into.

    I wonder if the difference, at least for some of these folks, is like that quality present in recovering alcoholics who are successful in staying away from booze. It’s number one on the hit parade for the twelve-steppers: “We admitted we were powerless over alcohol – that our lives had become unmanageable.” Maybe you have to admit your demons are more powerful than you alone before you can accept help. The cure sucks, but the disease is the road to hell.

    16 December, 2007 at 18:54

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