Aaron Alexis: My kingdom for a good night’s sleep

Thursday, September 19, 2013

Good afternoon:

The Aaron Alexis case is about gross indifference and lack of effective medical care for our brothers and sisters who are mentally ill.

The Washington Post reports today that

Navy Yard gunman Aaron Alexis had sought treatment for insomnia in the emergency rooms of two Veterans Affairs hospitals in the past month, but he told doctors he was not depressed and was not thinking of harming others, federal officials said Wednesday.

Those walk-in visits came just two weeks after Alexis had called police in Rhode Island to report hearing voices and feeling vibrations sent through his hotel-room walls. On Aug. 23, he went to a VA hospital in Providence. Five days later, he went to another one in Washington, seeking a refill of the medication he had been prescribed in Rhode Island, according to the officials, who spoke on the condition of anonymity because the investigation is ongoing.

In both cases, doctors sent Alexis home with the medication, identified by law enforcement officials as Trazodone, a generic antidepressant that is widely prescribed for insomnia. The VA doctors told him to follow up with a primary-care doctor. It is unclear whether he did.

“Mr. Alexis was alert and oriented, and was asked by VA doctors if he was struggling with anxiety or depression, or had thoughts about harming himself or others, which he denied,” the Department of Veterans Affairs said in a memo sent to Congress on Wednesday.

This article brings back frustrating memories.

As I reported yesterday, we invited our delusional and paranoid friend to stay with us in order to prevent him from hurting himself or others. Nothing we said or did appeared to make any difference. He could not sleep and his delusions worsened over the course of several days.

We realized that he needed psychiatric assistance so we took him to a nearby hospital ER. The triage nurse agreed, but all of the hospital psychiatrists worked in the secure mental health clinic and no ER patient could see a psychiatrist unless the screener admitted the patient to the clinic for a mental health assessment. Despite our friend’s obvious mental and emotional agitation, the screener refused to admit him to the clinic when our friend insisted that he only needed a good night’s sleep and denied that he was a danger to himself or to others.

The ER doctor subsequently capped the frustrating visit with a refusal to write a prescription for an effective sleep medication.

We scheduled appointments with various psychiatrists on a serial basis, a frustrating process by which we learned that, unless they have committed a violent crime injuring another person, no effective psychiatric relief is available to help a mentally disturbed person who refuses to admit that they are a danger to themselves or to others.

In other words, you cannot get there from here.

Aaron Alexis eventually figured this out during the six-week period of intensifying paranoid delusions, inability to sleep, and rising anxiety over losing his job and everything for which he had worked.

13 people are dead. This tragic case is not about collecting and maintaining better cross-referenced records so that people can be publicly identified and humiliated as mentally ill and have their security clearances revoked.

Mental illness comes and goes. Bipolar disorders can be managed with appropriate medication.

This case is about gross indifference and lack of effective medical care for our brothers and sisters who are mentally ill.

36 Responses to Aaron Alexis: My kingdom for a good night’s sleep

  1. silk says:

    @ rachael , im a heavey person wen it comes to science and the goverment . they can put a man in space and they can create a deadlly desease so dont be surprise at them program people to kill one another . i give u a small example – the media .

  2. silk says:

    i may sound a little off but i some times beleave that the goverment program people to kill . in other words , they take a normal person and over a corse of time that person is mentally program to kill . they test tube certain tactics on a person to make the individual beleave that he or she are mentally unstable . and it takes time . it is to create a political agenda . thats what i beleave . sometimes.

  3. dianetrotter says:

    My sister was released on parole two weeks ago tomorrow. I am surprised she hasn’t been sent back yet. She was diagnosed bipolar parahoid schizophrenic in the mid-90s. We tried to get help for her. The intake person said unless she hurt herself or someone else, there was nothing they could do. In May 2007 my sister killed a man, her friend. They charged her with first degree murder and villified her in the papers. Before she was released I told someone on the parole board that she should be on meds. That person agreed. My sister is out on NO meds. Gave an address for residence and is living in our family condemned house. That is where she killed the man. Here we go again. 2nd verse same as the first.

    • Your sister’s story is almost too painful to read.

      We’re discovering that there is no treatment for the mentally ill even when they seek it.

      Words fail.

    • Girlp says:

      That’s sad diane, my son has the same diognosis but also suffers from anxiety and has other health problems. How could they let her go without meds knowing that she could be a danger to herself or others I don’t know. We do need a system of caring for the mentally ill for their sake and ours. We also need gun control not everyone should have a gun.

    • fauxmccoy says:

      @diannetrotter

      i am so sorry to hear of these troubles 😦

      when my family of origin disintegrated in ’82 (i was 17) because of my bipolar father’s violence with guns, we, too, had done everything we could possibly do to get him help. he could always hold it together during the involuntary 72 hour observation so was always released.

      we went into hiding, but he eventually found us, left shotgun shells on our doorstep along with other horrific acts. we found out that the local sheriff’s dept had received over 200 complaints about his behavior and still, nothing was done. … oh, they did send a young female social worker out to visit him. she was scared enough that she never returned, but happily reported that my father seemed capable of providing food, clothing and shelter for himself.

      i lived in dread for many years of receiving a call from the sheriff that he either suicided or took someone else out. thankfully, he passed at age 80 without ever physically harming another. the damn ‘system’ is as dysfunctional as the mentally ill it purports to serve. mental illness is devastating to the families it leaves absolutely helpless and to the communities where these tortured souls reside.

      i wish i could offer some hope, alas, i cannot.

    • Trained Observer says:

      Oh my, diane … it’s so difficult to know where to start in a tension-filled situation like this. Take care.

    • Two sides to a story says:

      Have courage.

  4. Malisha says:

    Sleeplessness is a monstrous problem. See: article in American Journal of Psychiatry (back in 1987) by Dr. Thomas Wehr, et al:

    Sleep reduction as a final common pathway in the genesis of mania. Am J Psychiatry. 1987;144:201–204. [PubMed]

    Sleep is itself a form of mental health. Sometimes, the ONLY form.

  5. cielo62 says:

    What is disgusting is our western world’s focus on “cure” instead of “prevention”. We see this with everything medical. Shit, people do more preventive maintenance on their cars than on their health!

  6. bettykath says:

    It’s interesting that nutrition was brought up. I had occasion to take someone for a check up due to strange behavior. The dr. diagnosed paranoid schizophrenia and wanted to admit her. She absolutely refused. After spending some time with me and eating properly, her symptoms went away.

    • Trained Observer says:

      Hmmm, Betty Kath … I don’t believe paranoid schizophrenia — often difficult to properly diagnose — would be pinned down during a routine check-up, even by a specialist in such mental disorders .

      Nutrition can be key, though, with any number of personality issues, I am told by one who should know … who insists he does better on a mostly vegetarian diet, despite intense desire for steak and bacon.

      A couple of seasons ago, I allowed an old college era flame (our respective mothers had been colleagues) to come down for a few weeks as a winter houseguest. He had found me via Google, so after several months of e-mailing, I agreed.

      After arrival, this MIT & Cornell-educated soul told me I could read a synopsis of his doctoral thesis on pipe-flow online. To please him, I looked it up.

      But while Googling, a report surfaced showing that he had filed suit against the NTSB for denying him a pilot’s license. The NTSB’s concern? He had been both voluntarily and involuntarily institutionalized on several occasions after diagnosis as a paranoid schizophrenic.

      When I inquired about that, he denied accuracy of the diagnosis, but admitted to being a “wreck of a person.”
      His words, not mine. … and all because the NTSB had “helped ruin his life.”

      He truly was not the person I had known 40 years ago, and it was sad to see the wreckage.

      Over the decades, he’d made assorted poor decisions, and refused to take responsibility … instead always blaming someone else … his father, his uncle, brother (who was a big success in their shared field), his academic advisors, his landlord, the doctors who mislabeled him, the guy who sold him a defective boat. … Just listening to this was both sad and tiresome.

      Did I feel alarmed by the new-found possible schizophrenia knowledge or threatened by possible physical violence? No, although maybe I should have been.

      But I was relieved when he departed in a timely manner as planned.

      As a sidelight, during this visit, I learned two things:

      1) He never received the letter I’d written announcing my engagement because he’d moved to a different grad-school apartment. His mother told him during final exams, and therefore he blamed me for screwing up his grade on one course.

      2) I’d always sensed his now long-deceased father didn’t like me when we were dating, and I had assumed he didn’t think I (a state U. student) was in synch for his Ivy League son. What I learned — four decades later — was, yes, the old man did indeed disapprove of me. But it was because I wore contact lenses. My friend is color-blind and with my poor vision, the old man thought our children surely would be flawed.

      Fast forward: My wreck of a friend hardly can see beyond his nose despite Coke-bottle glasses — while my vision, with contacts, remains 20/20. (Even he thought that was amusing).

      My point in all this is that schizophrenia, of all varieties, is tough to pinpoint and difficult to understand, since often
      people can masquerade as quite normal — on the surface.

      And so what went wrong with the mind of Aaron Alexis, who seemed to have been a regular guy? I’m doubtful investigators will ever get to the bottom of it. I doubt that it was merely a nutritional issue.

      • bettykath says:

        As you point out, it’s hard to diagnose with a single visit so it’s not surprising that my person was given a wrong diagnosis. I don’t believe she was “cured” through better nutrition. I believe that her symptoms (undiagnosed) were due to poor nutrition and when her nutrition improved, the symptoms disappeared. I guess my point is that diagnosis is difficult and symptoms can sometimes get the wrong label.

        • Trained Observer says:

          Yes … that makes sense. Better nutrition could ease any number of mental issues, possibly spurred by physicial factors. In fact, better nutrition might help us all, I type while reaching for a Diet Coke, which definitely isn’t the brightest thing be doing.

        • Two sides to a story says:

          I had a friend with a schizophrenic husband. She kept him mostly at home and cared for him – he was apparently in very bad shape and spontaneously became better. She didn’t attribute this to anything in particular – apparently they’d tried a number of things including medication and diet for years and had no change and then he suddenly became lucid. So I guess my point is that there are probably many factors involved in different diagnoses and what might help one person may not help another.

          • Trained Observer says:

            Plus, people suffering from schizophrenia may have side mental/physical ailments that wax and wane.

          • fauxmccoy says:

            @twosides — i am likely re-stating this, but my bi-polar father who refused medication for his illness and never openly admitted it to me, did improve noticeably and spontaneously with age. i would say around 60ish. this is not to say he did not evidence unusual thoughts or behavior, but his body’s ability to act upon them slowed as did the peaks and valleys of his illness.

            i became intrigued enough to do some research. there is some evidence to support that at least some forms of bi polarism can ‘flame out’ with age, if the sufferer has not given in to suicide, which is a very viable option for them. just as we know that onset is usually late teens/early adulthood, for some, there seems to be a limit as to how long the body can continue that rapidly repeating cycle.

            one could not call it a remission, but i would be lying if i said that this process did not bring about an enormous sense of relief to family and most assuredly with my father.

          • cielo62 says:

            Faux McCoy- that supports my personal theory that hormones are a serious factor in mental illness/ health. Hormones flare into life in teen years, and subside tremendously later in life.

            Sent from my iPad

          • cielo62 says:

            Two Sides- I personally believe that hormones are an unstudied contributor to mental health. PMS is just a joke but shouldn’t be. When I first entered womanhood, my first menses landed me in the hospital. Passed out cold. Each month it was either very painful cramps or a phobic fear that would last 3 days. Damn doctor even told my parents to take me to a psychiatrist! With years of experience, I calm myself down with my mantra ” it’s just the hormones.” Men’s hormones change across life like women’s but they aren’t studied as deeply… Except to make Viagra!

            Sent from my iPad

  7. #FLORIDUH is an example of a state that uses the mentally ill as grist for the mill of injustice to generate funds through bogus facilities that recycle these human beings back into society without support to ensure that the fat dirty courts are fed their meals served on the backs of human suffering #FACT
    the status quo MUST GO

  8. fauxmccoy says:

    follow

  9. crazy1946 says:

    We live in a strange and confusing world. When a person is acting strangely or different than what we consider normal we question the mental stability of the person. If that person commits a crime causing harm or injury to himself or another we ask why he/she did not receive treatment, yet most of us also demand the government stay out of our lives. How do we resolve the problem of rights of the individual in forcing mental health care upon some people and at the same time demand our right to not be subject to the same process? Please understand, I’m not pointing fingers, all I am trying to do is point out that we live in a nation that all people (allegedly) have the right of freedom, and to force one of them to accept help could be seen as a violation of that freedom.

    • Two sides to a story says:

      Good point.

    • MedicineBear says:

      If we had Universal Healthcare for All (cradle-to-grave), people could actually receive health CARE for mental or physical problems. Few would need to be FORCED to get care — most don’t receive care now because they have been squeezed out by the existing USA Corporate Medical Profit system (“Mega-$oylent-Green-R-Us”).

      • crazy1946 says:

        MedicineBear, It would be a good solution to the health care crisis we have in this nation, but I don’t think we will ever see it as long as we have people in our congress that are owned by corporate America (and world)! How many working men and women who have insurance can’t even afford to seek medical attention when they need it? Even with insurance, the cost of treatment is more than most can afford to pay. Many younger people do not realize that even with Medicare (at a cost of over 10% of most peoples meager SS income) there is a deductible that forces many seniors to chose between health care and eating.. Think about it for a moment, the choice between paying to be healthy and not being able to buy food, or simply buying food and fighting illness with our medical care, tough choice for too many….

  10. loui$2012 says:

    And to our brothers and sisters who are veterans who are treated like garbage…..

    We have the same problem.

  11. Two sides to a story says:

    I lived for 36 years in a Southwestern state that , was rated as 51st in spending for mental health care for many years (I’m not sure what the standing is now -probably still very low in this economy) You may wonder why 51st since we have 50 states – because AZ was rated lower than the US Virgin Islands in mental health care spending.

    This is unconscionable. I don’t understand why we perpetuate the myth that this is the greatest country in the world. It is not – we neglect our own people’s social service needs on a regular basis.

    Right now Congress is angling to cut food stamps to 4-6 million people. Approximate 60% of people on food stamps work full time and can’t afford adequate food because minimum wage is too low. Conservatives yell about fraud and waste but the rate of fraud in the food stamp program is only 1%.

    Here’s a good article about how nutrition impacts schizophrenia and other mental disorders:

    http://articles.mercola.com/sites/articles/archive/2013/09/19/bad-diet-bad-behavior.aspx?e_cid=20130919Z1_DNL_art_1&utm_source=dnl&utm_medium=email&utm_content=art1&utm_campaign=20130919Z1

    It’s critical that mentally disabled people get not only the proper medication but proper nutrition as well. In fact, some people, as you can see in this article, can be stabilized with good nutrition and extra vitamins with no medication. I have two bipolar sons who are far more stable when they take certain vitamins in large quantities. One stays on meds and the other does well without them. Exercise is important in that equation too.

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