The diagnosis was adult onset schizophrenia. The symptoms would have been obvious to anyone. To anyone but the young man suffering the disease.
Carlos Larrauri heard voices. At a Heat basketball game, he was sure that athletes down on the playing floor were talking directly to him. He was in incessant conversation with himself. He could no longer manage rudimentary college assignments that should have been simple for a summa cum laude graduate of Miami Killian High School.
He developed an obsessive interest in religion. There was no hope he could hold a job. His behavior became increasingly erratic — dancing in the middle of the street and singing at the top of his voice as he headed out at 2:30 in the morning to shoot basketball at a nearby playground. He cut himself off from his acquaintances until he was nearly friendless.
Carlos also suffered from another devastating manifestation of the disease. He was in denial. He didn’t or couldn't recognize that his life had become consumed by his own delusions.
Now that therapy and psychotropic medicines and a determined Cuban mother pulled him back from the precipice, Carlos, 26, can look back and recognize his insistent denial with remarkable clarity. “I had a complete lack of insight,” remembers Larrauri, who serves as a case worker for the Miami-Dade County Court’s Mental Health Project.
Some 40 to 50 percent of those suffering from serious mental illnesses simply don’t recognize that they’re sick. They see no point to treatment, no reason to subject themselves to the unpleasant side effects of psychotropic drugs.
The conundrum around this illness is that even while a sizable percentage of its victims are sapped of rational self-analysis, the law assumes otherwise. In Florida, an adult not deemed an imminent danger to themselves or others can simply refuse treatment. Even as they sink into homelessness or get pulled into the criminal justice system. Even as family members and friends and healthcare workers watch their awful slog toward self-destruction, unable to intervene.
Before involuntary intervention and treatment are allowed, “They must be homicidal or suicidal,” said Miami-Dade County Judge Steve Leifman, chairman of the Florida Supreme Court's task force on mental health issues. “Anything short of that, it’s not happening.” After an involuntary patient is stabilized at a crisis intervention clinic, the frustrated Leifman noted, they’re simply released, back into the streets with little in the way of follow-up care, probably to repeat the brutal cycle.
Carlos Larrauri can see the problem now from the other side. He said dealing with the families of the mentally ill, homeless or in jail, “is one of the toughest things I encounter — talking to parents who’ve done amazing jobs, who’ve sent their son or daughter to good schools and then got them the best help.” But when their children become consumed by mental illness and rebuff efforts to provide therapy and medicine, they’re helpless. “It breaks your heart.”
The mass murder last week in Santa Barbara seems to have been borne of a similar denial. Reportedly, after receiving psychiatric therapy for much of his life, the 22-year-old killer resisted further treatment after his 18th birthday. Elliot Rodger apparently refused to take psychotropic drugs prescribed for him. His family was increasingly concerned by his erratic behavior. But there was little they could do.
U.S. Rep. Tim Murphy, R-Pa., a child psychologist, responded to the massacre by introducing legislation that would require states to amend criteria for permitting involuntary hospitalization from imminent danger to themselves or others to a “need for treatment.” That’s already the standard in 18 states, but not, sadly, in Florida (California passed legislation in 2002 that allows local authorities to order involuntary treatment, but only two counties, not including Santa Barbara County, have bothered to implement the law.).
But the killings in Santa Barbara hardly represents what usually happens when the mentally ill refuse treatment. Only some small percentage of violent crimes can be attributed to mentally ill perpetrators. Mostly, they’re the victims. Most of their encounters with the criminal justice system are the result of petty charges, and they then are trucked off to jails or prisons that are ill equipped to treat mental illness. The Dade Correctional Institution in Homestead has been roiling over allegations that guards routinely torment and torture prisoners on a cellblock reserved for the mentally ill, and that the guards locked one prisoner in a scalding hot shower and left him there until he died.
Or the untreated who are left to wander the streets, homeless, vulnerable to disease and thugs, sinking even deeper into an abyss. Judge Leifman cited new research out of Columbia University, “really good data” showing that allowing someone to go untreated leads to permanent brain damage.
But it’s a touchy subject, a civil rights issue, this notion of denying a mentally ill adult the same right to refuse medical treatment enjoyed by the rest of us. Anyway, in Florida, all this might be a moot question, with the state’s a notoriously underfunded mental health system and the paucity of hospital beds and community treatment facilities for the mentally ill. Legalizing involuntary treatment might not mean much if there’s no funding for that treatment.
Carlos is sure that without his family’s help, without his mother’s stubborn refusal to abide his denial, he would have slipped into oblivion, into joblessness, into homelessness and, like so many of the mentally ill, into the jails that serve as Florida’s de facto mental hospitals.
And let me just add this about Carlos Larrauri, who stood and told his story before a gathering of mental health advocates and providers in Miami on Thursday. He fits my idea of a hero, bravely recounting his struggles, despite the stigma that society still assigns to mental illness. We need his voice. He understands mental health issues from a perspective most of us can hardly imagine. He knows about denial.