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Free to live in a delusionary world
When loved ones refuse treatment for mental illness, families have few options
 
When you lose touch with reality, things can slip away fast.
When you lose touch with reality, things can slip away fast. (iStock)

EVERYONE IS WORRIED about the man in the house. His ex-wife, his mother, his father, his neighbors, the psychiatrists he has seen and no longer sees — they are all concerned because he has been alone in the house in suburban Maryland for two years.

No one knows what he is doing. No one knows what he is thinking, what he is eating, or how he is surviving. In two years, since his frightened wife took their three young boys and left him there alone, he has not spoken to anyone for more than a few minutes. He has not let anyone beyond the front door, which he has fortified with a new lock, a piece of plastic bolted over the window, and a piece of plywood bolted below that — all of which he has painted an almost fluorescent shade of yellow. He keeps the living room curtains shut.

The man in the house, a 42-year-old who once earned six figures working on Capitol Hill and was a devoted husband and father, tells his family that he is not sick.

As far as they know, he has stopped taking the psychiatric medication prescribed after he told police that God was speaking through his 3-year-old son. He has quit his job and stopped paying bills. His family doesn't know what to do.

His mother leaves bags of groceries on the porch. His ex-wife sends text messages, and his responses are increasingly worrying, such as when he refers to his sons as his "suns." His father is always leaving a version of the same phone message — "Hey, this is Dad. Let me know if you want to come out and talk. We love you. We care about you" — which his son never answers.

ONCE, THE MAN'S family might have handled the situation by having him involuntarily committed to a psychiatric institution. For decades, it was a routine and simple procedure: If a doctor agreed the patient had a mental illness, he could be institutionalized even against his will.

The problem was that it was a process with few safeguards, and during much of the 20th century, all kinds of people who didn't belong — from freethinking women to gay people, minorities and rebellious children — wound up locked in hospitals where abuse was common and conditions were often bleak.

So the system changed, with one catalyst being a 1975 Supreme Court ruling that effectively restricted involuntary commitment to instances when a person becomes a "danger to self or others," a phrase that now appears in one form or another in state laws across the country.

But 40 years after that standard was established, some people are asking whether society's concern for the constitutional rights of people with mental illness has led to their abandonment. At a moment when about one quarter of the homeless population suffers from severe mental illness, when the number of mentally ill prison inmates is higher than ever, and when mass shootings are often followed by stories that the shooter had heard voices, the people asking questions include the family of the man in the house. Their concern is growing every day.

Because he does not think he is sick, voluntary treatment is not an option. Unless he threatens to harm himself or someone else, or is so sick he cannot keep himself alive, he cannot be deemed dangerous, particularly in Maryland, where commitment laws are among the most stringent in the nation.

And though there are days when he wears bright yellow from head to toe, or all white including sandals he sprayed with white paint, he appears well-groomed and healthy at this point, so he is unlikely to meet even the most lenient legal definition of dangerousness.


(iStock)

ON DAY 730 of being alone in the house, he still tends his lawn. The few times he has opened the bright yellow door to get groceries or money from his worried mother, what she could see of the living room appeared clean, if bare — the family photos removed from the walls.

The ex-wife of the man in the house — who for privacy reasons is being identified only by her first name, Jennifer — wishes that her ex-husband, whom she still loves, could be involuntarily committed to a psychiatric hospital for however long it takes doctors to figure out what's wrong, for medications to work, and for him to once again be the person she married.

But because she can't have him committed, she is doing the only thing she can think of to do. In accordance with the divorce decree, she is selling the house, which she is hoping will force her ex-husband into a situation desperate enough that he might meet the standard for involuntary commitment. For him to get better, she realizes, she and his family have to let him get worse.

"He'll be homeless…" she says. "And we just have to let it happen."

SHE HAS BEEN watching him deteriorate for three years now, a process she traces to the night he didn't want to share a glass of wine, which had been their evening ritual since they bought the house and started building their life together.

He wanted to be on the computer instead. He began reading conspiracy theory websites. He started saying he was going to jail and taking batteries out of cellphones. Jennifer told herself it was stress and tried to get him to see a counselor, but he wouldn't.

Then one day a package arrived, and he told her to take the kids outside, and she watched as he put on a biohazard mask and used long-armed tools to open the box, which contained a crank radio he ordered.

He built an 8-foot-high cross and nailed it to a tree in the front yard. He started wearing all yellow or all white. When they visited a relative who had a gun with five bullets mounted on a wall, he said the bullets were a sign their family of five was going to be killed. Jennifer kept trying to persuade him to see a counselor, but there was nothing else she could do to get him treatment until the day he disappeared with the boys.

On that day, Jennifer called the police, who tracked him to Atlanta, where he reportedly told them that he and his children were going to be killed and that a flock of birds had signaled for him to take the boys south.

She and her father-in-law arranged for a mobile crisis team — mental health workers and police trained for such situations — to meet them back in Maryland, and when he still refused to see a doctor, police were able to invoke the "danger to self or others" standard because of the erratic trip, his delusions about being killed, and a small knife found in his possession.

It was the one time he met the threshold of involuntary commitment. He was taken to the emergency room in handcuffs, at which point an array of regulations aimed at protecting his civil liberties kicked in.

Within six hours, a doctor had to certify that he was dangerous. Within 30 hours, the ER had to locate a bed in a psychiatric hospital or release him.

Once he was admitted, he was appointed an attorney and a hearing was scheduled before a judge who would review whether he was still dangerous enough to stay hospitalized. And even then, he still had to consent to taking medication.

After a while, doctors felt he was improving. He admitted to making "errors in judgment," according to his medical records, and agreed that his thoughts about the family being killed were "not based in reality."

After 24 days, doctors found that he was "no longer suicidal or homicidal." He no longer met the criteria for involuntary commitment, and so he was discharged.

Back home, he went off his medication. He became angry and withdrawn, cursing his wife and family for putting him in the hospital. Then he sent Jennifer an email referring to her in the third person — "She's hell-bent on lying," it began — which a counselor told her exhibited the kind of dissociative thinking that precedes a potentially violent psychotic break, and she left.

He followed her. He banged on her parents' door in the middle of the night. She called the police, who saw that he was violating a protective order she had obtained and took him to jail, which as Jennifer now sees it was his last chance for help.

She said that during his court appearance she begged the judge to order mental health treatment, but a psychiatric evaluation found that he was only delusional, not dangerous, which limited what the judge could do. He was released after four days.

He went back to the house and painted the door yellow.


(iStock)

ON DAY 889, word comes that the man has disappeared again. Jennifer is standing at the yellow door. Her hands are shaking. She has her old keys, and she is trying to get inside the house for the first time since she left.

She had monitored his Skype call with the boys a few days earlier. He appeared to be in some kind of shed.

Jennifer slips through a window and lands in the laundry room, and for the first time in more than two years, she is inside of the house. She turns on a light

"Wow," she says.

The washer and dryer are sprayed with a streak of yellow. The labels on two bottles of Sun soap are covered with yellow duct tape.

She walks upstairs and into the foyer. "Please remove footwear," she says, reading a handwritten sign taped to the wall, and turns into the living room, where the stuff of their old life is heaped in piles.

"My God."

There is their leather chair, turned over. There is their couch, all the cushions pulled off. By the fireplace is a crate of wires and circuit boards, a half-disassembled power washer, and the boys' disassembled bunk beds.

She goes back downstairs, down into the basement den where they used to share their glass of wine. She opens a cabinet that is empty except for two things.

"Huh," she says, taking out a Coke bottle that she had kept for sentimental reasons and a sherry carafe that was a favorite wedding present.

"See?" she says. "He knows these are two things that would mean anything to me. He's not mean." The next morning, she comes back with a truck to pack up what she wants to salvage.

On Day 896, the house with the yellow door is empty. The man who was there stops communicating with his family, except for text messages he sends his ex-wife to arrange calls with his sons, which are becoming less frequent.

The family who loves him, who would do anything for him, stops trying to persuade him to get help. They wish he could be involuntarily committed. He can't be involuntarily committed. The man in the house is now out of the house and somewhere else on his own.

Excerpted from an article that originally appeared in The Washington Post. Reprinted with permission.

 

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