Very Bad Things

Well,
I don't know if I'll be able to post this one - it's going to require some fairly heavy anonymisation. And it's deeply, deeply violent - consider yourself warned. But the two stories therein are so indicative of how the whole field of commuity mental health works - or fails to - that it seems wrong to keep them to myself.

I've never been a fan of true crime stories. There is some very good stuff - a book called Tough Jews by Rich Cohen, the Godfather, some of the Sopranos, most of Deadwood - but that's almost despite the subject matter than because of it. I've got a vague interest in gangster movies and such, stories set in the twenties and thirties, Jews and Italians and Irish and Poles sighting the Statue of Liberty, but that's pretty much it. The other kind of true crime story, some muttering thug dressing himself in giblets, bathing in synovial fluid and flushing someone's hair down the toilet, doesn't interest me at all.

Part of this is because my experience with truly violent men - several murderers, an unknown number of rapists - has been that they are not personally interesting people. At best they are mundane, at worst they are spectacularly boring. A violent criminal does not have something glittering and special within him, something dark and mysterious that you can just understand if you look hard enough, some conundrum that can be solved. He - and it's almost always a he - has a lack, an absence, is less than his fellow man.

Honestly. A man on one hundred and twenty of methadone, killed some guy with an axe - boring. My psychopathic ex porn actor rapist - tedious. My articulate and clean-shaven standover man - virtually unendurable in conversation. Seriously, every consult with him I run the risk of dislocating my jaw like those snakes who can swallow an egg.

Part of this is as a result of institutionalisation - much of prison life is deeply deeply boring. You are surrounded by people you can't avoid. You can't go anywhere or do anything, a fair proportion of your fellows are depressed and withdrawn, many of them are on sedatives. In one of the local prisons you get two books every three months*.

But part of it seems to be that violent crime, with a few exceptions, seems to be carried out by people with few other intellectual or personal options.

Somewhere in a psych ward in New Zealand, by the way, is the Six Million Dollar man. I have this on good authority from one of our new psych regs who did a rotation in Orcland about three years back. The Six Million Dollar Man is called so because this is approximately what it costs the Government to keep him safe.

He has a ward to himself in Furby House, New Zealand's largest psychiatric hospital, with two guards on twenty four hour watch. He wanders through this ward, dressed in his orange, fire-proof overalls, which will be his clothing of (no) choice for probably the rest of his life.

This level of care is necessary because of his level of illness. Over the course of the last twenty years he has amputated a fair amount of his body - several fingers, a hand, a foot, his genitals.

He sets himself alight. He has done so on several occasions. He has set other people alight, too, and thrown scalding water on them, and attempted to rig up something with an electric cord from the kettle to electrocute the psychiatric registrar (my friend). His forensic history includes a particularly distressing abduction and slaying.

Nothing can be done with this man. He is resistant to any and all antipsychotics - Julia suggests that this is in part because he shows no signs of psychosis at all. It is difficult to work out what is wrong because she was never able to establish a dialogue about his emotional state at all - "no real data about mood, consistently blunted affect". She used to wonder if he understood what she said when she asked about his feelings. He didn't seem to be happy, but then, he didn't seem to be unhappy either, and he didn't seem to be angry the time he tried to electrocute her with the electric cord from the kettle.

Anyway. There was a move at one stage, years ago, to reunite him with his people, him being Maori and all. They bought him all this stuff, put him in a four wheel drive, drove off to the region he'd come from. His people had heard about this, they were waiting at the border with clubs and rifles. Shots were fired. The Mental Health team van didn't get down past second gear, turned around and sprinted back to Orcland.

The nexus between mental health and crime is a nightmare, like those places on the coast where two oceans mingle. In the simplest analysis, a lot of forensic stuff is about punishment, making things worse for the prisoner, whereas medicine is about helping the patient. It's a complicated, torturous dance sometimes to convince yourself you're doing one when you know you should be doing the other.

And it's under-resourced and unpopular too. A few years back Mordor Mental Health - just down the road from here - had a patient called Jacob. Jacob had what we call "polymorbidity", or several potentially serious conditions at once. The several conditions included paranoid schizophrenia, and being poor, gay and Aboriginal. It is no surprise that Jacob was a frequent client of Mordor Mental Health services.

And his paranoid schizophrenia was particularly resistant to treatment too. His neighbours were plotting against him. They were murderers, raping and murdering all day and burying bodies all night. They wanted to kill him and get his social security payments - the princely sum of three hundred and eighty dollars a fortnight.

The psychiatrist bumped up his olanzapine until it didn't work and then switched him to clozapine, the "gorillacillin" of antipsychotics. Clozapine basically bludgeons bad thoughts out of you, but it takes a fair proportion of the good ones with it, and is one of the few antipsychotics that can actually kill you. After they got him on five hundred a day of clozapine he pretty much stopped complaining, evidently it was working, and eventually MMH was able to close their books on him.

And they never got opened again, because a few months later he turned up dead, one of the only male victims of the Saltwater rapists I mentioned earlier. Truly ghastly men. All day murdering and raping, all night burying people in the back yard.

Anyway. it's been a die of uninterrupted grue today, sorry about that. More cheer tomorrow, or at least less violence.

Thanks for listening (and sorry!)
John

*Me, I'd go with Shakespeare (Complete Works plus Apocrypha) and some kind of "Teach Yourself - " book.