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The Baumhammers Case: Social isolation makes mental illness hard to control The mentally ill are not more prone to violence and mental illness is hard to prove in court Sunday, May 07, 2000 By Barbara White Stack, Post-Gazette Staff Writer
The two Allegheny County men accused of killing eight people and wounding three in shooting rampages in the last two months share more than a history of mental illness.
They also shared lives of relative isolation.
Richard Baumhammers, accused of shooting to death five people and paralyzing another April 28, resided with his parents in Mt. Lebanon. But he tried to find a mate through classified ads, not in person, and he chatted with neighbors on the Internet, not on the sidewalk that connects their homes.
Ronald Taylor, charged with shooting to death three men and wounding two others March 1, maintained some contact with family members, but lived alone in an apartment in Wilkinsburg.
Experts say social isolation for the mentally ill is distressingly common. They understand why it happens. Not only do many people fear and thus avoid the mentally ill, but the people who suffer from the illness also shy away from social settings because they're aware that people think they're odd, and they hear the ridicule.
The mentally ill are no more likely to be violent than anyone else.
It's hard to prove mental illness in court.
But isolation may allow a sick person to worsen dramatically without intervention. He may stop taking his anti-psychotic medication because he thinks he's cured. Or the medication may stop working. Or he doesn't have the money to pay the rent, which causes enough stress to launch a psychotic episode.
What worries Edward Mulvey, a psychiatry professor at the University of Pittsburgh who has studied violence and the mentally ill, is that tragedies like the recent shootings may only increase the tendency to isolate people with mental disorders.
"This is just another reason to shun the mentally ill," Mulvey said. "But the more we drive them out of our world, the less likely they are to get connections they need to prevent horrible incidents like this from occurring. It is a paradox."
Regular contact
The best way to ensure some kind of daily contact may be for a mentally ill person to live with parents. Parents may notice the signs that their loved one is deteriorating -- he's sleeping all the time or never sleeping; she sings incessantly because she insists there's a radio in her stomach; he believes neighbors are spying on him.
For people who live alone, medical insurance and state and federal programs are meant to substitute for friends and family. These programs have caseworkers who may visit frequently to find out how the mentally ill person is doing. If the person is delusional, the caseworker may be able to persuade him to get immediate treatment. If his phone or gas service has been cut off, the caseworker can help get it restored.
But even a parent or a caseworker may not detect the deterioration if it is gradual or may not be around at the moment the mentally ill person descends into a sudden psychosis.
That's when friends, neighbors, co-workers, even strangers, could become critical.
They can ask the mentally ill person if he needs help, or they can call 911 to get the bag lady who is ranting about giant insects out of the middle of the highway, or they can ask their employer's human services department to talk to the co-worker who has covered his desk in tinfoil to deflect voices from outer space.
And when people think someone is about to do harm to himself or others, they can call the county's Office of Behavioral Health emergency number, 1 (888) 424-2287, at any time of day to ask for an emergency response unit.
Yet many people may not have those conversations or make those calls because they are afraid of the mentally ill.
That creates a Catch 22 situation, the experts say. Because people have such fears, they're less likely to intervene when a mentally ill person needs help than they would be, for instance, to help a dazed diabetic get orange juice to stabilize his blood sugar, even though both conditions are chronic illnesses that afflict their sufferers sporadically. And insufficient intervention means mentally ill people are more likely to do things that make them scary.
"As a community, we have to be in close enough contact with mentally ill people so they aren't so alone that they see no one until" they have completely lost touch with reality, Mulvey said.
Are there always signs?
One unanswered question about Baumhammers, who has lived with his mother and father, is whether his parents could see that his condition was deteriorating.
While the answer isn't known, the mere fact that a mentally ill son or daughter lives with his parents doesn't mean they will see what is going on.
It depends on how knowledgeable they are about the disease and their child's patterns of psychosis. It also depends on whether the sick person has ever exhibited such behaviors before, or whether delusions and hallucinations suddenly overwhelmed them.
"The parent, quite often, is the last to notice," said Lee Carty, communications director for the Judge David L. Bazelon Center for Mental Health Law, a nonprofit advocacy group in Washington, D.C. "Things may change gradually day by day and you get used to it," she said. "Parents of someone with severe mental illness are likely to be exhausted."
In some cases, parents are helped by the fact that the mentally ill child will follow a similar pattern as he slides into each psychotic episode. He may begin talking about the John F. Kennedy assassination incessantly or contend the CIA has tapped his phone.
But not all mentally ill people follow patterns. Sometimes, a psychotic episode is triggered by something as unpredictable as the mention of a neighbor's name or reading a headline in a newspaper.
"Sometimes the signs are not there. It is hard to see what is inside a person's head," Mulvey said. And interpreting another person's behavior is not always easy. "We don't have a crystal ball to tell us what any individual will do on a given day."
Dr. Rohan Ganguli, a psychiatrist who has specialized in schizophrenia for 24 years and is chief of clinical services for Western Psychiatric Institute and Clinic, openly concedes he cannot read patients' minds.
"To this day," Ganguli said, "the conversation will stop at a party when I say I am a psychiatrist because people fear that I can read their thoughts. We don't have scopes that look into the mind. We only interpret what people say."
Sometimes parents disagree about what to do.
Often one parent will suggest a child see a therapist, and other will adamantly oppose it, denying anything is wrong, said Dick Jevon, a member of the board of the Southwestern Pennsylvania Chapter of the National Alliance for the Mentally Ill.
Even if the parents finally take a son or daughter to a therapist, they may not get a correct diagnosis. If a person has a mental illness, such as schizophrenia or bipolar disease, he probably needs to be diagnosed and treated by a psychiatrist, Jevon said.
Parents also may find themselves unable to cope because they mourn the loss of their dreams for their child. A son diagnosed with paranoid schizophrenia at 20 may have graduated first in his high school class and gone to college with great promise. If the university calls the parents to say their son was expelled for ranting while naked on his dorm roof, they may hope he was just drunk. It can be hard to admit it is so much worse than that.
When they live alone
Unlike Bauhammers, Ronald Taylor did not have regular daily contact with family members.
But even for those like Taylor who are living on their own can do well with sufficient services, the Bazelon Center's Carty said. That can include visits by caseworkers, drop-in centers where people with mental illness can socialize, job counseling and help with housing.
With funding from the state and federal governments and private and government insurance programs, Allegheny County provides many of these services to mentally ill people through contracts with hospitals and clinics.
There are social workers who help mentally ill people pay their bills and refill their medications. They visit at least once or twice a month, depending on how severe the illness is. The county provides housing that includes different levels of supervision, depending on the need. There is an emergency response team.
But members of the Alliance for the Mentally Ill say there is not enough money and not enough service. Pat Valentine, director of the county office of Behavioral Health, says that although the county provides intensely supervised housing for 1,000 mentally ill people, if it doubled the beds tomorrow, they would be quickly filled.
"The stigma in the community is a major factor in people not getting the help and treatment and money necessary for mental illness," Jevon said. The recent shootings show a need for more money for programs that connect mentally ill people to their communities, experts said.
"This is an awful thing that has happened," Ganguli said, "but it must be seen in context. One hopes the community will come together and understand each other more and take care of each other more. If we took more responsibility and had more contact, we wouldn't be so afraid."
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