She wondered if the voices did come for her, would she know they weren’t real? Would she know the difference between a DJ on the radio and a phantom?
In my second year of law school a good friend’s brother was diagnosed paranoid schizophrenic. ‘Mark’ was twenty-six when he started hearing voices in his head. Voices that whispered of violent mob conspiracies and warned of treachery and collusion everywhere, even among family and friends. Voices that never quieted, that got louder and more desperate once the sun went down. According to my girlfriend, there was no bizarre childhood to report, no telltale warning signs of mental illness that had always plagued her brother, made him a misfit or labeled him as odd. He was just an ordinary, affable guy trying to finish college, with a bright future, a girlfriend, and a baby on the way. For anyone who knew him, news of Mark’s illness was as shocking as a diagnosis of lung cancer in a young man his age.
Fortunately, Mark himself was able to recognize that something had gone terribly wrong inside his head and, with the help of his family, voluntarily checked himself into a psychiatric hospital. Although the onset of his psychotic symptoms was relatively quick, the initial long-term prognosis was good for him. Mark was discharged a couple of weeks later and sent home on antipsychotic medication.
Sadly, though, my friend’s story didn’t end there. In fact, for ‘Tina’, a real life nightmare was only just beginning. Like a scene from a twisted soap opera, as her brother lay medicated in a hospital psych ward, surrounded by psychiatrists and protected by padded walls, Tina was just outside the door being let in on a dark family secret: Mark wasn’t the only one in the family with schizophrenia.
The news was devastating. Throughout our last year of law school, Tina struggled to learn all she could about the debilitating mental disorder that had seemingly ravaged her family. A mental disorder that no one wants to talk about. That good families just like hers strive to keep hidden and out of sight, stashed away with the other skeletons and dirty linen in the proverbial family closet. And that was when Tina first discovered the terrifying facts about schizophrenia. There is no known cause. There is no clinical test, like an MRI or a CAT scan or a blood test, which can definitively diagnose the disease. There is no cure. But there was one consistent statistical anomaly that my friend just could not ignore.
Although doctors don’t know why, and scientists have not yet identified a ‘schizophrenia gene’, schizophrenia runs in families. And with each family member afflicted, the risk of another relative developing the disease rises dramatically. So at the age of twenty-four, with her whole life in front of her, my friend had to cope with the very real possibility that she, too, might one day develop schizophrenia. That she, too, might one day ‘go insane’. And there was nothing she could do to stop it. I couldn’t imagine anything more terrifying.
Except for a friend who’d struggled with anorexia in her teens, before Tina told me her family story I’d never known anyone with a serious mental illness – at least, no one who would admit it. And I’d definitely never known anyone who had schizophrenia – the Mother of All Bad Mental Illnesses. Russell Crowe hadn’t yet played the brilliant John Nash in A Beautiful Mind. And Geoffrey Rush hadn’t yet mastered Rachmaninov’s third piano concerto as Australian pianist David Helfgott in Shine. Unlike alcoholism or drug addiction – or even depression, as of late – schizophrenia is not, and will never be, a ‘vogue’ mental illness. No one talks about it. No one wants to talk about it. The social stigma associated with the disease is still far too heavy and damaging to careers and relationships. In fact, when Tina first told me about her brother, the only people who came to mind that I had heard of with schizophrenia were far more infamous and deadly than any gifted musician or mathematician catapulted to celebrity by brilliant screenwriters and talented actors. Like most people, I was ignorant of the facts.
I didn’t know schizophrenia affects one percent of the world’s population. I didn’t know 2.2 million Americans have the disease. I didn’t know that that’s more than those afflicted with AIDS, multiple sclerosis and ALS (motor neurone disease) combined. I didn’t know that schizophrenia is an organic brain disease. And, perhaps most important, I didn’t know that schizophrenics are not always psychotic and they’re not always aggressive or dangerous.
After graduation, I left New York to begin my career as a prosecutor with the State Attorney’s Office in Miami. Not less than five minutes after stepping through the courthouse doors, like it or not, my eyes were forced open to the very real, sad fact that mental illness – in varying degrees and with differing diagnoses – goes with the criminal justice system like pickle relish on a sub. It’s a condiment that’s not on every slice of bread, but it’s on a lot more sandwiches than you’d think. And I came to understand that for those who suffer from severe mental disorders such as schizophrenia and manic depression, and for their distraught families, that system can seem like a cruel revolving door, particularly for those whose illnesses cause them to resist help and refuse medication. Many self-medicate with drugs or alcohol. Many end up homeless.
As I hope I made clear in Plea of Insanity, not every violent crime is committed by someone who is mentally ill. And not every mentally ill person commits violent crimes. As a former prosecutor and police attorney, I can tell you that there are some unbelievably heinous or atrocious crimes that simply defy explanation, that leave victims and cops and relatives screaming for an answer to the question, ‘Why?’ So I must impress here that there’s a definite distinction from the thought disorders in a schizophrenic that may cause him or her to act violently, and the evil acts of a psychopath simply devoid of conscience. The latter is far more dangerous and unpredictable.
A little over a year after his initial hospitalization, as is typical for many schizophrenics, Mark stopped taking his meds and suffered a second psychotic break. While caught up in the terrifying web of the same bizarre delusion that had sent him to the hospital before, he slit his wrists and then drowned his baby in the bathtub. Mark lived, but his son did not. To understand the insidious disease that infected a young father’s mind and chewed away at his thinking till it was frayed like an electrical cord was to know that Mark never intended to murder his child. He was truly a sick man who was not responsible for his actions. And after lengthy discovery and consultation with the family, the State agreed as well. Mark was found not responsible and sent to a maximum-security forensic psychiatric hospital to get the help he needed.
My friend’s tragic story haunted me for years until I finally decided to write Plea of Insanity. I wanted to pen a courtroom novel that was psychologically thrilling, and yet, at the same time, sympathetic to those who suffer from this frightening disease and their families. I wanted to entertain, but I also wanted to educate, because that’s the real key to understanding and eradicating the ignorance that fuels the stigmas associated with mental illness. To accomplish that goal, I needed to make sure that the fictional tale I told was medically and legally accurate, which, of course, demanded tremendous amounts of research as well as the generous assistance of many people who donated their time, wisdom and insight to this project, and to all of whom I owe a great deal of thanks, especially, in no particular order, to Dr Jim Hicks, MD, Director of Psychiatric Services at Kirby Forensic Hospital, and the entire staff at Kirby, including former Chief of Safety and Security, James C. Gilbride, and Chief of Secure Hospital Therapy Assistants, Anthony E. Rouse; Dr Thomas Macaluso, MD, Medical Director of Psychiatric Services, Memorial Health System; Mr Dean Mynks, Director of Case Management, Henderson Mental Health Clinic; Dr Reinhard Motte, Assistant Medical Examiner, Broward County Medical Examiner’s Office; Kathleen Hoague, Chief Assistant, Felony Division, Miami-Dade State Attorney’s Office and Gail Levine, Senior Trial Attorney, Miami-Dade State Attorney’s Office, the SAO’s resident experts on insanity pleas; Janet Gleeson, Assistant District Attorney, Brooklyn County District Attorney’s Office, New York; Special Agents Eddie Royal, Larry Masterson and Chris Vastine with the Florida Department of Law Enforcement, who always answer the phone for me; Greg Cowsert, Esq., Regional Legal Advisor, Florida Department of Law Enforcement, Tampa Regional Operations Center; Anita Gay, Assistant United States Attorney, Legal Advisor for the Professional Responsibility Advisory Office; Douglas Donoho, Esq., Professor of Law, Nova Southeastern School of Law; Esther Jacobo, Division Chief, Domestic Crimes Unit, Miami-Dade State Attorney’s Office; Priscilla Stroze, Division Chief, Miami-Dade State Attorney’s Office; Julie Hogan, Assistant State Attorney, Office of Statewide Prosecution; Marie Perikles, Esq., Office of the Inspector General; Mr Tyrone Dean and Mr Richard Gagnon for their precious insight; Marta Marquez, Police Complaint Officer, Miami-Dade Police Department for a great tour of the Communications Bureau; and, finally, of course, to my amazing friend Tina for having the strength to share her story. Extra special thanks go to great friends Marie Ryan, Esq., Assistant Commissioner, New York City Police Department, and Joanne Marchionne, MSW, who offered up their time, comments and encouragement without hesitation when I know they had a zillion other things to do, and for my unbelievably supportive husband, Rich, who not only read the same sentences phrased a dozen different ways, but always listened. Over and over and over again. Last, but not least, thanks go out to my mom, Thea Pellman – my human thesaurus and recollector of strange trivia and odd facts – and, of course, my dad, John Pellman, who’s always the very first to offer to read a work in progress and always says it’s perfect.
I hope you enjoyed the read and I hope you indeed found it thrilling. Although part of the storyline for Plea of Insanity was inspired by Tina and Mark, I am happy to say that the story is not Mark’s. Nor is it Tina’s. Released from a state psychiatric facility several years ago, Mark continues to take his medication and is fortunately doing quite well. He lives on his own, supports himself and has a job. He is not a violent man. Tina, who thankfully never developed schizophrenia herself, has had a successful career and is busy raising a family of her own. Brother and sister remain extremely close. They pray daily for a cure.
For more information on schizophrenia or other mental illnesses, please contact the National Alliance for the Mentally Ill (NAMI), Colonial Place Three, 2107 Wilson Blvd, Suite 300, Arlington, VA 22201 – 3042, or to find a local NAMI chapter, call 1-800-95o-NAMIor visit their website at www.nami.org. Or contact NARSAD, the National Alliance for Research on Schizophrenia and Affective Disorders, at 60 Cutter Mill Road, Suite 404, Great Neck, New York 11021, (800) 829-8289 or visit their website at www.narsad.org. Other helpful websites that offer information about schizophrenia, including symptoms, treatment and support groups, include www.schizoophrenia.com and www.support4hope.com and www.webMD.com.