Of the details reported about the murder of Malcoum Tate, a thirty-four-year-old man who was killed by his younger sister at the side of the road late at night while their mother waited in the car, most striking is the fact that his sister shot him thirteen times. On December 18, 1988, Lothell Tate, thirty-two, used a .25 caliber weapon that required her to shoot, reload the seven-round magazine, and shoot again to hit her brother a full thirteen times in the head and back. Lothell and her mother, Pauline Wilkerson, checked for a pulse, and then they rolled Malcoum’s body into a gully before driving home to Gastonia, North Carolina.
As word of the crime spread, headlines from newspapers such as the Lakeland Ledger, the Herald-Journal, and the Charlotte Observer provided a framework for Lothell Tate and Pauline Wilkerson’s motivations. Headlines read, “NC Family’s Final Solution Was Murder,” “Family’s Nightmare Ends with Slaying of Problem Child,” and “Death Ends Family’s Nightmare.” The “nightmare” was a life starring their blood relation as a persistent threat—a man diagnosed with severe paranoid schizophrenia who had been hospitalized again and again and who had been jailed for assault, but who resisted medication and, according to anecdote, repeatedly threatened his family like a ghoulish specter. It is reported that Malcoum claimed Lothell’s two-year-old daughter had the devil in her, and that God had sent him to kill her; apparently, Malcoum loomed over their beds at night till either Lothell or Pauline startled awake, upon which he would laugh a “crazy laugh” and leave the room.
National Book Award–winning author Andrew Solomon describes schizophrenia in his 2012 book, Far from the Tree: Parents, Children, and the Search for Identity, as “like Alzheimer’s … an illness not of accrual but of replacement and deletion; rather than obscuring the previously known person, this disease to some degree eliminates that person.” Though there is no direct reference for this statement in the book’s extensive notes, his description remains a lyrical summary of how schizophrenia is commonly understood. Brain-imaging studies of patients with schizophrenia have shown a reduced volume of gray matter, as well as ventricular enlargement. In a BBC interview with Professor Paul Thompson of UCLA, such examples of tissue damage are described as “[moving] across the brain like a forest fire, destroying more tissue as the disease [progresses].”
Schizophrenia’s unpleasant prognosis today, as described by researchers like Thompson, is essentially the same as it was in the time of Emil Kraepelin and, later, as described by Eugen Bleuler. “Dementia praecox” was a progressive and neurodegenerative disease, unlike manic depression, or what we now call bipolar disorder. Kraepelin is credited for revealing that manic depression, which may also exhibit psychotic symptoms, is a fundamentally different disorder from what’s now called schizophrenia, and is also a disorder that does not, unlike schizophrenia, lead to a permanently damaged brain.
In 2013 I experienced a seven-month-long psychotic episode as a symptom of schizoaffective disorder, which I’d been diagnosed with that February. Beginning in 2002, I had tried every atypical antipsychotic on the market—atypical antipsychotics being the pharmaceutical family of choice for psychosis, proving less likely to cause the severe side effects of their predecessors—and yet none of those medications had worked for me. Even Clorazil, considered to be the powerful antipsychotic of last resort due its ability to cause a lethal plummet in white blood cell count in some people, hadn’t been effective in eliminating my delusions. I was terrified and concerned; my family was worried and concerned; my doctor was perplexed and concerned. Dr. M told me that the longer the episode lasted, and the more frequently the episodes occurred, the more damage was occurring to my brain.
It is disconcerting for anyone to be told that her brain is being damaged by an uncontrollable illness. It might have been especially disconcerting to me because my brain has been one of my more valuable assets since childhood. I began to read at two; I was the first student, boy or girl, to finish every available math textbook in my elementary school; I went to Yale and Stanford, and graduated from Stanford with a 3.99 GPA, after which I took a job as a lab manager and researcher at one of the university’s brain-imaging labs. My anxiety about a loss of gray matter fed a variety of delusions: one afternoon I frantically called my husband at work to babble about spiders eating holes in my brain. And so I took Solomon’s words like a punch in the gut, but his statement about “replacement and deletion” reflects a common narrative about schizophrenia, a narrative unlike those about psychiatric diagnoses such as depression or obsessive-compulsive disorder. The story of schizophrenia is one with a protagonist, “the schizophrenic,” who is first a fine and good vessel with fine and good things inside of it, and then becomes misshapen through the ravages of psychosis; the vessel becomes prone to being filled with nasty things. Finally, the wicked thoughts and behavior that may ensue become inseparable from the person, who is now unrecognizable from what they once were.
There isn’t much in the way of public information about Malcoum Tate from before he was diagnosed with schizophrenia, in 1977. Young Malcoum received high marks. He was good at, and enjoyed, reading; then he went crazy. One day his mother drove with him on Baltimore’s Wilson Street, where Malcoum spotted a mailbox with “Wilson” written upon it. The skewed logic of this coincidence triggered him to escape from the car, break into the nearest house, and brutally beat the man he found inside. This outburst led to his first hospitalization of five.
The National Alliance on Mental Illness (NAMI) describes itself as “the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness.” NAMI is also known in the community of mental health advocates as the first place that scared, and often desperate, families go to for support and validation.
On its website, a pop-up emerges with the headline “We Call It the NAMI effect.” The NAMI effect is described as such:
Every time you offer your hand to pick someone up.
Every time you share your strength and ability to persevere.
Every time you offer support and understanding to a family who is caring for a loved one.
The NAMI effect grows.
Hope starts with you.
It’s unclear from this pop-up who the targeted “you” is supposed to be.
NAMI prides itself on its activism: “Each day, NAMI effectively shapes the national public policy landscape for people with mental illness and their families.” Such shaping is described in a 2012 report: listed causes under “Legislation to Improve Mental Health Care in America” include the Helping Families in Mental Health Crisis Act of 2016 (HR 2646) and the Strengthening Mental Health in Our Communities Act of 2014 (HR 4574). “NAMI parents,” as the advocacy jargon goes—the parents of a child or children with mental health issues who are involved in NAMI-sanctioned activism—showed up and spoke out at 2014 committee meetings regarding California’s Assembly Bill No. 1421 (AB 1421).
Public comment at such meetings occurred in counties across California as each deliberated over whether to adopt AB 1421, created in 2002 to open the door for the benign-sounding “assisted outpatient treatment,” also known as the “involuntary treatment of any person with a mental disorder who, as a result of the mental disorder, is a danger to others or to himself or herself, or is gravely disabled.” AB 1421 “would [also] create an assisted outpatient treatment program for any person who is suffering from a mental disorder and meets certain criteria.” Like the idea of the Strengthening Mental Health in Our Communities Act, AB 1421 appears, in many ways, unassailable: who wouldn’t want to give help to people who need it?
And yet the debate over AB 1421, as I discovered in San Francisco, touched upon crucial issues of autonomy and civil liberties. The bill makes the assumption that people who display a certain level of mental disorder are no longer capable of choosing their own treatment, including medication, and therefore must be forced into doing so. Sartre claimed, “We are our choices,” but what has a person become when it’s assumed that said person is innately incapable of choice?
The Exorcist was released in 1973, four years before Malcoum Tate was first hospitalized. Named the scariest film of all time by Entertainment Weekly, The Exorcist is described by Warner Bros. as a movie about “an innocent girl … inhabited by a terrifying entity, her mother’s frantic resolve to save her … and two priests … who come together in a battle of ultimate evil.”
The “innocent girl” is Regan (Linda Blair), who becomes possessed by the “terrifying entity” after using a Ouija board; her mother is Chris (Ellen Burstyn), a busy actress who receives invitations to the White House and purposefully bustles across crowded film sets. We first meet Regan as she bounds on-screen, all blunt bangs and big eyes, to give her mother a kiss hello. How was her day? Well, she played a game in the backyard, there was a picnic, and she also saw a “beautiful gray horse.” She emphasizes her role as a sweetly privileged, all-American girleen as she wheedles, “Oh, Mom, can’t we get a horse?” Even her use of the doomed Ouija board smacks of whimsy: when she first uses it on-screen, with Chris by her side, she demonstrates the spirit’s presence by asking, “Do you think my mom’s pretty?”
Once possessed, Regan vanishes. She hits her doctor—her face seems plastic; her voice is an unrecognizable growl. “Keep away!” she screams. “The sow is mine! Fuck me!” Chris, frustrated by Dr. Klein’s explanations of her daughter’s behavior, demands, “What are you talking about, for Christ’s sake? Did you see her or not? She’s acting like a fucking out-of-her-mind psychotic or a split personality.”
As is Chris’s story in The Exorcist, Pauline and Lothell’s narrative is one about being both terrified and consistently let down. Regan’s doctor, a figure of authority and a source of hope, is useless. Malcoum Tate was repeatedly released from jails and hospitals once he was determined by authorities to be “better,” or “not a threat to himself or others.” After a yearlong 1984 hospitalization in Baltimore, Malcoum improved, but his condition regressed approximately two years later after he stopped taking his medication. According to Lothell, Malcoum kicked down an apartment door one morning in the fall of 1988, causing the family to be evicted. In both stories of possession we have a sense of familial desperation, of not knowing what to do.
In searching for local NAMI members who advocated for AB 1421, I was put in touch with a woman whom I’ll call Beth. A chatty, impassioned woman who asked to remain anonymous, Beth has been a NAMI member since the mid-’90s. Ask her to talk about mental health public policy, and she does so in the manner of someone who is both well informed and highly opinionated; her many thoughts about jails and 5150s (code for involuntary hospitalization) and the dramatic story of her own mentally ill family member come out in a rush of memorized statistics and mental health policies.
Beth’s family member, an adult male, lives with schizoaffective disorder. In relating the development of his illness, she says of him, “He was an excellent student, and the following year, he started having these rage attacks.” She tried to get him treatment. The mental health system, a mess of private facilities, hospitals, and HMO-limited therapy sessions, has hospitalized him over seventy times, says Beth, which has repeatedly put her into dire financial straits. She continues to fight for the laws that she believes would help him, including AB 1421: “If you have a history [like he does] … of when he’s off medicine, of getting so manic, and so violent that nine times in one year he’s called the police himself, saying, ‘Please take me to the hospital, I want to kill [Beth],’ then that person should be on medication, not after he kills me or himself.”
I nod when I talk to Beth. I say “Yeah” a lot. I find myself thinking, How can anyone possibly argue a case against this woman, who has found herself in terrible circumstances as she tries to help someone she loves?
Lothell Tate explained on the stand, “I was just saying to myself this is the only thing I know to do, that we done asked people to help us and we done begged people to help us and nobody did anything, and I was scared that one day Malcoum was going to lose his mind and harm me and my daughter.”
It is impossible for me not to feel sympathetic toward Beth; it’s even impossible for me to feel completely antagonistic toward Lothell and Pauline, both of whom were found guilty at their trial after only one hour of jury deliberation. I hear the bewilderment in Beth’s voice when she talks about how there are no options for long-term care—when I ask, “In San Francisco or everywhere?,” she replies, “All over the nation. Unless you have enough money.” To say that the options for family members with severely mentally ill, psychotic relatives are limited is a comical understatement. People like Beth go to NAMI because they feel that there’s nowhere else to turn.
Family-to-Family is NAMI’s signature course, developed in 1991 by psychologist Joyce Burland. The twelve-session course, which is now in its fifth edition and has had over three hundred thousand participants, addresses families’ emotional and practical needs in dealing with their loved one’s mental illness.
“One of our … fundamental beliefs and awareness is that it can be a traumatic event to have a diagnosis of a mental health condition,” the organization’s national director of education, training, and peer support center, Colleen Duewel, told me. “And what we do is provide that light at the end of the tunnel of recovery, and of ‘You can do this’ and ‘You’re not alone,’ and ‘You have the support and the tools and the skill set you need.’”
As she discussed the “traumatic” nature of receiving a mental health diagnosis, I realized that she was doing so in the context of the family members surrounding the person with a mental illness, and not in the context of people being diagnosed with mental illness; in the Family-to-Family documentation, NAMI specifically states that the program is based on “a trauma model of family healing.” When I asked her if most people coming to Family-to-Family feel “desperate,” she paused. Carefully, she replied that “a fairly universal feeling is feeling alone … How do I take care of me? How do I take care of my loved one? How do I find resources?” She uses the phrase “burden of care”—as in, Family-to-Family has been found to decrease the burden of care one feels because of having a mentally ill family member.
Considering NAMI’s origins, it’s not surprising that the organization’s focus tends to veer toward the family members who support a person with mental illness, and not the person with mental illness. As Duewel puts it, NAMI began when a couple of “mothers sitting at their kitchen table said, ‘We’ve learned our lesson the hard way. How can we share this with other people, so they don’t have to go through what we did?’” As with organizations such as Mothers Against Drunk Driving (MADD), it was the grassroots power of mothers caring for their children that fueled NAMI’s creation. Beth calls her group the “NAMI Mommies.” Duewel emphasized that “one of the most profound things that people get from [NAMI] is a sense of ‘I’m not alone.’”
For those living with mental illness, there are other options. Julian Plumadore, the manager of the antistigma speakers’ bureau SOLVE (Sharing Our Lives, Voices, and Experiences), and former community advocate of the Mental Health Association of San Francisco, describes MHASF as a “peer-run, recovery-oriented organization.” I know Plumadore because I’ve been a speaker for SOLVE since 2013, and have heard in his talks the way he understands his recovery. He describes his story as one in which he was targeted as the “identified patient.” The term is based on research on family homeostasis, and describes a pattern of behavior in which a dysfunctional family identifies one of its members as mentally ill, though their symptoms are actually manifestations of the family’s pathology.
“If only I could have gotten my shit together, everybody else’s lives would have been fine was the message that I was getting constantly, and so I was responsible for other people’s happiness,” he said—a difficult situation for anyone, but particularly challenging for someone diagnosed with a severe mental illness.
Plumadore, following MHASF’s official stance on AB 1421 and other such policies, is against forced treatment. He’s civil about, but clearly in disagreement with, “NAMI parents.” I don’t think I’ve ever seen him in anything but a button-down shirt, tie, and slacks, which is a conscious choice on his part; it’s what he wears to meetings like the AB 1421 hearings, where the visual difference between the pro– and anti–AB 1421 constituents is obvious. “The rooms were divided,” he said. “They were visibly split in two, and the power imbalance in those rooms was tangible. On one side of the room you would have the people who basically hold the power in society. Generally white, upper-middle-class, well-dressed professional people, the family members; and then on the other side of the room, you’d have a much more diverse group, generally more dressed down…. And,” he finished wryly, “you could see in the room who was actually having the mental health issues, and who were the people who were trying to get them committed, essentially.”
He told me about one woman, a mother, whom he spoke to at an AB 1421 hearing. She spoke to him about her forty-year-old son, who is “living at home with her ‘where he belongs.’” According to her, she is “his only hope.” He highlights both phrases with horror. “They’re so afraid of something bad happening to [their loved ones] out on the street, or out in the rest of the world, or [their family members] can’t take care of themselves, [so] they guard them and keep them home. And that situation becomes increasingly tense and frustrating for everyone involved.”
Plumadore knows about these situations because he was one of those people. The people who support forcible treatment sometimes don’t believe him when he talks about abusing substances, being homeless, or acting, as he describes, “in scary ways in public.” He’s better now, he tells me, because he was finally told that he himself knows better than anyone else what he needs. For him, that included harm-reduction techniques instead of involuntary rehabilitation, as well as estranging himself from his family. Because he could discern a method of recovery for himself, he believes that the issue of personal, bodily autonomy must take precedence. Plumadore says those with mental illness almost universally experience the effects of trauma when forced into treatment, and disagrees with “hurting someone in order to help them.” “We have the ultimate decision about what we’re going to allow into our bodies, what we’re not, and the decisions that we make about our own lives,” he said.
A key concept in the discussion of schizophrenia, psychotic disorders, and treatment is that of how far the possession goes—or, in psychiatric terms, the level of “insight” the individual is capable of. To have poor insight is to have a lack of awareness about one’s own condition. A fundamental argument for forcible treatment is that unwell individuals simply don’t understand that they’re ill, and therefore lack the ability to decide for themselves whether to, for example, take the recommended medication. Whether a person diagnosed with severe mental illness will take medication is an issue that repeatedly comes up in communities personally affected by mental illness; psychiatrists use the pejorative term “medication non-compliant” to describe those patients who won’t take recommended medications, no matter the reason for the patients’ decision.
I asked Beth what she wishes people would better understand, or what they currently misunderstand, about psychotic disorders. “There’s all this stuff about, ‘Give people information and they’ll seek help on their own,’” she said. “Somebody who has a mind that they cannot trust because it’s been taken over by whatever chemicals are not allowing them to think straight needs help in getting care, and they might need to be forced into it. It’s comparable to Alzheimer’s. Not to say that people with paranoid schizophrenia are demented or stupid, but they lose the ability to make rational decisions.”
The mind has been taken over. The mind has lost the ability to make rational decisions. There’s someone in there, but it’s not whoever it is we formerly believed it to be. Depression is often compared to diabetes—in other words, it’s not your fault if you get it, and you’ll be fine if you just take care of it. Schizophrenia, on the other hand, is compared to Alzheimer’s—it’s still not your fault if you get it, but there’s no fixing it, and though you may not intend to be a burden, you’ll still be one until you die.
I do have experience with the loss of autonomy that comes with involuntary treatment, as well as the loss of status that comes with being described as lacking a sense of my own illness: I was hospitalized against my will in 2002, 2003, and 2011, and the records from my first involuntary, inpatient psychiatric hospitalization stated that I had “poor insight.”
It is hard to convey the horror of being involuntarily committed. First, there’s the terrifying experience of forcibly being put in a small place from which you’re not allowed to leave. You’re also not allowed to know how long you’ll be there, because no one knows how long you’ll be there. You don’t have the things that you love with you: your journal, the bracelet your grandmother gave you, your favorite socks. Your teddy bear. There are no computers. In the hospitals where I’ve stayed, the only phones allowed were the landlines, which could be used at certain times of day for a certain period, causing patients to jockey for position by the phones and to bicker over who’d been taking too long.
Sometimes, someone will be allowed to bring something you cherish to you during visiting hours, although this must take place after a nurse inspects the goods; a lot of the time, your possessions won’t be permitted into the ward because they include a sharp point or a wire coil or a dangerous piece of cloth. You’re not allowed to choose what you eat, and within the limited choices that do exist, you’re forced to choose only between things that are disgusting. You are told when to sleep and when to wake up. If you spend too much time in your bedroom, it indicates that you’re being antisocial; if you do sit in the common areas but don’t interact with the other patients, you’re probably depressed or overly inward or perhaps even catatonic. Humans might all be ciphers to one another, but people with mental illness are particularly opaque because of their broken brains. We cannot be trusted about anything, including our own experiences.
We do get a brief sense of Regan’s internal life before she is possessed. Chris spends one scene raging down the hall from Regan, who is in the foreground and in another room; when Chris screams, “No, don’t tell me to be calm, god damn it!,” the camera lingers on Regan, who glumly sits herself down. In another scene, the camera lingers on Regan’s frightened face as Chris investigates a banging in the attic. We don’t know what happened inside of Malcoum, other than hearsay about some anguished confusion over his mental state, or even what he was reported to have said when the shooting began, which was “Whatcha doing? Whatcha doing?” Instead, we see the nightmares that need to be solved. We see the possessions that have subsumed the sweet girl or the bookish boy, who are understood to be long gone. In the stories of who they were before the illness, or the evil, or the possession—including that of Beth’s family member—there is an expectation of not only normalcy but goodness.
When I try to say that Solomon is incorrect when he speaks of the “likely reality” of schizophrenia as deletion, I recognize that it sounds like a form of denial. In speaking to a friend about the theory, she suggested that I might simply be parsing an inaccuracy: “How do they know?” she asked. And, more to the point, “Is everyone the same as they were ten years ago?” Of course, the fact that I don’t listen to Yo La Tengo anymore isn’t the same as fully believing, as I have done, that there are cameras installed in my shower. It’s not the same as hallucinating, in daylight, a maggot-ridden corpse in a car. Yet I recognize the ability to make a choice: to reject an image or perception of what my experience of schizophrenia looks like. As far as I can tell, it does not look like Malcoum Tate’s experience, whatever that actually was. I won’t permit myself the audacity of presumption; but I particularly can’t presume the experience of someone whose complicated humanity is now accessible only through anecdotes of “the problem child,” “the nightmare,” the reason for which a sister shot her brother while her mother waited in the car.
Malcoum Tate’s murder is an extreme example of what happens when a family caring for a relative with schizophrenia feels that they have run out of options—that they have become overwhelmed by a force larger than themselves. The burden of care becomes the burden that breaks people. On the stand, Lothell Tate described the crime itself as an act of love: “I said to Malcoum, I said, ‘Malcoum, I love you, and I only want what’s best for you, and I’m sorry,’ and I shot him … And I told him again, ‘Malcoum, I love you, and I’m sorry,’ and I shot him again until he quit moving.”
And yet jurors spent only a single hour deliberating before returning with the verdict: Lothell Tate was sentenced to life in prison; later, her mother was sentenced to ten years as an accessory, reduced to one year with five years’ probation. Judge Don Rushing told Lothell, upon her sentencing, that the way she killed Malcoum “truly was horrible,” and “as brutal and dispassionate a murder as I’ve had a chance to see as a trial judge.”
Lothell appealed once locally and then to the South Carolina Supreme Court, where her appeal was denied in 1990; she appealed again in 1991, and her appeal was again dismissed; her last appeal was denied in 1992. With that final rejection, Lothell stopped her diabetes treatment, and she died in a South Carolina state prison in 1994. I can’t speak to her now, but I do imagine what it was like to be her on the night she killed her brother. When I think about the murder, I think about how excessive thirteen shots is. I also think about how a man who loomed over your bed in the middle of the night, a man who claimed to be sent by God to kill your daughter, might seem like a man possessed by evil, and therefore capable of anything, including surviving multiple gunshot wounds—even if you once loved him, or still do.