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Diagnosis: Schizophrenia

A family fights a frightening disease and an impotent system
By Richard West |

iT WAS A sadly familiar routine for Sally and Bill Angleton: A telephone call reporting that their son, Hank, had suddenly turned dangerous, had struck a resident at the boardinghouse for no apparent reason, and was ranting and tear- ing up the place. “Hank needs medical attention. Please come immediately. This is the last straw.” Hank was no longer welcome at Gillespie’s Rooming House on Bryan Street.

Sally and Bill knew what had happened without having to ask. Nine years ago, their son had been diagnosed as a paranoid schizophrenic. Like many afflicted with the illness-one out of every 100 Americans; 100,000 new cases each year-Hank often denied that he was sick and neglected his medication. He was not one of those who had suffered only one psychotic episode; he floated in and out of psychosis constantly.

Without his medicine, Hank eventually unraveled and began a plunge into delusions, hallucinations and aggressive behavior. While gripped with this madness, he tolerated no one touching him. His attitude was an inviolable “Don’t tread on me, Buster, or suffer the consequences.” The fellow at Mrs. Gillespie’s probably had grabbed Hank from behind or had brushed up against him. Sally and Bill knew the story well.

Hank confirmed his parents’ suspicions at the psychiatric emergency room at Parkland Memorial Hospital when he lashed out at a young man standing nearby who had accidentally bumped into him. And their son admitted that he had cut back on his medicine. He said he was tired of living with its side effects: the hazy vision, the dry mouth, the drowsiness, the half-alive feeling and the craving for Coca-Colas-not a good thing for a 36-year-old hyperglycemic with too much sugar in his blood already.

The Angletons wanted Hank admitted to the Mental Diagnostic Center (MDC), the Dallas County Mental Health and Mental Retardation (MHMR) holding and evaluation unit for the mentally ill who are considered dangerous to others (homicidal or assaultive) or to themselves (suicidal or unable to survive in the community). The facility recently had moved from Westmoreland in Far West Dallas to a $4 million remodeled former staff residence on Park-land’s campus, just across from the emergency room.

Admittance to MDC is not voluntary. Before the court will issue an Order of Protective Custody, which commits the patient to the MDC for up to two weeks, the examining doctor must sign a certificate stating that the person is mentally ill and is likely to harm himself or others if he is not confined immediately.

After examining Hank, the physician on duty decided that MDC admission wasn’t necessary. He prescribed medication and sent the family home. On the way, the Angletons stopped at a Burger King, where Hank again became enraged, sweeping the food off the table, yelling, cursing and romping about the room.

“Later that night at home, we were furious,” Sally says. “What does it take, we wondered, to get into MDC? Does he have to kill someone? Three violent incidents isn’t enough? Four, counting the terrible one a few months ago.”

It happened in the kitchen of their comfortable Farmers Branch home. For no apparent reason, Hank began screaming threats and obscenities at his mother. Bill came up from the game room and tried to subdue his son. Hank wheeled around and knocked his father down. Bill, a small man who had already suffered two heart attacks, held on, grabbing his son by the neck and whispering, “Settle down now. This is your old buddy. Settle down.”

“I don’t think I’ve ever been as mad in my life,” Bill says. “I wanted to kill him. You just get fed up to here with it. It makes no difference if it’s your own flesh and blood. But of course, I couldn’t hit my son. Later, he said he didn’t even remember cursing his mother. And after all this, we still couldn’t get him in the county facility where he could be stabilized and cared for.”

The next morning, the Angletons took Hank back to Parkland’s emergency room and pleaded once again for his admittance to the MDC. This time-the first time in his nine-year battle with schizophrenia-they succeeded.

“I get four or five calls a day from parents with just that problem, and I’ve been through it personally with my own son,” says Susan Shortes, president of the Dallas Alliance for Mental Recovery. “The pendulum has swung too far over toward patients’ rights. No one thinks about the rights of parents any longer, those of us who have to deal with this every day of our lives.”

Dr. John Gill, assistant director for residential services at the MHMR, is also familiar with the problem. “I understand and sympathize, believe me, and I think the mental health code’s change that went into effect last September will help, broadening the definition of ’danger to self to include the inability to ’care for self.’”

The Angletons’ small victory in getting Hank admitted to the MDC was only a short reprieve in the days-without-end existence of living with a chronically, often violent, mentally ill family member. It’s a life of evercontinuing personal trauma, fear, expense, defeated expectations and sadness at seeing a loved one’s life arrested in mid-stride by an unknown malignity.

It means constant intercessions with police, doctors, landlords and outraged strangers, shuttling in and out of hospitals, police stations, seedy boardinghouses and shabby apartments in an everlasting search for shelter. Finally, it often comes to living under unparendike rules simply to survive, with the parents’ spirits battered by the savage transformation of a once gentle child into an alien being.

Hank is no longer allowed to live in his parents’ home-only to visit occasionally. This is the story of how one family learned to live with a son with an illness for which there are few exactitudes of truth, no naked absolutes-and for which there is no cure, ever. (The names of family members have been changed to protect their privacy.)



WAS HANK’S INABILITY to make friends-either in college or after he dropped out-an early hint of his illness? Or was it his taking a menial job at the Lone Star Laundry instead of pursuing a more ambitious career? Was he already tormented when his parents gave him a new red Volkswagen and it seemed he almost hated them for it? Was he sick when he told them that he was going to Galveston to work as a life-guard and then disappeared, finally surfacing six months later in California?

His parents don’t know, but they do know that in 1975, when Hank was 27, his behavior grew unmistakably bizarre. First, the letters from Los Angeles: cryptic notes written at odd angles on small slips of paper, never with the usual “Dear Mom and Dad” or “Love, Hank.” Then, after he returned home, he began to spend hours staring out the bathroom window at the sky, trying to predict the weather.

As the months passed, Hank developed the classic symptoms of schizophrenia: withdrawing from family activities, becoming more active at night, letting his personal appearance deteriorate. In fickle confusion, he spent hours writing letters to celebrities he said he knew-Gerald Ford, Merv Grif-fin, Elizabeth Taylor-then tearing them up. He blamed himself when he saw actors or athletes injured on television.

He developed a sudden interest in religion, claiming that he was receiving instructions from God. God, in fact, was going to kill him, Hank said, because he was the second coming of Christ. He was going to kill himself if his parents didn’t replace everything he had left in California. He became maniacally determined to contact Liz Taylor. She loved him. He began threatening his parents. His suicide promises became more frequent.

Finally, in the fall of 1976, Bill and Sally took him to one of the outpatient clinics operated by the MHMR. There, he was diagnosed as a paranoid schizophrenic and was given a shot of Prolixin, his first psycho-tropic medication.

Back home, Hank collapsed on the floor, hunch-backed, twitching and quivering, his neck stiff, his muscles rigid, his face frozen in an emotionless mask. He was suffering from a drug-induced parkinsonism (the symptoms of forkinson’s disease), a common reaction from anti-psychotic drugs such as Thorazine, Prolixin and Stelazine. Bill and Sally rushed their son to Parkland, where a shot of Benadryl quickly solved the problem.

“No one told us anything-not about schizophrenia, not about the medicine, not about the side effects,” said Sally. “We were horrified and in shock. There we were with a crazy son writhing on the living room floor about to die, for all we knew. Well, we had to face facts, so we began learning everything we could.”

The mystery of schizophrenia remains intact. Its possible causes (neurological brain disturbance, physical brain damage, genetics) have been endlessly debated since a Swiss psychiatrist, Eugen Bleuler, coined the word and outlined the modern concept of the illness. It does not mean “split personality” as is commonly thought, but it is a disorder of thought usually accompanied by agitation, delusions and hallucinations. About 50 percent of the patients in Texas mental hospitals are diagnosed as schizophrenics. Hank suffers from the most common of the five types of the disorder.

While the causes of schizophrenia are not known, treatment has been revolutionized during the past 30 years thanks to the discovery of powerful anti-psychotic wonder drugs like Prolixin. Others are Lithium (first used to treat mania in Australia in 1948 and still effective in 80 percent of manic-depressive cases), Thorazine (popular during the Fifties and Sixties, it has a heavy sedative effect) and the newer “neuroleptic” drugs such as Haldol, Mellaril and Prolixin, which don’t work by putting patients to sleep or by dulling the senses but by reducing hallucinations, delusions and other characteristics of the psychotic phase of schizophrenia.

When administered properly, these new drugs reduce the four principal symptoms of acute psychosis-agitation, hallucinations, delusions and thought disorder. The problem is that, with the exception of allergies, no field of medicine has such a range of possible dosages. The administering doctor must know a great deal about psychopharm-acology.

For the next six years, from his diagnosis and first medication until his first stay at Terrell State Hospital, Hank Angleton lived at home. Bill and Sally worked hard to maintain a semblance of normal life while suffering patiently and discovering through trial and error the sobering realities of living with their tormented son. From their initial be-fuddlement, bewilderment and feelings of betrayal at this catastrophic turn of events, they changed into battle-hardened veterans adept at handling the horrific and sometimes comic phases of Hank’s illness.

Hank also tried during these years. He took the courses at Richland Community College and El Centra Community College that were recommended by his caseworker at the Texas Rehabilitation Commission. And he did fairly well at keeping appointments with his other counselor at the Routh Street Clinic for outpatients.

These mental health workers, however, were terribly overworked and could spend only a few minutes with each patient. Their workload has increased appreciably since 1975, when the Supreme Court decided in a landmark case that mental patients had to be kept in the least restrictive setting possible for their own well-being. Hence, the number of patients in the nation’s mental hospitals has been drastically reduced, and the number of outpatients has increased accordingly.

Since 1965, the number of beds in the state’s mental hospitals has dropped from 15,652 to 5,600. The average inpatient population at Terrell State Hospital seven years ago was 2,500; today, it’s 800. This “dein-stitutionalization” policy of returning mental patients as quickly as possible to their communities has meant that the doctors, nurses, caseworkers and case managers at the center’s four outpatient clinics now bear the brunt of the work.

The average caseload for doctors at the four clinics is 277 patients; for caseworkers, it’s 285. Ideally, an increase in money follows an increase in the number of patients. But despite this radical change in patient treatment, the state legislature, with its usual “precast-in-concrete” state of mind, continues to allocate about 75 percent of the state budget for mental care for the 20 percent of those in institutions. Last year, state community centers, such as the Routh Street facility, received $74 million of the $522 million state MHMR budget.

Amazingly, in spite of the politicians, some improvements have been made in the MHMR outpatient clinics. The number of psychiatrists has been increased from five to nine, more than double the amount of time spent with each client-from 55 minutes a year to two hours and 12 minutes a year.

But for Hank Angleton, these efforts were futile. His illness grew worse. More frequently came the rages, the tumbling and soaring of moods; the manipulating, wheedling, then aggressive demands; the smell from his forsaken personal hygiene; the witless noise, the restless pacing. He would fasten himself to the corner of his room like a fly, then race downstairs to open all the drawers and doors to look for something hidden from him.

He tore up chairs and his mother’s Bible, punched holes in the wall, gave things away to strangers and turned himself into a verbal hose with a saturation flow of threats, pleas, curses and demands. Finally, on a March evening two years ago, the police at the Fanners Branch substation called Bill about his son, who was demanding that they call Liz Taylor and Frank Sinatra to warn them about the Mafia. Once he was home, Hank refused to go to Parkland.

For the first time, the Angletons had to call the sheriffs department to come get their son. They drove downtown to the Records Building for the interview and paperwork, as the mental illness department waited for the judge to sign the Mental Illness Warrant that would allow the deputies to pick up Hank at home and take him in handcuffs to Parkland’s psychiatric emergency room. In two hours, the family was back home in Farmers Branch.

After seven years, the Angletons felt numb, a despairing condition of being buried alive. They felt like prisoners in their own home, which had become a futureless place as long as their son stayed with them. His living with them had become unbearable.

“It was him or us,” Bill said. “I gave him three alternatives: live on the streets (which I really didn’t mean), go to Terrell or try to get on at Independence House. I think he believed I wouldn’t take him to Terrell, so he chose that.

To his surprise, Hank enjoyed the stay at the state hospital. He made friends for the first time in many years, became stabilized with regular drug treatment and participated in therapy programs. In two months, however, he was released, and Bill and Sally were faced with the catch-as-catch-can situation they will have to deal with as long as they care about their son: Where to put him besides the streets of Dallas?

Their first choice, Independence House, which is part of the county MHMR system, was one of only two residential treatment centers for mental patients living in Dallas that offered lodging and vocational opportunities. The other, the Phoenix Lodge program, limited its members to graduates of the Terrell State Hospital Fairweather Lodge Program, which did not include Hank.

“We have 80 members placed in 20 apartments around town,” said Jim Knauss, an Independence House worker. “They pay $115 a month rent, and we have four apartment coordinators who check on them regularly. We also have three transitional apartments with 12 beds, where members can stay for up to four months. There are about 30 working in our contract employment programs-stuffing ads in plastic bags, yard work.”

Hank Angleton wouldn’t go to Independence House. “He said he was too sick and didn’t feel he could compete with anyone, even at menial jobs,” said Sally.

Instead, the Angletons found Hank a small room (a garret, really) for $350 a month at Quinn’s Retirement Residence, a converted nursing home on Fairmount Street. Quinn’s provided laundry service and room and board, but no medication supervision.

Hank began his Routh Street Clinic routine, but he gradually went less and less. A few months later, he asked his parents to take him back to Terrell. Voices were telling him to kill.

They took him to Terrell-this time for only three weeks-then back to Quinn’s, where Hank remained until last fall, when he was asked to leave after a disagreement with Mr. Quinn. In October, he moved into a $325-a-month room at Mrs. Gillespie’s, until he was thrown out in February.



ARRIVING ON THE third floor of the Mental Diagnostic Center from Parldand’s psychiatric emergency room, Hank Angle-ton was checked in like other clients: His handcuffs were removed; his records were gone over; an informed consent statement was signed; his valuables were checked. He received a change of clothes and a shower.

The reek was washed away and the stubble was shaven. The medication had taken hold, and he was no longer violent or threatening suicide, so the therapeutic technicians put him to bed in one of the rooms on the Open Unit. On this wing are 33 beds, one nurses’ station and a patient lounge at the end of the corridor.

For the violent ones, there are 12 beds in the Intermediate Care Unit and the seclusion rooms: hollow-steel doors with 10-by-lO-inch vision panels, mats on the seamless floors with an almost epoxy finish for easy cleaning, stainless-steel mirrors flush-mounted on the back walls for corner surveillance.

“We wanted to create a detention facility with a homey, dormlike feel, rather than [like] a jail,” said Cecil Couch, MDC’s project engineer. “Instead of bars, we used stainless-steel screens and a heavy plastic that looks like double-coated windows. We spent $400,000 on the fully computerized security system-28 surveillance cameras, 17 different levels of card access to open doors and use the elevators. It’s safe and comfortable.”

The latest MDC is a radical change from the years when the mentally ill were thrown together in cells next to criminals in the Dallas County Jail, venomous areas of futility and grime, where they were often subjected to the bumpkin sadism of uneducated jailers and trustees. In October 1967, the patients left their criminal roommates for a somewhat nicer home: a section of the fifth floor of the Dallas County Records building.

Dr. Charles Lett, current medical director of the MDC, was working on that fifth floor in 1977 when the Dallas County Mental Health and Mental Retardation Center assumed the contract to operate the facility. Dr. Lett supervised the first attempts to make the center a home: Walls were painted in relaxing pastel colors; paintings from starving artists’ shows were hung; newer furniture was put in; and radios and televisions were installed. Staffers abandoned the all-white hospital uniforms for everyday clothes. But nothing could rid the old fifth floor of the constant smell-’three parts stale smoke, one part insecticide and a splash of old ammonia,” as Lett described it in his book, The Last House In Dallas.

Lett left the odor behind a year later, when he and 23 patients moved to Building C at the Hillside Center, a former private hospital in West Dallas with rolling grounds and lots of trees.

The Hillside unit remains part of the MHMR system. It’s an unlocked 20-bed unit for short-term adult inpatient care and a secured unit of 15 beds for children ages 6 to 12. (It’s the county’s only facility for this age group. There is no Dallas County inpatient facility for adolescents.)

One symbol of this gross neglect is on the second floor of the new MDC at the east end: a new 15-bed adolescent wing that is ready and waiting but is unused because of lack of funds. The 13- to 17-year-olds who are admitted to the MDC are placed with the adults.

“Of course, it isn’t a good situation,” said MDC’s Gill. “They are mixed with bigger and stronger, potentially dangerous people; they are more active than adults; and our wings aren’t sex-segregated.”

“We are not a treatment unit per se, but a diagnosis and holding facility,” says Lett. “What those kids need is a place to stay from 30 to 120 days for education and training rather than chemical stabilization. Terrell is the only place.” Meanwhile, the 15 beds in the MDC adolescent wing remain empty, and the space is used for furniture storage.

By 8 a.m. on a Thursday, six days after Hank arrived at the MDC, he sat in one of the big, overstuffed chairs in the day lounge watching a man entertain himself across the room with elaborate pantomime gestures. The rest of his fellow patients wandered about, most of them awaiting their turn before Judge Joseph Ashmore Jr. in the Mental Illness Court one floor below.

Over in the Intermediate Care Unit, a carpenter in one of the seclusion rooms was replacing a convex plastic ceiling mirror (similar to those used in stores to catch shoplifters) with the stainless-steel, flush-mounted wall variety. A patient had smashed the overhead mirror with his fist and had used the plastic shards on his wrists. There were other oversights to be corrected. The pull-out drawers in some of the room closets -possible weapons-had to be replaced. And something had to be done about the closet’s sliding doors, which patients hid behind.

Hank hadn’t contested the court’s recommendation that he be sent to Terrell for up to 90 days, so he remained behind while one by one the others left to appear with their lawyer downstairs.

Glen Williams, 15. Had taken 93 of his father’s blood pressure pills in his third suicide attempt. Committed to Terrell for a long-term stay.

Douglas Williams, 19. Threatened suicide; had begged his mother to slit his throat; asked the police to kill him; at MDC, he was assaultive, agitated and was placed in seclusion four times. Committed to Terrell for short-term stabilization.

Archie Page, 12. Recently at Hillside Center for four months; repeatedly threatened mother and sister with knife; assaulted younger brother; carved obscenities on living-room wall; chronic truant and user of marijuana and alcohol; lately obsessed with fire. Committed to Terrell’s adolescent unit.

Rickey Rodriguez, 25. Sees people without heads; bangs on neighbors’ doors; walks into mother’s bedroom and sees blood gushing from her throat. Committed to Terrell for the sixth time.

Ann Marie Sarelli, 16. Overdosed on 250 to 300 aspirins after hearing voices; older boy friend, 37, tried to coax her into prostitution and supplied her with speed, and she is willing to file charges on the man. Committed to Terrell for short-term stabilization.

Earlier in the morning, Judge Ashmore had rapidly read through the uncontested cases, remanding some to outpatient clinics, others to the Drug Treatment Clinic and still others-including Case Number 84-323, Hank Angleton-to Terrell State Hospital. Hank left MDC just after lunch for the 30-mile trip. A month later, Bill talked to his son at the hospital.

“He was miserable, doing terrible. Theywere giving him the Prolixin pills withoutthe Cogentin. The last thing he said was,’Dad, if this is how it’s going to be, I’d ratherkill myself.’ “