TROUBLED MINDS

July 22, 1999
		Last July's shooting of two U.S. Capitol police officers by a schizophrenia patient has brought the condition to the nation's attention. To better understand this disease that affects over two million Americans, Susan Dentzer of the NewsHour's health unit, follows one patient's struggles. (Originally aired September 8, 1998) The Health Unit is a partnership with the Henry J. Kaiser Family Foundation.

July 27, 1998: A schizophrenic man opens fire at the Capitol. Dec 23, 1997: Many homeless people suffer from mental illness May 9, 1996: Health insurance for mental health Complete NewsHour coverage of health   The White House Conference on Mental Health National Institute of Mental Health National Alliance for the Mentally Ill Schizophrenia Web site	SUSAN DENTZER: Aftershocks of horror still flow from the July 24th shooting rampage at the U.S. Capitol that killed two Capitol policemen. Since then, attention has also focused on the tragedy behind that tragedy: Schizophrenia -- the devastating brain disorder that counts 41 year-old Russell Weston Jr., the Capitol Hill shooter, among its many victims. Weston's mother described some of his delusional symptoms. RUSSELL WESTON, JR.'S MOTHER: He belonged to the FBI, or the CIA, a dentist had put something in his teeth that he received, that they could send down; they were watching him with a satellite; the TV, when it was on, they could talk to him through the TV and they would watch him through the TV. SUSAN DENTZER: In the wake of the shooting Weston almost certainly faces murder charges. Despite his illness, tough federal standards would make it difficult for him to plead not guilty by reason of insanity if his lawyers chose that route. As a result, Weston could well be convicted and sentenced for his alleged crime.
	Struggling with schizophrenia.
	The dire illness Weston suffers from affects more than two million Americans, including 21 year-old Kareem, whose last name is being withheld to protect his privacy. Just days before the shooting at the Capitol, Kareem was admitted to the hospital of the University of Pennsylvania in his home town of Philadelphia after suffering his latest psychotic breakdown. The hospital and Kareem granted the NewsHour permission to tell his story. That story is typical. Kareem's disease was misdiagnosed for years after his first breakdown at age 15. Because he has been on and off medication, the roller coaster ride that has become his life has landed him in the hospital more than 10 times and nearly destroyed his family. DR. RICHARD PETTY: Schizophrenia is arguably the most terrible illness that has ever affected humanity. SUSAN DENTZER: Kareem's physician, Dr. Richard Petty heads the psychiatric inpatient unit at the university hospital. DR. RICHARD PETTY: What other illness strips away the core of what makes you a human being. It takes away your understanding of where your limits are as a person. It interferes with your ability to rationalize, to socialize, to be a member of society. But the good thing is that if the patients can get and stay in treatment, we can put it all back together again. SUSAN DENTZER: There is no cure -- but staying in treatment with medication, psychotherapy, and other assistance can produce at least some semblance of a normal life, as Kareem's case shows. He had already spent time in another Philadelphia hospital earlier in July after a previous psychotic attack. Discharged, Kareem ended up at the university hospital just two days later, apparently off his medication and in a nosedive. Psychiatric nurse manager Susan Weisser was on duty that day. SUSAN WEISSER: We got a call the police were bringing him in. He was involuntarily being brought to us. And he came in, he was in four-point restraints. SUSAN DENTZER: Weisser learned that Kareem's boss at a nearby Home Depot had sent him to the hospital after he had threatened customers. SUSAN WEISSER: They had noticed a change in his behavior in the past few days, and that he had been wearing winter clothing to work, heavy, heavy winter clothing. Of course, this is in July. He was obviously hallucinating because he would laugh inappropriately in the middle of a conversation. I did get him to answer me that he was -- Are you hearing voices besides mine, because I was the only one in the room with him, and he said, "Yes, and I can't make them stop." SUSAN DENTZER: Weisser called Kareem's mother, who recounted what had happened between her and her son the day before. BESSIE, Kareem's Mother: He reached over and he had a knife in his hand and he just hit me in my chest with it - you know just hit my breast bone - but it didn't bleed or nothing but that's when I started saying I can't do it you know he needed help and he started crying saying "Mommy, I didn't mean to do it" and stuff like that and he just ran out of the house. SUSAN DENTZER: Even though disoriented, Kareem, himself, was shocked at this behavior. KAREEM: She done washed the knife off and put it back on the dish thing. I'm like, am I really crazy now? Am I doing things, am I really doing things and not knowing it. And I was like man, I'm walking to the police station because I don't know what's going on. SUSAN DENTZER: Two weeks later, the psychiatric care team at the university hospital gathered to discuss Kareem's case. Dr. Sarah Hicks, a medical resident in training, told the rest of the team about Kareem's treatment, including the shot of long-acting medication that he had received. DR. SARAH HICKS: We gave him a Decanoid shot of Haldol and he really reconstituted really remarkably. And over the course of about the first week, he really was able to, his thought became much more organized and his hallucinations have really basically tapered off in a consistent manner. SUSAN WEISSER: I think there is an education deficit with the mother and the family and they are just like coming to grips now with the fact that their son has an illness that is going to last a lifetime. DR. RICHARD PETTY: If we can do the family education components of this, that is important. It just emphasizes again the importance of not just treating patients and giving them a pill and hoping they will get better, because they won't. They need to have the psychological and social and even spiritual components of their illness all dealt with.
	Diagnosing schizophrenia.
	SUSAN DENTZER: In fact, a recent study showed that fewer than half of schizophrenia patients in the U.S. get appropriate medical treatment for the disease -- let alone adequate counseling or other help for the social aspects of their illness. This time around, though, Kareem seemed to stabilize, at least for awhile. KAREEM: The medication was - it's got to be working, because I have more - I have better thoughts in here than I have any hospital so far. SUSAN DENTZER: Thanks to advances in medical research and technology, doctors are now better equipped than ever to help patients like Kareem. They now know that, rather than one single disease, schizophrenia is probably a collection of separate diseases that manifest themselves differently in patients. And although they don't fully understand what's behind schizophrenia, they do know what schizophrenia is not. DR. RICHARD PETTY: Despite the name, despite what people say, it is not a split personality. SUSAN DENTZER: The root of the word schizophrenia is a German word meaning "to split." But this refers to the fact that patients afflicted with the disease become split off from society -- a syndrome that all starts with a diseased brain. DR. RICHARD PETTY: Schizophrenia doesn't occur because your parents treated you badly, or because of some other insult. It is an organic brain syndrome. SUSAN DENTZER: The causes seem to be complex. First come genetic factors: For example, individuals have a markedly higher chance of developing schizophrenia if one or both parents has it. But faulty genes alone don't seem to be enough to cause schizophrenia. Research shows that some environmental trigger may interact with genetic factors to kick it off – probably when an individual is still in the womb. DR. RICHARD PETTY: Any kind of damage that occurs to the fetus, particularly in the second trimester, seems to be associated with an increased chance of getting it, so viral infections, starvation, lots of different types of obstetric injuries seem to be associated with an increased risk. SUSAN DENTZER: As a result, evidence of schizophrenia can be seen in the brains of patients from infancy. First, their brains are smaller than those of healthy people and remain that way into adulthood. And there are other noticeable abnormalities, such as enlarged brain ventricles that carry the fluid that maintains uniform pressure throughout the brain. Dr. Ruben Gur and his wife and co- researcher, Dr. Raquel Gur, are two of the nation's top specialists in the brain function of schizophrenia patients. They have been retained as expert witnesses for the defense in the case of Russell Weston Jr. The Gurs have examined brain scans of people attempting to perform certain tasks. The images on the left are of healthy people; the scans on the right are of patients with schizophrenia. DR. RUBEN GUR: We see abnormalities in patients in the activation of the brain regions in response to those challenges, in the same way that if you drive the car, you see that the engine doesn't respond the same way that the engine should – DR. RAQUEL GUR: The lights flash on. The brake systems go on. All kinds of things happen. DR. RUBEN GUR: One wheel may go forward and another wheel may go back. SUSAN DENTZER: In turn, these abnormal brain functions manifest themselves in a range of symptoms from hallucinations and delusions to disorganized speech. These are called "positive symptoms" because people with schizophrenia have them and healthy people don't. DR. RICHARD PETTY: The most common is hearing voices. Imagine what it is like to constantly, constantly hear these voices talking to you, saying things, "You smell, you're bad, you're evil, you should die". And then other voices will tell them things, they will tell them what to do. Command them. "You must go and jump off a bridge. You should go and shoot somebody". KAREEM: Commands like "Get up, go over there, I don't care what y'all want me to do, just leave". It's like having a real bad twin that's always wanting to do something bad. And the voices was like demonic, and I couldn't control it, you know. And I would try to run to church on every Sunday to get them little spirits away from me and all that. SUSAN DENTZER: Other symptoms are termed "negative" because they represent an absence of normal human behavior. DR. RICHARD PETTY: It is the lack of will, a lack of ability to initiate actions. People lose the ability to socialize. People lose the ability to produce language, and in particular, lose the ability to have any pleasure. Imagine never again being able to enjoy pleasure, in anything. Anything you eat, anything you see, anything you read. Nothing. SUSAN DENTZER: In most patients with schizophrenia, this constellation of symptoms does not lead to behavior that is more violent on average than the rest of the population. But there is an increased risk among some patients such as those diagnosed with paranoid schizophrenia, as was Russell Weston Jr. Many do commit crimes, and that is why a number of people with schizophrenia are among the estimated 200,000 with severe mental illness who populate the nation's prisons. DR. RUBEN GUR: There are some forms of schizophrenia, particularly paranoid schizophrenia, where the patient develops a delusional system, and they do things that seem senseless to us, but make perfect sense within their system. And what we see as a wanton assault on innocent people, they basically may be seeing as a fight for their own survival.
	Anti-psychotic drugs: effective, but expensive.
	SYMPTOMS OF SCHIZOPHRENIA: Schizophrenia is characterized by a constellation of symptoms suffered for a number of months. These symptoms include: Thought Disorder: the diminished ability to think clearly and logically. Paranoid or Broadcast Delusions: A person affected by paranoid delusions may believe that he/she is being conspired against. Broadcasting describes a type of delusion in which the individual with this illness believes that his thoughts can be heard by others. Hallucinations: most often hallucinations take the form of voices heard only by the afflicted person. Such voices may describe the person's actions, warn him of danger or tell him what to do. At times the individual may hear several voices carrying on a conversation. Negative symptoms: flat or blunted affect (i.e. lack of emotional expression), apathy, and social withdrawal. Source: The Alliance for the Mentally Ill SUSAN DENTZER: For the Gurs and the hospital team, the special tragedy of Weston's case is that his rampage probably could have been prevented with the correct medication and other treatment. This has largely been true since the 1950s, with the introduction of the first effective anti-psychotic drugs including Thorazine. The drug curbed patients' positive symptoms, and it led to waves of patients being released from the nation's overcrowded and degrading mental institutions. DR. RICHARD PETTY: Thorazine was introduced in 1952. It was an absolute breakthrough and it started really making a dent in these huge populations that were in the old state hospitals. SUSAN DENTZER: But the medication also had pronounced side effects in patients, including serious motor disturbances such as shaking and shuffling, as well as impotence in men. A desire to avoid these side effects reinforced many patients' tendency to not take their medication because they didn't believe they were ill. In the last decade, a new generation of drugs has revolutionized treatment for many patients. These include Clozapine, Olanzapine, Risperidone and Quetiapine. Researchers don't fully understand how these drugs work, although the medications may influence the chemical neurotransmitters that send nerve impulses throughout the brain. But these newer drugs don't produce the uncomfortable side effects of earlier medications, and they are especially effective at treating patients' negative symptoms, such as apathy and social withdrawal. As a result, patients may be more likely to keep taking their medication. DR. SARAH HICKS: You take someone who basically would have been 20 years ago, 30 years ago, and 100 years ago, you know, completely marginalized and live in an institution their entire life and make them be able to have a life and get married. SUSAN DENTZER: Yet there are thorny issues surrounding the use of both the older and newer drugs. A recent study shows about a third of patients end up overmedicated and another third are undermedicated, leaving them barely functional. Another issue is cost. Taking the correct dose of the newer drugs can cost $200 to $500 a month. That can discourage their use by patients whose disease has forced them out of work or onto public assistance. DR. SARAH HICKS: I just had a patient come back to the unit who I discharged, furious with me, waving a prescription in her hand saying, "Dr. Hicks, this medicine was $500 for one month," and this was a woman who had no income, and it was just impossible for her to get her medicine. SUSAN DENTZER: But in the end, drugs are just one of many needed tools in the treatment of schizophrenia. The rest include lifestyle changes and coping strategies such as stress reduction. The last days of Kareem's stay at the university hospital were devoted to equipping him with these survival skills, including tips on managing his anger. KAREEM: When your anger feels intense as if you want to explode try nondestructive physical activity to blow off some steam first. LISA CLARK, Occupational Therapist: You can hurt yourself or you can hurt somebody else, right? You could really impair a relationship.
	Cautious optimism.
	SUSAN DENTZER: Two and a half weeks after Kareem was admitted to the hospital, the managed care company monitoring his treatment is pressuring his doctors to discharge him. Although Kareem is feeling much better, he admits to his mother and doctor he's ambivalent about getting out. KAREEM: I'm not all excited about leaving because I've done gone through this so many times. DR. SARAH HICKS: Well, you've done it before. Why don't we just go over it together, and this is what Kareem came up with, just what he'll do if things get bad again. SUSAN DENTZER: Kareem then listed the symptoms he would be on guard against. KAREEM: Disturbing thoughts, when I just lose track of where I'm at. And extreme paranoia that's when I'm questioning everybody, and I'm real uncomfortable where I'm at. You know, it's like I'm worried about what's going on outside when I'm in the house. RICH KAUFMAN: It does impact families, family members very strongly. And one of the things that I think we could recommend as well is for you to think through a support plan for yourself. BESSIE: They're right because I have to know how to deal with him, or how to talk to him, or how not to get too upset when certain situations come up -- and it's hard when he's fighting my help and the anger is showing and it's not like he's little and I can control him anymore like that and I have to know how to control myself. SUSAN DENTZER: As Kareem prepares to leave the hospital, his anxious physicians reflect on his treatment and his prospects. DR. SARAH HICKS: He looks really good, and he looks better than what we expected. But he's somebody who's had more than ten hospitalizations over the last five years, and people's track records often reflect most of what's going to happen to them in the future. I mean, there's no cure for schizophrenia right now. He's not on anything - the medicine he is getting is the same as many of these older people have always gotten. So I would like to think that things are going to go well for him, but I'm cautious. SUSAN DENTZER: (to Kareem) What do you think is the most important thing for people to understand about people like you who have this disease? KAREEM: I'm considered not normal, but I'm still a person. People have just got to understand that it's not like it's going to affect them if I touch them, or if I talk to them. SUSAN DENTZER: Since he left the university hospital that day in August, Kareem has been rehospitalized twice amid signs that he was again acting strangely. Now stabilized, he is waiting to be discharged as soon as an appropriate residential treatment program can be found. That report first aired last September. To update the Weston story, Russell Weston was charged with murder for killing the two Capitol policemen. A federal judge ruled in May he was incompetent to stand trial. He is being held in a prison medical center. Prosecutors have asked that he be forced to take drugs. They say that would make him competent to be tried.