WAGblog

After Northern Illinois University and Virginia Tech...

Last time I put up this reprint of an article I wrote for the Hartford Courant some years ago, I was told I should reprint it every two years. The recent events at Northern Illinois University and at Virginia Tech a year ago make that advice all too necessary and prescient. I believe you can glean the events that sparked this article from the article itself.

TWICE-TOLD TALES: NO HAPPY ENDINGS -- 1998

by Pamela Spiro Wagner

We may never know, or at least never fully comprehend, what short-circuited synapse, what blip of corrupted information or neurochemical glitch inside the brain drove Russell Weston to gun down two Capitol police officers this July, or Michael Laudor to murder his fiancee only weeks earlier, and with her his unborn child. Laudor was a Yale Law School graduate and activist on behalf of the mentally ill, and seems to be a man for whom adjectives like “brilliant” and “charismatic” crop up as reliably as Homeric epithets. Weston, in contrast, seems to have been largely unemployed and undistinguished, except as a loner with certain bizarre beliefs. Both men, long diagnosed with schizophrenia, had stopped taking medication. It also seems likely, at least in Michael Laudor’s case, that if he’d had adequate medication levels in his blood, Caroline Costello would be alive today, and Laudor a free man.

But why would someone so prodigiously intelligent, with such a promising future, stop taking the pills that were so essential to his well-being and sanity? Why would anyone? For Laudor, it wasn’t from lack of “insight,” as the shrinks like to say; by 1995, he was speaking openly about having schizophrenia, even in an interview with the New York Times. He knew he was ill and must have known, intellectually at least, the risks he was taking.
The information about Weston is sketchy at best, but it is clear that he had little effective follow-up after his discharge from a Montana state hospital.

I can’t speak for Laudor, much less for Weston, but after more than 20 years of struggling with schizophrenia, I’ve learned that the waxing or waning of symptoms is often as unpredictable to patients as to physicians. Relapses are usually caused by many factors but my guess is that Laudor’s relapse was induced by his success. Easily overwhelmed by stimulation or ordinary stress, as are many people with schizophrenia, and not recognizing his limits, or not accepting them, he may have over-extended himself, with tragic consequences.

Hold it! I can hear the objection: Most people occasionally over-extend themselves, yet they don’t commit murder.

But by at least one criterion, Michael Laudor and Russell Weston are not “most people”: most people don’t suffer from schizophrenia.

Although it doesn’t seem that Weston had any opportunity to try the newest medications, Laudor was taking risperidone, one of the new antipsychotic “wonder drugs.” He appeared normal, more or less unimpaired. But because he was so competent, people may have forgotten the shadow cast over his life by an incurable mental illness that even the best drugs treat imperfectly.

Schizophrenia is a brain disease, as anyone who is up to date will tell you. But the brain is the seat of the mind and the mind the source of one’s self and of all that makes us human. To suggest that such an illness, with its profound impact on a person’s mind and sense of self, is a biochemical imbalance no more troublesome than diabetes, is to invite cruel, though unintended and unforeseen, consequences. Russell Weston Jr. coped largely by keeping to himself. But the same was not true for Michael Laudor, who seemed to be outgoing by nature and to enjoy the spotlight. But because effectively treated schizophrenia can be controlled, and therefore concealed, the impact of the disability it inflicts is frequently discounted.

Imagine, if you can, that you have schizophrenia, as more than 2.5 million Americans do. The older “typical” medications, most of them similar to Thorazine, are not only less effective, but often produce side effects like the infamous “Thorazine shuffle,” as well as tremor, dry mouth, weight gain, an excruciating physical restlessness, and for some, the disfiguring disorder known as tardive dyskinesia. I suspect that Weston, like many, found this “cure” worse than the disease, if he believed he was ill at all.

But imagine that after years of illness, a new medication alleviates the worst of your symptoms, as it seems to have for Laudor. If you’ve always been a high achiever, you push ahead. Soon there’s a lucrative book proposal, a million-dollar-plus movie deal. You’ve gotten engaged, your fiancee is pregnant and you’re being hailed as a role model for all mentally ill people, a source of inspiration and hope. And yes, it is a thrill, it’s huge, it’s exciting and you would do it all, if only you could. . .

But the same miracle drug that helps you function makes you tire easily, gain weight and sleep more than you’d like. Maybe you feel you can’t ask for a breather because if others cope with the pressure, you should be able to as well and if you admit to being less than capable, you’ll disappoint people who are counting on you. Wondering how you could better manage to live up to the demands success has imposed, it occurs to you -- as it will at some point to most people with schizophrenia -- that if you temporarily stop taking your medication, maybe you could catch up, get some work done. At first, you cut back on your pills just a little, but it snowballs until you’re no longer taking any. Whether you’re Michael Laudor or Russell Weston Jr. the stage at this point is set for disaster.

If something can be learned from these tragedies to help avert a “next time,” it may lie, first, in acknowledging the often agonizing side effects of standard medications, which are inexpensive and therefore the only option for most cash-strapped state hospitals. Then society needs to acknowledge that if the side effects of medication feel intolerable, the likelihood is enormous that patients -- with or without “insight” -- will stop taking them, and be reluctant to return to treating physicians for fear of being forced to do so.

And finally to recognize the terrible irony of Laudor’s situation. While the “public” celebrated him as a shining exemplar of what a person with schizophrenia can achieve, it seems simultaneously to have treated him as if he no longer suffered from mental illness at all, and certainly not from the serious but less visible vulnerabilities that come with the package. In short, he was acceptable as a “schizophrenia poster boy,” but only so long as he wasn’t noticeably schizophrenic!

Russell Weston Jr. and Michael Laudor have a chronic illness that by its nature can obscure one’s judgment, including the ability to evaluate one’s own mental health. Sane as he apparently seemed until a few weeks ago, Laudor was not “in recovery,” he was “in treatment.” Weston was as isolated by his illness as by Montana’s wilderness.

My sense, and my sorrow, is that both might have been better served by someone who more vigilantly monitored the build-up of stresses, both external and internal, knowing how schizophrenia works, how the sufferer is often the last to recognize when enough is enough.

Posted by pamwagg at February 28, 2008 08:09 PM | TrackBack