John's path alternated between periods of lucidity and paranoia and hallucinations. He made a few unsuccessful attempts at college, then enlisted for four years in the Army, hoping the structure would straighten him out, serving in the South and Germany as a radar technician. Then he had a few brief civilian jobs. He tried enlisting a second time, but by then he had been diagnosed as schizophrenic, so the Army had no more use for him. He began what would eventually become hundreds of sessions with psychiatrists and counselors. He tried outpatient treatment and hospitals run by universities, counties, private businesses, and the Veterans Administration, the long grind of antipsychotic medications, even shock treatments. At times he wandered the streets incoherently, or landed in jail.
The first years of John's intermittent care were in the Illinois system. Then he and my mother returned to Tucson, where he spent 17 years in the Arizona system. I left Illinois for Colorado, but wound up in Tucson for most of John's crazy years there. I was old enough to be a better witness, and I saw how the Arizona system was itself crazy and sad.
Our family didn't have a lot of money for treatment. John got by mostly on small disability payments from Social Security and the Veterans Administration, and whatever the public mental-health care system could do for him. Arizona's system, like those of the other Western states, is a complicated array of dozens of agencies and companies, some of which operate to make a profit on craziness. The federal government provides some money through programs such as Medicaid and Social Security disability, but state governments are in the driver's seat. Every year, the legislatures and governors allocate state money for the systems, and it doesn't have much to do with what's needed. The principle is called "managed care," which really means managing costs.
"It's an oxymoron approach," says Chick Arnold, a lawyer who has pressed a class-action suit against Arizona's system since the 1980s, demanding a series of improvements. "The companies (and agencies) get a finite amount of money to provide an open-ended commitment for service for a growing population. They can't do it. ... The system is designed to screen people out, not in. It's all about cost containment."
At most, John would see a psychiatrist for one 15-minute visit per month. Most of his interactions with the system came through his case managers and counselors, each of whom juggled many dozens of patients. Much of the treatment is based on medications that try to soothe or dampen the brain chemistry. John would get his meds in pills, liquid potions or injections. All the meds had bad side effects, such as tardive dyskinesia - uncontrollable pacing, stiffness of posture, facial grimacing.
John would take his meds for a while, stabilize, and then stop taking them. He would fly without meds for weeks or months, then crash. Sometimes when he had bad spells, my mother and I would ally with local prosecutors and go to court, testifying against him, saying he was a danger to himself or others, the legal standard for court-ordered commitment to treatment. The commitment would last for a week or so in a locked hospital ward, then longer periods of follow-up and mandatory meds outside the hospital, sometimes for as long as a year. Always the commitment would end, and then the cycle would begin again. All this is familiar to people who pay attention to crazy people.
John tried taking megavitamins and nutritional powders. He paid to consult with psychics. Once, he drove to California to try to talk to the guy who wrote a popular book on primal scream therapy. The guy refused to see him.
When he wasn't in hospitals, John lived wherever Tucson landlords would rent to a crazy person, usually cockroach-infested dives. In one big apartment complex that was filled with various losers, one of his neighbors got stabbed, and the police helicopter regularly flew over with its glaring spotlight and warlike noise. The wait for federal subsidized housing stretched out for years, and he could rarely take advantage of it.
In the bad spells, he forgot to eat and grew extremely thin. Or he got mad at everything and everyone, sometimes attracting the cops. The busts I know about were for leaping out of bushes and threatening strangers with a hammer, for taking the hammer into a convenience store and causing a disturbance, for tearing the windshield wipers off a parked car, throwing rock salt into the swimming pool in his apartment complex, and for forgetting to show up in court. Landlords evicted him for hurling rocks through his windows and breaking his door. During visits to our mother's house he broke dishes, threw a hammer through the wall, broke furniture, or pounded on the front door demanding to be let in. One time when they were driving together, he became agitated and told her, "Pull over or I'll put your face through that windshield." Sometimes the cops took him to hospitals, and sometimes to jail. At least once he set a fire in his cell.
He had a series of troubled cars - a Ford Falcon, a Mercury Comet, a Ford Pinto, and then an old International Harvester Scout. He worked on them constantly to keep them going. During bad spells, he caused a few car wrecks.
Most of the world had no sympathy for him. Banks dunned him with extra charges for bounced checks, and he would struggle to keep track of all his bills, especially the ones from ambulances and other mental-health providers, with their complicated deductibles and formulas for benefits. Bills from the phone company, other utilities, car insurance and the dentist often came faster than he could afford.
In desert heat above 100 degrees, he went around in a long-sleeved shirt with a T-shirt under it, and long pants. He wore down the heels of his shoes with his pacing. He loaned money to "friends" and never got it back. He was incapable of bargaining and often got rooked. Now and then, he picked fights with strangers and put up no resistance as the blows began to fall - punishing himself like that. One of the times I talked him into going to a hospital, we sat on chairs in the waiting room, and suddenly he curled down onto the floor, a catatonic escape.
Music could soothe him. In his lucid spells, he liked a good joke. He could talk Arizona Wildcats basketball. He had a persistent hope of creating something special and lasting, a breakthrough in physics or some other wild dream. One time I asked him what he was up to, and he said, "The never-ending battle against entropy." I had to look it up: the natural tendency of all things in the universe to fly apart.
I would get angry at him, wanting him to take his meds, regardless of their side effects, because the alternative seemed worse to me. Now and then he threatened to commit suicide. I got tired of hearing it. Sometimes I secretly wished for him to die, thinking it was the only way for him to find relief, and also because it would end my duty.
Then in 1995 at the age of 47, he bought a pistol from a guy he found in the classified ads, took it home to his latest one-room apartment in Tucson, lay down on his bed, and, sometime during the night, shot himself in the head. I do not know the exact date of his death - only that it was sometime in late April or early May - because it took a while for his body to be found. He was that alone at the end.
I know there are many dedicated professionals in Arizona's mental-health care system. But sometimes it seems as if the system mostly amounts to passing out guns. Maybe for some crazy people that's the only effective treatment.