While the City Slept (13 page)

I
n 1955, more than half a million Americans were housed in mental hospitals. Many of them were there for no particular reason, other than that someone with a certain amount of power found them strange, or inconvenient, or of the wrong skin color. Conditions in these institutions could be hideous, and protesting one’s confinement could be taken as proof of one’s instability. It was an open question as to whether this system was creating more insanity than it was purportedly treating, and at the urging of reform-minded psychiatrists President John F. Kennedy closed the question by, effectively, closing down the institutions.

The community treatment movement began, with promises of increased respect for individual rights and an emphasis on tailored outpatient therapies whenever possible, all of it to be backed by the latest science and huge increases in federal spending. Mental hospital populations began falling, helped along by a 1975 Supreme Court ruling that declared it unconstitutional to involuntarily commit “a non-dangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends.” This, over time, evolved into a commonplace legal standard that, with some variations from state to state, prohibited involuntary psychiatric detention of any individual unless that individual posed “danger to self or others.”

By 1980, the population of American mental institutions was down to around 155,000 people, a fraction of the number just two and a half decades previous. It has been calculated that by 1994, adjusting for population
growth, about 92 percent of those who once would have been institutionalized were not. The problem was that new treatments weren’t as much of a breakthrough as thought, and in any case federal funding sufficient to the challenge of community treatment never materialized. The Vietnam War intervened, requiring attention and money. An oil crisis came, requiring attention and money.

Over the decades that passed after President Kennedy signed his 1963 Community Mental Health Act, whenever crises arrived, whenever budgets had to be cut, expensive programs designed to help a marginalized and stigmatized population, now dispersed throughout many communities and possessing little political clout, tended to be the first to get the knife. Dreams of widespread education about psychological instability did not materialize, either. Nor did dreams of services capable of responding rapidly to any individual in crisis. By 2008, when Isaiah found himself in crisis, multiple presidents had been warned that the system put in place by President Kennedy was failing because of neglect and was riddled with disparities and limitations. The same presidential commission that had described America’s “patchwork relic” of a mental health care system had, in its final report in 2003, called for a “fundamental transformation” of the country’s entire approach to people in psychological distress. It imagined a system in which, “at the first sign of difficulties, preventive interventions will be started to keep problems from escalating.” This commission was called the New Freedom Commission on Mental Health, and it reported to the then president, George W. Bush, who created it intending to fulfill a campaign promise. However, the commission had the misfortune of competing for attention with the aftermath of September 11, 2001.

No “fundamental transformation” ever occurred. Instead, in the years after the New Freedom Commission’s final report, the burden of handling people in psychological distress fell increasingly on families without the capacity to help and, when those families inevitably reached their limit, onto local police, emergency rooms, courts, and, finally, prisons, which
had effectively become the new mental institutions, except without the mission to provide restorative treatment. It has been pointed out that there’s strong irony to these developments. It was the shameful confinement of psychologically disturbed Americans to prisons that, after being exposed in the 1840s by a woman named Dorothea Dix, led to the creation of mental hospitals and institutions in the first place. According to the Treatment Advocacy Center, which has highlighted this irony, the mentally ill population of America’s jails and prisons now far outnumbers the population of its surviving mental hospitals.

At the time when Isaiah found himself in need of help, the vast majority of Americans facing psychological distress were, as always, nonviolent, far more likely to be victims of crimes than perpetrators, far more likely to harm themselves than anyone else. But whether they were among the vast, nonviolent majority or in the small minority with violent tendencies, if they were poor, like Isaiah, they found themselves encountering a public mental health system that was in a state of collapse. If they were African American, like Isaiah, they were “unlikely to receive treatment” from this system at all, another federal report found, and in the event they did receive treatment were “more likely to be incorrectly diagnosed.” Then the financial collapse of 2008 and, consequently, even more cuts to programs that might help people like Isaiah.

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Deborah didn’t know anything about this history. She didn’t know that she and her family lived in a state that had recently received a D grade for its public mental health services from the National Alliance on Mental Illness, nor did she know that this put Washington State exactly in line with the rest of America, which as a whole had received a D grade, too (with the alliance’s report describing a country in which people needing treatment “are allowed to falter to the point of crisis” and in which “the outcome of this neglect and lack of will by policymakers remains often horrendous”). What Deborah knew was that her brother was acting weird
and that at first she was having a hard time taking it seriously. She’d minimized it all, telling herself he was just mad, frustrated about pilot school and his job situation, and would get over it. At the same time, she was becoming increasingly scared. The last time she’d seen him, he was heading to the Burien Transit Center with a knife.

“A couple days pass,” Deborah said, “and he comes to the house”—her house, which at the time was in White Center, part of the drumlin field and about midway between West Seattle, where Isaiah had grown up, and Burien, where his mother now lived. Deborah’s home was in a low-income housing development, and it was where Isaiah was spending most of his time in those days. He knocked on her door, but by the time she got downstairs, he had kicked it in. She screamed at him about her children, that he was waking them. “Now, mind you,” Deborah said, “it’s not like, ‘I kicked in your door and I’m about to freak out and fight you.’ He kicked in the door, walks through the kitchen, like, ‘What’d you cook?’”

She lost it. Her children’s father came downstairs. Isaiah slammed a six-pack of beer on the floor, and the beer shot everywhere. Deborah said, “You have beer in your hands? You’ve been drinking? You don’t drink!” She knew he used weed from time to time, but she also knew he didn’t like to lose control like this. Isaiah was foaming at the mouth, she said. “I can’t forget it.” Her children’s dad put him in a full nelson, restrained him, and suddenly he seemed to snap out of it. Given no choice but to pause and calm down, Isaiah did. “He just releases,” Deborah said. “He just relaxes and is like, ‘I’m sorry.’”

Deborah was not feeling calm. She called her mom, began throwing Isaiah’s clothes out on the back porch and then in the trash, was furious. Their mother came, didn’t know what to say, told Isaiah to get into her minivan, a new 2004 Ford Freestyle. Deborah, feeling bad about her furious reaction, started pulling clothes out of the trash and putting them in a box for him. He tossed the box out of the minivan, told his mom to drive off. She did, so Deborah threw the clothes back in the garbage. Later, Isaiah’s mom ended up missing a payment on her new vehicle in
order to buy Isaiah some new clothes. Still, Deborah assumed the stress and the disappointment of flight school were mostly to blame for Isaiah’s behavior. She told herself Isaiah would never hurt her. She didn’t have a vocabulary for what might be going on with him psychologically, much less a method to effectively respond.

“These are acquired skills,” Dr. Lymberis said. “You are not born with it.”

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Not long afterward, Isaiah came by Deborah’s house with some cuts on one hand. He explained the cuts by saying his dog bit him, but Deborah didn’t believe him. Now she thinks they were actually from Isaiah’s break-in at the Auburn City Hall, which is not far from the Auburn Adventist Academy he’d attended and also not far from Auburn Station, a transit center where public buses come in from all over.

Isaiah’s paths of distress, and his paths of crime and violence, seem to have regularly circled back onto the paths of his childhood: back to Auburn, back to the Burien Transit Center, back to places reachable by long public bus rides across stretches of suburbia, rides like the ones that got him to Puget Sound Adventist Academy as a teenager.

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“Maybe a week later,” Deborah said, “he’s like, ‘Mom, I’ve got a place.’” Deborah had kicked him out, and now he would be leaving his mom’s apartment, too. Isaiah’s mother got in her minivan with Isaiah and his pit bull, and Isaiah directed her to a large house on Seattle’s Capitol Hill, not far from downtown. It was a huge, two-story Craftsman with a finished attic, bigger than any place Isaiah’s family had ever lived. They arrived at around 10:30 a.m., but the house was already occupied, by a small financial services business. Isaiah walked into the business with his dog, announced that he owned the place, and began firing people. He looked around, opened cupboards, peered in crannies. He explained that he was
an African king and that the home had been stolen from him during the sugar trade of the nineteenth century.

When the police arrived, Isaiah’s mother begged them to take her son to the hospital instead of jail. She explained that several members of her own family had serious mental disorders and that Isaiah’s sister had recently kicked him out because of his sudden personality changes. Isaiah’s mother now believed her son had what her own mother had: schizophrenia. However, she told the police what was true: up to this point, Isaiah had never been diagnosed with anything. In fact, he had never seen a psychiatric professional of any sort. The police escorted Isaiah to Harborview Medical Center, where emergency psychiatric evaluations are conducted, and where Jennifer would be brought a little over a year later, and where Isaiah, after his arrest on charges of attacking Jennifer and Teresa, would then be brought by Detective Duffy for the court-ordered blood draw. It is a Gotham-like complex of medical towers, some art deco, some afterthought, that occupies multiple city blocks and receives, on its helipad, trauma cases from all over the Pacific Northwest.

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“And here we go,” said Dr. Lymberis. “When the family turned to the system, the system had the same dynamic as the family.” The system was under financial stress. It was under time pressures. It had dysfunctions and limitations. No one could pay enough attention. Which was all well-known to people within this system. For decades, commissions at the state level, just like their counterparts at the federal level, had presented papers urging change, action, bigger fixes, more funds. “But, you know, everybody’s too busy with their own narcissism, and with the narcissism of the country, to really address problems,” Dr. Lymberis said. “So here we are.”

In Washington State, 2008 brought the elimination of a thirty-bed ward at Western State Hospital, the largest publicly financed psychiatric hospital in the region, which had already shrunk considerably in recent
years. Money saved by the ward closure was supposed to be invested in better community treatment programs, but that investment was effectively canceled out by recession-spurred cuts to those same programs. This contributed to an ongoing problem in which the system for handling people in acute mental distress was essentially locking up. Many other states faced, and still face, this problem. Like a number of those states, Washington addressed it by “boarding”—that is, strapping to gurneys in local emergency rooms—people deemed in need of psychiatric commitment but for whom there were no rooms available in any psychiatric hospital. In 2008, more than eight hundred people were held in this manner in the county that encompasses Seattle, kept in hallways or empty rooms in hospitals like Harborview, for various and unpredictable periods, waiting, often untreated, in a purgatory that local officials considered inhumane. By 2013, the year before the state’s supreme court ruled this practice unconstitutional, the number of Harborview boardings would be up to nearly one thousand.

The month Isaiah was brought to Harborview, March 2008, saw forty-three people being boarded. They were not all at the hospital at once, nor were they all there for the entire month, but the number means that on March 28, 2008, when Isaiah was brought in, there were likely one or two people already strapped to gurneys at Harborview, in urgent need of involuntary commitment but waiting, in states from untreated to insufficiently treated, until a psychiatric bed opened up somewhere.

“During the evaluation,” Dr. Lymberis wrote, “Isaiah actively tried to present himself as sane.” Deborah, who was called during the evaluation by a Harborview doctor, described the same thing but in different language. “He done gone into this Harborview,” Deborah said, “and talked to the man so cold where the doctor called me like I was the crazy one.” Deborah couldn’t believe it. She said she begged the doctor not to release Isaiah, explained that his family had become scared of him. She said the doctor told her Isaiah had not been deemed a danger to himself or others, so he would be sent on his way.

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The particulars of the Harborview evaluation, Dr. Lymberis wrote, involved Isaiah denying “any depressive or psychotic symptoms, admitting only that, in the last two months, he has become more enlightened. He was ‘being in the zone.’ He refused to discuss any of the details of what actually brought him to the hospital.” The hospital recorded Isaiah’s family history of schizophrenia, but it diagnosed him with something different. It said he was in a manic state of bipolar disorder.