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 “The Jason I raised is gone”: Sylvia Charters looks at pictures of her sons, Billy and Jason.
Charlie Leight/Genesis
“The Jason I raised is gone”: Sylvia Charters looks at pictures of her sons, Billy and Jason.

Broken minds, broken lives

Mental illness | Millions suffer from mental illness, and their families say they feel abandoned by a failed mental health system and often by churches

Issue: "Getting paid not aid," Feb. 22, 2014

PHOENIX—Some stories of the mentally ill have a happy ending. Most don’t. Medical advances make it possible for many people to function in the world instead of undergoing institutionalization. But many seriously mentally ill people don’t follow prescriptions for a simple reason: They don’t realize they’re ill.

Anosognosia, or lack of insight, is not the same as denial, which is a psychological impairment. Instead, it’s caused by damage to the brain. About half of the seriously mentally ill have anosognosia. To be forced to take medicine that makes them feel terrible, when they don’t even believe they’re sick, is torture. Many refuse, lie, spit, or even throw up to avoid medication.

I agreed to use only the first letter of T’s name. A 28-year-old Arizonan with bipolar disorder, she described what it’s like to have anosognosia: “I thought everything that I was thinking was completely true and accurate, but I was just completely delusional.”

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She remembers most of her paranoid hallucinations. Her first real psychotic break was in 2004, when she was a 19-year-old “typical cool chick” with a job and a car. Her symptoms dawned one weekend before Mother’s Day: “I couldn’t sleep for probably two or three nights. I was shaking uncontrollably, I hadn’t eaten in a while, and I was really anxious and my heart was racing.” She finally ran to the nearest gas station in just a T-shirt and underwear, screaming and crying that her father wanted to kill her. 

Such episodes continued. During the worst ones even her father, a large man, couldn’t restrain her. She and her father once tussled and toppled onto the floor. He sat on top of her, struggling to hold her down as she screeched and flailed around. She pulled off her father’s glasses and scratched his eye. The police came and led her away in handcuffs. T said, “When the cops came, I was completely shocked that I was the one being put in handcuffs. I was like, ‘What’s going on? He attacked me!’ I was just completely thrown.” 

During T’s first hospitalization the nurses gave her an anti-anxiety medication, which finally put her to sleep. Her drug tests came out clean. Because she was a nonconsenting adult and not yet a danger to self or others, the doctor couldn’t legally send her to the urgent psychiatric care center. She was taking up precious bed space and was calmer after 13 hours on medication, so the doctor discharged her and advised T’s mother, “Just be supportive.”

It took eight very tiring, very miserable years for T finally to gain insight into her bipolar disorder. She’s among the one-third of those with anosognosia who recover awareness after proper medication. When I visited T and her parents one evening, she sat relaxed and chatty in their living room, in front of the same TV from which they once watched the Tucson shooting news. 

T can’t say she’s cured, because mental illness is a chronic condition. But she now willingly takes her medicine daily, in part due to her stints at the psychiatric ward, where she remembers seeing deranged female patients drooling over their gowns with hair uncombed and bushy. “I’m still a young woman. I care about how I look, and I never ever want to look that way,” T said. Her mother reminded her, laughing, “Trust me, you used to look that way.” T recalled her first lucid thought after she received medicine in the hospital: “I really wanted to brush my teeth.”

THAT'S A SUCCESS STORY, at least for now, but other parents see no light at the end of their tunnels. Sylvia Charters of Phoenix, Ariz., says of her son, now 36, “The Jason I raised is gone. There’s a new Jason now.” Jason Charters is a tan, big-sized man with heavy-lidded eyes and a nice smile. He loves the beach and dreams of living in California. He was once a Mr. Social who played soccer for 13 years, loved school, surrounded himself with friends. Not too long ago, he told his mom he wanted to be a pastor and help the homeless. Then he suffered a psychotic break.

That break makes Jason a special case. Most people with bipolar disorder and severe psychosis like Jason’s show symptoms in their late teens or early adulthood. Jason developed his when he was 34 and had just lost his job as a security guard. He was back home living with his parents, planning to get a new job and his own apartment. 

—Part 2 of a two-part series on mental illness (see “Saving Seth,” Feb. 8)

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