Elinor Carucci/Redux, for The New York Times
Jeneen Interlandi, who wrote this week’s cover story about hospitalizing her father because of his struggle with bipolar disorder, is a science and health reporter and 2013 Nieman fellow at Harvard University. Her last article for the magazine was about patients waking from states of minimal consciousness.
At what point in living through these experiences with your family did you start to consider writing about this?
Some parts, about my parents as characters, I have always wanted to write — they are the very things that led me to writing in the first place. But I started to think about writing about the larger story — the fractures in our state hospital system — when the Tuscon shooting happened. We were in the middle of dealing with our family situation, and I was working at Newsweek at the time, and stories started trickling out about how some of the people around the gunman Jared Loughner had suspected he was seriously mentally ill, and then the question was raised, “Well, why didn’t anybody do anything — get him committed?” I remember wanting to jump out of my skin when I first heard the question. “Because it’s almost impossible!”
Before that, I had really felt like my family was just missing something — somehow we weren’t navigating the system properly, because this could not possibly be the norm. But when the Tucson shooting happened, I started poking around and saw that our case was not even remotely exceptional. And that it was happening this way all across the country — not just in New Jersey, where we live.
Were you aware of how complicated the state hospital system is before your father started to struggle with mental illness?
Only vaguely. The first time my father was committed involuntarily, during his last episode in 2005, I was in Alaska — on the North Slope — completing research for my master’s thesis. I knew that he had cycled through several short-term care facilities before finally landing at a state hospital. But I had zero understanding of the process or the system through which that happened. My sister would call and say, “He’s in the hospital,” then a week later, “He’s out,” and then “He ran off and we can’t find him.” And I’m thousands of miles away, scratching my head, thinking, Why do they keep releasing him when he’s so obviously sick? What happens if he gets hurt or hurts someone else? This time around, I was living nearby and in a position to be more proactive. Which, as the story shows, really didn’t make much of a difference.
How did you get in touch with the other families you spoke with who were also trying to have their family members committed?
The Treatment Advocacy Center, some of whose data I cite in the story, was invaluable in connecting me to families like mine. I think ultimately about half the families I talked to I found through them. For the other half, it was a matter of going back through newspaper archives and various testimonies to various legislative bodies — where families speak about why a given law should or shouldn’t be enacted. I think I talked to almost 30 families. They weren’t tough to find or to reach out to, only because I had been through the same things as they had, and was planning to write the piece from that perspective. But the interviews for this piece — I don’t think I’ve ever had so many sources break down crying on the phone.
Your affection for your father must have made it difficult to figure out his treatment options. Is there no one neutral figure, like a social worker, to guide families through the process?
I think in many places those services exist — in New Jersey, at least, they have this thing called Integrated Case Management Services, which is exactly what you suggest — a team of experts that help people with mental illness and their families navigate the system. But there are two problems with it. One, not everyone finds their way to those services. My family couldn’t seem to access those things until we reached the criminal courts.
The second, equally intractable problem is that people suffering from mental illness very frequently don’t recognize that they are ill, and thus resist all treatment (the clinical term for this is anosognosia). You end up with families and patients who are at cross-purposes. The family wants the person to go to the hospital and take medicine. The person who is sick wants to do neither. Who is the social worker supposed to advocate for? That’s why I think involuntary-commitment statutes are so important.
Did other families make decisions that surprised you? I was shocked at people suggesting that you ought to let your father “hit rock bottom,” given the vulnerable and sick state that he was in.
I think that people who frame it in those specific words (and it’s something almost all of the families I spoke to have heard at one point or another) don’t fully understand or accept that it is really an illness and not a personal choice to behave as my father was behaving. Having said that, the basic premise — letting someone bottom out — is something too many families are forced to accept. Not because it’s good or fair or right, but because there’s simply no other option.
I never imagined I would or even could get a restraining order against my own father. It still sounds crazy to me even now. So coming from that experience, nothing anyone else did surprised me either.
What about the civil liberties implications of committing people?
I think those concerns are all completely valid. As I say in the story, even as we were struggling to get my father committed, I worried about what would happen if he was actually committed. But I also think a lot of that worry is part of the larger anxiety of being trapped in a system that seems so haphazard and chaotic. And there are ways to alleviate that part of it. First, by having a system that is more reliable — that is, where all the key actors are well aware of the laws and adhere to them. And second, by having human resources that are adept at working with families in crisis. In every story I heard, there was always one nurse or social worker or doctor who met the chaos with compassion and good sense. And that goes a long, long way toward putting families at ease.
So you see when you have stories to tell, writing can come in many different forms. The above shows the importance of Interviews as a writing form. Be encourage... and Write, Write, Write!
FLAG