EPISODE TRANSCRIPT
JESSE: I have spent the past year sifting through medical records to try and understand what happened on the day I was section 12’d. While I have found several pages of records and results from other hospitalizations, I've only found one paragraph from that day. Here's committable contributor Brian Patrick Williams reading the only medical record I have from the day I was section 12’d.
BRIAN: Psychiatric admission note, October 13th, 1999, Paul Hayley MD. A 19 year old male referred by UMass for treatment of anorexia nervosa and adjustment disorder with mixed emotional features. The patient presented to M-5 and then immediately refused to sign into the hospital. He was therefore not formally admitted.
I spoke with the father at length and he would not agree to have his son in the hospital and the son was requesting discharge and did not meet criteria to be held in the hospital against his will. Technically the nursing staff never received admission orders regarding this patient and he did not consent to the admission although he was brought onto the psychiatric floor. He was evaluated by the crisis service extensively and then discharged and those notes are available from the crisis service.
JESSE: When Dr. Bynum initiated the section 12 process, there was some aspect of that process that was mishandled or left incomplete but to the staff that received me at the psych ward, all they saw was a new patient. A new patient that they assumed was at risk of serious self harm.
I was only there for a few hours and how I got out was not due to any brilliant legal action, it wasn't because I was brave, or because I made a compelling argument. I got out because my father showed up and he understood the law well enough to make it very clear that he knew they were violating my rights.
Sometimes simply having someone present, someone who isn't a patient but can witness how the patient is being treated? Sometimes that is all it takes for patient's rights to be respected.
So in some ways I got lucky. This could be seen as a good result.
So why have I been trapped in a cycle reliving these experiences every day for over 20 years?
What happened when I left that psych ward?
Here's my mother Jean talking about what she remembers from that day.
JEAN: Okay. Before you went to the UMass health services, I mean, I was aware of mental illness, but I honestly didn't see you as mentally ill. I saw you as somebody who knew you had some issues with, um, eating and that you were paying attention to those and that you were trying to do the best you could do.
You would exercise but you also ate. And we were talking a lot, the two of us, and then that day happened and that all changed.
When you came home, when dad got you out and brought you home, it was like a different person walked in the house. You were suddenly rigid. It wasn't okay to really hug you and touch you. Forever after your behavior in my mind was changed because it was such a shock and it was such a shock to me too. I mean, the whole thing didn't make any Fu...didn't make any fucking sense. Okay. Sorry.
JESSE: You can swear.
JEAN: That call that day and you were crying and I'm trying to figure out what's going on. You had told me you were making this appointment to go in and ask for help.
So what's going on with this? Why aren't they giving you the help you need?
JESSE: So when Bynum called you, what happened?
JEAN: What happened was, um, basically I was in shock and I tried to ask questions because then I think he put you on and you were crying. There was some point at which you were crying and I'm like, I just didn't understand what was going on.
You'd gone in to ask for help. Yet, they didn't seem to be helping. And there was some point I think I actually knew at some point during the day, Tom said to me,
“But they haven't given him anything to eat except for a juice box.”
And it was like, well, why aren't they giving him something to eat then? I mean, if they're so concerned, why aren't they feeding him? And I never got an answer for that.
JESSE: I may actually have an answer for that. I was diagnosed with anorexia, told them my weight was so low that if I moved too much, I might die. Then kept at health services for over eight hours without ever being given food. Dr. Weber and Dr. Bynum have both stated that I was offered food and refused it.
What I remember is being offered food and responding by asking to speak with the nutritionist to hear what she recommended I eat because clearly I wasn't making the right choices on my own.
My response was met by an awkward smile and some comment about going to see if the nutritionist was still around.
My older brother, Tom was there with me that day. Here's what he remembers.
TOM: I remember the physician coming in and you basically saying,
“Should we consult a nutritionist first?”
You know, what's your opinion, asking for input. And that stuck with me because later when they were like,
“Oh, you demanded this.”
And I'm like,
“No, the fuck he didn't.”
But I remember you asking and him just being very strange. I don't even remember what words he used when he answered, but he seemed to, he wanted you to decide for him. He wanted you to make a decision on it, and it was consistent to me that your decision was,
“I'll take whatever you advise.”
JESSE: Here's my mother, Jean, again, talking about what she remembers from later that night.
JEAN: So when the whole thing fell apart and they strapped into that ambulance and took you off to a locked place to find that out afterwards, after you'd gone in asking for help, after both parents are there going,
“Yes, we want him to go to a hospital, let's do this. Let's find out what's going on.” Because that was, you were asking for help.
So for them to take that and lock you up and basically turn you...change your behavior, they changed your behavior. I know that. You came in that house that night and you were rigid. I couldn't, I didn't know what to do.
I just really didn't know what to do.
JESSE: When I arrived at health services that day I was fragile. Vulnerable. It took every bit of willpower that I had left just to get there, to accept that I needed help and to trust the people who said they were going to help me.
So when that trust was met with deception and manipulation, that resulted in me being strapped into a gurney and wheeled into a locked psychiatric facility, that clash from the world as I thought it was and the reality of what Dr. Bynum had chosen to do, that clash drove down into the fragile internal structures that I relied upon and broke me. And my mother wasn't the only person to witness the effects of that. My younger sister Susan, who was 13 at the time, also saw me that night.
Here's what she remembers.
SUSAN: My memories are of you coming home after being committed and just like, that you were crying on the floor for so long.
And I just remember like, seeing that and just feeling like you were so broken and I didn't know what to do, and the parents clearly didn't know what to do. So I remember when you came home from that, and then I remember that you went away, it was horrible.
I mean, I guess for context too, you know, you're not just my brother and especially at that time, I worshiped you.
So I think it was watching my brother cry but it was also watching my hero cry.
And I think when your heroes fall like that, it's a real life lesson. It's a lesson that like, if you're crying, what does that mean? Like, is anything safe? Is anything sacred? So I just felt like, helpless.
I wish there was more I could do.
I wish there was some amount of love I could give to you. I mean, it was very clear. I remember, um, trying to hug you or seeing like mom try to hug you and you just, like, it just seemed like none of that could reach you or touch you. And that was so scary. Cause I also feel like we had always kind of had an understanding, even though I was much younger and sort of to look at you and feel like I couldn't reach that part of you or connect with you was just really hard.
And um, and I just wanted you to feel better.
JESSE: I have spent a lot of time contemplating whether or not I really should have been given a diagnosis that day. Maybe things weren't really that bad? Maybe I didn't really need help?
Here is Committable producer, Jim McQuaid speaking with Steve Brown.
Steve, Jim and I have all been friends for almost 30 years.
Here's what Steve remembers about the last time he saw me before I was committed.
STEVE: I have a very vivid memory of the last time I saw him before he was committed. So I was at Lowell, Jesse had, I think, taken the first year off. And so he had just started at Amherst and I'd seen him over the summer at some point.
And everything was, you know, as it always was with Jess, he was eating healthy, he was doing the situps, he was doing other exercises.
And so I hadn't seen him for a few months and I saw him at King Richards fair, which we would go to like every autumn. And he was just so thin, you know, this was a guy who like, for the past four or five years had been like fit, fit like an athlete.
And so in a few months he went from that to, you know, like if you've seen The Machinist, the Christian bale movie, that's where he was headed.
If he wasn't already there.
I was completely freaked out. I didn't know if he had cancer or something and he didn't tell me? I'd talked to him and I didn't know what was going on.
So I, uh, I went to his mom and I was just like,
“What's up with Jesse? Is he okay?”
And his mom said,
“He's fine. We're watching him.”
And I didn't say anything to him probably because I was afraid. I didn't know what to do. I was also like 18 or something, 19, whatever, you know, like you don't really know.
JIM: So this wasn't just a matter of, he seemed fit and muscled and now he was thin.
STEVE: Yeah, he looked ill. The muscle was gone, his face was almost skeletal, and this was in a period of a few months. And it was like, I don't know what to do. And I guess I wasn't alone. Like his parents clearly didn't know what to do either.
I have the excuse of, having been a very young person who didn't have the experience to make a better choice, but I also regret that I did not have a conversation with him at the time.
JIM: When you say you have the excuse of being younger, I mean, what is it that you're excusing?
STEVE: That I didn't talk to him. He probably wouldn't have listened to anything I said anyway, but like, clearly something was wrong, something, and you know, it was only like, not very far after that when he was committed at Amherst, but I just kept thinking, like, why did I not say something to him?
Like, you've lost too much weight. I don't know what you're doing, but you're not doing it right. You know, but again, would it have helped him? Probably not. But you know, the hard thing about mental illness is like, it makes the people around you feel as helpless as it probably makes you feel.
JIM: when you found out that he had been hospitalized, were you surprised? I mean, what was your reaction to that?
STEVE: I don't remember specifically. I feel like that whole time period, just like it was nervous, it was...I was pretty lucky that I didn't really have a young experience where I lost any friends and when this happened, I felt like I might. I guess there was a lot of nervousness and fear that he wasn't gonna make it through this.
And I just didn't want my friend to get worse. I didn't want to cause him any harm. And so I was a little bit scared to be around him.
Not scared to be around him, but like scared to do the wrong thing around him or say the wrong thing, you know, just like knowing that I didn't know.
And knowing that he had been hospitalized, I didn't know what would send him back in. What would help him move forward or what would not? There's a lot of not knowing how to deal wit someone you care about having mental illness and being nervous that you're going to make the wrong move. You're going to say the wrong thing.
JESSE: This is what Dr. Weber and Dr. Bynum saw when I walked into health services at UMass. An emaciated young man in tears asking for help.
Agreeing that he needed to go to a hospital.
Agreeing that he should gain weight.
But what they also saw was a diagnosis, anorexia, and that diagnosis comes with a lot of preconceptions; lack of insight, deception manipulation.
So, when faced with what is perceived to be a crisis, do you trust the person? Or do you trust the diagnosis?
To try and better understand this complicated web connecting the person diagnosed, the community around them, and the professionals interpreting that diagnosis.
To try and better understand all of that, I contacted Pat Corrigan.
PAT CORRIGAN: My name is Pat Corrigan. I'm a psychology professor at the Illinois Institute of Technology. I have a 30 year career of looking at services for people with serious mental illness. Part of that is looking at how the stigma of mental illness impedes people in achieving their goals.
JESSE: For someone living with a diagnosed mental health condition they're experiencing stigma from a lot of different places. How do you categorize those different types of stigma?
PAT CORRIGAN: I think there's different types. I think the two obvious types are public stigma, what the public does to people with a labeled diagnosis when they buy into the stereotypes and discriminate against them.
And then I think there's self stigma, what you do to yourself.
If you're a person with mental illness and internalize stigma leading to low self-esteem, low self-efficacy, something we call the “Why try effect.” Why should I even try to seek out my goals, I’m not worth it.
A third group is called label avoidance. Stigma is a Mark. So, if I'm with a group of people and they have a different colored skin, which is a mark, and I'm racist I could act against them accordingly. Or different body type and I'm sexist, or gray hair and I’m ageist.
The mark of mental illnesses is fundamentally hidden. One way you get the mark is you're seeing coming out of a psychiatrist's office.
So, there's “Crazy Joe” coming out of the psychiatrist's office. Joe doesn't want to be labeled crazy, so he won't go. He'll avoid the label.
So, we know there's pretty clear evidence that maybe a third of all people with serious mental illness won’t seek out care. One big reason is to avoid the stigma.
JESSE: Because mental illness is something that could go on being invisible, you could have someone who's within a family or within a community who is experiencing stigma that the rest of the people in the community might not comprehend or know. Have you been able to research the effects of a community? Is it sort of a ripple effect? Do you see stigma on the individual ripple outwards?
PAT CORRIGAN: Erving Goffman is the Sigmund Freud of stigma research and he would kind of call this courtesy stigma, the fact that stigma of one person is extended to other people by association.
So, in mental illness one group to which the stigma of an individual with mental illness is extended is to family members. And so they must have caused it, or they must be nuts themselves to want to associate with this person.
And another it tends to be affiliated with is mental health providers, especially psychiatrists.
I mean, if you're a real doctor, why wouldn't you be an internal medicine doctor? Why do you want to hang out with these crazy people?
So it does get extended to the community and can in its own way, lead to prejudice and discrimination against those other folks.
JESSE: When Steve asked my mother if I was okay and she said I was fine, even though I really wasn't, on some level it may have been a fear of courtesy stigma that drove her answer.
But Pat also mentioned that there can be stigma directed at mental health professionals. If psychiatrists and psychologists are experiencing some form of stigma because of their profession, how does that affect their ability to connect with the people they treat?
PAT CORRIGAN: Our research has consistently shown the most stigmatizing group of professions amongst lawyers, and plumbers, and carpenters, the most stigmatizing group are psychiatrists.
And the second highest group are clinical psychologists. I'm a clinical psychologist. That might partly represent the stigma that I'm the butt of. It probably also represents the fact that a lot of times, psychiatrists in particular only see people when they're really, really sick.
And so they have a hard time understanding recovery is the norm. It'd sort of be like if you were in a diabetes clinic only for people who are going into comas all the time, then you're gonna think diabetes is a deadly illness. And in fact, that's not the case.
JESSE: Is there a specific type of stigma associated with people who have been through an involuntary commitment? Or an inpatient stay in a psych ward?
PAT CORRIGAN: So, in our research we would suggest that because the stigma of mental illness is hidden you need to qualify for it. Because if I were to say,
“I have a mental illness.”
You’d go,
“No way, you don't have a mental illness, you don't really qualify for that one kind of guy.”
So what makes you qualify as a true psycho worthy of stigma?
One is have you been hospitalized.
Two is if you’re on meds.
Three is if you see a psychiatrist.
We've never tested for whether you've been involuntarily hospitalized. I got to think that would make it even worse. There's clearly this interaction between having a mental illness in the criminal justice system. So I would imagine much of the population would think involuntary commitment would be some sort of legal issue.
Well, it is a civil issue but people might think it is a criminal issue.
So it seems quite likely that involuntary hospitalization would worsen public stigma and self-stigma.
JESSE: Is this a common association between mental illness and criminality?
PAT CORRIGAN: There is a common association between mental illness and dangerousness.
Clearly the single biggest stereotype of concern is that people with mental illness are all dangerous. I don't care whether you have schizophrenia or something more benign, like a grief reaction to a loss of a loved one, all mentally ill people are the same. And so if I think you're dangerous, I'm not going to want to hire you, or rent to you, or be your classmate.
It's a big problem.
JESSE: How would you approach trying to break that stereotype?
PAT CORRIGAN: How do we beat stigma? That's really what our research has looked at over 20 years. We've kind of simplified it, reduced it to two issues.
One is education, teach people the facts of mental illness that are contrary to the myths. And the other is contact, have interactions with people that have lived experience.
For adults the summary of our research pretty clearly shows education has no real benefits. I don't care what you tell me by the time I'm an adult I know they're mentally ill. I know they're dangerous. It's not gonna make a difference. What really makes a difference is contact. Is interactions between the people that have lived experience and the rest of the population.
And you want an example, and it makes a lot of sense to your listeners, a good example is how we've made great strides in the LGBTQ community.
You know, over my lifetime, we've gone from it being a very dangerous identity you'd never admit, to people out with wonderful multicolored rainbow flags. That's not because we told students it's genetic or hormonal, it's because back in my time very brave, LGBT men and women came out and we could look check for ourselves.
That those persons are not dangerous or evil or whatever. So it's the same thing. The degree to which people with mental illness come out and tell their stories is the degree to which the rest of the population knows they're not dangerous. They can get jobs, they can be successful, like everyone else.
JESSE: Is there anything I haven't asked about, that you think people should know, about stigma related to mental illness?
PAT CORRIGAN: So one other important thing that is interesting is that there are different agenda for why you'd want to change stigma, and those agenda conflict with each other. The one agenda is we know there are evidence-based treatments that will help people with their depression, schizophrenia, and the like. And we know they won't go get treatment unless we decrease stigma. And so the practitioners agenda is to try to decrease stigma to get people into care. That can be different than the advocates, the activist agenda, which is much similar to Martin Luther King and black rights.
Namely the stigma of mental illness is unjust. It robs me of opportunities. I want you to stop discriminating against me. That tends to be the grassroots advocates agenda. Those two agendas compete.
For example, there have been anti-stigma programs across the world. For example, one in Australia is called Beyond Blue, where they try to represent depression as a treatable mental illness, which it is, but the way people hear that is when you go with treatable brain disorder, you think people with mental illness are different than we are.
And again, anything that pushes the difference can actually worsen public stigma and lead to greater support of the prejudice.
So, people need to be aware of those competing agenda.
I’m not necessarily saying one's better than the other, it's just that messages are not always so simple.
JESSE: So should people be looking at not only the research they're seeing but where that research is coming from? Or should they be trying to ask that question of who's pushing for this legislation and what is their agenda?
PAT CORRIGAN: I would suggest the latter. I mean the nature of research, unfortunately, is research comes from people like me because it comes from researchers. And that's what I do is sit around all day, collect data, analyze it and put it in journals.
Its value is the degree to which advocates take it and try and change the dialogue. And so who the advocates are matters a lot.
JESSE: Stigma is a mark. And the mark of mental illness is fundamentally invisible but anorexia is fundamentally visible.
For me anorexia was the only way I knew how to clearly show that something was wrong. Physicality was deeply woven into my identity and on some level I knew that if I tore that physicality down, maybe then others would start to notice that things weren't okay.
Here's committable producer Jim McQuaid and Steve Brown again.
STEVE BROWN: I would certainly say that up until King Richard's Faire, Jesse was Jesse. These were things Jesse did, you know it wasn't what everyone else was doing, but Jess always kinda did his own thing, you know?
So until it was very visual, until it was very obvious visually that something's wrong, he does not look healthy, I don't think anything was like jumping out at me. After that it was like, something's definitely wrong. And then at that point I was worried up until I found out what had happened at Amherst. And then it was, you're worried in a whole different way.
Suddenly it's got a name and stuff's real.
And that was scary because like, you're going from a person who I always viewed very strong. Like he was physically strong, he was mentally strong. And then suddenly he seemed very fragile physically, and conceivably mentally too in terms of his condition.
So we didn't really know any of us.
If that had happened to somebody else it would have probably been a similar experience, but Jesse was a bit of a sucker punch. Cause you're like, you don't expect it from him.
JIM MCQUAID: How does it feel right now to reflect back on that time and those feelings?
STEVE BROWN: When you start retreading that stuff and remembering that stuff, it's like a bit scary, it's a bit sad, you know, it's...what the hell? You know, this doesn't line up with my version of reality. Um…
JIM MCQUAID: What do you mean “...this doesn't line up with my version of reality”?
STEVE BROWN: Well, because you know, you have a reality and this is who your friend is, and then you show up a place and that person is someone completely different.
And, you don't want that, like, you're denying that. And I often wondered if the whole family was kind of denying that in the moment. I don't know.
JIM MCQUAID: There was a reaction that I had, and this is my emotional reaction, and I'm wondering if anybody shares it. So for me looking back on that I, you know, I very much had that superhero image and once all this stuff started playing out I felt really guilty and really bad about carrying that image in my head and kind of putting that…
STEVE BROWN: Putting it on him.
JIM MCQUAID: Yeah. And it was almost like I was kind of celebrating this thing that was leading him to suffer and I was blind to it because I had constructed this image in my head. I don't know. I'm just curious if, I've always wondered if I'm alone with that or if anyone else…
STEVE BROWN: I don't think so. I think that I did the same thing, you know, you’d brag about Jesse to people like,
“Oh, my friend Jesse can walk up the stairs on his hands.”
JIM MCQUAID: I've said that to people, I don't know how many, yeah.
STEVE BROWN: I felt like, you know, I would just talk Jesse up to people. Like he didn't really even know so it's not really necessarily on him, although, I don't know...
JIM MCQUAID: I actually, I never, I didn't ask him that. I wonder how much he was aware that we saw him that way. I think he must've been.
JESSE: I was not.
STEVE BROWN: I think he and I have probably talked about this before…
JESSE: We have not.
JIM MCQUAID: So just, this really reminded me of that and I think I'm gonna ask him.
STEVE BROWN: You should ask him.
JESSE: He never did. Unless you count giving me the recording of that interview, in which case, well played McQuaid. Well played.
Several years ago I had no job and no home. Steve took me in and got me employed. I worked that job for as long as I could until...I couldn't.
And then when I was desperate and spiraling Jim called me, showed me compassion, and in that conversation Committable was born.
I love them.
And I will never know how much of our interactions are driven by guilt, and by the perception that I might break...again.
Mental illness doesn't just affect the individual diagnosed. It can affect the community around them.
And involuntary commitments don't just remove an individual from the community. Commitments can ripple out into the community as well.
Next time on committable.