Will Rogers Was Right

Will Rogers famously said “I don’t belong to any organized political party, I’m a Democrat!”

In what should be a tsunami year for Democrats, both leading Democratic presidential candidates are essentially tied with John McCain in the polls. 

Let me see, now, do I have this right or am I in some alternate universe: 

Home values are tanking and foreclosures are skyrocketing. Gas is moving inexorably toward $4 per gallon in time for summer vacation. Wheat prices have tripled in ten months and everything from bread to pizza to eggs, chickens, pork, and beef– anything made with wheat or fed by it - has shot up along with it. Anything transported by truck goes up in price nearly every day – my wife just told me even the cheapest paper towels are now $1.50 per roll. And anything imported (what isn’t?) gets much more expensive as the dollar becomes devalued in comparison to the euro and the yen – the dollar is no longer “sound as a dollar.” 

And John McCain – he who has promised four more years of Bushenomics – is tied with the Democrats?????!!!!!

The war drags on into its 6th year. Al-Qaeda is resurgent. We have many fewer allies than six years ago. More people hate us. Oh, right, I forgot. The surge is working. We’re losing “only” thirty dead Americans per month instead of 100 or more. That must be such a comfort to the families of the thirty. Never mind the 565 Iraqi civilians killed each month. Who counts them anyway? The total cost of the war – all borrowed from our grandchildren’s future earnings so tax cuts for the very wealthy can be continued now – is estimated at two to three trillion dollars. I know, I know, the Bush Administration estimated the total cost of the war would be “only” 150 to 200 billion dollars, all to be eventually repaid by Iraqi oil profits. Hey, what’s $2,998,000,000,000.00 among friends? After all, Exxon-Mobil will make about $13,000,000,000 profit these first three months of the year. And Dick Cheney’s Halliburton spin-off KBR has figured out a way to avoid paying those pesky Social Security taxes on the employees it pays with no bid Defense Department contracts. That should be of some comfort as you spend $65 to fill your tank to go to the store and buy a $4 loaf of bread. 

And John McCain – he who has promised to stay in Iraq 100 years if that’s what it takes to drive out the Al-Qaeda fighters who weren’t there before we invaded – is tied with the Democrats?????!!!!!

The Republicans, some of whom believe GOP means God’s Own Party, the party of family values, moral righteousness, and conservative principles have brought us gay bashing, Larry Craig, Mark Foley, David Vitter, and the trashing of constitutional liberty in the name of security. Mike Huckabee, who may yet be their Vice Presidential candidate, promised to change the Constitution to conform to his notion of God’s will. Never mind the separation of church and state. That radical Thomas Jefferson must have been a communist. 

And John McCain – he who sucked up to the bigoted Jerry Falwell and Pat Robertson and actively sought the endorsement of the anti-Catholic nut case “Rev.” Ted Hagee– is tied with the Democrats?????!!!!!

How can this be? Why is it so? The answer I think lies somewhere in the long tradition of the Democratic Party and Democratic politicians doing almost everything possible to lose elections. In the last 40 years there have been only two winning Democratic candidates. Jimmy Carter – a nice man but a terrible leader – was driven out of office after one term. Bill Clinton – a good leader but perhaps not so nice a man – squandered much of his presidency and got himself impeached though not convicted. In 1968 many liberals sat out the election because they were pissed off at Humphrey. The result was Nixon. In 1972 the nominee was George McGovern – a great man but a lousy candidate – and we had a convention that began the fairness rules which have now evolved to the point where it seems impossible to pick a candidate. 1988 should have been a Democratic year given the cyclical nature of presidential elections. The candidate was Michael Dukakis who ran on competence and offered the famous Howdy Doody in a tank picture, squandering an early 18 point lead in the polls and giving us George I. In 2000 Al Gore was convinced to run a poll driven, sound bite campaign free of his prescient passion for the environment - “you don’t want to sound like a tree hugger, Al” - and the result was George II. In 2004 John Kerry the war hero somehow allowed himself to be transformed into John Kerry the windsurfing wimp. 

And have we (yes, in case you haven’t figured it out yet, I am a yellow dog though despairing Democrat) learned anything from all this? Have we profited from our defeats and finally learned how to win and win with enough of a Congressional majority to actually govern rather than fight rear guard actions in preparation for the next election? No, not on your endangered pension we haven’t. Instead, we seem headed toward a convention in which the candidate with the most votes, the most states, the most delegates, and the most appeal to independents and Republicans may lose the nomination. And in getting there it appears we will – again – fight each other so viciously that the eventual nominee will be so crippled as to prevent recovery. And the beneficiary is, of course, John McCain and the ‘Publicans. And we will yet again – as difficult as it is to imagine - honor the proverb and snatch defeat from the jaws of victory. If so, it won’t be just the loss of another presidential election. It will be the loss of an opportunity to transform our civil life, our politics, our party and our country. We will have failed to seize the opportunity to come together, heal as a nation, and actually do something about our many problems at home and around the world. 

Will Rogers was right.

No Justice

It has been exactly one month since Kathy Faughey died. Life moves on. The world is now pre-occupied with other stories which excite, anger and titillate: Governor Spitzer’s resignation, his prostitute’s story, the dust up over Geraldine Ferraro’s remarks. The tabloids and TV stations have found other tragedies to sell. And Kathy Faughey the victim of a senseless rage so brutal as to be incomprehensible, of being in the wrong place at the wrong time and becoming a(nother) casualty of our failed mental health system, is now the victim of our increasingly short attention span. A month ago she was the object of disbelief, concern, caring, pity, compassion, and confusion. Now she is off the radar, not thought of much if at all by those who a month ago read and watched everything they could about her wonderful life and awful death. What remains is the grief of her family, friends, colleagues, and patients. That hole in the heart that will never quite fill for her family and those who knew her well. That ineffable sadness, anger, and mystery for those who knew her not so well or, like me, knew her long ago.

Something else lingers. A question of justice. David Tarloff sits in jail awaiting a trial that may never come. What will be his punishment? What should be his punishment? What is just in his case? When I first learned of Kathy’s murder I expressed the fervent hope that her killer would be found, would resist arrest, and be shot to death by the police. The anger and the passion for revenge have subsided. I no longer believe killing David Tarloff would atone for Kathy’s death. It would just bring more pain to another grieving family. There is no justice in that. I do believe that David Tarloff should never again have the opportunity to hurt another human being. He should never again be free to refuse his medication and roam the streets fermenting his delusions into rage. That would be a form of justice adequate but not particularly satisfying.

I don’t really believe there can be any atonement, any reparations for Kathy Faughey’s death. Nothing can give her the years she rightfully had in front of her. Nothing can console her family’s grief or take away their deep horror in knowing the way in which she died. Any attempt to find meaning in her death would be another injury, another insult, another injustice. It was her life that was meaningful, not her death.

The meaninglessness of her death will be perpetuated – and replicated with other victims and other families - by a corrupt mental health system. A system that ultimately values money more than people. Upholds the individual’s civil right to be psychotic and homeless. Replaces institutionalization in hospitals with institutionalization in jails and prisons. Turns doctors and therapists into “providers,” and patients into “consumers.” Punishes providers who spend more than the allotted few minutes with consumers. Turns treatment into quantifiable units of productivity. Pushes consumer turnover rather than patient health and well-being.

There is no justice in this for Kathy Faughey. Nor for the mentally ill. Nor for the rest of us.

Dis-Inviting the Disabled

Had to go to downtown Albany this week for work. Interesting thing about Albany: the capital city of one of the most progressive states in the union basically invites anyone with a disability to stay the hell away. My meeting was in the Alfred E. Smith State Office Building directly across from the Capitol. The parking situation downtown is terrible for everyone. There are just not enough garages, lots, or spaces for all the bureaucrats and those doing business with them. State workers, business people, and local residents all complain, and they’re right. It is more difficult to find a parking space in downtown Albany than it is in Manhattan.

What is for most people difficult and daunting can be overwhelming or impossible for someone with a disability. Most of the time I walk with a cane, gimping around with a bad back and knees derived from poor genes and bad habits. As these things go, I don’t have much of a disability nor much to complain about but under the right circumstances, even my minor disability can be handicapping. Negotiating the Empire State Plaza is such a circumstance. There were some disability parking spaces in front of the Smith building but they were time restricted and I did not want to have to leave my meeting several times during the day, negotiating security each time to get back in the building after feeding the meter, presuming I could locate enough quarters. I knew enough to get to Albany early and, after some frustration, happened upon a lot that wasn’t full. The lot had no handicapped spaces so I found myself at its back, with an uphill walk of perhaps ½ to ¾ of a mile on a cold and windy morning. The lot and road surfaces were uneven and pot-holed from the winter’s wear and there were small mounds of snow and ice on the sidewalks, necessitating greater caution than usual to avoid ending up on my ass in Albany. As I approached the Smith Building, stiff and hurting, I saw that the entrances were not easily handicapped accessible – no ramps, and steps that were for whatever reason higher than usual. I know this because I tripped on one and looked at it to see if the cause was the step or my clumsiness.

As I entered the building I thought about the people I know with significant disabilities, most with much more limited mobility than I, some in wheelchairs. What was for me mainly annoying and irritating could for them become insurmountable. There would simply be no way for them to gain access and conduct their business with or for the State of New York. More than 17 years after passage of the Americans with Disabilities Act and equal access is an illusion more than a reality. That is unacceptable

Winter March

When I was a kid, I loved the winter. Couldn’t wait for it to snow so I could build an igloo in our tiny back yard in the housing project, or throw snowballs at the city buses, or rejoice at the rare snow day. I much preferred the cool and the cold to the warm and the hot. Fall and winter were “way better” than spring and summer.

Even as an adult, well into my thirties, I liked the winter more. There was something about the challenge of the cold and the snow that was invigorating, that somehow emphasized the sharp edges of being alive. The first winter we were in upstate NY was brutal – 24 inches of unexpected snow on Christmas day, the thermometer at our old farmhouse barely registering 0 for the first two weeks of the New Year. Slogging buckets of water out to the barn for our few but definitely hardy animals. It was wonderful. I don’t know that I ever felt more aware of and connected to my environment. Even driving was stimulating, though the 37-mile commute to work got old by March. I was generally much happier in the fall and winter than any other time of the year.

No longer. Over the last 20 years and especially the last few, winter has become a burden to endure rather than a joy to experience. The cold stiffens my arthritic joints and it is painful and sometimes debilitating. Snow is a mess to be moved – and moved – and moved again, not a scene of sheer beauty and exhilaration. The constant gray skies and short days depress the body, mind, and spirit. I dread the coming of winter, despair in the middle of it, and guard against intimations of its end just in case it doesn’t.

My relationship to the month of March has changed. As a child in Connecticut I simply didn’t like the month at all. Its arrival meant winter would soon end, although it always seemed to snow the first day of spring, even if only flurries. Now I experience ambivalence with a negative tilt. The days are definitely longer so that is good. The roads clear of snow much more rapidly so that is a relief. The time until golf begins can be measured in weeks (6 to 8) rather than months, so that is wonderful. Yet I fundamentally don’t trust the month. Some of the worst blizzards in memory occurred in March. The rapid warming is often followed by bitter cold spells, a chilling slap in the face of hope not dared earlier in the season. Experience teaches that although spring is around the corner, the corner is a long way off, no matter what the damned Pennsylvania woodchuck reported on Groundhog Day.

Casualties of a System That Worked

Kathryn Faughey died for de-institutionalization. As did Daniel Parmeter and Catalina Garcia. And Ryanne Mace and Julianna Gehant. And Gale Dubowski.

In less than 48 hours six innocent people lost their lives and six families were thrust into unbearable agony.

On the evening of February 12th David Tarloff walked into Dr. Kathryn Faughey’s office in New York and butchered her with a meat cleaver and a knife. The struggle was fierce and by all accounts she fought hard to live. But she died, and her last moments must have been terrifying and excruciatingly painful. She was slashed fifteen times, her blood was all over the office, and the meat cleaver was bent from the force of the blows.

On the afternoon of February 14th Steven Kazmierczak walked onto a classroom stage at Northern Illinois University carrying several weapons. Without saying a word he started shooting, killing five people in less than five minutes before killing himself.

Two days and a thousand miles apart, these murders have one thing in common. They are the result of society’s failure to effectively, even adequately, treat the mentally ill. The real cause of death is a failed policy of de-institutionalization with discharge to the streets and the criminal justice system.

Both killers have histories of mental illness and revolving door hospitalization. Both have histories of refusing medication and treatment. And in both cases the system worked exactly as it is designed to work. During acute episodes they presented to the criminal justice/mental health system, voluntarily or otherwise. They were evaluated and in most instances quickly released to the streets. They were considered not to present an imminent danger to themselves or others so they were sent on their way. No treatment except perhaps medication which they were free to take or not. No follow up. No attempt to actually ensure that these individuals got the help they needed.

David Tarloff’s illness tells him he is not ill. He sees no need for treatment or medication. And Kathy Faughey is butchered. Steven Kazmierczak’s illness tells him it is not him but the world that is wrong. And five people sitting in a classroom are slaughtered.

All this pain, all this senseless, meaningless loss occurred because the system worked the way it is supposed to work.

I have heard people angry with doctors for not keeping David Tarloff in the hospital when they had him there. The reality is that the doctors who evaluated Tarloff could not keep him. The criteria for involuntary hospitalization are very strict and usually require that the person present a clear and present threat to their own or other’s safety. Being delusional or psychotic is not enough. Patient privacy laws, well-intentioned but in some cases Kafkaesque, prevent doctors and health care providers from obtaining information that might enable them to make better decisions. I also suspect the last time Tarloff was evaluated, the hospital’s small psychiatric unit was filled with people who were even more acutely ill at the time than he was. So the doctors made the only decision they could within the system they have.

Even when hospitalization does occur, the goal is not resolution or even significant improvement in the patient’s underlying illness. The goal is stabilization and release, as quickly and cheaply as possible. Insurance companies demand it. The government demands it. Patient rights advocates demand it.

Treatment of mental illness most often consists of managing whatever symptoms are most troubling while ignoring the underlying illness in all its complexity. Treatment is largely and by design limited to medications. There have been major advances in medication for mental illnesses but they are not enough. The medications for severe illnesses like paranoid schizophrenia at best manage some of the more troubling symptoms. In many cases they simply do not work very well or have unacceptable side effects or are too expensive. Or patients simply refuse to take them, as did Tarloff and Kazmierczak.

The reality is that there is no comprehensive, integrated system of care to provide the mentally ill with the kind of treatment they need beyond medication: safe places to live, real support for meaningful integration into the community, psychotherapy to give hope and teach the skills needed to effectively manage illness and lead a successful life.

The overriding goal of most mental health treatment is economic rather than psychological. The government and insurance companies – as well as Medicaid and Medicare – are in the business of limiting – not providing – treatment. Managed care restrictions pressure doctors to release patients prematurely. Reimbursement rates for psychotherapy are lower than they were 25 years ago. There is no other profession where practitioners make less than they did 25 years ago.

In the last 40 years there has been a great movement to de-institutionalize the mentally ill. The cause was just and the motive noble. Many of those housed for years in state psychiatric centers did not belong there. Sometimes – but not always - the conditions were terrible. Sometimes – but not always - the treatment was little more than warehousing. Sometimes – but not always - there was awful abuse. So in New York State, 90% of the individuals who lived in the state psychiatric centers were discharged in a relatively brief period of time. While many of these discharges were successful, for many others the horror just shifted locations.

The closing of the psychiatric facilities was supposed to be accompanied by resources to provide the services needed in the community to prevent re-institutionalization. That’s not what happened. Adequate resources were not provided. However, since the institutions no longer existed, patients could not be re-institutionalized. Its advocates considered the lack of re-institutionalization a resounding success. What happened to the thousands of people released in the purge of the state hospitals? They were not suddenly and miraculously cured of their illnesses. They were not receiving services that didn’t exist in the community. Often, they slipped through the cracks and were lost to the mental health system, such as it is. (This too was a success because it meant fewer people receiving services.) Often, they joined the legions of homeless. Very often, they simply shifted from one system to another, from mental health to criminal justice. Living in poverty, often in squalid conditions, developing substance abuse problems that exacerbated their mental illnesses, they committed crimes, usually petty, sometimes serious. So, they were back in institutions but this time it was the county jail or the state prison. In New York State, one of eight prisoners is mentally ill. So much for the economic benefit of de-institutionalization to the taxpayer.

The mentally ill present to emergency rooms or police departments and enter the revolving door of hospitals and jails where they are managed but not really helped. And they suffer for it. And society suffers when their illness leads to horrific acts.

What passes in this country for a mental health care system efficiently meets its goals with David Tarloff and Steven Kazmierczak. And six people die.

David Tarloff and Steven Kazmierczak are not unique. Based on what is known about them, they are like thousands of others throughout the country, struggling with terrible illnesses within a system that fails them. They are not the first whose inner torment led them to destroy other lives. And they will not be the last.

None of this is meant as a criticism of those who work within the mental health system. Most are dedicated and competent professionals working extremely hard with a very difficult population and doing so with very limited resources. They are overburdened, have too many cases, and are limited by laws and bureaucracies in their ability to help those who suffer. They deserve support rather than criticism.

I have a personal as well as professional connection to these events. Kathy Faughey and I were in grad school together in the 1970’s and were good friends for a time. Although I had not seen her in many years, news of her death came as a profound personal shock. She was a wonderful, bright, funny, passionate, and caring woman who was so very full of life. She helped many, many people over the course of her life and career. She did not deserve to have her life ended in this brutal way. She did not deserve to die a casualty of our failed mental health system.


Ray Bepko, Ph.D. is a licensed psychologist. He lives and works in Utica, NY.