Columbia Missouri Tribune Online
Lives in the balance: Battling mental illness in the maximum-security Biggs unit
Published on Friday, September 4, 1998
Richard Mitchell: The inner battle
By Mark Horvit
Of the Tribune’s staff
Richard Mitchell is in the middle of a heated debate.
“Why have a God? If you don’t appreciate God, keep it to yourself.”
It is late morning, and the 47-year-old is seated in a padded armchair in the dayroom of Ward 13. His morning smoke break is over, lunch is still an hour or so away.
“People think you’re crazy. You run your mouth too much, people fix you up like that, too.”
The conversation is taking an ugly turn, and Richard is getting angry. His large body shifts restlessly, long legs bending and straightening in constant, agitated motion. The broad smile that so often graces his face has been obliterated by a menacing scowl, his easygoing shuffle and lazy body language ratcheted into a series of harsh movements and spasmodic jerks.
“He’s supposed to be the boss of the church. What have you heard?”
A fellow patient is sleeping on the end table next to Richard; another is standing a few feet away, clapping. Richard pays them no mind.
“Supposed to be the key? You damn right it is.”
Richard’s eyes are narrowing, his voice rising.
“Jesus might want to sip on some of your blood next!”
Suddenly he bounds from the chair, his powerful legs taking him across the wide room with alarming speed.
“Son of God? Kiss my ass!”
There are a half-dozen other people in the room with Richard, but he’s not talking to any of them.
For this ongoing debate, Richard needs no partner. He is arguing with a voice only he can hear, with a demon that has battled for control of his mind since he was 12 years old.
OK Richard, I’m coming in here tomorrow morning saying I’m the Queen of Egypt, and who am I really?”
“So, if I was the Queen of Egypt, could I be the nurse?”
“Well, you could be.”
Richard has a quiet laugh, almost a pantomime of someone enjoying himself.
He’ll smile, an inviting grin that that gains character from the wide gap where his front teeth should be. His head will shake, but little sound emerges.
And Richard laughs frequently – when they sing one of his favorite songs in music class, when one of the staff members praises his work.
Richard’s laugh also punctuates conversation when he’s asked about something that makes him uncomfortable – say, his periodic urges to swallow keys – or when admitting something that he knows his listener will find odd, such as his belief that the Army extracted his muscles so he wouldn’t harm any more people.
It’s been 112 weeks since Richard has been placed in seclusion, as sterling a record as is held by anyone on Ward 13.
The 6-foot-2 Kansas City man, who suffers from schizophrenia, keeps mostly to himself. He is polite and soft-spoken, cooperative when one of the aides asks him to do something. When he’s participating in one of the many activities designed to occupy his mind and fill his day – math class, understanding mental illness – he is a model student.
But the turmoil raging in Richard’s mind surfaces whenever he’s left to his own devices, when there’s nothing to occupy his thoughts and the voices take over.
Being in the room when Richard is debating his invisible tormentors is like watching someone argue on the telephone, his angry monologue broken by silence when the voice on the other end is speaking.
Although he’d been sick since childhood, the first time he remembers hearing the voices was when, at age 22, he was committed to Osawatomie State Hospital in eastern Kansas.
They started criticizing him when he was with other patients. “I’d try to tell myself they was talking abstractly, but I didn’t know why it seemed like it was directed at me.”
The voices sounded vaguely familiar, like friends and distant relatives, and their intrusion into his life was unnerving. “I thought”- he pauses briefly for that silent laugh – “I was going crazy or something.”
As the years have passed, Richard says, the voices have become increasingly sarcastic.
“I communicate with them until they start talking real ugly, or ridicule. They be telling me that other people around me are more important than I am…Some things I hear the voices say make me super upset, charged up or something.”
He is evasive when talking about the subject of those debates. “Let’s see, ah, there’s something…I don’t even know if you’d think there’s reason to talk about. It’s something about being a Jesus person. It’s something that I be communicating in my thoughts, about religion, that I thought I had personal reason to think I was a black Jesus.”
And the voices agree? “Nah,” he laughs, “the voices would tell me they don’t know why I think like that.”
Religion is a subject that inspires some of Richard’s most perceptive thoughts and his greatest confusion.
He believes God can be seen in individuals. “You know, like out of all the people you meet, one person might be real outstanding or something, or have a lot of ability to do different things. You might meet someone that has really went through a challenge.”
But he believes he personifies God in a much different way. He says he once saw a copy of his birth certificate, on which the space left for “father’s name” was left empty. He speaks of being born in “navinity,” hinting that he believes he has no father, at least not in the traditional sense.
“Everybody’s talking about being a bastard or something. I don’t know where they get that from. “ Laughs. “Cause I might be the first special one.”
Do you have mental illness, Richard?
“Well, I don’t feel I’m a lunatic.” Laughs. “I think I’m going through stages.”
Richard has spent most of his life going in and out of mental wards; the first of his 40 hospitalizations took place at an age when most kids are entering sixth grade.
He was born in a small town in Tennessee, but grew up in Kansas City. He says he never knew his father, and his mom remarried when he was young.
“I played hooky from school a whole bunch. And I sort of had a problem with becoming a juvenile delinquent. I wasn’t messing with drugs or nothing, but I was stealing and fighting all the time.”
As he got older, he found himself being shifted from class to class, ending up in the ones reserved for students with the most academic troubles. “I ended up barely passing from the eight grade to the ninth.”
Although Richards says he didn’t mess with illegal drugs as a kid, his charts show that he apparently managed to try a few over the years: heroin, cocaine, speed, PCP.
He can’t explain why his mom started taking him to see the psychiatrists. But he remembers what they were saying about him by the time he was in high school.
“I was being called psychotic. I’d go in and ask for my medication, and they’d give me a whole bunch of runaround, and when I’d start talking loudly they’d say, ‘We gonna’” – laughs – “’take you to the state hospital,’ something like that.”
He remembers being in a medicated haze through many of those days, some of which were spent at another state hospital in Kansas. He was taking anti-psychotics, swallowing pills every four hours.
“I took my medication, and between the four-hour period, I’d pass out, wake up, have to go to the bathroom pass out again,” he says.
Of course, that only happened when he got around to taking the medicine. Richard says sometimes he had problems making it to the hospital. And there were side effects – the ultra-sensitivity to sunlight, the grogginess – that made it easier to just leave the pills in the bottle.
Why aren’t you getting into fights these days, Richard?
“I think I have some kind of phobia…where I don’t want to think about having to get into a fight, get my nose bloody or break somebody’s jaw. All those things go through my mind, like on a railroad track.”
Richard arrived at Biggs on April 30, 1981. He was transferred from Western Missouri Mental Health Center for what his record describes simply as “assaultive behavior.” The trouble continued in his new surroundings, as he lashed out at patients and staff when he became upset.
“Richard’s sent a lot of people to the hospital,” psychologist Lee Baldwin says.
“And he feels terrible about it, “ says Lynn Geeson, who oversees the social learning wards. “He really doesn’t want to hurt anybody.”
Richard was one of the first patients to enter the social learning program when it started in 1988, coming straight from the aggression management ward.
“He was absolutely scary when he first got here,” Baldwin says. “He was huge and very violent.”
“That’s been the biggest improvement, is Richard’s aggression,” Baldwin says. “It’s very rare now.”
Richard lists a number of things that used to set him off: being called names, being spit on, feeling like someone was out to get him – which happens a lot to a paranoid schizophrenic.
Though Richard’s medication hasn’t quieted his voices, it has helped cool his temper. But he gives most of the credit to the lessons he’s learned on the ward.
While his dislike of being placed in restraints certainly has played a part – Richard repeatedly talks about how he never wants to be strapped down again – he also completed an anger management class, an accomplishment he points to which no small measure of pride. “We read and discussed thoughts, reasons why you shouldn’t be so angry, how to let it go, how to go somewhere and stay to yourself, how to read or write or listen to music.”
But staying out of trouble is an ongoing battle, because it doesn’t take much to trigger Richard’s temper. Just this morning, at breakfast, he almost lost his cool.
Richard, who has been placed on a diet, was in line at the cafeteria. “The cook said something about – I thought she was getting ready to say ‘cottage cheese’ – and I said ‘No, don’t talk that funny shit.’ “He laughs. “And I didn’t really mean to be saying that, but I was thinking about what I don’t want at all as a meal is cottage cheese, but I couldn’t tell her that…I blew up, and then had to calm down real fast, ‘cause I thought they’d send me back to the ward.”
Richard got himself under control. For breakfast he at a biscuit, two bowls of cereal, juice and two cups of coffee. And cheese. American cheese.
What are some other reasons you haven’t hurt anyone lately, Richard?
“The Army had my arms, um, my muscles, extracted for some reason. I don’t know exactly what year, but it’s since I’ve been in the hospital…They had them medically removed so I wouldn’t be able to harm people.”
Do you really believe that happened?
There are success stories on Ward 13. Thus far, Richard’s reviews are mixed.
He’s gone more than two years without striking anyone – an impressive accomplishment for anyone on the ward, and certainly the initial goal of Richard’s treatment.
But he’s still battling with the voices; some say his arguments are getting louder and more intense.
He can’t be trusted with books, because he rips out pages if he believes they contain stories about wicked people, sometimes trying to flush them down the commode.
He’s requested another Bible, but the Rev. Dan Russell knows what will happen to it. “He’s sincere, and that’s the sad thing,” Russell says. “He’s sincere about his feelings, then something happens and it’s stuck in a toilet.”
Richard’s schizophrenia has shown itself in other ways. He periodically suffers from a condition known as pica, the desire to swallow objects not meant for consumption. Richard has choked down watches, bracelets and batteries.
Geeson remembers that, a couple of years ago, 12 keys were missing from a ward key ring. Richard had been swallowing them. “He would just say to me, ‘I had to swallow that key,’ “Geeson recalls.
Richard’s explanation today isn’t much more illuminating. “I was swallowing keys because I knew something about certain numbers, whether it was magic number or what.”
Was it painful, Richard?
“Well, I had to swallow a cup of water with each key.”
But did it hurt?
“Not that I – well, a couple of keys.”
He hasn’t done anything similar in a while. Richard believes the problem has been solved, because “I had my stomach and gall bladder removed.”
His psychiatrist, Max Teng, says there’s no way to determine exactly why many of his patients do the things they do. He doesn’t know why Richard swallows keys, for example. But he knows why someone like Richard might swallow things. Sometimes it’s because they find an object objectionable; sometimes they’ve incorporated into it meaning only they understand. And some cases are easier to figure out than others: A patient who rips pages from the Bible and chews them up may be taking in the Word of God.
For the past several months, Richard – who suffers from a type of paranoid schizophrenia that includes manic-depressive mood swings – has been taking Clozaril, one of the newer anti-psychotic drugs. Some patients make remarkable recoveries with the drug: Richard has not.
But Teng says Richard is better off than he was with Haldol, his previous medication. His body isn’t as rigid, he doesn’t shake and he’s no longer complaining of a dry throat. Also, Clozaril is known to help tame aggressive impulses. “Even if he hallucinates, he doesn’t act on them, as he used to,” Teng says.
To try to silence the voices, Teng has considered an even newer drug, Olanzipine. But there’s a risk in changing medicine. Clozaril has muted Richard’s aggression; there’s no guarantee the new drug will be as effective.
Richard has his own theories about where the voices come from. When they started, Richard says, “I thought I was hearing radio-ology from somewhere, some kind of radio transmitter or something. But I don’t know for sure. I don’t hear no static electricity, so I don’t know.”
He sees other possibilities. “Whatever I hear, I be thinking that, ah” – he laughs – “These are police departments monitoring me, or watching me, or something.”
The criticism from his voices, their constant derision, only magnifies Richard’s unease at being locked up.
“I don’t know exactly what I’m in the hospital for. I’ve been here 17 years, and everybody thinks I’m the problem.”
Are your dreams fantasy or reality, Richard?
“It’s real, but a fantasy can be both true or false.”
Richard leads a solitary existence. Or at least one that’s as solitary as possible while living under constant scrutiny with more than 20 other men.
So when the Biggs Fall Festival gives the men of Ward 13 a rare chance to go out onto the hospital grounds, Richard finds a spot apart from the crowd, on a bench wedged in the narrow strip between the chain-link backstop of the hospital’s softball field and the towering perimeter fence. He spends most of the morning staring at the grass, “lookin’ for a four-leaf clover.”
But getting outside doesn’t hold the allure it once did.
“I used to like to be outdoors as much as I could be, “ he says, “until I started getting reactions from the medication.” Clozaril, like many anti-psychotic drugs, makes many people ultra-sensitive to the sun. So Richard is covered head-to-toe – purple baseball cap, back windbreaker, sunglasses and denim overalls.
“I used to like watching the grass blow in the wind. I liked watching the sun before it went down. I liked watching squirrels and rabbits run, and deer.”
What Richard really treasures about this morning is that it offers something even more rare than the chance to breathe fresh air – he can get away from everyone. Or as he puts it, find a little “peaceful solitude.”
That’s not to say he wouldn’t mind an occasional visit from someone living on the outside. Richard doesn’t understand why no one comes to see him, while many of his companions on the ward hear from friends and relatives all the time.
“I’ve only had one visitor,” he says, “in 17 years.”
“Richard I couldn’t help you if I was the Queen of Egypt. I couldn’t help myself f I was the Queen of Egypt. I am royalty, I don’t need anything.”