I am probably or possibly under surveillance by the Drug Enforcement Administration, private
investigative officials, and various units of the NYPD.
The FBI once told me that they weren't interested in me, which was kind of refreshing, who knows.
See when determining whether something is real or something is not real, it's real simple,
get the facts.
Keep up with me or it's over.
Tonight on Frontline, the enigma of schizophrenia.
The whole capacity of the individual to relate to the world has been shaken and devastated
by this illness, and we don't understand why.
The system's frustration with schizophrenia has often led to neglect of the most basic
human needs.
What we did is we emptied out the hospitals and then did not provide the care for these
people, and we are now paying the consequences of really the severe mistakes we made back
there.
Tonight, Broken Minds.
With funding provided by the financial support of viewers like you and by the Corporation
for Public Broadcasting, this is Frontline.
Oh, look, look, look there.
Somebody there.
Is that a person or is it clothing?
No, it's clothing.
Wow, look at that in there.
What, what, what?
Way, way over.
We're talking.
Okay.
Or is that the other guy?
No, this is Jerry.
That's the other guy who's, who's very, very, very paranoid.
God, how are we going to approach him again?
This is what we're going to do.
I'm going to stop a little in the front and then we get out and try to put the sandwich
few feet before he get there to see if he pick it up.
Okay, well, let's, we got to do it before he gets over here.
We'll see.
We're going there.
Okay.
Jesus, he looks bad.
He's looking worse and worse.
I know, he looks terrible.
But it's so difficult to find him.
He's going this direction.
Yeah, he's going this direction.
I want him to see us through the front.
Yeah, but we don't want to, we're going to make it clear to him.
Okay, he's on my side.
All right, I see.
You want to do it from the van?
No.
Jerry?
Want a sandwich?
I'm going to put it here, okay?
Maybe he'll come back and take it.
The client that I approach in the park doesn't allow me to approach them for years.
I understand.
I don't take it personal.
You tell me if I, if I encounter you in a park and I get out of the van and I go to
you and offer you a sandwich, you tell me if you're going to take the sandwich from
me.
And you are normal, supposedly.
You don't have any problems in your brain that doesn't make you perceive reality different
than when a schizophrenic perceives it.
Then you tell me how a schizophrenic who is paranoid is going to react when I offer a
sandwich.
They may think it's poison.
They may think I'm coming to kill them.
You never know what can, what can go through the mind of these people.
Oh, Jerry's coming back.
Jerry's coming back for the sandwich.
All right, guy.
Maybe he's going to sit.
Yeah.
There are at least 150,000 severely mentally ill men and women living in the parks and
on the streets of this country.
Project Reach Out is a private New York agency that tries to draw some of them in for shelter
and treatment.
Last year, Patty Moon and Margarita Lopez, one of three Reach Out teams, made contact
with more than 2,500 he took the sandwich.
Here's a damn good instinct.
How did you know to approach him again?
I don't know.
He was too.
He was too, too.
Saddle that too.
So he's going to eat it even if it better, he'll throw it first sandwich.
I know, I can't believe this.
Margarita Lopez calls New York Central Park the largest open psychiatric ward in the world.
30% of the nation's homeless suffer severe mental illness and the most psychotic try
to isolate themselves in places like this.
The primary diagnosis is schizophrenia.
Schizophrenia is a major problem for us to understand and it's been a tough nut to crack
and for a number of reasons.
First of all, we can't sense a central problem in schizophrenia.
We can only say, look, all of mental life is devastated by schizophrenia and we can't
point to a central mental function that is at the heart of the problem.
That's not true of conditions like mental retardation or dementia or manic depressive
disorder.
With each one of them, we can say, but the central problem here is a dilapidation of
intelligence or the central problem here is a dilapidation of mood.
In schizophrenia, we say the whole mind and the whole capacity of the individual to relate
to the world has been shaken and devastated by this illness and we don't understand why.
This was when the twins were a year old, Sharon is on the left and Marge is on the right.
I looked back and they were awfully cute then and why so much attention was drawn to them
when I would take them out in public.
It's the kind of thing where I had all the dreams and everything that a typical parent
has for their children and then to see them cut down in such a dramatic way.
I guess I'm glad I didn't know then what I know today.
What Amy Murphy didn't know then was that one of her daughters, Marge, would become
acutely ill with schizophrenia in 1982 when she was a junior at college.
In 1989, the Murphy twins and their mother came to the National Institutes of Mental
Health in Washington to be part of a major study into the enigmatic causes of schizophrenia.
Okay, this is for the procedure that Dr. Torrey talked to me about, Marge, Marge, Marge, but
you're not, you're not listening a minute, you listen just a minute, okay, remember we
said you were going to have a needle in both arms and they're going to take the white blood
cells out?
Okay, okay, that's the machine that is doing it, so you didn't see the machine before.
With Marge's illness, her whole personality has changed.
It's like there's a shell that her body is standing there and it talks and says things,
but the girl I knew, the daughter I raised, isn't there.
She's gone, or not quite gone, but almost.
Marge, the only thing that's going to be a little bit different about yours is that we
have to do a finger stick first, which we don't have to do with Sharon because we were
able to get her blood sample the other day, and we couldn't, so we just have to do a finger
stick first.
When Marge got sick, Sharon lost her best friend.
It's hard to describe how twins are, but they've always had each other and they've always shared
each other.
There's a bond that's so close that it's real hard to break, and when that bond is broken,
it's hard to replace.
Can you make a statement?
What kind of a statement am I supposed to make?
I don't know.
In the case of the Murphy twins, Marge has a more severe form of the disease than the
average person with schizophrenia.
Marge is kind of in the same class as my sister, who was hospitalized for many years also.
Schizophrenia is a brain disease.
We know that now.
When my sister got sick in the 1950s, we didn't know that, and there was a lot of confusion
about what schizophrenia was.
We know now that schizophrenia is a disease like Parkinson's disease or Alzheimer's disease
or multiple sclerosis.
We know that something gets in the brain and changes the chemistry in the brain and causes
symptoms so that the kind of symptoms that people have, and my sister had, are hearing
voices, delusional thinking so that you misinterpret what's going on and think that things don't
refer to you, and the inability to think logically from A to B to C.
Can you take this off, the needle, off?
I can use, you know?
No.
We have to leave it in now for a while.
We'll have to leave it in for a few minutes.
Well, for being a bad little girl.
No, you've been an excellent girl.
Marjorie, this is the 40 minutes now that we were telling you about.
When we take blood from the twins and we hook them up to this special machine that will
take a small amount of blood, but will take selectively the lymphocytes that we want to
study, they are the best means for studying the immune system, and we know that many people
with schizophrenia have abnormalities in the immune system.
In all, there are 17 pairs of identical twins in the study, identical in every way, except
that one twin has schizophrenia.
Yes, again.
I'm trying to.
I don't want to be wrong.
It's okay, Bjorn.
This is Sharon.
Yeah.
It's hard, really hard, very hard to guess.
Adenical twins are extremely useful for all kinds of medical research, including research
on schizophrenia, because they start with the same genes.
They start as basically clones of each other, if you like, and in any disease, including
any schizophrenia where genetics are thought to play a role, this is the best way to separate
the genetic from the non-genetic aspects of the disease.
If it were a purely genetic disease, then whenever one set of identical twins, whenever
one person got the disease, the other one would always get it because they have the
same genes.
In studies of twins that have been done for about five decades now, the likelihood that
if one twin has the illness, the other twin will have the illness is only about 50 or
60%.
In other words, half the time the twins are concordant, meaning they both have the illness,
and half the time if one has the illness, the other one does not have the illness.
Now, this means by definition that genetics cannot be the entire story.
We don't understand what the factors are that make it possible for someone to have the gene
but not have the illness.
But there are many human illnesses like this.
This is not unique to schizophrenia.
I'd like to ask you a couple of proverbs.
Can you tell me what the saying means?
A rolling stone gathers no moss.
I don't know.
What do you mean?
Well, this is a saying.
This is something people sometimes say.
A rolling stone...
Is it a cliché?
Sort of, yeah.
Yeah.
A rolling stone gathers no moss.
What does that mean to you?
I think it's one of those things, that it's whatever you think it is.
Grabbing a rock, you think you throw it?
I don't know.
A rolling stone gathers no moss.
Okay.
What that means to me?
What does it mean to you?
That something is moving so fast that it gathers no extraneous material.
Okay.
How about people who live in glass houses shouldn't throw stones?
Or stone thrones.
You've heard that one.
Yes.
Okay.
People in glass houses.
The relief I got from the twin study was just incredible.
Dr. Torrey said out of the first 35 things to worry about in life, getting sick like
her ought to be 37 on my list.
People looked at me and said, you've lost weight.
I hadn't lost any physical weight at all.
I'm just kind of the same.
I knew what they were talking about because it was emotional weight that was gone.
People saw it and people I hadn't seen in years said that, well, since the twin study,
she looks lighter and brighter and so much more relaxed.
I wish my life were different and I wish this illness never existed, but it's a part of
my life and it is a part of who I am.
It's not going to change.
Schizophrenia strikes one in 100.
There are different degrees of severity, but to see the disease at its most severe is to
see it untreated.
We first met David when he had just come in from the cold to Project Reach Out.
Although he agreed to talk to our producer, Dewitt Sage, he was also deeply suspicious.
Dewitt is a paranoid schizophrenic.
My stomach kind of gives me trouble when I don't have enough sleep.
The stomach and the legs are the two things that tend to most prominently go when I don't
sleep.
Reach Out's Mike Mastra Giovanni is David's caseworker.
Oops.
Happens often.
What happened to the lens there?
They fell off my face one day in their glass and they were cold.
It was cold, so they were probably a little extra brittle and mangled.
Because this happened since the last time I saw you, right?
Which was just a couple days ago.
Yeah, it fell and hit the sidewalk and that's just a glass lens.
Have you confirmed your prescription?
Is it the right prescription?
You were going to check that out?
I can't answer that at the moment, but the reason that I'm setting it up so that I can
confirm the prescription is having had lenses stolen, so on tape, having had glasses disappear
and then reappear when I squawked.
So I definitely must, must, must, must, so that I can be safe crossing streets, make
sure that I get the correct prescription.
And that means all the way from the stage of getting the prescription to actually having
the glasses made.
And one other thing I'd really appreciate, and in light of what else is on the tape,
this is going to make sense, I really appreciate if there's no transmitter embedded in the
frame.
Okay?
You know, I would hope that that's not the case.
Like the one that's probably here.
Anyway, that's fact, folks.
This will get lost on a cutting room floor for sure.
I am probably or possibly under surveillance by the Drug Enforcement Administration, private
investigative officials, and various units of the NYPD.
The FBI once told me that they weren't interested in me, which was kind of refreshing, who knows?
David, let me ask.
The FBI, all of this intense surveillance, could this be part of an illness that you
have?
Nice try.
When you say, well, maybe it's just something I'm thinking of and proud to my situation.
When it happens a hundred and fifty times, I mean, let's take an example.
Someone might be reading a book and leave it on a telephone booth as he's making a call.
Someone might do that and sometimes that book might be a really attractive book or an expensive
book or somebody else might have liked that book and that book might not be there when
you turn back, say, 30 seconds later, okay?
When that happens 30 or 40 times, when sometimes those books are obviously of no conceivable
cash value to anybody, when sometimes the books contain your identification documents
and your money, which nobody but someone maintaining close surveillance on you could have discovered.
See when determining whether something is real or something is not real, it's real simple.
Get the facts.
Schizophrenia has to be viewed as the cancer of mental illnesses.
It is certainly the most profound illness treated by psychiatrists.
Part of the desperation that people felt in treating this profoundly disabling and dramatic
illness was reflected in the amazing treatments that were brought to bear on schizophrenia.
I mean, there are treatments from surgical treatments where people would, you know, lobotomies,
people would do surgery on the brain, but there were surgical treatments on other organs.
People used to take out the adrenal glands, castration at one time was considered to be
an effective treatment for schizophrenia.
There have been all kinds of medical treatments.
There have been all kinds of psychological treatments.
Lobotomies to me, just seeing them devastated me.
I was a part of it.
You have to remember that in the early 50s, there were no tranquilizers.
Lobotomies were done for those patients that we completely had no control of.
They were assaulting other patients, employees.
We had over 15,000, 16,000 patients here.
If you looked at a patient two weeks after admission, they have already started to regress.
If you picture yourself in one room, you know, nothing to think about, just meals.
You were told it's meal time.
You were told when it was time to go to the bathroom.
That's how they existed.
Well, lobotomies were the last resort.
I'm sure many of these patients had been patients that were in camisoles, sheet restraints.
They may or may not have gone through insulin shock.
There were the cold wraps.
You can remove a camisole.
You can remove a restraint.
This is a mechanical device.
Lobotomy was not mechanical.
Lobotomies are permanent.
Justin, can we talk for a minute?
Sure.
You want to sit up or do you want to lie down?
I want to lie down.
Really?
Yeah.
Come on.
I remember on lobotomies, they'd bring the patient in, doctor would be here, complete
head shaved, they would take gentian violet and score the head.
Novocaine would be injected and the surgery would begin.
The patient was fully awake.
I remember as a young student for that matter, I would be standing here and they would, on
the side, this capel, then they would use a little drill.
I remember, to me, especially as a young girl, this to me was absolutely terrible.
They would take a probe and insert.
They did not know where they were going, but they were hoping that something would slow
down the process of this patient.
Justin, what kind of treatments have you been given over the years?
Ambulatory insulin, insulin coma, electric shock, neurosurgery, and finally drug therapy.
And finally?
Drug therapy.
And when you say neurosurgery, what do you mean?
Brain surgery.
I prefer lobotomies.
There are 152 in New York State Psychiatric Institute and Hospital, 722 West 168th Street,
New York 22, New York, phone number Lorraine 8-4000.
And as slowly as you can and as clearly, what happened that day?
The operation, the stretcher, I thought there was a big move into a lie-in room with four
surgeons there, with the Aronson, with the Setman, with the Pierce, and at the Ronson
Hall.
And they started the operation at Pierce Hill.
In 1949, when Stanley Gross was lobotomized at Pilgrim State, the treatment was seen as
a cure for the most extreme schizophrenia.
Although the operation did subdue violence, it soon became clear that the underlying illness
was not affected at all.
Stanley, we had been warned, never discussed his operation.
Follow him to?
No, he died, I told you about the time, the bomb dropping and boom, the big, a great big
hole about four foot right in the ground.
It was a baby bomb, a major bomb.
Stanley, which planet should have come down to attack the earth?
The planet of headbreakers.
The planet of headbreakers?
Yeah, one meter miles up, so you know, it takes about two and a half days before they
can land.
Probably a meter miles and out.
Planet of headbreakers, and Stanley's supposed to be the head of that planet.
Right, Lord.
How many heads is Stanley broken?
What are you thinking, you remember?
Anything else you want to tell me?
Oh, sorry, you didn't break any heads around here?
Did I see them break any heads around here?
Did Stanley ever break any heads in Pilgrim?
In Pilgrim State, did Stanley ever break any heads?
No.
But let me ask you a funny question.
Did Pilgrim State ever break any heads?
I don't know.
I know this isn't a joke, but we're too old for that.
I'll tell you something.
I read on a bulletin that was put up that if a doctor did that anymore, he could find
$15,000 and spend 10 years in jail.
He got the law to do it.
What do you think, a doctor wanted to go to prison for 10 years and pay $15,000?
By the time lobotomies were stopped at Pilgrim State in the mid-1950s, over 30,000 had been
performed throughout the United States.
At that time, this now abandoned building was filled beyond capacity, a monument to
the ineffectiveness of any known treatment for schizophrenia.
The desperate search for cause and treatment continued.
It further polarized psychiatrists already divided between those who embraced the principles
of modern medicine and the promise of antipsychotic drugs and those who held to the more dominant
tradition of American psychiatry.
Sigmund Freud's couch was never used as a window into the souls of madmen.
While his theories revolutionized the way we think about ourselves, he never treated
any schizophrenic patient.
Freud considered psychoanalysis, his theory of unconscious drives and conflicts, inappropriate,
impossible for the treatment of schizophrenia.
But after Freud came to America to deliver a series of lectures in 1909, the practice
of American psychiatry would eventually come to be dominated as nowhere else by the theories
and techniques of psychoanalysis.
Not infrequently, Freud's followers in treating schizophrenia would practice what the founding
father never preached.
An important thing to know about the Freudian idea is that it's fundamentally a salvationist
idea.
It says that it knows the cause and the trouble built into human nature and human life experience
and it has the cure for it.
And we Americans at least have been again and again ready to take up at least temporarily
with a new philosophy, a new doctrine, if we think it's going to make this world and this life
and it better.
That's what psychoanalysis offered to us.
It's a shame that it didn't work out really.
I think psychoanalytic treatment for schizophrenia is not only not helpful, I think it's quite
harmful.
And the reason is because it implies very clearly that the reason the person is sick
is because of the way they were treated in childhood, because of what happened with their
mother, because of what happened with their father or their baby sister or whatever it
is.
We know that has nothing to do with it.
I mean, when you talk about someone with polio, when you ask them, gee, how did you feel when
your little sister was born?
If someone comes in with Alzheimer's disease or multiple sclerosis, you don't say, how
did your mother treat you when you were little?
It's that silly and yet we still do that in some cases.
Today the struggle between opposing factions in psychiatry is largely resolved.
There's wide agreement that schizophrenia is a disease and that psychoanalysis is an
inappropriate treatment, although no one disputes the important role of supportive talking therapy.
But old ideas die hard.
Some training institutes still teach that schizophrenia sometimes springs from the traumas
of childhood.
We asked Dr. Phyllis Meadow for an example.
We absolutely know what causes schizophrenia and I wish more people would just study schizophrenia
in depth and learn about it.
For example, the child comes into the world already frustrated.
He's just been born, which is a terrible experience.
And the only thing that woos him towards the life drives is the relationship with the breast.
He doesn't have a relationship with the mother, but he has a relationship with the breast.
It's never there every time you want it, but it's there enough of the time.
I think some analysts refer to that as good enough mothering.
It is the child can feel magical, omnipotent.
He can call up the breast and within a few minutes he'll hear the noise of the breast
approaching something to indicate that the breast is forthcoming.
He'll have a fantasy in his mind of a breast and it will usually trickle milk if he's healthy.
If he's very unhealthy, he'll roll over, feel apathetic and feel there's no breast, there's
no fantasy and there's no way to get anything he needs.
And that is what leads to pathology.
Sometimes it leads to death, but that would certainly lead to schizophrenia.
Hi, David.
Morning, Dr. Nyninger, I shake your hand, but that's all right, have a seat.
We're in a different room this morning.
This is David's second meeting with Dr. Jim Nyninger, a reach-out volunteer psychiatrist
who tries to treat schizophrenia with a combination of supportive talking therapy and medications.
He believes both are necessary.
So I need to say, I need to say at the first of this, don't mind me, call it my paranoia
or my carefulness, anyway, that anything which has been taped prior to this on this date
of what was yesterday's date, so I know today's, Tuesday, October 24th was taped when to my
knowledge the camera was not running, therefore I have not consented to its taping.
Okay, that being said, the camera's now running and this stuff's all good.
Okay, anyway, don't mind me, I was a political science major.
So it's been a couple of weeks since we met, can you bring me up to date on how you've
been since then?
My weekends have been fine, my weeknights have been hellish.
And the weekends you have a place to stay and during the week you don't, right?
That's correct.
And I, during the week, I lately have been inhabiting subway stations and parks.
Does that get you depressed to have to- Sure it does, and I wonder, you know, I sort
of think, wow, I'm depressed, maybe I need an anti-depressant, but who wouldn't be?
Let me ask you this, how have you been sleeping?
Last night I slept great, if I had any decent place to stay, whereas a rule, a pair of glasses
once went poof there, but as were asked a rule, my possessions in my body aren't being
searched and I have something resembling a security perimeter between me and the other
guy.
I mean, I trust my friend implicitly, you know.
Then you can sleep.
Then I sleep much better.
But these glasses have almost gone poof.
These aren't mine.
These aren't even my prescription and they're glass glasses, so, and you'll notice that,
I have yet to have a complete pair of glasses in months.
Anyway, and that the- Are there people here or recently that you've
worked with that you do trust?
Nobody implicitly.
I trust absolutely nobody implicitly that I have met within the last two years.
Since I came under surveillance at least, nobody.
I can't.
You know, it's like, unless I have, I mean, I take everything else on a situation by situation
basis on, you know, when it comes to the level of trust, but when it comes to nobody that
I've met since I, since I undertook that surveillance, could I ever trust implicitly?
There might be- Let me just tell you what my thoughts are
at this point in terms of, as you said, I think, you know, you are at this point on
an ongoing basis getting treatment with your peer counseling and coming here and that's
good so that if things started to emerge, hopefully that could be contained, you know.
My own feeling though, just so you know it, is that I think probably low doses of medicine
would help you in terms of minimizing the chance that under stress that you'd feel too
aggressive or that you'd hear voices and also I think it might help you organize your thinking
a little.
You and I last time said, and I think we agree on that, that medicine would only make sense
if it offered you something and that that outweighed any side effects and that's why
I'm not pushing it, but I want you to know it's available.
In the treatment of schizophrenia today, it is very clear that the absolute mainstay of
treatment is the use of medications that reduce psychotic symptoms, but medications are not
the whole story and just like when a patient leaves a hospital with a heart attack and
they go out to an environment that's extremely stressful, they're not going to do well.
The patient with schizophrenia goes to an environment that's extremely stressful, where
there may be a great deal of difficult relationships and anxiety and hostility in their environment,
they're not going to do well.
Hello.
Hello, sir.
Would you like a sandwich?
You would like a poncho?
Yeah.
Thank you.
And a sandwich?
Look, this is an invitation.
Yeah.
If you would like to come to our son giving dinner, you will be welcome to come.
It was clear in schizophrenia that if the brain were involved, it was a subtle problem
because you didn't see it just by casually looking at the brain.
So what we've needed to do is be able to say, well, what would this person's brain have
looked like if they maybe never had schizophrenia?
And in our view, the best solution to this is to look at twins, twins where you have
one twin that has the illness and one twin that does not have the illness.
Now, if you look at the brains of these twins and you find a consistent anatomical difference
that goes along with that illness, you can pretty much conclude that this deviation is
related to this illness.
With twins, we've been able to say that these subtle anatomical deviations appear to be
characteristic of almost every patient with the illness because when we compare them to
what their brain should have looked like genetically, environmentally, et cetera, physically, if
they didn't have the illness, it looks as though there's a consistent change that we
see that is associated with the ill twin but not associated with the well twin.
Most of these areas involve what's called the limbic system, which is a part of the
brain that we think is very important for emotion, memory, and higher order kinds of
human behaviors.
We think that somehow when this part of the brain was being formed, its connections, its
wiring the way cells early in development have to sort of travel, they travel from one
part of the very primitive embryo brain to what becomes the fetal brain.
There's good reason to think at this time that something goes wrong during that process
that's affected the development of these areas.
What the insult is, whether it's a virus or a toxin or a little less blood supply through
the placenta or some hormonal thing, we just have no information on that.
Do you need help?
No, no, no.
You couldn't get done.
Okay.
Well, when I first heard schizophrenia as a diagnosis, my reaction was one of bewilderment
and shock.
Do you want a hand?
Yeah.
I need a hand.
The most terrifying thing was when it was around four years ago, I had injured my foot,
so I was on crutches and in a blind psychotic rage, she came after me and tried to kill
me.
It was clear then that there was violence, intent.
It takes all the courage I have to deal with this illness because the one thing is the
most intimate relationship I've ever had in my life is gone.
Then on top of that, Marge has been hit harder than a lot of people I know.
She's far sicker than any of the other twins that I have talked to.
They told me I was sick as a dog and I had bubonic.
Who told you that?
Oh, one of the doctors.
And when you went down to Washington, why did you go down there?
Why did I go down there is because there was a problem that wasn't going to get straight.
Problem with whom or what?
Well, there was a problem of being on a 10 most wanted list and no one had turned me
in in the United States.
When I think who is that client there, a client that I know for three years, in three years
today was the first day that he accepted a sandwich from me and took it directly from
my hands.
That's enormous progress.
Some people may think that it's not progress, but it is a lot of progress because I bet
that this man is being hospitalized a thousand times.
I bet to you that he's been medicated a thousand times and I bet to you that he's been discharged
from the hospital to the street a thousand times and I bet to you that he in here in
Central Park every time that he gets discharged 80 percent of the hospital beds for the mentally
ill in the state system have been closed since 1955.
Hundreds of thousands of people have been displaced from these hospitals.
What we did is we emptied out the hospitals and then did not provide the care for these
people and we are now paying the consequences of really the severe mistakes we made back
there and to have literally at least 200,000 seriously mentally ill people on the streets
in the United States with serious mental illnesses among the homeless population is probably
a disgrace of a magnitude that we haven't seen in this century.
Before its introduction of anti-psychotic medications in the mid-60s, Bangor State Hospital
in Eastern Maine had 1,200 patients.
Today only 300, including Marge Murphy, are left.
Now there is the suggestion that Marge, too, should prepare to leave the hospital.
I was just wondering if you wanted to, if you had thought about after the hospital or
what you wanted to do.
I don't know.
It depends.
It's your concern about this, is that-
The concern about it isn't real, you know?
You know, I really can't go to an elementary school and walk in and sit in a chair and
just do it.
You know, the reality of this, I can't do it.
You know, I can legally do some things and I can legally do others and then I cannot
legally do anything.
I don't know.
Right now, what's happening with Marge is they want to move her from the hospital into
what they call a less restrictive setting.
The problem is Marge isn't really ready to go.
It's hard when she has been violent to know what to do.
I think the most difficult thing for me to work through and deal with was having to call
the police to come and pick her up and take her back to the hospital to know that I had
to do that for her benefit as well as for ours because she was out of control at that
point in time and she was a danger both to herself and to possibly anybody else.
And I didn't want anything to happen to any of us.
If you had a choice of your living situation, what would you like?
What would I- you know, you're asking me something and I don't know what you're talking about
again.
Well, we're talking about dreams of it.
I'm not talking about a dream, I'm talking about a place to jump in a car, drive to and
get out into it and sit and, you know, watch the football game.
Oh, is that what you want to do, watch the football game?
Yes.
About leaving, you know, I'm not a committed, totally insane patient.
I have a problem and it has to be, you know, fixed where it can be and then let out, you
know.
It's a material.
What will fix it?
I don't know.
Like they said, I might have to do chemotherapy with instruments, electronic instruments,
high voltage on it.
Although Marge's thinking often seems bizarre, her severe psychosis has been successfully
checked by medications and a safe hospital environment.
Mrs. Murphy fears that if Marge leaves too soon, she will go off her medications, become
violent again and have to be forcibly returned to the hospital.
The word psychiatrist sees things differently.
The most difficult problem that Marjorie faces at this time would be separation and individuation
from her family.
What I mean by that is she is an individual in her twenties who has never really been
independent, has been able to live and function on her own and I feel her greatest task is
to pull away and to be able to develop a character and a personality for herself.
I think it's very important for Marjorie to move away at this time and to be independent.
She voices that desire quite regularly.
She and I were talking earlier and the hospital is a safe place for her.
It's one of the few places that she knows she's not going to get kicked out on.
She said, they've got to take me here.
Other places, group homes, boarding homes, apartments and everything else, if mental
patients get a little rowdy, they can be evicted from these living situations and then they
have nowhere but the streets to go.
Where's the whip, where's the whip?
You keep up with me or it's over.
Maybe you've got all the videotape you need today.
You keep up with me and continue to talk.
This is not a photo op, Dave's habits, you've got guys with long lenses and parabolic mics
for that, okay?
No comment.
Now, keep up with me, you want to talk with me, otherwise I really mean it, it's over
this morning.
Not to mention throughout.
Where are we headed right now, where are we and where are we going?
I'm attempting to secure newspapers.
My income doesn't permit me to buy them.
By now, David was convinced that Frontline was part of the government's surveillance
network which was sabotaging his life, but he had come to trust producer DeWitt Sage
and so he made one last exception, he would allow the crew to follow him on his morning
rounds at Penn Station, given the severity of his paranoia, it was an especially brave
decision.
Today's Wednesday, right?
And how are things going with ReChat, David?
No comment.
Dave, tell me more about the quid pro quo, because this is important, and we...
The program is saying in a defective manner that I have to be on medication to get housing.
I repeat, there's no real justification for that.
That's all I'll say about it right now.
Sorry, you repeat what, David?
I repeat, there's no, there's no, I am not going to answer any more details than what
I have just said, and remember, when I say no comment, no follow-up, when I say no comment,
no follow-up, the discussion on that subject is ended.
The idea of clowning, it's something that just evolved.
What Marge's illness made me do is just, you know, stand up for myself more and say the
heck with this.
I mean, I have all this pain to deal with, I'm going to do what I want to do.
How do I cope?
Well, I think under those circumstances, I'm doing remarkably well.
In performing, the hardest thing I ever had to do was a birthday party for twins, where
the little boy, he was developmentally disabled in some way, I don't know what the diagnosis
was, but he was disabled, and the little girl was well, and I was almost in tears in the
back.
And that's the only thing that has ever touched me that deeply, that I really had to pull
myself together.
That was the hardest thing I ever did.
I think for any family that's faced with schizophrenia, the pain that is involved in it is really
extraordinary.
When you have identical twins, especially identical twins that have been very close
in which one gets sick, it's almost like part of them has died because they're interchangeable
in a way.
In terms of Marge, I think Marge is likely to benefit from some of the improvements in
medication that are going to come along in the next decade, and I think she is going
to really benefit from the research that we're doing on the disease right now.
She is someone that I can say is likely to see some real effects of the research we're
doing on identical twins.
In my thinking, one of the most fascinating things about the brain evidence in schizophrenia
is that it suggests that somebody's walking around for 20 years with something wrong with
their brains, approximately 20 years, until the time that they manifest the illness, and
that they're walking around with a brain abnormality, but for some reason they're able to compensate
for it.
For some reason, it doesn't show itself as a clear illness, disease, schizophrenia.
It doesn't show that.
In the case of the twins, we have two twins who are both relatively well doing very well
for most of their lives, even though one twin, it seems, was probably born with some difference
in their brain from the other twin.
Now what happens that all of a sudden, this brain difference, which can seemingly be compensated
for for 20 years, all of a sudden is no longer compensatable?
Is that environmental stress?
We don't have an answer to that question.
Strange things happen.
Nah, it was all, it was all.
I found it in the trash in my buddy's building.
Somebody threw it out.
It's fine, mate.
The zipper's a little bit broken, but the snaps work, and, you know, when you're sleeping
in the subway or somewhere, warmth's rather a premium.
It turned out that the morning filming at Penn Station was the last time we ever saw
David.
Having steadfastly refused medications for his paranoia, he parted company with Reach
Out the next day.
David is back where he was first found.
What's your name?
Jim.
Jim?
Okay.
I like your beard.
It's very nice.
This is the one that I'm talking about for Wednesday, okay?
You're very much welcome to come.
Now, on Thursday, I wonder why, why, why we cannot deal with mental illness.
What is so bad about it?
What is so bad that people refuse to look at it, you know, and take care of the problem
instead of ignore it, put it in a psychiatric ward where nobody can see it, or completely,
you know, abandon them?
But what keeps me going day by day is that after working with a client for three years
and seeing that person coming into a van for the first time, it's so fulfilling that it's
bigger than a candy in the hands of a child.
You know, it's bigger than, I don't know, than, you know, the miracle that is when the
spring comes?
It's bigger than that.
There are some moments of hope in the search for the cause and treatment of this terrible
illness.
But in the past, we have often, with the best of intentions, done more harm than good.
There are now twice as many severely mentally ill people living on our streets as in all
of our state mental hospitals.
We're being tested to find solutions, not just in our science, but in ourselves.
Santa Claus, Santa Claus, over there.
Where?
Over across the street.
I haven't seen him in so long.
He's in so much shame.
I can't believe he's still here.
Okay, you have to put down now the videotape, please.
Santa Claus, Santa Claus, over across the street, over across the street, over across the street,
over across the street, over across the street, over across the street, over across the street.
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