A week ago I saw my sister Austine, on the occasion of her birthday, and I haven’t been able to write a word of this blog since.

You see, there’s this depth of fear in her eyes that haunts me, an inconsolable sadness.

Plus, she doesn’t speak. My sister Austine is sunk in silence, so meekly catatonic that the vast distance between us fills me with dread. She’s as unreachable as a distant star, and I am helpless to help her.

I found her a week ago Wednesday where I usually do, asleep in her very nice single room, this day on her 57th birthday.

I sat on her bedside. She seemed happy to see me at first, though she didn’t talk, responding “yes” or “no” in a tone with the same sad inflection that matches her visage.

Hello, goodbye, yes, no, and I don’t think so are the only words she’s able to muster.

“Did they have a cake for your birthday?” I ask, trying in vain to provoke some sort of small exchange.

“No.”

I find out later that the house had. Austine wasn’t being coy. She lacks the cognition to converse.

Whatever schizophrenia is, it’s robbed her brain’s prefrontal cortex of the capacity to process the simplest answer to the simplest question.

Through her group home and government disability care, she is offered a variety of rehabilitation, peer support, and education services, but Austine has been unable to make use of them.

Medication causes her to walk with a shuffle and there’s a yellowish pallor of skin, a consequence of 40 years of heavy smoking.

Lots of teeth have fled her mouth, and she won’t be taken to see a dentist. She won’t say why. She can’t say why.  We’ve pleaded, to no avail.

Which reminds me of a recent news story about a British woman, diagnosed with schizophrenia, who’d won the right not to have her leg amputated even though it had been infected with gangrene that was spreading.

Justice Peter Jackson ruled that the choice was hers to make as “a part of what it means to be human.” He said a forced amputation would amount to a “criminal assault.”

I agree. I’d never force aging Austine to do anything against her will, as compromised as her capacity to make rational choice is.  Who doesn’t dislike dental visits? Her fear is nearly normal.

We don’t know because, for 35 years, she’s been unable to verbalize her thoughts, but if she’s determined not to do something, then she can make her wishes known.

All we can say for sure is that schizophrenia hit her like a cannonball–quickly and with enormous impact–as she was leaving adolescence. Before it hit, Austine was the life of the party. Ever since, you’ve never met anyone more shut down.

The before-and-after contrast could not be starker. When you live twenty years with a girl whose brightness dazzles, you never get used to the 36 years of deep, zombie-like schizophrenia that follow.

Austine and I were as tight as teenage siblings could be, back when she had a sparkling personality–lively, lovely, funny, quick, sharp, cool, and the best dancer this side of the nineteen seventies.

Those are the nicest memories, but on the occasion of her birthday, the only feeling I have is the anguish of absence.

I always think of mom when I see Austine. She was mom’s fourth child—and second daughter with schizophrenia. Schizophrenia arrived like a windy breeze through an open window, and then returned a few years later through another window, and then swept mom into an early grave.

She’d seen enough of the whole tornado returning too many times. It’d taken not just two daughters, but her own mother and brother as well, before it came back to scoop up Austine, the cruelest case of all.

Mom couldn’t face it. She was looking right at Austine the moment she died. Looking at her baby girl, whose mind had been run down by a train, she died.

Fast forward near four decades, and Austine refuses to leave the premises of her red-brick residential home, even with me, her closest sibling.

Smoking cigs dished to her outside in the cold, she shudders and manages a hug back by way of saying goodbye.

I don’t cry easily, but on my way out of Austine’s, I’m always a man of quick tears.

It’s not for everyone. Blood tests for biomarkers raise the specter of mental illness scorecards for one in five Americans, generally, who have a clinical mental disorder. Whether to be tested for the markers will be a very personal choice.

Yet since there’s no lab test or brain scan to confirm schizophrenia, when someone’s sanity crumbles like a wall of dust, as happened, twice, in our house, families go on an endless search for answers.  A blood test that confirms one condition or another would seem to be a good place to start.

Still to me, at first blush, the idea of crunching an algorithm to identify dozens of molecular markers for schizophrenia (that’s essentially the blood test that’s on its way by 2016) sounded more like a Rorschach test than the rock-solid certainty needed for something as profound as schizophrenia.

But this Youtube video of a British woman ruminating on the benefits of knowing, one way or another, has me convinced. A blood test can only help in breaking the news to others, and to oneself, and can eliminate the need for self-identification when the patient has already lost insight into his or her own state of mind.

If it doesn’t make the disorder any less challenging to live with, a test may make it easier to accept for some 20 million families worldwide.

What do you think? It’s hard to quarrel with the argument that a biomarker test would promote more objective diagnosis. Or help guide psychiatrists in tailoring medications to underlying symptoms.

Could it also aid in erasing the stain of stigma?

Could it help normalize the illness?

Diabetes of the Brain?

After 15 years of research, Dr. Sabine Bahn, director of the Cambridge Center for Neuropsychiatric Research and of Psynova Neurotech Ltd, believes a test would help people accept the diagnosis and cope with the stigma surrounding it.

Bahn says it even has the potential to identify high-risk individuals for intervention trials and monitor their response to drug treatments.

Bahn, who also chairs the Translational Neuroscience at Erasmus Medical Center in Rotterdam, has said that her technique (using advanced profiling techniques to find abnormalities in postmortem human brain tissue, and in blood and other samples derived from patients and matched controls) is already guiding some novel therapeutic approaches.

For instance, when abnormal glucose levels were found in post-mortem brain tissues, leading some to wonder if schizophrenia isn’t “diabetes of the brain,” Bahn and her team went to work checking the cerebrospinal fluid (CSF) in living patients “to see if we could identify the same changes as seen in the postmortem brain,” she told a psychiatric conference.

They studied spinal fluid samples from these minimally treated patients with first-onset paranoid schizophrenia and demographically matched their samples to healthy controls.

Bahn said her “findings suggest alterations in glucoregulatory processes in CSF of drug-naive patients with first-onset schizophrenia.”

Eventually, her researchers were  able to develop blood serum based on its molecular profiles. “Short-term treatment with atypical antipsychotic medication resulted in a normalization of the CSF disease signature in half the patients well before a clinical improvement would be expected,” she said.

Because inhumane treatment of mental patients should always shock the public, the governor of Massachusetts showed his own undisguised disgust for the unpunished death of a 23-year-old Massachusetts man diagnosed with paranoid schizophrenia.

Massachusetts Governor Deval Patrick intervened Saturday with disciplinary action for three Massachusetts state prison guards put on paid administrative leave for their roles in the death of Joshua Messier.

Correction Commissioner Luis S. Spencer was also given a formal reprimand for his inaction.

Patrick said at least two should face disciplinary proceedings for improper use of force in the death, which was determined to be “homicide” four years ago by medical coroners–with no further action! The district attorney never presented evidence to a grand jury, despite the homicide finding.

“Mr. Messier’s death was tragic,” Patrick fumed. “When tragedies happen during this administration, I expect the responsible officials to get the facts and deal squarely with them. That did not happen here.”

Patrick, who had previously called the death “disgusting,” also asked for the resignation of Assistant Deputy Commissioner Karen Hetherson from her $117,000-a-year job for overruling a 2011 report that cited two guards for misconduct.

The case came to a head two weeks ago when the Boston Globe investigation detailed the questionable circumstances surrounding Messier’s death.

On the night of his death his mother, Lisa Brown, had seen him and worried that he was close to having another violent psychotic episode. In a staff break room Joshua allegedly punched a guard, who punched him back. He and other guards subdued Messier on the floor.

As other guards joined in, two pushed down hard on his back as he sat cuffed and shackled in leg irons, a banned method known as “suitcasing” that causes suffocation.

As this video shows, he was placed, spread eagle, in four point restraint and ignored by a roomful of guards as he turned blue and  groped toward death.

He had been sent to Bridgewater State Hospital, a prison facility, for a psychiatric evaluation following two incidents in the psychiatric unit at Harrington Memorial Hospital.

The Department of Corrections Internal Affairs has a ban on guards putting pressure on a restrained inmate’s back.

Surveillance video clearly shows two guards pushing down hard on the cuffed patient’s back, forcing his chest toward his knees.

But the finding was ignored by Hetherson, the assistant deputy commissioner.

A month later the state’s Disabled Persons Protection Committee cried foul, saying the guards were responsible for Joshua’s death.

Citing the horrific death of 29 year-old  Joshua Messier, Massachusetts Governor Duval Patrick said inmates who are not a serious danger to themselves or others “should not be tied down, limb by limb, in the 21st century here in Massachusetts,” the Globe reported today.

The comment follows the controversy surrounding the 2009 death of Messier, a man diagnosed with paranoid schizophrenia and sent to Bridgewater State Hospital for a psychiatric evaluation. One month later he was killed, dying ten minutes after prison guards placed him in four-point restraints.

Patrick said using restraints may “seem reasonable in the moment but does not necessarily protect the inmate or the officers.”

The video of the death had been airing all week on local television, but the move isn’t kabuki on Patrick’s part.  The governor’s disbelief seems genuine and obvious.

And why not? It’s video that shocks the conscience. Or should shock it. Patrick is a scrupulous politician who renews my faith in the breed.

His intervention comes too late for Joshua Messier, of course. He paid the dearest price for his disability.

Nor will his martyrdom diminish the grief of his parents at the way he died.

Messier Did Not Deserve to Die

His disability had made him violent, but he was not violent in the minutes before he was restrained.

Joshua Messier died unnecessarily for the crime of showing a symptom, the voices that had been in his head since college.

It wasn’t premeditated murder on the part of the prison guards, but a case could be made for manslaughter.

After your back is wrenched with a knee, the suitcase position is a follow-up maneuver that can send a heavy man to his death. As you can see from the video, he’s in four point restraints only for ten minutes as he turns blue and dies.

No one has been prosecuted, much less reprimanded, and all but one of the guards in the video still works for the state’s Department of Corrections.

Patrick’s action may be the best possible outcome. It shuts down a practice that shocks the conscience.

The governor said restraints would be banned for use on pregnant inmates in labor as well.

He made his comments as he unveiled a new program to cut recidivism by prison inmates in half over the next five years, the centerpiece being treatment options for inmates struggling with substance abuse and mental illness.

Transferring civilly committed prisoners to Department of Public Health facilities instead of state prisons makes a lot of sense, he said, noting that  Massachusetts is the only state that sends them to prisons, such as the medium security Bridgewater State Hospital where Messier breathed his last.

After being restrained by all these big guards at Bridgewater State Hospital putting all their weight on him, you can see him turning blue and die.

Read for yourself today’s expose in the Boston Sunday Globe.

It begs the question: Was he killed by the state just for exhibiting symptoms of schizophrenia?

As the video suggests, the man with diagnosed schizophrenia, here from a hospital for psychiatric evaluation for violent psychotic behavior in the first place, is having another episode, hearing voices, seeing visions, when state prison guards subdue him, hands and feet, in four-point restraint.

Ten minutes later, turning blue as his guards chat to each other beside him, he’s gone.

The explanation of the prison guards transcends belief. They know nothing about schizophrenia. They’ve had no meaningful training in mental health disorders. This at the state of Massachusetts’ prison for the mentally ill. (Despite its name, Bridgewater State Hospital is a medium-security prison.)

Of course they don’t. Why would they know the least about the most severe mental illness dealt with in psychiatry? They only have to face it every day.

Am I the only one who catches the cosmic irony of a man hospitalized for an illness being murdered, essentially, by the system meant to help him?

No Arrest, No Reprimand

Globe investigators couldn’t get to the bottom of why no one has been arrested, prosecuted or even reprimanded. (Internal Affairs cited two guards for putting pressure on a restrained inmate’s back, but that was it.)

Why? Because the state medical examiner called it homicide, then changed her mind.

Why? We don’t know that either. She wouldn’t respond to the Globe investigation, but it seems odd. It’s just extraordinarily unusual to have homicide listed as the cause of death with no additional court action.

The video shows medics were called when Messier’s pulse had stopped, and not before a crowd of guards  had been standing idly by, chatting as he lay dying.

In the surveillance video, two guards are also seen pushing down on his  back as he sits in handcuffs and leg irons on the bed, crunching his chest toward his knees.

The practice, known as suitcasing, is banned in Massachusetts prisons because it can cause suffocation.

The medical examiner called in for the autopsy found his heart had stopped beating during the guards’ effort to strap him down, but she couldn’t say exactly when.

Her autopsy also found internal bleeding on Messier’s brain, and blunt force injuries to his neck, torso, arms, and legs, suggesting that he was beaten before he was dragged into cell 13.

In the Globe piece, the prosecutor who won’t call a grand jury to consider a manslaughter charge comes across as the final word on weakling. Either that or a law enforcement authority trying to protect fellow law enforcement authorities, almost as a professional courtesy.

The bizarre unwillingness of Plymouth District Attorney Timothy J. Cruz to at least call a grand jury to decide if a trial is warranted is so unusual that it’s raising eyebrows.

Cruz claims the medical examiner told him she couldn’t tell exactly when Messier expired during the ten minutes that he was turning shades of blue in cell 13.

All righty, then. So when it comes to mental illness, it’s the age old story: Close the curtain and darken the room. Nothing to see here, folks. Just move along.

Messier was there at the medium security prison, even though he had not been convicted of a crime.

Messier had been transferred after he allegedly assaulted three staffers at Harrington Memorial Hospital.

Misdemeanor assault and battery charges were filed against him and he was moved to Bridgewater for psychiatric evaluation.

His death is a tragedy for his parents who’ve managed to keep their own sanity throughout the ordeal. They’ve filed a wrongful death suit against the state of Massachusetts.

They said their late son was a normal boy with a sanguine outlook on life until he developed signs of schizophrenia in his second semester of college:  voices, paranoia, religious delusions, and in his case dancing mania and violence.

“I kept telling them it’s not a behavioral thing,” his mother Lisa Brown said. “He hit people because he thought they were the devil coming at him.”

There is no gene test for schizophrenia yet, but it’s on the horizon, coming to a genome lab near you, eventually.

When it does, we’ll all be genetic pioneers. Or genetic guinea pigs if we’re not careful.

This weekend four writers facing four different genetic disorders were interviewed on the BBC Health Check Series, each unpacking a family history that’s a reminder of the cruelties of biology.

(Full disclosure moment: The four are my fellow essayists in The Story Within: Genetics and Personal Identity.)

Think about it: a tiny spelling error in any one of the roughly 20,000 genes that comprise the human genome can disable a person for life.

Of some 7,000 disorders that plague man, about a quarter of them have genes that have been implicated.

In about 600 of these, genes can be diagnostically tested.

Joining the BBC host to help guide the discussion led by Claudia Hammond, Sir John Burn, a  professor of Clinical Genetics at Newcastle University and a world authority on genetics, noted that, in the opinion of many, it’s only a matter of time before all genes are known for all disorders.

Schizophrenia may be one of the last genetic locks to be picked. This is because there’s not one single gene for the disorder but dozens, none necessary nor sufficient alone to cause it.  Non-Mendelian, in other words.

Still, every few months sees exciting new discoveries. Just last week, a link was found between a largely unstudied gene for schizophrenia, ULK4, and bipolar disorder, depression and autism.

While the University of Aberdeen-led research–published in the Journal of Cell Science–set out to look for genes that might be important for schizophrenia, this particular gene had been associated only with hypertension, never with mental disorder.

“What’s going to happen increasingly is that people are going to have their whole genome sequence for one reason, and then be found to carry a spelling mistake in an important gene elsewhere,” Burns observed.

He predicted that drug makers will be interested in families afflicted multiply with specific genetic illnesses.

If an anti-psychotic works for a family as hard hit as our own here in Boston, say, then it’s a better bet to work for many more families with schizophrenia.

Still, decisions to have your genome sequenced may never be black and white. Much hinges on whether there’s anything useful to be gained from the  information.

“We don’t twist people’s arms,” says Burns. “We simply give the opportunity.”

Amy Boesky, a Boston College literature professor who edited The Story Within, told the BBC she’d elected to have her breasts and ovaries removed without testing for the braca gene that took her mother.

While the essayists in the collection have a range of disorders that thrust themselves into our families, that seems only fitting: what unites us is the need to encourage greater respect and tolerance for genetic variation.

“A number of us said when we met this fall that we felt like we were part of a larger family,”Boesky notes.

“Many of us feel that we are working against generations and layers of guilt and shame and stigma associated with hereditary conditions.

“And I think that’s been a reason for not only being willing but wanting to speak out and write about this, no matter how hard it is.”

Hammond sums up the misfortune. “You want to be the lucky one, but you don’t want the others in your family to be the unlucky ones either.”

Clare Dunford’s son JP has Fragile X, a disorder that comes out of the blue to consume one’s life.

JP was diagnosed at age 7. “It erupted and transformed my family and in some ways makes us feel our families have come to a dead end,” Dunsford tells the BBC.

Tufts University creative writing professor Michael Downing was tested for the genetic mutation for his family’s hypertrophic cardiomyopathy, which causes sudden heart attack, and killed his father at 44. After his brother died in 2003, the family was tested.

Asked how he copes, Downing frankly says he doesn’t. “You don’t cope with it, actually. You just receive it and try to take it in.”

Kate Preskensis speaks about the early onset Alzheimer’s that has claimed her mother among five family members.

“I live under my own magnifying glass—a  constant examination of my memory, choice of words, and emotional state,” she writes. “All aspects of my life are stifled by the knowledge that Alzheimer’s  disease in our family is linked to a specific traceable gene.”

Like me, Preskensis has held off on having kids. However tragic the past, genetics stalk our future too. Until there’s a cure, mischances shadow the unborn too.

It’s a family tragedy of the first order, so it’s admirable to say the least that this family has plucked up the courage to tell it like it is. So few do, it’s a rare thing indeed, yet it is what’s needed most of all.

Voices and visions are what Jennifer Cristini and her husband Vittorio are up against with their 10 year-old boy Giovanni, who they call Gianni. She says she’s weary from re-telling their adopted son’s story to other relatives, doctors, teachers, neighbors and friends.

“There’s no sympathy,” she says.

The CNN reporter asks incredulously how that can be.

Cristini has no answer–there is none, and we all know it. It’s shrugs from shrinks who can’t find a cause or a cure, and even our dearest friends don’t know how to discuss psychosis.

 ‘They’re just not friendly’

Adopted at birth, Gianni is not unaware of his condition. He says he hears voices, which has never been an unusual human experience, but his are of the worst sort. “They are not going,” the poor boy shrieks.

“Are they friendly? Are they nice? No!” he says of voices that come right out of his stuffed animals. “They’re just not friendly,” he says again, stressing each word.

A video of him three years ago shows a 7-year-old boy having hallucinatory fits. While Gianni is nonplussed, his mother Jennifer handles her boy with perfect aplomb.

Her worries about him started to grow at 18 months when she spotted unusual behavior, chiefly tantrums that would not end, not even for sleep, his head noisy with voices.

“He’s threatened to kill us,” says Ms Cristini. “He says ‘I want you dead, I want to kill you. I want you out of my life.’ And he comes after us.”

Alarmed by what he says, his parents don’t trust him to be safe.

The Cristinis worry about him harming their other two children, 5-year-old Tizita and 7-year-old Gabriella, too.

‘It’s this incredible puzzle’

“I lift weights to stay strong,” Mr. Cristini says. “But what will happen when we are old?”

“He isn’t getting better,” says Ms. Cristini. “We see his mental illness getting worse every year. You hope for everything but you have to be realistic.”

The Cristinis invited CNN cameras into their home to share their experience for other families that are suffering in silence.

At first, family doctors had no notion of what was ailing him. Gianni’s symptoms—voices that seem like persistent phantoms—didn’t fit the profile for autism. But the waiting list to see a specialist was a full year.

“Just for testing, and you don’t get a diagnosis,” Ms Cristini says. “You ask friends or neighbors and nobody has a clue. They stop talking to you. They’re tired of hearing your son screaming all the time. There’s nothing you can do except fight and wait and call.”

On antidepressants since age 5, Gianni continually threatens suicide and homicide. The medication works for no more than a week.

“You feel like no one knows how to help you or really what to do or really what they’re doing,” Ms Cristini says. “It’s this incredible puzzle that you’re trying to figure what piece goes where and what combination will work. And that puzzle is always changing as he grows.”

Sound familiar? Yes, but it’s still rare and heartbreaking to see in a child knowing that Gianni is one among some 4 million American children struggling with mental illness.

Gianni attends a private institution in Albuquerque started by another parent fed up with the paucity of public school resources for special-needs kids.

If most people shun people with schizophrenia—and they do—every third person working professionally in the field of mental illness also keeps a  distance.

The more exposure you have to schizophrenia, the less fearful you are. And if you’d had a mental illness yourself, you tend to be more understanding. Ignorance breeds fear breeds isolation.

Such surveys have long been collected by social scientists hoping to gauge stereotypes against other groups such as gays and substance abusers. This study, funded by the Substance Abuse and Mental Health Services Administration and National Institute of Mental Health, is among the first in the United States to examine attitudes among mental health professionals vis-a-vis schizophrenia.

Mental health professionals given vignettes to read were asked if the person described would be welcome as a co-worker?

A neighbor?

Housemate?

Spouse?

Would they see the individual with schizophrenia as able to make financial decisions?

It turns out that, among mental health workers, greater seniority tracks with positive attitudes.

35 percent of mental health workers and 70 percent of the public consider people with schizophrenia to be dangerous enough to keep at arm’s length.

That’s not to say that they don’t proceed with caution. They are careful, of course, yet they understand that you’re more apt to be attacked by a drunk or druggie.

That being said, the victims should be acknowledged, like the mental health worker killed here in Massachusetts, 25-year-old Stephanie Moulton, who was stabbed to death on a snow-covered January evening three years ago. Who can forget the images of her blood smeared vehicle?

When violence bursts, it seems abrupt, rash, unfathomable, unanswerable, as happened here. It’s tragic because it seems so unpremeditated.

The survey of 731 mental health professionals and 400 nonprofessionals in Washington state, reported in a study published online in Psychiatric Services, linked positive attitudes with having advanced degrees and, interestingly, reporting a mental illness themselves.

The findings were compared to some 400 adults taking the biennial national General Social Survey.

“The results suggest that the more exposure you have personally and professionally to mental illness, the more positive attitudes you’ll have,” Jennifer Stuber, the lead author of the paper and an assistant professor of social work at the University of Washington, was quoted as saying.

Experience can cut both ways however. Stuber said bias among mental health workers may sometimes hamper recovery.

“On one hand, it may be the case that mental health professionals become hardened, because they see people at their worst and become discouraged if treatment is slow,” she said.

“On the other hand, more experience may make mental health professionals more empathetic to their clients and aware of the possibility of recovery.”

The series of 30-minute online surveys was conducted with counselors, social workers, psychologists and case managers. What stood out was the realization that nearly a third of those surveyed had received a diagnosis of mental illness themselves.

Said Stuber: “This prior experience was associated with less negative attitudes, which has implications for how we think of the relevance of that experience in recruiting for a mental health workforce.”

While mental health professionals are more empathetic, a strong strain of stigmatizing attitudes persists. 40 percent of mental health providers and 70 percent of the general public agreed that they wouldn’t want someone with schizophrenia as a co-worker.

Stuber suggested training mental health providers to dispel false perceptions. “We know that mental illness alone isn’t a predictor of violence. But when combined with alcohol, drugs or abuse, a prior history of violence mental illness can be a contributing factor to violence,” she said.

I’ve seen these rash acts of violence first-hand. Why my sister went for the knife one day still mystifies, but I’ve come to understand that she’s not some sadistic killer. She has a neurobiological disease of the brain whose effects are devastating. And she is very well looked after in her group home.

For more information on this study, contact Stuber at jstuber@uw.edu or 206-616-3874. It can be accessed through http://ps.psychiatryonline.org/article.aspx?articleid=1814533.

The story of how Deeds was slashed and stabbed repeatedly last November by his son Gus, who then took his own life, feels like a galvanizing moment.

But in listening to the president’s State of the Union Address tonight, not a word was heard about mental illness, apart from a passing reference to the Sandy Hook Elementary school shooting.

It was an impressive act of courage for Deeds to liberate the nation from naive notions about the availability of mental health treatment–even for the sturdier pillars of society–for one night only. But my inner cynic tells me our restless nation has already returned to its obliviousness. Only fellow families truly stay with this story.

In case you didn’t catch the 60 Minutes piece, the pair had been in an emergency room just hours before the attack but didn’t get the help that they needed. The lawmaker found he had nowhere to turn for help for his musically talented son when his bipolar disorder exploded into full-blown psychosis.

The interview makes for riveting television because it’s unusual to hear a family go public. “I really don’t want Gus to be defined by his illness,” Deeds says movingly.

“I don’t want Gus to be defined by what happened on the 19th. Gus was a great kid. He was a perfect son. It’s clear the system failed. It’s clear that it failed Gus. It killed Gus.”

There’s a tenderness there that’s hard to forget, mostly because it’s not often that men speak publically about deeply-felt personal tragedy. Talking about this stuff is harder for many a man than opening an oyster without a knife, and yet here was this guy, this father, literally wearing the scars of his son’s attack on his face.

For now, Creigh Deed is the indelible face of family madness. He is the face of the severe damage that untreated mental illness inflicts on millions of families.

We all mourn the passing of his son, a banjo-picking young man who was breezing through William & Mary, by all accounts completely normal, when he slipped over the falls.

If we all have sympathy, some of us realize that the laments of the next family’s untreated tragedy lie right around the corner. At least those of us out there in TV land who find this story so familiar see that behind Gus Deeds stands the next avoidable death, and behind each one of them there stands countless more still.

Notes found later in a diary told the full story of how the voices had badgered him into believing his father was evil and needed to be executed. No one should ever doubt how real these voices were to him.

State Legislation Introduced

In the Virginia Senate, Deeds has introduced legislation to expand ER custody from  six to 24 hours and to compile a database of all open psychiatric beds statewide.

Let’s hope more state legislation follows suit elsewhere.

Another problem is that insurance typically pays for care only so long as the patient is at imminent risk of harming himself or others. Normally it’s never more than two or three days even though most patients need help lasting for years.

“There’s just a lack of equity in the way we, as a society, and certainly as a government and insurance industry, medical industry, with the way we look at mental health issues,” Deeds complains.

“Don’t want to fund it. Don’t want to talk about it. Don’t want to see it,” 60 Minutes correspondent Scott Pelley says, summing it up.

‘The reality is, it’s everywhere.’

“Absolutely,” Deeds replies. “That’s exactly right. But the reality is, it’s everywhere.”

Deeds is right about the ubiquity of psychosis. Sadly, his family story is not unusual. It’s a rare small town in Ameica that has not seen psychosis.

To underscore the point, Pelley then interviews seven Connecticut mothers who share some of their own ER horror stories.

Says Deeds of his late son: “If he could have been hospitalized that night, they could’ve gotten him medicated, and I could have worked to get Gus in some sort of long-term care.”

It’s one of those stories too powerful to be snubbed by the competition. Sure enough, CNN picked up on the tragedy on Monday, interviewing the Virginia lawmaker again.

And for one mother the Deeds story was enough of a motivator for her to make her own  video about her efforts to get help for her hallucinating son, a boy taunted by his voices, the same sort of voices that sent the younger Deeds to his death.

All this human drama helps enormously, but the basic problem is that the deinstitutionalization of the last 40 years has been a bust.

Why?

Because the promised residential care to replace a drop from half a million to fewer than 100,000 psychiatric beds out there has yet to materialize. Do the math.

Since 2008 some $4.5 billion in mental health care funding has been slashed by the states nationwide. Do the math again.

Now count the number living with a diagnosis of bipolar or schizophrenia who take their own lives: One in ten.

The dimensions of the mental health crisis in America are absolutely mind boggling. Gus Deeds–the great kid, the perfect son–is but the latest face of nameless millions.

As of Thursday, at least, in Pakistan.

That’s when an elderly British man was handed a death sentence–hanging–for having a religious delusion, a symptom so commonly found in  schizophrenia.

Amnesty International, which has cried foul, is calling for his immediate release.

Despite a well-documented history of mental illness, 71 year-old Mohammed Asghar was convicted under Pakistan’s strict anti-blasphemy laws for claiming to be the Muslim Prophet Mohammed.

Defense attorneys parried all questions from the prosecution with records of psychiatric hospital stays.

Prior to his arrest in 2010, Asghar had been treated for grandiose delusions at Edinburgh’s Royal Victoria Hospital and diagnosed with paranoid schizophrenia.

Asghar also felt that he was being followed by the world media and by operatives reporting to Tony Blair and George Bush because of his opposition to the Iraq war.

This is not out of the ordinary. To many with the disorder, every utterance from the voices is filled with causal, mystical significance.

Asghar was arrested soon after leaving the psychiatric hospital in 2010 after a tenant he was trying to evict had shown Pakistani police several letters in which he’d referred to himself as the Prophet Mohammed from 1400 years ago.

Despite his psychosis, a Pakistani medical board deemed him fit to stand trial.

Amnesty International is calling for the reform of Pakistan’s blasphemy laws along with his release.

“Mohammad Asghar is now facing the gallows simply for writing a series of letters,” said Polly Truscoitt, Amnesty’s deputy Asia Pacific director. “He does not deserve punishment. No one should be charged on the basis of this sort of conduct.”

His lawyers say they’ll appeal the conviction. The British High Commission in Islamabad is providing assistance.

Pakistan Fifth in Executions

Time, at least, may be on his side. While the death penality is legal in Pakistan, a moratorium in place for six years has 8,000 people waiting on death row. But the moratorium ended six months ago and the government has no plan to renew it.

Pakistan ranks fifth after China, Iran, Saudi Arabia and the United States in executions per capita.

Likening oneself to the Prophet Mohammad is as invidious as it gets in Pakistan, but making religious delusions a capital offense puts any one of Pakistan’s million plus with schizophrenia in jeopardy.

If Pakistanis feel uncomfortable in seeking psychiatric help for schizophrenia in the wake of the Asghar case, it’s sad and ironic that the root of all world religions—shamanism—cared for the mentally disabled with a great deal of respect.

Anthropologists have documented countless cultures where the fury of the mind was taken as a mystic state. Right up until the Spanish Inquisition, the iniquity of punishing the insane was universally recognized.

Who knows why Asghar would claim to be the Prophet? When you observe schizophrenia, as we have for decades, you grow used to statements that defy explanation.

The issue isn’t whether you’re for or against the death penalty here–it’s whether you’re for capital punishment for a victimless offense.

Beyond that, it’s whether the mentally ill are morally culpable for crimes far more harmful than unintentional blasphemy.