State of Mind

By Rebecca Rosen Lum
IJ reporter

Warren Barlick’s illness first appeared when he was 17.

His mother remembers hearing agitated voices coming from the bathroom – one  unfamiliar,  low and gravelly.  She ran from the kitchen to find Warren climbing into a boiling hot bath in his jeans, struggling to reason with a belligerent antagonist no one but he could hear.

Diagnosed with schizophrenia, he was placed in Napa State Hospital, “back when people with mental illnesses were treated worse than criminals,” Roma Barlick said. “The people who worked there were apathetic; they didn’t understand them, they were afraid of them, they over-medicated them.”

Yet that is where Warren, now 47, would spend most of his adult life.

The film “A Beautiful Mind,” a contender for eight Academy Awards including Best Picture, has focused new attention on the mysterious disorders and their treatment. The film is based loosely on the life of Nobel Prize-winning mathematician John Nash, who, like Warren, has schizophrenia.

“One of the values of ‘A Beautiful Mind’ is that it provokes discussion,” said Jay Zlotnich, executive director of Marin’s Buckelew Programs, a nonprofit organization that serves mentally ill clients in three Northern California counties.

“We know a lot more than we did decades ago,” he said.

While medication is one of the central pieces in treatment, “equally important is support from loved ones, stable, affordable housing, something that gives a sense of enjoyment and meaning, skills training, counseling, coping mechanisms,” he said.

Mental illnesses generally fall into two categories: mood disorders, including depression and bipolar disorder, and cognitive disorders, including schizophrenia. But the lines are not clean, and recognition and treatment are “an evolving art,” Zlotnick said.

New ideas about the causes of mental illness may be emerging, but researchers still do not understand what makes 60 percent of people with schizophrenia hear voices.

Researchers say roughly 1 percent of the population, or 2.5 million people, live with schizophrenia; another 2 million suffer from bipolar disorder. Both are as physical in nature as diabetes or epilepsy, but nowhere near as well understood. And the incidence cuts across all socioeconomic, ethnic and racial lines.

Mental illnesses typically surface in late adolescence or early adulthood. Many people will suffer a first breakdown while away at college.

The right treatment is key

In the film, Nash abandons medication and wills himself to recover. Highly unlikely, therapists say.

“That’s a dangerous idea,” Zlotnick said. “It feeds the myth that if people tried hard enough and used enough will power, they could cure themselves.”

More likely, Nash’s illness reached a plateau – not a given, but not uncommon either.

Without treatment, the disorders can be equally devastating. Symptoms may include acute terrors, disorganized thinking and debilitating depression. Many sufferers say their illness robbed them of their character and their sense of self.

Those who have struggled with them describe a journey of common steps, which can include an initial misdiagnosis, a long search for the right medications at the right dose, and a need to relearn basic skills, like shopping, and budgeting, that were once second nature.

Busy professional CiCi Wright taught psychology at Santa Rosa Junior College and ran her own catering business while raising her son. After a painful divorce, Wright suffered a breakdown that began with a manic period and quickly spiraled downward.

She imagined her son was always in peril and took steps for emergency rescue.

“My sister disowned me,” she said. “She was frightened.”

Wright landed on the streets, and eventually made her way to a Monte Rio group home.

“There were eight people to a bathroom,” she said. “Sometimes there would be dinner, sometimes not. It was awful. The people weren’t being cared for at all.” For this, she paid $600 a month.

A social worker put her in touch with Buckelew Programs. A counselor there helped her cobble together a monthly budget. The agency found her an affordable condo and matched her with a compatible roommate, also a former educator. They garden together. Wright sits on the Buckalew Client Board.

“I take three different meds,” she said with a grin. “They all work together to make you fat.”

Faulty diagnoses

A psychiatrist once put San Rafael resident Bob Brandt’s profoundly depressed daughter, who had graduated with honors from UC Santa Cruz, on an antipsychotic medication that induced tardive dyskenesia, locking her muscles into a rigid state.

Another psychiatrist diagnosed her by lining up the family and comparing their relative size and stature. His conclusion: “No wonder you’re having a problem. Your mother is overpowering.”

In fact, Brandt’s daughter suffered from bipolar disorder, characterized by wide mood swings that can bounce from a heady high to a frantic, disorganized state of mind, finally crashing in a disabling depression.

Like schizophrenia, bipolar disorder is physiologic in nature and cannot be spurred by faulty parenting, Brandt learned.

“I could have killed him,” he said of the second psychiatrist. With at-home visits from counselors and the right balance of medications, his daughter now works, volunteers at a legal clinic, “and smiles all the time,” according to a family friend.

Buckelew counselors help loved ones understand and cope with symptoms – like disorganized thinking, or hearing voices.

Disorganized thinking causes people to make faulty connections – like passing a road sign that says “Interstate 98” and assuming the number refers to the year 1998, or a distance of 98 yards, for instance. It can make the simplest of tasks – like cooking a meal – a nightmare.

“First you must negotiate a shopping trip and select the things you need to buy,” Zlotnick said. “When you get back, which foods do you refrigerate, and which do you leave out? In what order do you cook the dishes? Putting things in sequence can be overwhelming.”

“A psychiatrist told me (hearing voices) is like having the radio on, and the station is just off the frequency,” Roma Barlick said. “You hear different voices coming in and out.” Muffling one ear can help, as can minimizing stress. Since Warren has been in a small Buckelew group home, the voices have quieted, she said.

Resources are spare

In Marin County alone last year, the agency housed 89 clients at seven  residential treatment centers and served another 131 though the Marin Assistance Independent Living (MAIL) program. Nearly 330 obtained recovery, vocational, companion or family outreach services at its day treatment center and 207 through Ritter House and Helen Vince Detox Center.

Buckelew is one of a handful of agencies that contract with the Marin County Department of Mental Health to service clients with psychiatric illnesses. Last year, they received nearly $3 million to do so.

But despite its successes, Buckelew remains threadbare in critical areas. Its vocational program gets no public funding. And it desperately needs more sites for group homes, such as Stephanie Draper House, located on a quiet street in San Rafael.

Resident and clients Charles Mosser has nurtured an organic garden out back and, with the help of his housemate, grows potatoes, garlic, leafy greens, strawberries and fruit trees.

“Our people do very well,” marketing director Judy Berger said.

Not all Buckelew clients live in a group setting; some start there and work their way into greater independence. Therapists visit clients who live on their own. Other clients train as peer counselors.

“We do not take a one-size-fits-all approach,” Berger said. “What’s going to work for a John Nash won’t work for someone else. If one thing doesn’t work, we try another.”

With the support of federal, state and local agencies, Buckelew this month spent $2.1 million to buy and upgrade an 11-unit complex in San Rafael.

Positive results

The result for Warren Barlick has been transformative.

When Roma Barlick brought a sheet cake and a pitcher of Kool-Aid to Napa State Hospital, she would find her over-medicated son tied to a chair in the middle of a room.

“I’d sit outside and just weep,” she said. “The guards, with their rings of keys, would be shouting at them: ‘Get over here, Barlick. You’re late for your meds.’”

Eight years ago, Warren was moved out of Napa State Hospital at the tail end of a state push to move in-patients back to their communities. Roma learned about Buckelew Programs, one of the very few community-based programs available to receive the newly discharged.

“He wasn’t quite like an animal, but close to,” she said. “He’d been institutionalized for so long. But over time, because of their great humanity, the people at Buckelew turned him into a civilized human being with regard for others.”

When Roma saw the dining room table at the Novato group home set with placemats, she felt like weeping again – this time, with relief.

“I never knew, on top of the terror of having a child who is mentally ill, this bright star would come out,” she said. “If there wasn’t Buckelew, what would people do? Where would they go?”

Bob Brandt shook his head.

“I’d hate to think.”


Client: ‘My life has changed a lot’

By Rebecca Rosen Lum
IJ reporter

A fresh-faced 23-year-old, Joe Breyer entered Napa State Hospital at 11 and left at 18. He could neither read nor write.

“They used to put me in restraints a lot,” said Breyer, who now resides in a San Rafael group home. “They used to tie a sheet around my neck and sit on my back. Not just me, a lot of adolescents and teens.”

As for the attendants: “Some of those people should be in jail.”

He takes Clozaril, one of a class of medications called “atypical.” They are frequently used in conjunction with “typical” medications to counterattack over-production of both dopamine and serotonin, neurotransmitters that can trigger symptoms of schizophrenia when they flood the brain.

Although Breyer also contends with Tourette Syndrome, a neurological disorder, his symptoms are so well in hand that he is preparing to move to a more independent group living situation and to take on a new job in a university kitchen.

He has learned to get around by bus. He takes classes at College of Marin, frequents the YMCA, shops at Northgate Mall. He just finished a five-week swimming class and is saving his money to take another.

And he reads voraciously.

“I like to read about the Middle East, Africa,” he said. “Someday I’d like to travel there.”

If he continues on his healing trajectory, he may be able to return to his family in Humboldt County. In the meantime, he says he has grown to love his friends at Buckelew.

Grinning, he says, “My life has changed a lot.”

Marin Independent Journal March 24, 2002


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