An Awakening – and a Wakeup Call

Monday June 5, 2023

By Don Sapatkin

And a North Carolina man found mentally unfit to stand trial has been in jail longer than the maximum possible sentence if he’d been tried and found guilty.

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A catatonic woman awakens after 20 years – and so does psychiatry

April Burrell was once a high school valedictorian in Baltimore. Then, as a 21-year-old college student, she suddenly became incoherent, after some kind of traumatic event. She was hospitalized, diagnosed with schizophrenia, and eventually transferred for long-term care to Pilgrim Psychiatric Center on Long Island, N.Y., where she would sit at the nurses’ station, unblinking, with no idea of where or who she was. She lived in that catatonic state for 20 years.

She was the first patient seen by Sander Markx, a medical student visiting from Germany on a Fulbright Scholarship, and he never forgot her. Two decades later, Markx, now director of precision psychiatry at Columbia University, encountered her again and was shocked to see her in the same state. He pressed for a full medical workup, which found lupus, an autoimmune condition that was attacking her brain, and she received intensive treatment. The treatment worked.

In what could serve as a sequel to Oliver Sacks’s “Awakenings,” April Burrell woke up, regained her memory and her ability to function. Now 49, she is not fully recovered but was discharged to a rehabilitation center and reunited with her family.

“The awakening of April − and the successful treatment of other people with similar conditions − now stand to transform care for some of psychiatry’s sickest patients, many of whom are languishing in mental institutions,” wrote Richard Sima, a neuroscientist turned journalist who writes the Brain Matters column for the Washington Post. Researchers working with the New York state mental health system have so far found about 200 patients, some of them institutionalized for years, who may be helped by the discovery.

While Burrell’s circumstances may fit only a small subset of patients, other scientists, doing related research around the world, have found that underlying autoimmune and inflammatory processes may be more common than previously believed in patients with a variety of psychiatric syndromes. The University of Oxford is enrolling patients in clinical trials to test the effectiveness of immunotherapy for autoimmune psychosis patients. Researchers also have identified 17 diseases, many with different neurological and psychiatric symptoms, in which antibodies specifically target neurons. And unrelated early research has found inflammation and immunological dysfunction to be  potential players in a range of neuropsychiatric conditions, including schizophrenia, depression and autism.

Another patient found by Markx’s team is Devine Cruz, who began hearing voices at age 9 and was eventually diagnosed with schizoaffective disorder and an intellectual disability. She too, was diagnosed with lupus, back when she was 14, but doctors didn’t connect it to her psychiatric symptoms. She moved in and out of hospitals for a decade. Last August, doctors prescribed monthly infusions of corticosteroids and chemotherapy drugs, similar to what Burrell received. Cruz, 21, is now writing poetry, babysitting her siblings and considering a career as an art therapist. When Sima asked her to share a piece of her poetry, she picked “The Healing.”

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Opinion: The big flaws of mandatory mental health treatment? It’s forced, and relies on meds that often don’t work

Moves in California, New York City and many other cities and states to force some people with severe mental illness off the street and into treatment have been met with praise (it’s best for them), anger (it’s a violation of their civil rights) and skepticism (it won’t do much without more housing, treatment beds and funding).

But “the most difficult problems aren’t budgetary or logistical,” journalist and author Daniel Bergner wrote in an opinion piece for the New York Times. “They are fundamental. They involve the involuntary nature of the care being called for and the flawed antipsychotic medications that are the mainstay of treatment.” Even the antipsychotic considered the most effective, clozapine, reduces delusions and hallucinations for only 50% to 60% of patients and, like all of these medications, can cause serious side effects. Another flaw, Bergner says, is the forced nature of the approach:

Imagine being cut off from society by a tormented psyche and extreme poverty and then being hauled off to an emergency room, forcibly injected with a powerful drug like Haldol and held in a locked ward until being dispatched into a compulsory outpatient program. Will this set the stage for a stable life? Or will it add to people’s trauma, sense of isolation and lack of agency – and lead to their slipping away from whatever program they’re ordered into and back toward dire instability? For a few, such intervention may be a positive turning point. But that’s not the likely result.

He suggests thinking “less fearfully and more creatively, genuinely seeking the counsel of people who’ve learned to cope, in varied ways, with their psychiatric conditions.” This, Bergner writes, will mean building adequate housing, embracing “approaches that may seem hazy in contrast to the chemistry of pharmaceuticals,” and fostering supportive communities like Fountain House and the Hearing Voices Network, “which combat isolation and despair with an emphasis on sharing experiences and solutions.”

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Declared mentally unfit to stand trial, he remains in jail − long after the maximum sentence for his crime

Dillon Ledford apparently thought he was saving lives when he called 911 last June, telling the dispatcher that there was a bomb at a high school 30 miles east of Charlotte, N.C. He was arrested and, four months later, evaluated as mentally unfit to stand trial. No state hospital bed was available, so he has remained in jail, where he refuses treatment, WSOC-TV in Charlotte reported.

Ledford’s attorney, Veronika Monteleone, says that if he didn’t have mental health issues, he would have been sentenced for the alleged bomb threat long ago: “If he was found guilty and given the worst sentence he could for his record, he would already be out of prison.”

A judge rejected Monteleone’s long-shot attempt to have the case dismissed and said that Ledford’s mental health evaluations indicate he could eventually be declared fit to stand trial after treatment. The law allows Ledford to be held in jail for 39 months. .

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In other news…

Quitting smoking can significantly improve your mental health, Medical Xpress reports. The study, in JAMA Network Open found far greater reductions in anxiety and depression scores among people who quit for at least 15 weeks, compared with those who continued smoking, for participants with psychiatric histories. In a global first, cigarettes sold in Canada will carry warnings like “Poison in every puff,” “Cigarettes damage your organs” and “Cigarettes cause impotence” under regulations that will be phased in beginning Aug. 1, NPR reported. South of the border, the Biden administration plans a “government-wide draft framework for smoking-cessation help” − essentially linking efforts among agencies − as part of the president’s ongoing cancer “moonshot,” according to the Politico Pulse newsletter.

Religious people from many faiths often use their beliefs as reasons not to seek therapy, wrote two mental health professionals in a Washington Post advice column.They noted that one patient’s reluctance to seek therapy “stemmed from her belief that it would complicate her relationship with God…as though she was asking for help from someone other than God.” The authors, Rania Awaad, a psychiatrist, and Taimur Kouser, an MD candidate both work at the Stanford Muslim Mental Health & Islamic Psychology Lab. They offered this bit of advice for overcoming that reluctance:

One of the ways we encouraged the patient, an observant Muslim, to seek therapy was by quoting this saying of the prophet Muhammad, ‘O servants of God, seek treatment. Verily, Allah did not send a disease but that He also sent its treatment or cure.’

The Federal Aviation Administration removed more barriers for pilots with mental health issues, according to the AOPA Foundation, an association of pilots. The policy change says that pilots who are taking an approved antidepressant will no longer have to undergo routine follow-up neuropsychological evaluations to continue flying. The agency also added the widely prescribed Wellbutrin XL (bupropion) to its short list of approved psychiatric medications. The FAA’s historically rigid policies forbidding pilots with mental health issues from flying have in recent years come up against a society-wide increase in the use of antidepressants, keeping more pilots on the ground.

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If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

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