Exposing injustice in mental healthcare and inspiring systemic reform
Back in August of 2002, I made an unauthorized visit to Central Intelligence Agency headquarters in Langley, Virginia.
I said something about this unauthorized visit to my father. Then my father said something about it to my mother and my brother. Then my mother and my brother said something about it to a psychiatrist.
Then, without asking me one single question about it, the psychiatrist arranged for police officers to take me into custody, and to transport me to a for profit mental health care facility named MeadowWood, to be involuntarily admitted for emergency psychiatric care, that I had to pay for in spite of the fact that it was provided to me against my will and against my explicitly expressed wishes.
Subsequent to being taken into custody, the psychiatrist filled out the requisite paperwork to justify why he was involuntarily committing me.
Subsequent to being admitted to MeadowWood, the resident psychiatrist there, Caroline Ekong, reportedly reviewed the paperwork completed by the psychiatrist who civilly committed me. Then, prior to meeting or speaking with me, Caroline Ekong directed staff to inject me with a powerful antipsychotic drug called Haldol.
About a decade later Caroline Ekong civilly committed a University of Delaware student named Christopher Frick to a different private, for profit mental health care facility. A few years later, in October of 2015, Christopher Frick stabbed Caroline Ekong to death.
In May of 2016, while working on a manuscript for a memoir about my involuntary psychiatric treatment, I learned of Caroline Ekong’s death after Googling her name.
In early 2017 I wrote and published the following open letter to the psychiatrist who civilly committed me.
Dear Dr. Michael Marcus,
Back in 2002, I had some ideas on July 31st and August 1st that led me to get into a pickup truck, and drive to Langley, Virginia, from my home in Philadelphia. Before leaving, I grabbed a glass pipe with a hunk of hashish in it and a larger than life sized poster of Albert Einstein with his tongue sticking out. A few hours later, after slowly driving past a large sign informing me that I was trespassing onto CIA property, I told the first federal police officer that I encountered, that I had driven there, in part, to identify myself as the person who had just registered a particular domain name related to Osama bin Laden.
I explained how I had lost my Internet connection at home earlier in the day, just seconds after registering the domain. I was questioned by a few different federal officers over the next hour as I remained in my truck, and was eventually surrounded by four armed officers, with weapons at the ready — three on foot in front of me and on either side of me, and one atop a military humvee, behind me. After that an officer wearing body-armor asked me to get out of the truck, and frisked me before cuffing my hands together behind my back. Then four officers escorted me inside, through a metal detector and down a hallway into a small room with a table and two chairs. There were two cameras in opposite corners of the room, near the ceiling, that were aimed at the chair they sat me down in.
Next, an officer came into the room and read me my rights, and then, an unassuming, middle-aged man not wearing a uniform came into the room, sat down in the chair across from me and asked me to explain myself. We had a cordial, cogent conversation for over an hour, during which I explained my reasons for doing what I did, in detail.
After that, one of the federal officers removed my handcuffs, and gave me a citation for misdemeanor possession of cannabis, and for trespassing at the CIA. Next, my questioner escorted me out of the small room and down the hallway again towards the door I had originally entered the building through. To my complete surprise, he extended his right hand, as if to shake mine, and said, “Thanks for your cooperation tonight.” I instinctively reached up, and started shaking his hand.
“There’s a difference between wisdom and intelligence. You only made one mistake. You should have thrown the pipe out the window before you pulled up to the gate,” he said.
We were still shaking hands when I responded, “That’s what you think.” Our handshake ended. Neither of us said anything else, and I got back in my pickup truck, and headed home to Philly.
Thirteen days later I arrived at the Pathways office at Wilmington Hospital with my mother and older brother. At that time, you told us that you wanted to speak to my mother and brother first, in private, before speaking with me, your patient. They went into your office, and I accompanied another patient of yours outside for a cigarette.
“So, what’s up with Dr. Marcus talking with your family without you in there?” he asked.
“I’m pretty sure I’m about to be committed,” I replied.
“Really? What for?” he asked.
“It’s a long story,” I said.
“Well, for what it’s worth, you don’t look crazy to me man,” he said smiling wryly. I smiled back.
“Hey thanks man, I’m not. I just…”
“You just what?” he asked.
“I just don’t think like most people think, I think. You know what I mean?” I said.
“Sure,” he said. “Maybe you should get away for a while. Bus station’s just a couple blocks from here,” he said.
“I know,” I said, as I reached into my pocket, and pulled out a train ticket to Penn Station in New York City and smiled.
“Even better! What are you waiting for?!” he asked.
“I don’t know… there’s part of me that wants to be on the inside again,” I said.
“Why?” he asked.
“The last time I was inside a mental hospital I was miserable, but I’m not miserable now. You ever heard of Nellie Bly?” I asked.
“No, who’s that?” he said.
“She was a reporter in the late 19th century who feigned madness in order to get committed so that she could write about what was wrong with mental health care back then,” I said.
“Is that what you’re trying to do now?” he asked.
“Sort of… I just think I might be in a better position to help the people inside than the doctors who work there,” I said.
“Is that what you’re going to tell Dr. Marcus?” he asked.
“No. He thinks I have bipolar disorder. I’m sure he’d think I was suffering from delusions of grandeur if I said that,” I said chuckling.
“I think you’re right about that. Do you think you have bipolar disorder?” he asked.
“I don’t know… I mean, my energy and mood ebbs and flows sometimes, that’s for sure… but I like to think of myself as more of a… bipolar explorer, you know what I mean?” I said.
“Yeah… I think I do,” he said as he took the last drag on his cigarette. “Well, wherever you end up… I wish you luck,” he said.
We shook hands. “Thanks brother. You too, and be well.” I said.
“Same to you,” he said and walked away.
Next, I headed back inside the hospital and took a seat again in your waiting room. A few minutes later, you opened the door to your office, and invited me to come in. I went inside, sat down in front of you with my brother and mother seated behind me, and you proceeded to ask me questions about my mood, my appetite and how much I was sleeping.
You also asked me if I was having any suicidal thoughts. I told you that my mood was elevated, my appetite was fine, I was sleeping a little less than usual and that I hadn’t had a suicidal thought in years.
Next you asked me if I’d be willing to admit myself to a psychiatric hospital for a while. I said no, and told you there was no good reason to do so. You asked me if I would be willing to participate in an outpatient, day-program, and I said I was willing to consider it. Then, you said that we were done talking, and that I was free to go. I opened the door to leave your office, and I was greeted by two police officers who took me into custody.
I cooperated completely with the cops. It seemed apparent that they were pros adept at handling people in my situation — someone who had just been summarily stripped of his inalienable right to liberty by an agent of the state with considerably less due process and civil rights protections than suspected violent criminals. The two cops and I had a convivial conversation on the ride from the hospital to MeadowWood, the private, for-profit psychiatric hospital you committed me to.
It had been four years since I’d been in a mental health care facility. I was in a good mood by the time I was admitted, and shortly thereafter I was chatting idly with my fellow patients in the common room of the adult ward. Within half an hour of arriving I was standing in front of a whiteboard distinguishing Einstein’s theory of special relativity from his general theory of relativity for a small cadre of my fellow patients, as staffers sized me up.
I excused myself from the group when a staffer asked to speak with me in private. She explained that MeadowWood’s resident psychiatrist had issued an order for me to begin treatment immediately by taking a dose of Risperdal, a powerful antipsychotic medication.
“So the doctor wants me to begin treatment before meeting or speaking with me?” I asked.
“That’s right,” the staffer said.
“Well, that doesn’t seem right to me. I’d like to meet with my doctor before he decides how best to treat me,” I said.
“Dr. Ekong is a woman,” she said.
“Fine. Her gender has nothing to do with why I want to meet her before I begin taking a new medication. How can she prescribe a course of treatment for me without ever meeting or speaking with me?” I asked.
[Please pardon my sexist bias evident in this reply!]
“Dr. Ekong reviewed your file — ”
“My file? I have a file already?” I said, cutting her off. “I’ve been here less than an hour and haven’t spoken with a doctor yet. What’s in my file? Can I see it?” I asked.
“You can discuss that with Dr. Ekong during your time with her tomorrow when she’s here,” she said.
“Okay great. That’s all I was asking for. Thank you,” I said and turned to walk away, feigning that I thought I had sold her on me not taking the Risperdal.
“Wait a second! Dr. Ekong’s order still stands, and if you don’t take your medication, I have to report back to her,” she said calling after me.
“I thought you just said that I could wait to discuss this with her tomorrow when she’s here,” I said, continuing with my feigned misunderstanding.
“I said that you can discuss your file and your treatment plan with her when she’s here. That doesn’t mean that I don’t have to do my job, and administer the medication prescribed for you by your doctor,” she said.
“Okay. I’m assuming you can reach her by phone then?” I asked.
“Yes,” she said.
“Then why can’t I speak with her?” I asked.
“That’s not how it works,” she said.
“Okay… well… can you please explain to her that I would like to meet with her before she unilaterally decides on a course of treatment for me?” I asked.
“I can, but if you continue to refuse to take the medication prescribed for you, she’s likely to order us to treat you with a different one. One that can be injected with a needle,” she said.
“Can we please cross that bridge if and when we get to it? You just said you would explain that I want to meet her before beginning treatment, and I appreciate that. I really do… so thank you,” I said.
“Fine,” she said with a smirk as I headed back to the whiteboard to resume my impromptu lesson on relativity. As I rejoined the group, another patient asked me how long I had been working at MeadowWood.
“Me? Working here?” I asked smiling. “I’m a patient just like you brother!” I said.
“If you’re a patient here… I’m the Pope,” he replied.
“Well, it’s nice to meet you… your Holiness,” I responded, smiling even wider and winking.
About five minutes later, the staffer called me over again and told me that Dr. Ekong had confirmed that I was to begin treatment immediately. She said if I refused to take the Risperdal, that Dr. Ekong had instructed her to give me an injection of Haldol. I told her that I would not willingly take any medication before having the chance to speak with Dr. Ekong, but added that I would not physically resist being injected against my will. I asked the staffer if I could make a phone call before being given the injection. She said yes, and I called my father and explained to him what was going on.
Five minutes later, in a private room, a woman dressed like a nurse gave me an injection of Haldol. After giving me the shot, she began preparing a second injection.
“What’s that?” I asked.
“It’s called Cogentin. It’s to counteract the side-effects of the Haldol,” the nurse said.
“What side effects?” I asked nervously as I felt my pulse quicken.
“Muscle spasms… muscle rigidity… stuff like that,” she said. Then she injected me with the Cogentin shot.
I was already feeling dizzy and nauseous just seconds later as I went back into the common room. I walked right by the patients still gathered around the whiteboard, ignoring their calls to rejoin them, and headed straight for my bed in my room. I laid down, my whole world spinning, and quickly lost consciousness. The day following my harrowing experience with Haldol I began swallowing the Risperdal tablets originally prescribed for me by Dr. Ekong. I’m grateful that I didn’t know then what I know now: having Haldol injected into me and swallowing a single Risperdal tablet could have killed me via Neuroleptic Malignant Syndrome.
Imagine my utter lack of surprise when Dr. Ekong released me from my involuntary psychiatric care experience ten days after you committed me. This was the same day that, had I not been released, my case would have been reviewed by a judge in a court of law.
I don’t believe it was a coincidence in timing.
Imagine if judges in our legal system could imprison suspects and order them to be injected with potentially life-threatening substances without meeting or speaking with them. Imagine if imprisoned criminal suspects and criminals were financially responsible for paying fees for being in prison, including one to the judge who jailed them!
I do not blame you or Dr. Ekong for treating me as you did. I blame the poorly designed system that empowered you to mistreat me as you patently did. I share this true story publicly with the intention of trying to improve an improvable system.
I harbor zero ill will for you or for anyone else involved in my mental health care mistreatment. I believe that you and Dr. Ekong were necessarily influenced by forces of institutional corruption at work within our mental health care system.
Robert Whitaker and Lisa Cosgrove have written masterfully on this subject in Psychiatry Under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform. I’m playing my role in affecting change by highlighting a perfect example of what institutional corruption in psychiatry looks like in reality.
I don’t seek attention for my anecdotal experience with mental health care mistreatment for the purpose of retributive justice against you, or for sympathy for myself, and unlike some survivors of less than optimal mental health care, I do not want to burn the existing system to the ground.
Rather, my motivation is to increase awareness about human rights violations occurring within our mental health care system in order to inspire social change and systemic reform. I can’t help but wish that I had been compelled to share this true story earlier. Dr. Caroline Ekong might still be alive and Christopher Frick might not be in custody for the rest of his life, if I had done so.
As you must know, in October of 2015, Christopher Frick, at age 21, stabbed Dr. Caroline Ekong to death, three years after she committed him to the Rockford Center, claiming that he was a danger to himself. I share the true story of my forced care at the hands of you and Dr. Ekong to highlight her tragic death with the aim of preventing others like it.
Despite the fact that she ordered that I be treated before ever meeting or speaking with me, I saw her as a caring and conscientious mental health care professional. Despite the fact that you decided to hospitalize me against my will before you examined me, and despite the blatant incompetence or dishonesty you clearly documented on my committal paperwork, I see you too as a caring and conscientious mental health care professional.
I share this true story, Dr. Marcus, so that you, and other doctors empowered by the state to suspend people’s liberty, will be less likely to use that authority in a way that leads some patients, to want to kill their psychiatrists.
Caroline Ekong and Christopher Frick were both victims of an improvable mental health care system. You and I are brothers on the front line in the battle of trying to bend the U.S. suicide rate curve, and I am in a special position, given my professional experience in systems quality assurance to provide valuable feedback on the mental health care system.
Feel free to consider me your personal Nellie Bly.
You necessarily took action to have the police waiting outside your office prior to your examination of me, and to this day, you and I have still never exchanged a single word about my unauthorized visit to CIA headquarters in 2002.
Four federal CIA police officers and a staffer from the CIA questioned me for about three hours with a degree of professionalism that still blows my mind, especially considering that I pulled this stunt just forty-one days before the first anniversary of the 9/11 attacks. It’s worth pointing out that these men, despite the fact that I was in possession of a controlled substance when I illegally trespassed at the CIA, decided to release me on my own recognizance versus throw me into a jail cell for the night, pending arraignment.
Things played out the way they did for me at the CIA because the people there that I spoke with were open to hearing a reasonable explanation for my actions… which is precisely what they received from me… and precisely why they let me go.
You and Dr. Ekong, on the other hand, were patently not open to even attempting to reason with me. You failed to give me a chance to explain my actions before stripping me of my liberty, and she treated me with a potentially life-threatening medication before ever meeting or speaking with me.
It is clear to me, as I am confident that it will be to many others, that the forces of institutional corruption in psychiatry were at work in your respective decisions.
The knowledge you had about what happened at the CIA was the by-product of a five-person game of Telephone or Whisper Down the Lane.
I told my father some of what happened that day, without much explanation as to why. My father told my mother. My mother told my brother. And then my afraid-for-the-life-of-her-son mother told you. You did what you did, and then Dr. Ekong became Telephone / Whisper Down the Lane player number six.
While you were sympathetic about the anxiety experienced by your patient’s mother, you failed to even try to understand me, your patient, whom I believe you assumed was psychotic.
The fact that I was exhibiting some of the symptoms of a mental disorder described in the Diagnostic and Statistical Manual of Mental Disorders — a nosology essentially abandoned due to its lack of validity in 2013 by Dr. Thomas Insel, the former Director of the National Institute of Mental Health — is a pathetically inadequate justification for involuntarily subjecting me to forced treatment that could have ended my life.
If you failed to notice this label on the committal form: “as observed during my examination of the patient” you were reprehensibly incompetent when you filled out the form.
Not one scintilla of information about my unauthorized visit to the CIA or about anyone breaking into my home was provided by me to you.
If you did notice the aforementioned label, then you were reprehensibly dishonest by claiming that any of that information was discussed during your “examination” of me.
Why I willingly trespassed at the CIA with cannabis and a big poster of Einstein with his tongue sticking out was, and still is an absolute mystery to you.
I invite you to speak with me, in front of a live microphone, for a podcast — a frank talk about mental health — to provide me the opportunity that you denied me years ago.
If you agree to meet with me, I will also explain my version of the stories that you were apparently told by my mother and/or brother that prompted you to write down what you wrote about me on the aforementioned form.
I genuinely believe that a public conversation between you and me could be valuable for people besides you and me, and that is my aim — to create value for others as I try to improve the mental health care system in this country.
If you have no interest in engaging in a public conversation with me, to provide the reasons why you behaved as you did, I will offer up my best guess as to what I believe motivated you, when I explain my own actions, in a subsequent message.
I sent this letter to Dr. Marcus after posting it online in early 2017, and I have yet to receive a reply.
Earlier this year, the launch of Van Jones’ Redemption Project rekindled my desire to speak with the psychiatrist who civilly committed me, and the idea of The Nellie Bly Project occurred to me for the first time. I already had the domain name iamnelliebly.com, so I created a landing page and installed a blog on the site, and I created a Twitter account for it.
Finally, President Trump’s rhetoric around mental illness and the recent Washington Post publication of Sara Pearl Kenigsberg’s article about involuntary confinement reminded me about the opportunity I have to make a valuable contribution to a conversation about what mental illness is, and how we, as a society, can and should aim to help people grappling with it.
I am actively seeking collaborators and contributors interested in the mission of The Nellie Bly Project: exposing injustice in mental healthcare with the aim of inspiring systemic reform.
Ideally, this project will become a series like that which Van Jones created, with a moderator facilitating conversations between people like myself and Dr. Marcus.
Ultimately, I want to hear from people who have had experiences similar to mine in order to change how we, as a society, handle situations that result in involuntary admittances to mental health care providers.
Dinah Miller and Annette Hanson recently co-authored an important book on the subject of involuntary psychiatric care that provides a nuanced view on the subject by examining it from multiple perspectives.
A passage in the Foreword for the book authored by Pete Earley, a reporter and mental health advocate highlights a guiding belief behind The Nellie Bly Project.
“While practical information gives Committed its spine, it is the emotions that we feel in reading patients’ firsthand accounts that prick at the conscience and ultimately distinguish this book from some impersonal, analytical tome. That is one of the many reasons that this book should be read — because emotions lie at the heart of the involuntary commitment process, whether they are expressed in the angry voice of an unwilling patient or the anguished voice of a parent, spouse, sibling, friend, child or professional caregiver.“
Pete Earley writing in the Foreword to Committed: The Battle over Involuntary Psychiatric Care by Dinah Miller and Annette Hanson
As far as contributors go, The Nellie Bly Project is looking for firsthand accounts of injustice occurring within the mental healthcare system that will “prick at the conscience” of people curious to know more about personal narratives about being involuntarily committed.
Whether you are an “unwilling patient” like I was years ago, or you are someone struggling with the damaging effects of trauma or any other problem described as a mental health condition, and your civil rights were violated by a mental health care provider, and you are willing to share about your experience in service of making a positive difference for others (anonymously if you prefer) please get in touch with me at incredulity at gmail dot com.
As far as collaborators go, Elizabeth Cochran Seaman, better known as Nellie Bly, shared what she learned through firsthand experience in the mental health care system through writing.
The Nellie Bly Project will utilize any media available to increase public awareness about injustices occurring in the mental health care system and to inspire systemic reform.
If you are a creative with a passion for this cause who is interested in collaborating, please don’t hesitate to reach out to me.