{"id":2396,"date":"2023-03-03T02:09:29","date_gmt":"2023-03-03T02:09:29","guid":{"rendered":"https:\/\/niemanstoryboard.org\/2023\/03\/03\/mental-health-treatment-narrative-profile-schizophrenia\/"},"modified":"2024-10-21T16:17:08","modified_gmt":"2024-10-21T16:17:08","slug":"mental-health-treatment-narrative-profile-schizophrenia","status":"publish","type":"post","link":"https:\/\/niemanstoryboard.org\/2023\/03\/03\/mental-health-treatment-narrative-profile-schizophrenia\/","title":{"rendered":"Reconstructing a fractured life and broken system"},"content":{"rendered":" \n
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When Thomas Curwen<\/a> of the Los Angeles Times decided to write about mental health care in California through the lens of one patient, he faced a daunting challenge: tracking the erratic chronology of a severely ill man\u2019s life on the streets and in and out of institutions, and investigating the broken systems that failed him for a decade.<\/p>\n\n <\/div>\n <\/div>\n \n

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Curwen succeeded with \u201cA world gone mad: Schizophrenia and a journey through California\u2019s failed mental health system<\/a>,\u201d<\/strong>  published on Dec. 8. 2022. It\u2019s a 5,000-word tick-tock tragedy that effectively blends exposition with a riveting focus on a young man with Anthony Mazzucca, a young man with schizophrenia, and Anthony\u2019s mother, who is forced to blindly navigate her way as she desperately seeks help for her son.<\/p>\n\n <\/div>\n <\/div>\n \n

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Chronology \u201cis the backbone of the story,\u201d Curwen told me, \u201cand it was critical to nail down.\u201d<\/p>\n\n <\/div>\n <\/div>\n \n

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Thomas Curwen<\/figcaption><\/figure>\n\n <\/div>\n <\/div>\n<\/div> \n
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Patience and old-fashioned legwork enabled him to gain access to the story\u2019s main character and his family. Together, they patched together details about a past strewn with painful and often obscure memories. Official records requests and persistence netted him reams of medical records that filled in gaps. Close reading of authoritative texts and interviews with experts helped him paint a larger picture of a mental health system that left schizophrenics and their families with few viable options.<\/p>\n\n <\/div>\n <\/div>\n \n

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\u201cI\u2019ve long believed that the more intimate you can make a story,\u201d Curwen said, \u201cthe more universal it becomes. That was the appeal of Anthony\u2019s story: his and the family\u2019s willingness to let me into their lives and to share the details of their struggles. I knew that the deeper I went with this one story, the more I could illuminate the broader tragedy of so many others \u2014 today and in the past \u2014 whose fate differed from Anthony\u2019s only by degrees.\u201d<\/p>\n\n <\/div>\n <\/div>\n \n

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\u201cI\u2019ve long believed that the more intimate you can make a story, the more universal it becomes.\u201d <\/p>\u2014Tom Curwen<\/cite><\/blockquote><\/figure>\n\n <\/div>\n <\/div>\n \n

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To accomplish this goal, Curwen leads with an evocation of Anthony\u2019s bewildered mind and disordered lifestyle from an \u201cinciting moment\u201d in 2015, then circles back and ends in the present. He inserts a 414-word nut graf that places Anthony\u2019s plight at the heart of mental health care in California, then creates an alternating pattern throughout the piece, moving in close with taut, sensitive scenes and pulling away for wide shots of scientific, social and political context. He studs his story with poignant details and quotes that draw the reader into Anthony\u2019s troubled life at home, on the streets and in treatment.<\/p>\n\n <\/div>\n <\/div>\n \n

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Rather than clutter the narrative with history about a long-standing residential treatment center in Los Angeles or a first-person \u201cHow we did the story,\u201d Curwen fashions two sidebars to convey that information, including the cry for help that first connected him with Anthony\u2019s devoted mother, Mary, five years ago.<\/p>\n\n <\/div>\n <\/div>\n \n

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Curwen partnered with photojournalist Christina House,<\/a> whose photos are, at times, raw but never exploitative. Taken as a whole, the package shows the power of narrative writing to serve the tradition of public service journalism. It leaves the reader with a greater understanding of schizophrenia and how society continues to fail its sufferers and their families, while introducing a there-but-for-the-grace-of-God sense of relevance.<\/p>\n\n <\/div>\n <\/div>\n \n

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Curwen has been both reporter and editor at the Times, with award-winning work as both. He was editor of the Outdoors section, deputy editor of the Book Review and an editor-at-large for features. In 2020, he received the Meyer Berger Award<\/a> from Columbia Journalism School for distinguished human interest reporting for a series of stories that followed eight residents of a homeless encampment into housing in South Los Angeles. In 2016, he was part of the team that won a Pulitzer in breaking news for coverage of a terrorist attack<\/a> in San Bernardino. He was a 2008 Pulitzer finalist<\/a> for his story about a father and daughter who were attacked by a grizzly bear in Montana. He has received a Rosalynn Carter Fellowship for mental health journalism and was honored by the Academy of American Poets.<\/p>\n\n <\/div>\n <\/div>\n \n

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In an email interview, Curwen talked with Nieman Storyboard about his research into an opaque system, the ethical and privacy challenges raised in an intimate narrative about someone with schizophrenia and how he consulted psychiatrists for guidance on his interview approach. Our interview has been edited for length and clarity, and is followed by an annotation of the main narrative.<\/p>\n\n <\/div>\n <\/div>\n \n

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 H<\/strong>ow were able to reconstruct Anthony Mazzucca\u2018s life in such granular and chronological  fashion?
<\/strong>I presumed that the family would have been able to provide details, but I underestimated what the last 10 years have been like for them. Not only is 10 years a long time, but the early years, as Anthony\u2019s symptoms started to emerge and required hospitalization,. were undoubtedly traumatic for them.<\/p>\n\n <\/div>\n <\/div>\n \n

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Anthony and his mother, Mary Liciaga, were able to provide names of most of the facilities Anthony in:: the hospitals, board and care ,and residential homes. But coming up with the dates was more difficult. After acquiring Anthony\u2019s medical records, which provided the specifics of his admittance and discharge, I was able to put together the sequence.<\/p>\n\n <\/div>\n <\/div>\n \n

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There were times when I wondered if all the pieces would fall into place. I had to do a lot of nagging of bureaucrats and medical administrators. I even considered what it would be like to tell the story without a complete chronology. But the payoff proved worth the trouble: It was in the course of assembling the chronology that I learned Anthony had been involuntarily committed five times and had been held in Twin Towers jail. The family was unclear of these details.<\/p>\n\n <\/div>\n <\/div>\n \n

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What were the ethical challenges of profiling someone with a severe mental illness?
<\/strong>Our work is dictated by a version of informed consent. But how do we determine if we have informed consent from someone with severe mental illness?<\/p>\n\n <\/div>\n <\/div>\n \n

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First of all, it is important to realize that when I met Anthony, he had been in treatment with anti-psychotic drugs and therapy for more than three years. He was coherent, engaging, tolerant and accepting of the work that we were doing together.<\/p>\n\n <\/div>\n <\/div>\n \n

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That said, I spoke with a few of my sources on the story \u2014 psychiatrists who have treated schizophrenic patients \u2014 to get their opinion. They recommended that I begin and end each session with Anthony by asking if he was clear on what I was doing, if he had any questions or any reservations about continuing. I followed this practice throughout the course of reporting the story.<\/p>\n\n <\/div>\n <\/div>\n \n

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I also had a number of conversations with Mary about Anthony\u2019s state of mind. I wanted her to speak with him when I wasn\u2019t around, to make sure he understood what we were doing and that at any moment he could stop the process. I felt that he would be more candid with his mother than with me. And as Anthony\u2019s conservator, she was in the best position to assess his state of mind.<\/p>\n\n <\/div>\n <\/div>\n \n

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Finally, I treated Anthony and Mary as I would anyone else I was writing about. I explained in advance the scope of my reporting \u2014 including relying on medical records and speaking with other family members \u2014 all of which corroborated what I learned from her and Anthony. I also made clear that I would share what I learned with both of them.<\/p>\n\n <\/div>\n <\/div>\n \n

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How long did it take for you to report and write the story?
<\/strong>I met Anthony for the first time in early March 2022. Most of the reporting with the family took place over the next two months. During this time I conducted interviews with the psychiatrists and sociologists who would provide deeper context for what I learned from Anthony and Mary. I also began to reach out to hospitals and other facilities where he had received treatment to get his medical record.<\/p>\n\n <\/div>\n <\/div>\n \n

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I started writing part of the story during the summer and by early fall was filling in holes in the narrative with missing elements as they arrived in the mail and by email.<\/p>\n\n <\/div>\n <\/div>\n \n

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 <\/em>Were there books, stories or writers that inspired you as you worked on the story?
<\/strong>I\u2019m reading constantly, so everything plays into how I think about my stories. But three books in particular helped me to understand Anthony\u2019s condition:<\/p>\n\n <\/div>\n <\/div>\n \n

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\u201cDesperate Remedies: Psychiatry\u2019s Turbulent Quest to Cure Mental Illness\u201d<\/a> by Andrew Scull. I have followed Scull\u2019s work for a number of years and have always been impressed by the historical perspective that he brings to our tangled relationship to mental illness. This is his latest book, and its publication last year, gave me a chance to interview Scull for a Q&A<\/a> for The Times.<\/p>\n\n <\/div>\n <\/div>\n \n

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\u201cThe Center Cannot Hold: My Journey through Madness\u201d<\/a> by Elyn Saks. This memoir provides an important first-person account of schizophrenia as a condition that while debilitating, is also manageable. Saks is a wonderful writer whose prose takes us straight into the experience of auditory and visual hallucinations. I also spoke with Saks a number of times in the course of writing the story; she was generous with her time and insights.<\/p>\n\n <\/div>\n <\/div>\n \n

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\u201cHidden Valley Road: Inside the Mind of an American Family\u201d<\/a> by Robert Kolker. This is a dark tale of schizophrenia as it affected a family in Colorado. Of the 12 children, six of the sons were diagnosed with schizophrenia. Kolker\u2019s reporting is remarkable, and he clearly lays out not just the history of schizophrenia but also the most current research.<\/p>\n\n <\/div>\n <\/div>\n \n

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What role did your editors play?
<\/strong>My primary editor was Steve Clow<\/a>. We\u2019ve worked together for six years, and he has an excellent understanding of what I need in the course of reporting these stories. I\u2019ll be working on other stories as well, which means we check in with one another once or twice a week. He\u2019s an excellent listener, helps me strategize my time and, most important, brings to the story a reader\u2019s objectivity. That makes him a perfect editor for my first and consecutive drafts.<\/p>\n\n <\/div>\n <\/div>\n \n

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My second editor on this piece was David Lauter<\/a>, who is helping oversee the LA Times\u2019 mental health reporting initiative. David is an equally sensitive reader and identified and helped iron out bumps in the narrative \u2013 where the exposition fell short or seemed redundant \u2013 that had eluded me.\u2260<\/p>\n\n <\/div>\n <\/div>\n \n

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Photojournalist Christina House captured intimate moments of Anthony and his family. How would you describe your working relationship?
<\/strong>The joy of working on stories like this is to have collaborators, and Christina is one of the best. We would often talk before and after getting together with Anthony and Mary to share what we saw and where we felt the story was taking us. While we were working on the same story, we had two different objectives. Her images of Anthony and Mary brilliantly reveal a side of their lives that I wasn\u2019t able to capture.<\/p>\n\n <\/div>\n <\/div>\n \n

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I especially admire how she met the challenge of conveying Anthony\u2019s condition in her work. Ostensibly, he is no different from anyone else, so she needed to show how this invisible condition manifested in his life. I think she caught these moment with remarkable sensitivity, showing the isolation he experiences. As much as Anthony enjoyed the company of his family, he was also alone.<\/p>\n\n <\/div>\n <\/div>\n \n

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Annotation<\/strong>: Storyboard\u2019s questions are in red; Curwen\u2019s answers in blue. <\/em><\/p>\n\n <\/div>\n <\/div>\n \n

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A world gone mad: Schizophrenia and a journey through California\u2019s failed mental health system<\/h2>\nBY THOMAS CURWEN\u00a0\/ STAFF WRITER\n
\nPhotography by CHRISTINA HOUSE\n
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\nDEC. 8, 2022

\nStanding in the dappled sunlight of a Westside city park, Anthony Mazzucca was trying to make a point. The words flew out of him, like birds, a flock of words. He laughed at the thought.
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\nYet he wondered whether he was being clear. No one \u2014 not God, Obama, the devil, his counselor from high school \u2014 seemed to understand him.
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\nIt was the summer of 2015, and between the voices he heard and meth he had smoked, Anthony was once again slipping away. <\/a>These first short paragraphs evoke a familiar, tragic character in American cities struggling with homelessness. Why did you choose to open your story with those impressionistic strokes rather than telling the reader outright that Anthony was schizophrenic?<\/span>I wanted to begin with a moment that best conveyed the psychosis that Anthony experienced. This particular scene was vividly remembered by Mary, who at the time shared it with her family. Seven years later, it was clear in all their minds. What was interesting to me was how Mary recalled that Anthony was talking to the trees, and in an early draft I wrote it that way. But then I realized that this was what she saw, not what he was experiencing. My goal in this scene was to present the world from Anthony\u2019s point of view. This required extrapolating from the most common hallucinations he described to me when he was psychotic. I also wanted to capture his rather wonderful poetry, the associations that he makes \u2013 words to birds to the trees (dappled sunlight) \u2013 and the sense of paranoia (\u201cno one \u2026 seemed to understand him\u201d) that gives his reality such a disarming edge.<\/span><\/span>
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\nPassersby might have seen just another homeless man talking to the trees. But in his mind, he wasn\u2019t: He had a job as an incendiary non-pedophile informant for the FBI, and he had a home, Media Park off Venice Boulevard in Culver City. The cops left him alone, and his mother, Mary Liciaga, brought him food. <\/a>Why this direct reference to “non-pedophile informant,” which many readers might not know. Did you consider explaining it more specifically?<\/span>After three years on anti-psychotic drugs, Anthony was remarkably lucid and consistent in his memories. When he first described his job with the FBI, I thought it would be a passing reference, but he repeated it often. Once when I mentioned how challenging it must be, his eyes lit up with acknowledgement. I didn\u2019t feel it needed explanation, especially so soon in the story. I wanted its strangeness \u2013 this \u201cword salad\u201d that schizophrenics often toss about \u2013 to speak for itself. The more strange and disorienting I could make this opening, the more I felt I could set the hook for driving readers into the story, searching for explanations.<\/span><\/span>
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\nHe was close with his family. He remembered standing up for a sister when she was bullied, giving money to another when she was broke.
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\n\u201cNow you don\u2019t have to worry,\u201d he had said, waving his hands over hers as if sprinkling coins. <\/a>How were able to use this quote with confidence?<\/span>This quote came from his sisters, and I had confidence in all the memories \u2013 relayed in such detail \u2013 that they shared with me. When I thought about this, I realized that to watch their brother slip away in the early stages of his condition must have been an indelible experience for the family. I think trauma imprints our psyches so deeply because it is so out of the ordinary. This detail was also important because I wanted to try to build sympathy for Anthony from the beginning. I wanted to make sure that readers saw him as more than his illness, but also a thoughtful and generous brother in his own way.<\/span><\/span>
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\nBut that was kid stuff. These were adult matters now \u2014 what with the demons in his brain, the strangers trying to poison him, the flying saucers, black widows and torture devices lying on the sidewalks. <\/a>Again, how were you able describe his mental demons with such specificity?<\/span>These details came from Anthony. He was remarkable clear on the symptoms he experienced in the early stages of his schizophrenia. But once he started talking about them, he often grew quiet and seemed somewhat shy about sharing them unlike, say, his memories of playing soccer as a boy. I attributed this shyness to how frightening it was to be reminded of how his world changed so quickly and to have this new disorienting reality imposed upon the world he once knew.<\/span><\/span>
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\nHe had tied himself to his bicycle with the belt to the bathrobe that he wore. He wanted to be ready when the other riders came and together they would fly through the night, city lights blurring around them until dawn. <\/a>You launch the narrative seven years in the past. Why?<\/span>It\u2019s a good question: Once you have filled out your chronology, where do you begin? Most commonly, I\u2019ll follow one of two choices: Begin at the beginning and follow the chronology A to Z; or begin in the middle, adopting what John McPhee calls the \u201c9,\u201d where you introduce readers to the \u201cinciting moment\u201d and then go back to time to explain how we got here, then close the 9 and continue into the present. I felt that this \u201cinciting moment\u201d \u2013 when his psychosis was just developing \u2013 as the most compelling, and it allowed me to introduce his mother \u2013 who is a major part of the story \u2013 while capturing how scary it must be to find your world so crowded with phantoms.<\/span><\/span>
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\nA popular adage in psychiatry goes like this: If the human brain were so simple that we could understand it, then we would be too simple to understand it. <\/a>Here you step back from Anthony\u2019s narrative. Why?<\/span>Soon into the reporting, I realized that I needed to explain to readers what Anthony was experiencing. I didn\u2019t want to merely describe the symptoms of schizophrenia without providing deeper context and background. I was also aware of how little I knew about this condition, which required me to turn to psychiatrists and sociologists who have studied severe mental illness in much greater depth.<\/span><\/span><\/a>But I had a problem. They would not be able to comment directly on Anthony\u2019s condition. They weren\u2019t in a position to meet him. His own psychiatrist was reluctant to talk about Anthony, and the facility where he was living did not want to comment on him for this story. I needed to create two separate story lines: One would be Anthony\u2019s narrative, and the other would be explanatory. I wanted to alternate these two threads with the hope that the drama and suspense of Anthony\u2019s story \u2013 the narrative \u2013 would carry readers through the expository sequences. I also wanted readers would draw their own connections between the two.<\/span><\/span>
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\nAnthony might agree. Ask him what it is like to live with schizophrenia and his reply is \u201cdorsch,\u201dand if schizophrenia is as incomprehensible as that, then its treatment for anyone who is homeless is even more baffling. <\/a>This is the first direct reference to \u201cschizophrenia.\u201d<\/span>I\u2019m glad you noticed. It was intentional. Like everyone who has a severe mental illness, Anthony is not a label. As I point out in the sidebar, the more I got to know him the more I realized that we are all on the same spectrum with little setting us apart. I wanted readers to get to know him without the assumptions and biases that labels perpetuate.\u00a0\u00a0Also, clinically speaking, more and more experts are considering ditching \u201cschizophrenia\u201d as a diagnosis altogether. That\u2019s why we\u2019re seeing more the terms \u201cschizo-affective disorder.\u201d I didn\u2019t go quite that far because I wanted to build upon some common knowledge without going too far down the clinical rabbit hole.<\/span><\/span> <\/a>The last clause, after “dorsch,” seems to set up your theme and launch into a long exposition about the issue of the treatment of the severely mentally in California. Is this your nut graf?<\/span>I don\u2019t so much believe in a nut graf as I believe in letting readers know what lies ahead of them, especially with a story like this which is a more complicated than a straight-forward narrative. I didn\u2019t see a way I could tell readers about Anthony\u2019s condition, convey the strain it put upon his family, describe his life on the street, his addiction or treatment without letting readers know how and why our mental health institutions are so incapable of providing meaningful help. With Anthony\u2019s story alone, I would have only told half of the story, and I believed from the beginning that Anthony provided us with a clear example of how this system works or doesn\u2019t.<\/span><\/span>
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\nSince 2013, Anthony has been detained, hospitalized and confined at least five times. His family tried to intervene and manage his symptoms, but the volatile nature of his condition and the cost of treatment made it impossible.
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\nDeemed a danger to himself and to others, he passed through a system that helped him when he was in extreme distress but was unable to provide consistent, long-term care. For six years, nearly two dozen agencies \u2014 from the San Fernando Valley to the San Gabriel Valley, from the Westside to Long Beach and downtown Los Angeles \u2014 got involved.
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\nWhen he was severely psychotic, he was hospitalized. When he was medicated, he was sent to an acute-care facility. When he was able to care for himself, he was sent to a board-and-care, where he went off his medications, began taking drugs and ended up back on the streets, vulnerable to the next psychotic episode. <\/a>Here you sum up Anthony\u2019s treatment arc in just 55 words? How much drafting, revision and editing was required?<\/span>I\u2019m glad you pointed this out. I\u2019m proud of this paragraph for the distance it travels in a few words. It was easier to write that it might have seemed. Once I had the chronology nailed down, I was able to discern a pattern. Then I simply had to write it. I like to bring a rhythm to my prose, and the syllogism (the \u201cwhen\u2026 then\u201d construction) helped. I also like the Rule of Three. If readers fall into that melody, then they would be all the more surprised when I break it up in the final sentence with a drawn-out subordinate clause that takes us in three steps full circle.<\/span><\/span>
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\nHis experience is far from unique.
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\n\u201cThe mental health care system in L.A. County, like almost every jurisdiction in our nation, is broken badly,\u201d said Dr. Jonathan Sherin, former director of mental health for Los Angeles County. \u201cI could spend my whole career trying to fix what\u2019s wrong here in L.A. and still not succeed.\u201d
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\nBy some estimates, close to 40% of people living on the streets are experiencing severe mental illness, a substance abuse disorder or both. More precisely, the California Policy Lab at UCLA counts just over 4,500 people living on the streets of the county who have a psychotic disorder like schizophrenia, and that number includes only those who have received outreach services.
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\n\u201cMany are not connected to services,\u201d said Janey Rountree, the group\u2019s executive director, \u201cand they are even more vulnerable and in need of help.\u201d
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\nEver since the state hospitals were shuttered in the 1970s, California has tried to make up for deficiencies in its care of mentally ill individuals.
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\nIn 2002, Laura\u2019s Law allowed for court-ordered outpatient treatment. In 2004, the Mental Health Services Act added funds to mental health facilities and programs. More recently, Proposition HHH and Measure H brought more money and resources for homeless people to the city and county of Los Angeles.
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\nNow, the CARE Act<\/a>, signed into law in September by Gov. Gavin Newsom, promises to mandate treatment and housing<\/a>\u00a0for those unable to care for themselves.
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\nThe legislation will put in place an infrastructure to provide services to a projected 12,000 of the state\u2019s most vulnerable residents for up to two years. It has been hailed as a major transformation<\/a>\u00a0in how the state addresses mental illness.
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\nBut Anthony\u2019s story over the last 10 years is a caveat for the state if it intends to end the epidemic of mental illness on the streets. Existing treatments and services can ease the immediate distress of severe mental illness but don\u2019t go far enough in helping individuals like Anthony commit to long-term recovery and return to their communities.
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\nDuring each step of his treatment \u2014 from psychiatric wards in some of the county\u2019s best hospitals to the board-and-care facilities that are the hope for long-term housing \u2014 he had opportunities to stabilize and heal from the worst of his symptoms. None of that kept him from cycling through the system time and again.
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\nA challenging patient, Anthony tested the facilities that treated and housed him, and they were unable to keep him engaged in his recovery.
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\nPressured by overcrowding and a chronic shortage of suitable psychiatric placements, providers release patients like Anthony \u2014 once improvement is seen \u2014 to community-based settings that are ill-equipped to give them the treatment and long-term support that might lead to independent living. <\/a>What were the challenges blending a narrative about one person with a focus on the larger issue of the treatment of the mentally ill in California?<\/span>That came easily and was one of the reasons I was drawn to this story. I had read a number of news stories about mental illness that talk about policies, and I had read a number of human-interest stories about families struggling with mental illness. Each were reported separately. The former are dry, and the latter are heart wrenching. I wanted to write a piece that brought them together with the thought that the policy would make more sense when juxtaposed with the personal story.<\/span><\/span><\/a>In the course of reporting, I realized that Anthony\u2019s story \u2013 his experience five times in and out of treatment, on the streets, hospitalized \u2013 would soon become repetitive. And I wanted to write a story that would be a little different, a hybrid between narrative and explanatory journalism. My goal was for each of these expository sections, including this longish nut section, to be brief enough for a reader to tolerate an interruption in the action. We commonly do this in all narratives where step-backs provide essential information in a sentence or two. I wanted to push this formula a little, offer up more information, and yet try to be as succinct as possible, lest I lose readers.<\/span><\/span> <\/a>Some narrative writers abhor nut grafs, fearing they tamper with a narrative\u2019s momentum. Many other writers and editors believe they\u2019re essential, a debate that played out in a 2019 package <\/a>in Nieman Storyboard. Where do you stand?<\/span>This is a conversation that narrative writers should consider and reconsider, especially as reading becomes more endangered in our culture. (I well remember someone asking me why I was writing about Anthony when there are so many TikToks on mental illness and schizophrenia.) The competition out there is fierce and it is important, especially with a long and complicated story, that readers are told what they\u2019re in for. You also need to tease out what lies ahead, otherwise readers might ditch the story based on a quick judgement or just a sliver of information from a nut graf-less lede. Of course there are wonderful exceptions. I remember well the package you put together in 2019, using John Branch’s \u201cSnow Fall\u201d as an example for not writing a nut graf<\/a>. I had a chance to offer Storyboard readers my own addendum<\/a>, and I still feel that the nut graf should fit the story. Not all narratives are like \u201cSnow Fall.\u201d<\/span><\/span>
\n
\nFor more than three years Anthony has lived at Meadowbrook Behavioral Health Center, a locked facility in West Los Angeles, his worst symptoms kept in check by medication. The cost of his treatment is covered by a range of government agencies and programs, including the county Department of Mental Health, Medi-Cal and the federal Supplemental Security Income benefit Anthony receives as a disabled adult. <\/a>Was there any way to estimate the cost of his treatment over the years?<\/span>Trying to estimate costs for Anthony\u2019s treatment was one of the more vexing aspects of the reporting. I wanted to come up with a numbers, but whenever I asked, I found myself in such a large ballpark as to be meaningless. To get anything close to precise would have meant working with billing departments \u2014 and securing medical records was hard enough. I know this sounds like a cop-out, but this is one of those moments when you realize that the time spent chasing information would not be commensurate with its importance and play in the story.<\/span><\/span>
\n
\nInterviews with Anthony, his family and mental health professionals, along with a review of his medical records, demonstrate not just the bewildering nature of this condition, but also the helplessness with which it leaves families. Meadowbrook\u2019s administrators declined to speak to The Times. <\/a>You use a sidebar to present the personal story of how you came to know Anthony and profile him and his mother and father. Did you consider including some of that first-person background in the story, introducing yourself as some narrative writers do?<\/span>This is a fascinating question \u2014 certainly one, pros and cons, for Storyboard to take up on another occasion. I have read more and more stories in which the reporter becomes part of the narrative. I tend to feel this technique is overused, can be intrusive and often breaks the narrative spell. I\u2019m not completely averse to the practice<\/a>. I just feel there has to be a compelling reason for the reporter to become involved, and I don\u2019t believe readers come to these stories to learn about a reporter\u2019s experience or perspective. The sidebar was written merely as a value-added element to the main bar. I believed that my personal experience, being in Anthony\u2019s company, might help destigmatize schizophrenia for readers who would be afraid, leery or wondering how to approach someone with a severe mental illness. To include that in the main bar would have added another element to an already complicated story.<\/span><\/span>
\n
\nMary, who is Anthony\u2019s conservator, lives close to Meadowbrook and drives past a cluster of tents beneath the 405 Freeway whenever she visits, a reminder of how vulnerable her son is to the street. <\/a>How were you able to describe what Mary saw?<\/span>Meadowbrook was such a mystery to me. Its administrators did not want to participate in the story, so I took any chance I could to be on site, <\/strong>even if it just meant walking the sidewalk in front. On occasion, I would meet Mary at the facility when she picked up Anthony and follow them in my car to her home. I would also drive back to Meadowbrook when it was time for him to return. Each time I drove past this particular encampment.<\/span><\/span>
\n
\nHe is 31, and she wants to take him out of Los Angeles. She has family in rural New York, and Florida is also an option. Anything, she hopes, would be better than here.
\n
\n\u201cIt feels like a battlefield,\u201d she said. \u201cI want to leave, but I can\u2019t leave my son, and I will not have him stepping foot by himself in this city again.\u201d <\/a>This is such a trenchant quote. How do you decide, from the voluminous words you collect during interviews and research, which ones to use in your stories?<\/span>You know it when you hear it, right? Mary said this to me on March 18. It was the first time I met Anthony outside of Meadowbrook, and there was something so clear and defiant in her words \u2013 \u201cI will not have him \u2026\u201d<\/em> \u2013 that I never forgot them. This line summed up the story\u2019s key question: What will become of Anthony when he\u2019s discharged from Meadowbrook?\u00a0 Ending up back on the street is Mary\u2019s greatest concern and fear. I hope it is the readers\u2019 as well.<\/span><\/span>

\n

* * *<\/p>\n
\nSo many thoughts and memories, invited and uninvited, fill Anthony\u2019s head.
\n
\nThere he is: a boy running with his soccer team during matches, a teen laughing and smiling with his grandmother in her wheelchair, a young man feeling the warmth of the sand on summer days at Venice Beach with his three sisters beside him. <\/a>How do you know these things?<\/span>My first meeting with Mary was at a Starbucks. Over coffee, she pulled out a folder in which she kept a number of photographs of Anthony. Like any mother, she held onto these pictures, these touchstone memories of her son when he was healthy. This brief sequence is a description of some of those snapshots.<\/span><\/span>
\n
\nBut shadows fall on the sunny images. His family moved around the country: New York, California, Arizona. Drunk or high, his mother and father fought. Skirmishes left her, Anthony and his sisters bruised, both parents recall.
\n
\nMary got sober when Anthony was 7, and a few years later, his father, Anthony Sr., left them. He says he regrets losing touch and is trying to stay connected to their lives.
\n
\nWith help of a local agency, his mother found a hotel room above the Venice boardwalk. Anthony slept in a sleeping bag on the floor.
\n
\nShe eventually moved into a two-bedroom apartment in Palms and started working as a cashier. She met Dan Williams, who was also in recovery. The 12-step program became their religion, but Anthony never came to the altar. <\/a>Nice turn of phrase. Did it come to you during reporting, writing or revision?<\/span>Mary\u2019s Christian faith is an important part of her life and her recovery from addiction. I\u2019m not sure if it led her to the 12-step program or whether it was the other way around. But I wanted to emphasize how closely aligned they were in the household and how far removed Anthony was from the program. As for coming up with this phrase, who knows? When it comes to you, you know it\u2019s good.<\/span><\/span>
\n
\nA short, skinny kid with glasses growing up in a tough neighborhood, he survived by playing the prankster. Sometimes he crossed the line: taking a BB gun to school after a classmate punched him, blowing up a car with an M-80 placed near the gas tank.
\n
\nHe started getting high, too: pot at 9, methamphetamine at 14. <\/a>What did you rely on to state his delinquent behavior as fact?<\/span>One of the tragedies of schizophrenia is that memories are left intact, so someone with the condition is in touch with this past while having to cope with present. These details came from Anthony and from his family. Everything Anthony told me about his childhood was corroborated with at least two sources: be it his mother, his sisters or his father.<\/span><\/span>
\n
\nA few years later, he threw a 40-ounce beer bottle at a probation officer. He was arrested, and Mary refused to bail him out.
\n
\nHe went to a group home in Van Nuys and another in San Diego County, and after nine months, returned to West L.A., renting a room from a friend and working at a bike rental in Santa Monica. He was 20.
\n
\nEvery week he flew through the streets of the city on his fixed gear with nearly 200 other riders.
\n
\nThen he began hearing voices.

\n

* * *<\/p>\n
\nSchizophrenia typically emerges after adolescence with personality changes that erase some capabilities, behaviors and memories while retaining others. <\/a>Here comes another break from Anthony\u2019s story. How did you keep track of the moments when you wanted to switch between exposition and dramatic narrative?<\/span>Whenever I step back in a narrative, I want to leave the reader hanging. Sometimes this means asking a question. Sometimes it means hitting them with a line that is either stunning or especially poignant. In this instance, I have to credit my editor, David Lauter, who proposed this break. I had initially taken the reader to the scene below where Anthony is looking at the old photograph of himself and Mary is saying, \u201cI miss that Anthony.\u201d David\u2019s decision was the right one.<\/span><\/span>


\nThe break between past and present can be disorienting. Memories mix with delusions. Psychotic episodes, the worst of its symptoms, are especially terrifying. A tree, a street, a face lose context and meaning. In the absence of understanding, the imagination fills in the blanks.
\n
\n\u201cEvery sight, every sound, every smell coming at you carries equal weight; every thought, feeling, memory and idea presents itself to you with an equally strong and demanding intensity,\u201d Elyn Saks, a USC law professor and MacArthur Foundation fellow, wrote in a 2007 memoir detailing her experience with schizophrenia.
\n
\n\u201cIt\u2019s the crowd at the Super Bowl, and they\u2019re all yelling directly at you.\u201d <\/a>How many researchers did you interview or learn from books or articles to be able to make this assertion?<\/span>Sak\u2019s book is so vivid in its depiction of schizophrenia, and this line just leapt out at me. I had to use it. It is one sentence in a longer sequence in the book describing what schizophrenia is like. I could have quoted more \u2013 it is that brilliant \u2013 but I had to be selective.<\/span><\/span>\u00a0Researchers believe they have traced the illness to misdirected electrical impulses in the brain, arising from a loss of brain tissue caused by genetics, the environment or both.
\n
\nSome people with a strong genetic likelihood of illness may develop schizophrenia regardless of what happens in their lives. For others, \u201ccertain stressors may be associated with earlier or more severe illness,\u201d said Dr. Alaina Burns, assistant clinical professor of psychiatry at UCLA.
\n
\nStressors may include viral illness during pregnancy, the effects of poverty and racism, neglect or abuse during childhood. Chronic use of marijuana at an early age has been implicated, as has abuse of methamphetamine.
\n
\nAddiction can be a contributing factor as psychotic disorders make impulse control difficult and substance use becomes a compulsion. That\u2019s especially true among people living on the streets, where the use of drugs is rampant, leading to psychoses that are especially difficult to treat.
\n
\n\u201cMethamphetamine use can cause psychotic symptoms without schizophrenia being present,\u201d said Dr. Larissa Mooney, an addiction psychiatrist at UCLA who studies the intersection of substance use and mental illness. \u201cAnd it can also exacerbate or worsen the underlying symptoms of schizophrenia when it is present.\u201d
\n
\nUntangling the connection between substance disorders and schizophrenia is particularly challenging if someone is cycling in and out of an inpatient setting, Mooney said.
\n
\nBoth Burns and Mooney believe that schizophrenia can be treated given time and patience. Burns, who runs a treatment program, describes patients who have jobs, spouses and children. Many of those don\u2019t disclose their diagnosis due to the stigma of the condition. Others require lifelong care.
\n
\n\u201cThere is no one illness called schizophrenia,\u201d said Burns. \u201cTwo people with schizophrenia may have completely different presentations and prognoses.\u201d <\/a>You braid your narrative between exposition and dramatic action to tell Anthony\u2019s story of schizophrenia and, more broadly, the state of care for schizophrenics in California. How did decide on this structural approach?<\/span>Sometimes I think I get too caught up in the art of writing these stories, and in this case I wanted to find balance and symmetry with each chapter by creating an A-B, A-B pattern. I had to fight for it, too. There was a moment after one edit when a B sequence (the penultimate expository segment) didn\u2019t work; it was too redundant. My editor, David Lauter, rightly called me on this and proposed cutting it entirely. But then the balance would have been off, so I had to dig deeper and find a new angle.<\/span><\/span>

\n

* * *<\/p>\n
\nMary and Dan knew something was wrong. Anthony had started making strange sounds and gestures with his hands. One day he accused them of poisoning his coffee.
\n
\nAt first, they thought he was getting too drunk or too high, which was unacceptable in a household that maintained its distance from alcoholism and addiction through discipline and Christian devotion.
\n
\nMary wanted him to take responsibility for himself. Dan gave him work, simple construction like laying tiles, but Anthony lost focus and wandered off.
\n
\nOne day when he was home, Mary caught him looking at an old photograph of himself.
\n
\n\u201cI miss that Anthony,\u201d she recalled saying.<\/a>Why did you choose this attribute verb rather than just “said”?<\/span>I think it is important, now and again, to remind readers that I am not witnessing these moments and to be transparent regarding their source.<\/span><\/span>
\n
\n\u201cSo do I,\u201d he said, crying.
\n
\nEarly in 2013, he had his first hospitalization. He was 22. He had been standing in the middle of Venice Boulevard and was nearly hit by a bus. After a psychiatric evaluation, he was placed on an extended involuntary hold and transferred to Gateways Hospital and Mental Health Center near Elysian Park.
\n
\nOnce discharged, he moved in with his father but stopped taking his medications and was soon delusional. On one occasion, he said he found diamonds in the street. He held the stones in the palm of his hand, and they glittered in the light.
\n
\n\u201cLook,\u201d he said to his father, who recounted the incident, \u201cnow we can get a big house and all live together.\u201d <\/a>Why did you attribute this scene?<\/span>Again, just exercising a little transparency for the reader who might wonder where this information came from.<\/span><\/span>
\n
\nAnthony Sr. studied them. They were pieces of a broken windshield. When he threw them in the trash, Anthony took a swing and dislocated his father\u2019s shoulder.
\n
\nHe later tried to jump from a moving car. Police drove him to the emergency room against his will, and for the next 14 months he was confined to locked facilities.
\n
\nHis medical records would soon fill the shelf of a library. <\/a>How did you know this?<\/span>I\u2019ll never forget one day working at home on the story when the USPS truck pulled up in front. The delivery person walks up with six large manilla envelops filled to capacity \u2013 page after page documenting Anthony\u2019s treatment at Kedren. The daily detail was both tedious and astonishing.<\/span><\/span>\u00a0One facility \u2014 Kedren Community Health Center \u2014 documented his behavior three times a day for nine months through June 2014:
\n
\nMr. Mazzucca presents with a labile mood and a flat affect. His thought process is disorganized with a low content. He is isolative, withdrawn, hyper religious, internally preoccupied, guarded and suspicious.<\/em><\/a>Do you assume readers know what these terms mean?Did you consider defining or describing them?<\/span>My editor asked me about this (\u201clabile\u201d? really?), but I made the case for it. The medical profession resorts too often, in my opinion, on words, phrases and language that no one uses or understands. As if the bureaucracy alone isn\u2019t challenging enough, language is another alienating factor for families and patients trying so hard to understand these illnesses and get the necessary help. I wanted to use this excerpt not so much as a description of Anthony\u2019s symptoms than a description of how he was perceived by doctors.<\/span><\/span><\/a>How did you obtain this record?<\/span>Obtaining Anthony\u2019s medical records was a bit of a challenge due to HIPAA constraints (the Health Insurance Portability and Accountability Act of 1996). I needed to contact the hospital or residential facility where he had been treated and request a release form from patient records. I filled it out, had Mary sign it, and then I returned it to the hospital or facility and waited. Some returned the information promptly; some needed constant reminders. Some printed out his records, some gave it to me on a CD, and one had destroyed them because they were older than required time for saving them).<\/span><\/span>
\n
\nAt Kedren, he was assigned a public guardian and eventually transferred to a facility on the Westside, Meadowbrook, where he successfully appealed his involuntary commitment and moved into an unlocked, 185-patient board-and-care home in Pico Rivera.
\n
\nSupervision was minimal, and Anthony could walk to a nearby shopping center and panhandle. He would buy beer and cigarettes, even methamphetamine and cocaine, according to toxicology reports cited in records provided by the county Department of Mental Health. <\/a>Did you have to FOIA these or any other records that you cite?<\/span>I followed the same procedure with the county Department of Mental Health as I did with hospitals or residential facilities. So it wasn\u2019t a FOIA request but a HIPAA release. But it might as well been a FOIA request, considering how long it took for the county to provide me with the records. Suffice to say, through phone calls and weekly emails, I got to know the administrator fairly well.<\/span><\/span>
\n
\nHe again went off his medications. He stopped sleeping, stopped wearing shoes. Once he ripped the handle off the door, frightening his roommate.
\n
\n\u201cI am God. I am the devil,\u201d he declared. \u201cI\u2019m saving the world.\u201d <\/a>How do you know this?<\/span>This was verbatim from one of Anthony\u2019s medical reports.<\/span><\/span>
\n
\nA response team from the county Department of Mental Health was called in but did not recommend an involuntary hold. He was \u201coriented,\u201d they reported, denied being suicidal or homicidal, and could identify \u201chow to have his daily needs met.\u201d
\n
\nFour months later, the team came to a different conclusion. Sheriff\u2019s deputies had cited Anthony for violating Pico Rivera\u2019s municipal code that bans \u201csoliciting food, clothing, alms in any public place in the city or from any person.\u201d
\n
\nHe had gotten worse: acting belligerent, pushing people, stalking a bank employee for cash. \u201cI\u2019m going to squeeze you like a bug,\u201d he said. <\/a>This is such a powerful quote. How did you obtain it?<\/span>Again, verbatim from one of Anthony\u2019s medical reports. It was almost too easy to get this level of detail; it was all carefully documented by individuals on his psych team who documented his behavior with pen and paper on a regular basis.<\/span><\/span>
\n
\nHe was taken to L.A. County-USC Medical Center and transferred to Mission Community Hospital in Panorama City. Ten days later he was discharged \u201cwith bus tokens and a list of homeless shelters,\u201d as Mary recalled, and showed up at her door.<\/a>How do you make the decision whether to attribute scenes and information?<\/span>It\u2019s a good question. I wish I had a better, more journalistic answer, but sometimes I just have a feeling that the reader might wonder where the information came from. I suppose this comes from reading stories and raising this question myself. In this particular case, I wanted to present these details (\u201cbus tokens and a list of homeless shelters\u201d) from Mary\u2019s point of view, so readers would get a sense of what it might have been like for a mother to see her son being treated in such a dismissive manner.<\/span><\/span>
\n
\nHe stayed until Mary and Dan kicked him out for bringing drugs into their home. He moved to Media Park, where he began talking to God, Obama and others.
\n
\nOne day, Mary found him face-down on a sidewalk, hoodie over his head, the naked soles of his feet black with dirt. She woke him with some food, and he propped himself up against the wall of an Albertsons and feasted.
\n
\nThey celebrated his 24th birthday on the street.

\n

* * *<\/p>\n
\nYears ago, Anthony would have been committed to one of 14 mental hospitals in California. These asylums were the hope of psychiatric professionals who believed that \u201cmentally disordered persons\u201d could be treated in an institutional setting. By 1955, 37,000 people with severe mental illness lived in these massive state facilities.
\n
\nInhumane conditions \u2014 worsened by overcrowding and deteriorating infrastructure \u2014 led reformers in the 1960s to call for closing the hospitals and shifting toward community care.
\n
\nThe philosophy held that with new medications and therapy, the mentally ill could be integrated into society.
\n
\nWhile the Mental Health Act of 1967, also known as the Lanterman-Petris-Short Act, was hailed as the beginning of a new era of psychiatric rehabilitation, legislators failed to adequately fund smaller county-run facilities. <\/a>What reporting or research did you rely on to condense this history with such concision and authority?<\/span>Through my reporting on homelessness (\u201cThe Street Within<\/a>\u201d) and mental illness and suicide<\/a>, I had a good familiarity with the state\u2019s conflicted efforts to treat individuals with addiction and severe mental illness. Having watched the closure of the state mental hospitals, having read the work of sociologists like Andrew Scull and having written about recent efforts to move unsheltered people off the street<\/a>, I had a fairly good understanding of this troubled history. It\u2019s stunning and shameful, especially now that schizophrenia is so prevalent, and as new legislative efforts are advanced to try to curb this epidemic, I can\u2019t help but wonder why we, as a society, have so profoundly miscalculated the needs of these individuals.<\/span><\/span>
\n
\n\u201cThe great failure of public policy over the last 50 years is how we discharged people from mental hospitals with no replacement,\u201d said Andrew Scull, a sociologist at UC San Diego who studies the history of mental illness and its treatment.
\n
\nThe burden of caring for the mentally ill fell largely upon families left to navigate a complex system of public and private treatment facilities that are \u201cill-designed to help them,\u201d Scull said.
\n
\nThe worst off ended up on the street, subject to Section 5150 of the state\u2019s mental health law, which allows forced hospitalization for those considered a risk to themselves or others or those who are \u201cgravely disabled.\u201d For many families, neighbors and social workers who have watched as psychoses and homelessness overlap, that sets the threshold for action too high. The CARE Act, which the state plans to begin implementing next fall, aims to be a step toward remedying this.
\n
\nOnce hospitalized, patients are often treated with antipsychotic medications that eliminate their worst symptoms. Eventually, severely ill patients under extended involuntary holds \u2014 with no family to take them in \u2014 are transferred to long-term care facilities, referred to as Institutions for Mental Disease, where treatment is less expensive than in hospitals.
\n
\nTreatment includes medication management and group activities. Neither are compulsory, and staff members encourage compliance through an incentive system with privileges, a marked change from the era of treating mental illness with more brutal and often harmful interventions.
\n
\nIf patients gain insight into their condition, understand their medication needs, maintain daily hygiene and appear sociable, they can be discharged to unlocked facilities, referred to as board-and-care homes.
\n
\nThese privately owned homes play a critical role, housing individuals who would have no other place to live, but they form a weak link in the mental health system, said Neil M. Gong, assistant professor at UC San Diego who studies the sociology of mental illness. They are minimally staffed by people who are trying to do their best with minimal funding, said Gong, who has visited a number of board-and-cares for his research.
\n
\n\u201cThey can\u2019t be real homes or provide much care,\u201d he said.

\n

* * *<\/p>\n
\nSheriff\u2019s deputies caught up with Anthony in 2016 for skipping three arraignments on the misdemeanor charge of panhandling in Pico Rivera. They took him to the county\u2019s largest mental health facility: the Twin Towers jail in downtown Los Angeles.
\n
\nThe district attorney\u2019s office eventually dropped the charges, and deputies issued an involuntary hold rather than release Anthony to the street. They took him by ambulance to Harbor-UCLA Medical Center.
\n
\nAnthony arrived \u201cgravely disabled \u2026 with no viable plan of self-care,\u201d the psychiatric staff wrote.
\n
\nThey searched him. They asked him to take off his clothes and put on a gown. He twisted up his face. He refused to take a shower. He thought he was surrounded by cyborgs.
\n
\n\u201cWho\u2019s president?\u201d they asked, writing down his response.
\n
\n\u201cWashington.\u201d
\n
\nThey called his mother, who hadn\u2019t seen him in nine months and thought he was dead.
\n
\n\u201cPlease help me save my son\u2019s life,\u201d she said. <\/a>How were you able to reconstruct Anthony’s behavior and his mother\u2019s plea?<\/span>Yes, it really captures Mary\u2019s desperation. Given her commitment to Anthony, her heart must have been broken for those nine months not knowing where he was living or if anything could be done to help him. I found this quote in the medical records I obtained from Harbor-UCLA Medical Center. Amid the details of his behavior and treatment, this line certainly jumped out at me.<\/span><\/span>
\n
\nThey wanted to give him medication, but he yelled at them \u2014 \u201cI don\u2019t need this poison\u201d \u2014 and pulled a blanket over his head.
\n
\nDays became weeks. They listened and took more notes.
\n
\nThey told him that his mother wanted to be his conservator. \u201cWhatever,\u201d he said, and they escorted him to court.
\n
\nWith the medications coursing through his body and brain, the voices became less loud, and by the end of January 2017, staff told him that they were trying to find a place for him to live. They mentioned a few facilities. He said he didn\u2019t care, as long as he was allowed to smoke.
\n
\nThe next month, Anthony arrived at La Casa Mental Health Rehabilitation Center in north Long Beach. Staff asked what his goals were.
\n
\n\u201cSuccess, money and to be an RN,\u201d he said, adding that he looked forward to taking classes like computer skills, Bible stories, music and medicine.
\n
\nAt first he needed little encouragement showering or taking care of himself. But slowly he began to fall back upon old habits. He started smoking marijuana with other residents, and eight months into his stay, he climbed the fence surrounding the outdoor patio.
\n
\n\u201cI\u2019ll be back,\u201d he said and dropped to the sidewalk. <\/a>How were you able to describe this moment so precisely?<\/span>It\u2019s stunning, isn\u2019t it? I was so surprised that Anthony was able to get out of this locked facility so easily (Meadowbrook\u2019s outdoor areas are completely enclosed with fencing). This detail was thoroughly documented in the medical records that La Casa provided.<\/span><\/span>
\n
\nBecause La Casa is a treatment center, it has no security guards, and the staff, trained in crisis intervention, do not try to stop anyone from leaving, which could lead to injury.
\n
\nAnthony bought cigarettes and beer at a nearby Shell station. When he returned, he was put on restrictions.
\n
\nTwo weeks later, he slipped out again, returning late at night. He was found sitting near the entrance, sick to his stomach. Beer again. He said he had been drinking forties.
\n
\n\u201cI\u2019m sorry,\u201d he said. \u201cI can\u2019t help it.\u201d God had told him to.
\n
\nHis medication was adjusted, and then smoking was banned. A nicotine patch didn\u2019t cut it. The next time he got out, he scored some crystal meth. A drug test confirmed it.
\n
\nAfter that, the voices seemed only to get louder and more demanding. After a treatment team meeting, he got out again and picked up three 32-ounce Miller Lites and some Newport menthols.
\n
\nStaff found him and talked him into returning. But he stayed only half an hour before he climbed the fence for the last time.
\n
\nBy spring 2018, Anthony, now 27, was living somewhere in Compton. Mary had to find him. She and a friend drove the alleys and visited homeless camps. They passed his picture around until one women recognized him.
\n
\n\u201cHe\u2019s a little off, right?\u201d
\n
\nThey were directed to a McDonald\u2019s, and within an hour they saw him crossing the street, oblivious to the cars. His pants were torn, his beard long, his hair grown out. He was smelly and filthy, and when Mary tried to reach out for him, he pushed her away.
\n
\n\u201cI\u2019m a grown man, Mom. Leave me alone,\u201d he said, walking to the stoop of a day-care center, where he fired up a glass pipe and drew smoke into his lungs.
\n
\nMary called the sheriff\u2019s station, as she recalled, but they said there was little they could do. If they arrested him, he would be back on the streets within hours.
\n
\nShe broke down in tears. <\/a>Who is the source for this tragic scene?<\/span>This was the moment that I first met Mary. She called me at The Times after reading a piece that I had written<\/a> about legislative efforts to make involuntary commitment for individuals like her son easier. She shared with me photos of Anthony, who by then had been living on the street for months. Four years later when I wanted to write this story, we began with this memory. I had thought it might be the opening sequence, so I spent a little more time getting the details. I also spoke to the friend who joined Mary trying to track Anthony down. The friend\u2019s account of this reunion \u2013 and the rebuff \u2013 matched Mary\u2019s recollection.<\/span><\/span>
\n
\nTwo weeks later, deputies did pick him up. They had received complaints that he had exposed himself to children, that he had nearly been hit by a car. They put him on an involuntary hold and took him back to Harbor-UCLA.
\n
\nFor six weeks, doctors chased his symptoms with different medications \u2014 Risperdal, then Haldol, then Klonopin, then clozapine and finally back to Haldol \u2014 before they started to see an effect. <\/a>“Chased” is such a vivid verb here. How did you choose it and why?<\/span>Thank you for asking about verbs! I\u2019m a fan of Constance Hale\u2019s \u201cVex, Hex, Smash, Smooch: Let Verbs Power Your Writing.\u201d<\/a> In this instance, \u201cchase\u201d felt natural. On one hand, we often hear about pharmaceutical \u201ccocktails\u201d delivered to patients, so I think I was thinking obliquely of these drugs as being a \u201cchaser.\u201d But, more significantly, this word felt right because the drugs we give patients with mental illness do nothing to cure the illness. They just force the symptoms to retreat, and that\u2019s the image I had in my mind: Of these drugs, like hounds, driving the devils and angels of his mind into the woods.<\/span><\/span>
\n
\n\u201cI\u2019m a new man,\u201d he said, once they were able to control his tremors, a side effect of the drugs.
\n
\nMary brought him fresh clothes and popcorn. He showered and trimmed his beard. He played Yahtzee, shot hoops, did yoga. He talked about working again, helping Dan. He started to ask when he could leave.
\n
\nAs the hospital put together a discharge plan, Mary visited a few facilities. She wanted him to be close to home, and eventually he was readmitted to Meadowbrook.
\n
\nOn a quiet residential street in Mar Vista, Meadowbrook houses 77 men and women, most of whom are schizophrenic, who range in age from their early 20s to early 60s. The locked facility is owned by three limited-liability companies, one of which goes by the name Meshuga Operations Holdings LLC \u2014 Meshuga, Yiddish for crazy. The company has ownership interests in four other facilities in Southern California that have contracts with the county Department of Mental Health.
\n
\nAnthony has lived there since January 2019. He says it\u2019s boring: \u201cI just smoke and sleep.\u201d <\/a>Were you able to visit Anthony there?<\/span>Yes. But it wasn\u2019t as much of a visit as I would have liked. On two occasions, Mary and I met Anthony in an outdoor patio where we had a chance to talk. These visits were always supervised, and our time was limited. On another occasion, I went with Mary into the reception area and had a chance to glance through the window of a locked door to see a corridor where \u2013 as it seemed to me \u2013 the patients were milling about. I had wanted to get inside the facility and see his room, the hallways where he walked, but the administration wasn\u2019t going to let that happen.<\/span><\/span>
\n
\nHe describes waking up at 6 every day and getting his first round of medication. He takes clozapine twice a day and then more pills to counter the side effects of the clozapine, his medical records show.
\n
\nBreakfast, he says, is served at 7:30. He likes two oatmeals and keeps to himself. He works out twice a day and is proud that he can press 55 pounds.
\n
\nHe has two roommates but no friends. Watching television gives him a headache.
\n
\nMeadowbrook encourages residents to attend group meetings on topics such as memory and concentration, anger management, conflict resolution, medications and current events.
\n
\nMostly, though, Anthony, by his own account, walks up and down the halls, drinks coffee, gets an occasional Twix from the vending machine and smokes on the back patio: two cigarettes a day, one in the morning, the other after dinner, which is served at 5 p.m. He is in bed by 9.
\n
\n<\/a>Why did you use the qualifier “by his own account?” And what were the challenges posed by interviewing a severely mentally person? How did you get Anthony to open up?<\/span>I felt the need to qualify this description of his daily life because I didn\u2019t see or experience it firsthand. For all of this I had to rely on Anthony. As for the challenges, Anthony was helpful in our causal conversations when we were on the trail walking together or sitting in Mary\u2019s backyard. He was clear why I was there asking questions, taking notes, and he was engaging, forthcoming and receptive. The only time that he proved recalcitrant was after the story was written. This was before publication, and when I started to fact-check it with him, he grew restless, a reaction that I attributed to feeling self-conscious.<\/span><\/span><\/a>Fact-checking was very important to the process of reporting this story. It gave me an opportunity to share with Anthony parts of the story \u2013 which I felt I had an ethical responsibility to share. First, I did not want to surprise him when the story came out. Second, it gave him an opportunity to question or correct, even participate in what was written. I wanted to give him this degree of agency. I felt that he had so little control over his life that I didn\u2019t want to compound that feeling. I repeatedly asked him ifhe needed to change anything and if he was OK with this detail or that. He assured me that he was. I also made the point of asking Mary to check in with him when I wasn\u2019t there. I wanted to make sure he wasn\u2019t being shy, intimidated or simply courteous. She reassured me that he was fine with what I had reported.<\/span><\/span><\/a>Did you have any concerns about invading Anthony\u2019s privacy, given his condition?<\/span>Of course I did, but this is a reaction I have with all my stories. I work hard to limit the Law of Unintended Consequences, and while I can never be entirely sure that I\u2019m successful, I want to make sure the people I write about understand the possible implications of these stories. When they express reservations, I listen and try to address their concerns. With Anthony\u2019s story, I was even more attentive, constantly checking in with him and with Mary to make sure they were comfortable with my questions and the process.<\/span><\/span>

\n

\u00a0* * *<\/p>\n
\nIf the goal for treating individuals with severe mental illnesses like schizophrenia is independent living, then progress has stalled at medication and confinement with little focus on long-term management.
\n
\n\u201cWe still see psychiatric illness too narrowly,\u201d said Dr. Joel Braslow, a professor of psychiatry at UCLA. \u201cWe still hold on to the 19th century model of mental illness, as if it were a bacterial illness\u201d \u2014 as if once treated, it\u2019s cured.
\n
\nSevere mental illness is not simply misdirected electrical impulses in the brain, he said. It is also the confusion, distress and social isolation, which also require treatment.
\n
\n\u201cWe need to understand that the suffering brought on by these disorders is not just biological, but also psychological and social,\u201d said Braslow. \u201cOur definition of treatment should extend far beyond medical management.\u201d
\n
\n\u201cPeople need help with things like going back to school, maintaining a good relationship with friends, or dealing with social phobias not just in therapy at the clinic, but by going out to a restaurant with a case manager,\u201d Gong said.
\n
\nPsychiatric rehabilitation comes down to \u201cpeople, place and purpose,\u201d said Sherin: medical services alongside family support, a home and reason to get up in the morning.
\n
\nAnything short of that, writes Scull, is abandonment of \u201ca collective moral responsibility to provide for the unfortunate.\u201d It is, in other words, warehousing. <\/a>Why did you present this information here?<\/span>I believe in the importance of this story. Anthony and Mary\u2019s experience over the last 10 years has been tragic, and they are not alone for what they have gone through. In fact, they are lucky to have gotten as far as they have: to have Anthony safely housed. I wanted this penultimate section to be prescriptive, to be as blunt as possible in laying out what experts believe needs to be done to make sure that individuals like Anthony can live a healthy life. I continue to be amazed at how short-sighted we are as a society when it comes to addressing severe mental illness. I believe that this litany of the experts \u2013 Braslow, Gong, Sherin and Scull \u2013 makes this clear.<\/span><\/span>
\n
\nSince the lifting of COVID-19 restrictions, Mary has tried to visit Anthony regularly. Over tacos and a decaf, they sat in Meadowbrook\u2019s fenced-in patio. On other visits, she took him to Venice Beach. They practiced tai chi in a local park, hiked through Temescal Canyon with his father, rode bikes and had a backyard barbecue with his sister and her daughter. <\/a>How much time did you and photojournalist Christina House spend witnessing these reunions? How important is hanging out with a source, and how do you remain patient?<\/span>I don\u2019t think we spent that much time with Anthony. I count roughly a half dozen reporting sessions with him, each about a half day in his company (we were limited by how long Meadowbrook gave him on a day pass). Other information came from phone calls and meeting with his family. I think \u201changing out\u201d is critical for the success of a story, and I\u2019m grateful that my editors understand. This is what makes narrative work, in my opinion, the most honest form of journalism. In essence, we\u2019re documentarians, aren\u2019t we? We witness what others don\u2019t. We put a frame around the dross of life \u2013 and in the process bring a little order and rationality to the chaos of the world. As for patience: As long as I\u2019m curious, I\u2019m patient. Sure, there are times when the work feels repetitive or seems to go off-tract, but I\u2019ve learned from experience that the moment my mind wanders, something really interesting happens.<\/span><\/span>
\n
\nThe reunions were rewarding and frustrating. He seemed to be improving, but he needed supervision. Without monitoring, she could see him drinking coffee and smoking cigarettes all day.
\n
\nHe had been at Meadowbrook for more than three years; most patients transition to board-and-care facilities after two. The pandemic had slowed progress, but Mary wanted to know what steps were being taken to prepare her son for eventual discharge.
\n
\nFour times a year, members of the Meadowbrook staff and a representative from the Department of Mental Health meet with Anthony and Mary to discuss the treatment plan.
\n
\nWhen the call came in for one of those meetings earlier this year, Mary put her phone on speaker so she could take notes.
\n
\nAfter the staff recounted his medical history and a little good news \u2014 because of his increased participation in groups, Anthony had been named Resident of the Month \u2014 Mary got to the point.
\n
\n\u201cDo you see Anthony living independently?\u201d she asked.
\n
\n\u201cNot at this time,\u201d someone said.
\n
\nFor a moment, Mary said nothing. She felt the pain of seeing her son locked up, but there seemed to be no other choice. As grateful as she was for their help, she wondered if they were doing enough, but she worried about asking too many questions or appearing antagonistic. She depended on them for Anthony\u2019s care.
\n
\nWith the meeting almost over \u2014 her questions partially answered \u2014 she wanted to remind them of her continued commitment to his recovery.
\n
\n\u201cI want to be a partner in Anthony\u2019s mental health, and I want us to work together,\u201d she said, \u201cand I don\u2019t want him to be just discharged. My biggest fear is him ending up homeless again, so I want a concrete plan, and I really hope that we work together for that.\u201d <\/a>Were you with Mary at this time?<\/span>Yes. I had wanted to capture her reaction to this quarterly review of Anthony\u2019s treatment plan. This always struck me as critical to the story \u2013 and would provide me with an ending \u2013 as this conversation would address (or not) the question of what\u2019s Anthony\u2019s future \u2013 Mary\u2019s biggest question \u2013 might be.<\/span><\/span>
\n
\n\u201cAbsolutely,\u201d came the response, and after 20 minutes, the meeting ended.
\n
\nIn silence, Mary sat at her kitchen table, a cool breeze coming from the open window, and Anthony returned to his room, to the voices who still whispered in his ears, still crowding out the world he remembered: the world of his childhood, his family, his mother and his sisters, the world before everything became incomprehensible. <\/a>What a poignant closing. Why did you choose to end with this scene?<\/span>Thank you. I had wrestled with this ending \u2013 this final paragraph \u2013 for quite a while. I knew I could end the story with the phone call, but I felt readers needed a little more. This language came out of some of the free-writing I did about this moment, the feeling of how inconclusive all of this is, so much drama amounting to so little \u2013 and Anthony\u2019s experience remaining unchanged. Schizophrenia is still the mystery, the tragedy, it has always been.<\/span><\/span>
\n
\n* * *
\n
\nThomas Curwen is staff writer for the Los Angeles Times, specializing in long-form narratives, and was a Pulitzer Prize finalist in 2008 for feature writing. The below sidebars ran with his story on Anthony.<\/em>


\n

Schizophrenia is a black box. How \u2014 and why \u2014 we reported Anthony\u2019s story<\/h3>\n\n<\/a>What is the purpose of this sidebar and why did you decide to use is to describe the story behind the story?<\/span>After spending time with Anthony, I had something of an epiphany. I realized that there was really very little separating his experience of the world with mine. Of course I don\u2019t have the hallucinations he experiences, but if I had, I would most likely be reacting to them the same way. This is why that small detail \u2013 caught out of the corner of my eye one afternoon \u2013 him turning in a circle a few times before sitting down \u2013 seemed so eloquent. Don\u2019t we all try to find behaviors, routines, patterns that allow us a modicum of peace and calm in the midst of the chaos that surrounds us?<\/span><\/span><\/a>For this reason, I grew fairly philosophical in my understanding of schizophrenia. Forgive me, but here goes. I came to see human intelligence on a spectrum longer than what we commonly think of when we talk about \u201cbeing on the spectrum.\u201d At one end, there lies severe mental illness. At the other end, there is \u2013 I suppose \u2013 Einstein-like intelligence. But really, the ends don\u2019t matter. What lies in between is everything else: mental illness, autism, OCD, addiction, workaholic-ism, obsession, all the countless eccentricities that you, me and everyone who has ever lived exhibit. Given how profoundly we stigmatize differences, especially in how we think or behave, this insight struck me as important, and I wanted to make this point. Some of us just need a little more help.<\/span><\/span>
\n
\n One cool spring afternoon, Anthony Mazzucca and his mother, Mary Liciaga, stopped into a Starbucks in Marina del Rey. They had just come from an Alcoholics Anonymous meeting, and Mary had promised her son a coffee.
\n
\n Standing at the counter, Anthony asked for medium roast and a coconut lemon bar. Mary reminded him to make it a decaf. His voice was soft, and as always, he was polite. Waiting for his order, he moved to the side. Standing alone, he began talking to himself, quietly muttering and occasionally gesturing.
\n
\n If customers noticed, they didn\u2019t seem concerned. His posture slightly hunched over, Anthony seemed shy and withdrawn, not likely to be trouble or a nuisance for anyone. His words were indistinguishable, but his expression was absorbed and intent.
\n
\n If you were to ask him whom he\u2019s talking to, he\u2019ll tell you. Often he\u2019s in conversation with the Maker of All and with God (they\u2019re not the same). He\u2019s negotiating for power, and I could only assume they drive a hard bargain. He once told me it would cost him $410.
\n
\n I met Anthony in March, but I have known his mother since 2018, when I wrote about the efforts of state legislators to strengthen the law<\/a> allowing for involuntary hospitalization of people who are gravely disabled or a danger to themselves or others.
\n
\n Mary called me at The Times, introduced herself and told me that her son has schizophrenia, was living on the street in Compton, and she wanted to help him. I contacted an outreach worker with a homeless services agency who met Anthony and reported that he didn\u2019t want to go into treatment. A few weeks later, L.A. County sheriff\u2019s deputies took him to Harbor-UCLA Medical Center.
\n
\n \u201c\u2026 patient was irritable, disorganized, laughing inappropriately, making clicking sounds, with bizarre gestures (i.e. hitting himself on the chest and abdomen, raising his hand in martial-art-like gesture) which appeared volitional,\u201d wrote the attending psychiatrist.
\n
\n In the weeks that followed, with the help of antipsychotic medications, Anthony calmed down, and Mary texted me updates. She eventually got him into a locked residential facility, and we continued to keep in touch.
\n
\n I was impressed by Mary\u2019s commitment to her son. Severe mental illnesses often break families apart, especially those that cannot afford private treatment, but Mary didn\u2019t turn her back on him. I sensed complicated motivations \u2014 a mother\u2019s love and guilt, denial that he was as sick as he was, hope that he could get better, and indignation that more help wasn\u2019t available \u2014 but none of that mattered.
\n
\n Anthony needed an advocate, which is why Mary had become his conservator in 2017. She had seen how close he had come to dying on the streets or getting lost in the jail system.
\n
\n Earlier this year, Gov. Gavin Newsom laid out a proposal to compel people with severe mental illness and addictions<\/a> into court-ordered care, medication and housing, and I thought Anthony\u2019s story would illustrate how difficult this would be, especially in the long run.
\n
\n Mary and Anthony agreed to share their story and to help me track down his medical records from facilities across the county. Throughout the spring, Times photographer Christina House and I joined them on their weekly outings.
\n
\n Anthony spoke a lot about himself, blending real and fantastical stories. He is imaginative and often poetic, making up words to capture the strange and private worlds that he has occupied for nearly 10 years. \u201cThese are adult matters,\u201d he told me. \u201cNothing kitschy here.\u201d
\n
\n He is an inventor who has accomplished a lot in the last \u201ctemeculon\u201d \u2014 100 years \u201cin condensed time.\u201d Using \u201clandscaping devices\u201d (his hands), he made heaven and hell, the movies \u201cThe Texas Chainsaw Massacre\u201d and \u201cThe Matrix,\u201d some boats, a few books (\u201cBook of Life\u201d and \u201cBook of Death\u201d) and \u201cthe Gizzard,\u201d a reptilian sea creature.
\n
\n As reserved as he is, he is also confident in what he knows, and the breadth of his mind, evidenced either by his language or hallucinations, is always on display. He is also exceedingly courteous. When I asked why he has this gift to see and hear this invisible world, he was quick to answer.
\n
\n \u201cIt\u2019s a good question. It\u2019s my intelligence,\u201d he said. \u201cI\u2019m very smart. I\u2019m a mathematician by hobby. I coagulate differences between America and other countries. I understand things about the Mafia and simple daily living.\u201d
\n
\n Packed with allusions, references, random associations and wordplay, Anthony\u2019s answers to my questions were illustrative of schizophrenia with its steady, unfiltered bombardment of information, real and unreal, that he struggles to organize.
\n
\n Listening to him, I came to understand why he is so busy negotiating power with the Maker or occasionally needing to turn in a circle a few times before sitting down: whatever it takes to find a little peace amid the chaos inside and around him.
\n
\n But this is a guess. Schizophrenia is a black box \u2014 no seeing inside \u2014 and although the diagnosis comes with a formal description (\u201cdelusions, hallucinations, disorganized speech, disorganize catatonic behavior, negative symptoms\u201d), what I saw in Anthony in the course of our visits was more familiar: funny, smart, nervous, afraid, embarrassed, perhaps even frustrated.
\n
\n As he waited for his coffee and ate his coconut lemon bar, I wondered what assumptions I would make if I met him for the first time and didn\u2019t know he had schizophrenia.
\n
\n Dispense with the label, and we all fall on a spectrum measuring degrees of mental illness and mental health. Some of us just need more help navigating a world that is scary, complicated and overwhelming.<\/blockquote>\n\n

Meadowbrook and L.A.\u2019s long and conflicted relationship with mental illness<\/h3>\n<\/a>What is the purpose of this sidebar and why did you decide to use it?<\/span>Los Angeles is popularly considered a city without a past, so when I first visited Meadowbrook and stood in the street, taking in this neighborhood, I had to know more about its history. First, the building itself was architecturally unique, and second, the street with its broad sidewalks, parks and curving road was unlike anything I\u2019d seen. So I went into the LA Times morgue and was fascinated with what I soon learned. That the building had served as institution for mental illness going back to the 1920s was a revelation. Equally intriguing was how its relationship with its neighbors precisely mirrored the deinstitutionalization of mentally ill individuals from state hospitals from the 1960s through the 1990s.<\/span><\/span>\n
\n To stand on East Boulevard in West Los Angeles is to get a short history lesson in the city\u2019s conflicted relationship with mental illness.
\n
\n East Boulevard and its companion street, Marcasel Avenue (formerly West Boulevard) form the Mar Vista Oval, one of the region\u2019s first subdivisions. Laid out with broad sidewalks and parkways planted with Canary Island palms, the development was advertised in The Times on New Year\u2019s Day 1912.
\n
\n \u201c\u2026 no better place for a country home…\u201d
\n
\n Visitors to \u201cthe new aristocratic suburb\u201d dubbed Palm Place would have found one home, an architectural bell cow, standing in an empty field. Italianate-Mission in style, boxy with projecting cornice and flat roofline, it belonged to the developer, who in 1925 turned his private villa into a sanitarium and orphanage.
\n
\n At the time, the area \u2014 far enough away from complaining neighbors \u2014 had already begun to attract similar institutions. The St. Erne Sanitarium had opened on the adjacent West Boulevard, and three others nearby specialized in the feared and stigmatized afflictions of tuberculosis, alcoholism and, in the language of the day, insanity.
\n
\n In 1927, the city of Los Angeles annexed Mar Vista, and the city, citing a zoning violation, sought to close these facilities. Their owners were threatened with arrest, but in 1930, a state Court of Appeal blocked the city\u2019s action, finding it discriminatory.
\n
\n Over the decades, the developer\u2019s home has served as an asylum, an orphanage, an \u201cold-folks home,\u201d then in the 1960s, with the construction of an adjoining single-story brick building, the Meadowbrook Manor Nursing Home for men and women with mental illness.
\n
\n The timing was opportune. Lawmakers in Sacramento, eager to close the state-run psychiatric hospitals, had delivered to Gov. Ronald Reagan a sweeping reform package known as the Lanterman-Petris-Short Act.
\n
\n Administrators of those hospitals began to place their patients into smaller, community facilities. The elderly were among the first. Passage of Medicare in 1965 provided a federal revenue stream for treatment of those 65 and older who suffered from diseases such as Parkinson\u2019s and dementia.
\n
\n By the late 1970s, with the creation of another source of federal money \u2014 the Supplemental Security Income benefit for the disabled \u2014 the demographics of these community facilities shifted to younger and more seriously ill patients.
\n
\n Meadowbrook Manor, once an open board-and-care facility, was converted in 1978 to a locked residential home. Neighbors complained. Patients were described in public hearings as getting out, wandering the street, screaming and cursing day and night.
\n
\n The city of Los Angeles once again got involved and tried to restrict Meadowbrook to caring only for convalescing patients or those with \u201cmild\u201d mental conditions, but Meadowbrook\u2019s attorney argued that the 1930 decision protected the facility from this restriction.
\n
\n Neighbors continued their fight. Eventually a new conditional-use permit was written in 2004, establishing stringent rules for monitoring patients.
\n
\n In the midst of these negotiations, the parents of patients at Meadowbrook reminded the city that institutions like this are needed.
\n
\n \u201cMy son has been disturbed for 15 years,\u201d one parent told The Times. \u201cHe was in places like Norwalk, Camarillo. This is the best place for him so far.\u201d
\n
\n \u201cMeadowbrook helps turn these people back into human beings,\u201d said another. \u201cIf [my son] has to go somewhere else, he\u2019ll regress, and then we\u2019ll have to start all over again.\u201d
\n
\n Twenty years later, Meadowbrook Behavioral Health Center, a 77-bed facility, is one of 82 Institutions for Mental Disease throughout the state. The Los Angeles County Department of Mental Health sends patients to 16 of these facilities, which can treat approximately 1,000 patients.
\n
\n The department needs to find room for an estimated 3,000 more.<\/blockquote>\n
\n* * *
\n
\nChip Scanlan <\/em><\/strong>is an award-winning newspaper reporter who taught writing at The Poynter Institute for several years. He lives and writes in St. Petersburg, Florida, publishes\u00a0 <\/em>Chip’s Writing Lessons<\/a> and two new books,”Writers on Writing” and “Thirty-three Ways Not to Screw Up Your Writing.”<\/em>\n\n <\/div>\n <\/div>\n","protected":false},"excerpt":{"rendered":"

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