Today is September 5th.
Exactly 27 years ago today I had a 2 p.m. appointment with a Miami psychiatrist to explore the possibility of starting on antidepressants. It was 1990 and Prozac had been on the market for just three years. Before Prozac, antidepressants had a bad reputation for causing uncomfortable and sometimes serious side effects. Prozac promised relief with little or no discomfort.
I liked the idea of a pill that could cure all my woes. I was unhappy to the point of despair. Talk therapy was doing me no good and I was exhibiting classic symptoms of depression: loss of appetite, insomnia, lack of interest in things that used to give me joy, isolating myself, constant worrying. I was miserable. And I wanted something or someone to help.
But antidepressants for the masses was a new concept. What if taking this Prozac was the equivalent of getting a chemical lobotomy? Would I end up forever altered? I didn’t know anyone on antidepressants, or what was more likely the case, anyone who admitted to being on antidepressants. I was okay with mind-altering substances when taken for occasional recreational purposes (I am, after all, a child of the ’70s), but this was going to change my brain chemistry, perhaps forever. That scared me.
And then there was the stigma. I didn’t want to be labeled a “mental case” and have that label follow me around for the rest of my life. I was a 30-year-old attorney working at a prestigious international trade law firm. Two years before I had been a lawyer for Congress on Capitol Hill, and before that, I had been a lawyer for U.S. Customs. I had worked hard to establish my career and I knew that being diagnosed with any mental illness could affect how my colleagues, and potentially how the Florida Bar, saw me. I might never pass a government security clearance again. And I could kiss any ambitions of running for public office goodbye.
I went to that doctor’s appointment hopeful that I’d finally get some relief, yet full of fear. As it turned out, I was afraid of the wrong thing.
The psychiatrist, who I had seen just once before, asked me if I was suicidal. I told him I was not. He asked again. Again, I told him I was not. Nevertheless, after discussing with him how I WAS feeling (the weight loss, sleeplessness, anxiety), he informed me that he was going to invoke Florida’s Baker Act and have me involuntarily taken by the police to the psychiatric unit of Jackson Memorial Hospital in Miami because, in his opinion, I was a danger to myself. If I wanted to, he said, I could avoid Jackson by voluntarily checking myself into the private and very expensive Charter Hospital of Miami, where he happened to be on staff.
After pleading, arguing, bartering, imploring, and begging him to not do this to me, I acquiesced in defeat. I was beaten. Jackson was not an option. It was an infamous public inner city hospital and the halls of the psych unit would be filled with homeless people, prostitutes, and indigent drug addicts. To avoid being dragged to the hospital by the police, I had a friend pick me up and take me to Charter.
Thus began the saga that eventually would land me at the John Bradshaw Center at Ingleside Hospital in L.A., the subject of the memoir I am currently writing.
If my involuntary stay at Charter hadn’t been so traumatic, it would have been laughable. Even though my time there was just shy of a week, remembering the experience still conjures up feelings of fear, hopelessness, humiliation, and abandonment. There was no therapy to speak of and the good doctor who put me there only came to see me twice for 15 minutes each visit. No one discussed medication or any other treatments with me. I was kept in a locked unit populated by people with severe mental disorders. The coed unit was filled beyond capacity and several people slept on mattresses in the hallways. It felt more like a holding cell than a hospital.
I came to find out that what happened to me was not an isolated event. Throughout the ‘90s, investigative reporters and whistleblowers exposed instances of people being underserved, overcharged, and fraudulently forced into psychiatric hospitals around the country.
In fact, Charter was one of the worst violators. Employees purchased a majority of the company’s stock in 1987 so staff had a vested interest in keeping those beds full. I don’t know if my doctor was a shareholder, but I do know he was a staff psychiatrist who forced me into the hospital when I denied being suicidal, was not acting suicidal, and had no history of attempting suicide. I had great health insurance, and I have records showing that my insurance company was charged exorbitant fees for therapy and other services I never received. But, as I later found out, I got off lucky.
CBS’ 60 Minutes, in 1999, did an expose’ on Charter, entitled “Unsafe Haven: The Inside Story,” presenting evidence of unsafe conditions, falsified records, patient neglect, and patient abuse.
The fraud was extensive. Charter, which had 91 facilities at the time, was the nation’s largest chain of psychiatric hospitals, taking in more than $300 million in taxpayer money annually. That was just the Medicare and Medicaid payments and didn’t include amounts billed to private insurance companies. About 120,000 patients were admitted to Charter every year, about 35,000 of them children and adolescents, many covered by private insurance. The New York Times began reporting on the fraudulent practices of private psych hospitals as early as 1991. (See Paying for Fraud: Mental Hospital Chains Accused of Much Cheating on Insurance.) Charter, specifically, paid out millions following whistleblower lawsuits and federal fraud investigations. Charter filed for bankruptcy in 2000.
It has taken me almost 30 years to come to terms with this experience. I understand what happened and I think I know how it happened. The nagging question has always been, why did it happen?
I’m still working that one out.