Editorials

What Richard Taught Me About Psychiatry


Phillip W. Long, M.D.
June 3, 1999

In Memory of Richard John Whiting (July 28, 1948 - May 17, 1999)

Richard's Life

Richard graduated from the University of British Columbia with a Bachelor of Science in Agriculture in 1971. The next year, he experienced the onset of schizophrenia and had his first psychiatric hospitalization. Over the next 17 years, Richard had nearly yearly psychiatric hospitalizations for schizophrenia.

Despite the severity of his illness, Richard always tried to work. He obtained a teacher's certificate from the University of British Columbia in 1976 and worked for one year as a teacher. Then he completed his Masters in Animal Nutrition in 1983 at the University of British Columbia. Richard then worked for one year as a research assistant in poultry science. Unfortunately, illness prevented his employment for the next four years. Then in 1988 Richard returned to steady employment as a janitor at the Vancouver General Hospital. After a few years, he secured employment as a janitor at a local health care facility where he was permitted to live in his own tiny quarters.

Richard's Religious Beliefs

Richard asked me to be his psychiatrist in 1986. When I first started treating Richard, I asked him: "What gives meaning to your life?" He told me that his religious faith gave him the strength to survive his illness. Richard's faith stressed peace, faith, hope, forgiveness, understanding, and - above all - brotherly love.

Soon after we first met, Richard established a weekly prayer group for people with mental illnesses, called "Easter Friends." A number of my patients attended this prayer group and found great comfort in knowing that others shared both their religious beliefs and their illness experiences.

Richard's Private Crusade

One of Richard's most remarkable gifts was his great empathy. He was deeply moved by the suffering of the homeless mentally ill. Richard couldn't understand how our affluent community would turn its back on the severely mentally ill. I told Richard about the hospital cutbacks and lack of mental health funding, and he pointed to the millions every year that the government wasted.

One winter, Richard took action. He started offering his tiny living quarters as overnight shelter for any homeless, mentally ill person he saw sleeping on the street near his home. Every morning, Richard would quietly slip the homeless person out the back door before anyone could discover his overnight guest. Soon, however, Richard's employer discovered that he was giving overnight shelter to the homeless at his care facility, and Richard was fired. That was the last job that Richard ever held.

A few years later, Richard was diagnosed as having bowel cancer. Knowing that he only had a few months left to live, Richard decided to leave Vancouver and return to live with his mother in Sidney, on Vancouver Island. A few months later, fifteen of his friends and I visited Richard in Sidney. He was the gracious host, and thoughtfully prepared a luncheon for all of our group. At lunch, Richard spoke of his acceptance of his pending death, and of the beauty of life and of friendship. Richard's one major regret was that he was now too weak to do his mental health volunteer work. Richard ended our visit with his favorite prayer, and I left not knowing that I would never see Richard again.

A few months later, at age 50, Richard suddenly died of cancer.

News of Richard's Death

I was attending the annual convention of the American Psychiatric Association in Washington, D.C. when my wife phoned telling me of Richard's death.

Washington D.C. is the capital of the richest and most powerful nation in the world. My hotel was within five blocks of the Convention Center, so I walked to the Convention Center everyday. Every block that I walked had at least one severely mentally ill person sleeping on the street overnight.

During our convention, one homeless elderly gentleman sat for five days on a street bench with his dog faithfully underneath the bench in a little tent the man had fashioned out of tattered cloth. The gentleman was very thin, as was his dog. I tried to give him money, but he said "go away, leave me alone." I quickly remembered what Richard had said, that giving cash to the homeless mentally ill won't solve their problems, that they needed to be cared for and given a home.

It was really quite incredible. Here, in Washington, were ten thousand psychiatrists like myself walking by scores of homeless, severely mentally ill people while we attended our annual psychiatric convention. No one stopped to offer medical assistance to these severely ill people living on the streets.

Outside the Convention Hall, an attractive female psychiatrist tripped and took a bad fall. Immediately, a dozen fellow psychiatrists offered medical assistance. Fortunately the female psychiatrist suffered no injury, and was able to continue on her way. I marveled at how quickly we psychiatrists instinctually respond to a medical emergency. Yet moments before, we had all walked without stopping past scores of homeless, severely mentally ill people camped on the streets.

At this year's psychiatric convention, of the hundreds of research papers given, there was none on the plight of the homeless, severely mentally ill. However, I attended days of lectures on new psychiatric drugs that many of the homeless mentally ill would never be able to afford.

After the Convention, while flying home, I thought of Richard and his death. I remembered that, even when psychotic, Richard would never walk by scores of homeless mentally ill people without trying to help them.

Richard was still teaching me about psychiatry and about life.

Richard's Memorial Service

I returned to Vancouver just in time to attend Richard's Memorial Service. This Memorial Service was held on Vancouver Island, which meant that I had to take a two hour ferry trip. Thirty minutes into the trip, our ferry received a May Day emergency distress call from a sinking small sailboat. By maritime law, our ferry had to respond to this distress call. A nearby ferry going in the opposite direction also responded to this emergency distress call. Each ferry carried at least two thousand passengers, but no one complained about our ships answering this distress call.

Thirty minutes later, the two ferries discovered the sinking sailboat. By this time, the sailboat was being assisted by a Coast Guard ship, a Coast Guard hovercraft, a Coast Guard helicopter, a rescue lifeboat from our ferry, and a private powerboat. Fortunately, the sailboat was saved by the use of emergency pumps from the Coast Guard, and was able to return to port under its own power.

I thought how ironic it was that our maritime law made it mandatory that we assist a sinking vessel, but our mental health law didn't make it mandatory that we assist the homeless, severely mentally ill persons floundering on our streets.

Richard's Memorial Service was beautiful. His congregation held a very loving service celebrating his life. The church was filled with the many friends that he had made during his years of volunteering for various mental health agencies. The Memorial Service ended with Richard's favorite prayer, the prayer that best described the faith that had guided his entire life:

“Lord, make me an instrument of your peace.
Where there is hatred, let me sow love;
Where there is injury, pardon;
Where there is doubt, faith;
Where there is despair, hope;
Where there is darkness, light;
And where there is sadness, joy.”

What Richard Taught Me

It was a privilege to be Richard's psychiatrist. He taught me many things about schizophrenia.

Richard firmly believed that schizophrenia was a medical disorder. That's why it upset him so much that people with schizophrenia weren't offered the same dignity in hospital that medically ill patients were offered.

Richard accepted his diagnosis of schizophrenia. However, it was years before his first psychiatrists ever told him, or his family, his true diagnosis. No wonder then that, in the first years of his illness, Richard would often stop taking his antipsychotic medication. Once he felt better, he believed that medication was no longer required. Somehow, at the beginning of his therapy, we psychiatrists had failed to impress on Richard that schizophrenia was a life-long disease requiring life-long antipsychotic medication.

Richard eventually faithfully stayed on his antipsychotic medication, but it had serious side effects. His earlier antipsychotic medication caused him to become obese and he was never able to lose his initial 40 pound weight gain. However, each time he stopped taking his antipsychotic medication, his crippling psychosis returned. Towards the end of his life, Richard finally accepted that his antipsychotic medication dramatically helped him regain his sanity and his ability to help others.

My own greatest personal failing was not taking up Richard's own personal crusade to help the homeless mentally ill. In the decades that I have been a psychiatrist, I have shirked my responsibility as a physician to take some direct action to help the homeless people that Richard spent his life trying to help. Our modern psychiatric medications in combination with supervised housing and adequate financial support would dramatically benefit the majority of these severely ill individuals.

Richard Wanted To Reform Psychiatry

Richard wanted a few major reforms in psychiatry, and I now agree with him.

Richard wasn't asking too much. He just wanted humane, dignified treatment for people like himself who were struggling with severe mental illness. We owe them this - they are our brothers and sisters.

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