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- The pictures of the year
A mother's journey with mental illness
Stephanie Escamilla admits there were days when she wished she could
just give her son away. She's ashamed of that now, but realizes she's
only human. FULL STORY
He is 14 and hears voices. He's
been hospitalized more than 20 times. Stephanie Escamilla is tired of
seeing the country focus on the mentally ill only when there's a
national tragedy. So she and her son are telling their story — of a
family on the brink.
By Wayne Drash
Video and photography by Evelio Contreras
Video and photography by Evelio Contreras
San Antonio, Texas (CNN)
The boy wears SpongeBob pajamas and sits up in bed, a blanket draped over his shoulders. In his right hand he holds a rosary.
"Please, please, please help me," he whimpers.
Imaginary voices bark at him. "Go away," he tells them. "Go away! Go away!"
He screams for his mother: "They're making me have these bad thoughts."
Stephanie Escamilla is videotaping her son
Daniel. He is 10. Nobody believes her when she says he hears voices.
This tape will be her proof.
When the voices come, they tell Daniel to
kill his brother, his mother and himself. Sometimes he turns the TV on
full blast to drown out their commands. Or sprinkles holy water around
his bed.
As the camera rolls, Stephanie calls
psychiatric hospitals near her home in San Antonio. Repeatedly she is
turned down. Nothing can be done for her son, she is told, unless "he is
a danger to himself or others." It is December 2009, and Daniel's
hallucinations last more than two hours.
See Stephanie and Daniel tell their powerful story
The 11th Hour
Wednesday at 11 p.m. ET
Wednesday at 11 p.m. ET
Sanjay Gupta MD
Saturday at 4:30 p.m. ET
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Sunday at 7:30 a.m. ET
See more from CNN Parents
Daniel is 14 now, and his mother no longer
needs to convince doctors that he is mentally ill. He suffers from
bipolar disorder with psychosis. In the past four years, he has been
hospitalized more than 20 times.
But a diagnosis merely marks a beginning.
Raising a child with mental illness is "a roller-coaster ride through
hell," Stephanie says. She is engaged in an epic battle on multiple
fronts.
What if Daniel has an outburst in public and
is misunderstood? What if he succumbs to the voices? How can she help
Daniel find joy?
And what about the rest of her family? They need her, too.
With broad shoulders and a thick frame,
Stephanie looks the part of a worthy combatant and strong advocate. It
wasn't always this way. She was a single mother with self-doubt, quick
to blame herself for Daniel's plight.
Imagine what it's like for a mother to watch
her son suffer – the little boy who sang and danced to Michael Jackson
tunes, who tossed the baseball out back, who she dreamed would become a
doctor.
Think how painful it is to hear him say nearly every day that he wants to kill himself.
Stephanie's fight is literally one of life
and death – a desperate attempt to win back her son from the mental
illness trying to consume him.
She'll do whatever it takes to save Daniel.
One family's experience
The Navy Yard.
Newtown.
Aurora.
Tucson.
Virginia Tech.
The only time mental illness dominates the
national conversation is when something goes tragically wrong. But the
dialogue doesn't last. It gets buried under arguments about gun control,
video game violence and unheeded signs of trouble -- until there's yet
another mass shooting.
When Daniel feels he might have an episode of psychosis,
he goes outside to ease his anxiety and to make sure he is not around
his siblings.
"What we always say is we had the tragedies
in Arizona, Colorado, Connecticut and Virginia," says Mike Fitzpatrick,
executive director of the National Alliance on Mental Illness, "but
there are smaller tragedies that happen every day in this country
because people are untreated for mental illness. And they end up in
jails, in homeless shelters – and families are torn apart."
Those small, quiet tragedies don't usually
make headlines. The 75 million American families touched by mental
illness, like Stephanie Escamilla's, largely deal with it in private.
Every day.
It frays bonds, breaks up marriages. It steals hope.
People don't ask how to help boys like Daniel.
It takes a James Holmes to grab the nation's attention. A Jared Loughner. An Adam Lanza.
Something has to be done about America's mentally ill.
That refrain emerged stronger than ever last
December after the mass shooting at Sandy Hook Elementary in Newtown,
Connecticut. Never mind that no one knew whether it was mental illness
that drove Lanza. He killed 26 people, including 20 children. Wasn't
that the definition of madness?
I covered the tragedy in Newtown the week
after the massacre and returned there a few times in the months that
followed. A shuttered mental hospital overlooks the idyllic New England
town; just down the hill sits a high-security prison housing the
criminally insane. Standing there, I wondered about the state of our
mental health system.
I later learned the scope of the problem:
More than 60 million adults and about 15 million children in America
suffer some form of mental disorder. That's one in every four adults,
one in five children. Far fewer live with a serious mental illness, such
as schizophrenia, bipolar disorder or severe depression, but the
numbers are still large: 13.6 million adults and about 2 million
children.
The mass shootings that shine a spotlight on
mental illness actually stigmatize those who suffer with it. The vast
majority, advocates point out, are far more likely to be the victims of
violence – they often get beat up or bullied -- than to commit a violent
act.
What if the issue could be seen through the
prism of an average American family – not just through the lens of a
national tragedy? What could be learned from people who deal with the
day-to-day reality of mental illness?
I asked the largest nonprofit mental health
advocacy group, the National Alliance on Mental Illness, to spread the
word of my interest in telling that story. I recognized the hurdles. A
family would open itself to scrutiny and, possibly, judgment – on top of
everything else it faces.
"It is a risk factor for a marriage, for a
family, to have a seriously ill child," says Ken Duckworth, medical
director for the National Alliance on Mental Illness.
Even for families who have resources and do
everything right, it can take years to find the proper care, he says.
But people who get that help can stabilize – and function in the world.
Duckworth cautions against drawing
conclusions about the paths of children or teens with mental illness.
"One person who loves you," he says, "can make all the difference."
Stephanie Escamilla believes that. She also
believes complete strangers could make a difference if only they
understood. That motivates her to try to teach people about what it's
like to walk in her son's shoes. A board member of the San Antonio
chapter of the National Alliance on Mental Illness, she welcomed CNN
into her home beginning in June. In the months that followed, I
witnessed her resolve to change the path of a 14-year-old boy
oscillating between the trials of adolescence and the anguish of mental
illness.
It's not just her fight, or Daniel's. It
touches the entire family. Stephanie, 37, and her fiancé, Jose Farias,
33, are raising three other children, ranging in age from 7 to 10, in
their merged household. Also living with the family is Stephanie's
mother, who has brain cancer.
Stephanie and Jose asked that CNN refer to
their oldest son as Daniel; that is not his real name, and his last name
is different from theirs. They also asked that CNN photograph him in a
way that keeps his face hidden. Many in his hometown know Daniel has a
mental illness, but the family didn't want that label to extend to the
Internet, where it could dog him when he seeks a job or applies to
college.
If his illness has taught them anything, it's that people judge.
But Stephanie and Jose – and, indeed, Daniel –
are willing to take that risk. By telling their story, they hope to
help others raising a mentally ill child and shed light on mental
illness for those who remain clueless.
Stephanie included Daniel in the decision to lay their lives bare.
"I'm going through a lot of stress and a lot
of things that no kid should see, no kid should hear – and things you
shouldn't do," he told me. "I just don't want anybody else to go through
that."
If it's true that one person who loves you
can change your outlook, that force in Daniel's life is his mother.
Stephanie hasn't sold out her son's dreams. She believes he can
accomplish whatever he sets out to do.
Yet she worries for his future: Will people
accept him? Will he adapt to the world around him? Will he someday live
under a bridge?
'I thought I hated my son'
The lights go dim. Stephanie stands at the
podium and shows a photograph of Daniel looking dapper with deep brown
eyes, trimmed brown hair and a broad smile. It's a recent picture. The
next one shows him at 6 months, dressed in a Dallas Cowboys bib and
winter cap.
"You would never know that he was going to
have a mental illness," she tells the crowd. "I mean, does he look like
he has one there?"
Seventeen cadets being trained to work in the
Bexar County jail system sit in the audience and shake their heads.
Several blurt out: "No."
"He was a baby," she says. "He was awesome. He was always happy."
On the day Daniel was born -- January 29,
1999 -- Stephanie eyed his tiny frame, all 5 pounds and 15 ounces, and
marveled at how delicate he was. She felt a bond that touched her soul.
She dreamed he would become a doctor, or join the military to explore
the world. She was 23 and single.
Raising a child alone, she knew, would not be
easy. She promised her son one thing: I will always take care of you,
no matter how hard it gets.
The PowerPoint presentation moves to the next
slide. This one, titled "Many Hospitalizations Thereafter," is jarring.
It shows the dates of Daniel's hospitalizations:
-- 03/25/09
-- 12/11/09
-- 03/26/10
-- 04/29/10 ...
-- 03/25/09
-- 12/11/09
-- 03/26/10
-- 04/29/10 ...
On and on, the list goes: 17 in all. She tells the cadets the slide isn't up to date – the hospitalizations now number about 20.
"It is a roller-coaster ride," Stephanie
says. "I don't know if any of you guys have anybody in the family that
have mental illness or have dealt with anybody with mental illness, but
it is a ride that no one wants to take."
Stephanie moved from the rural town of
Uvalde, Texas, to San Antonio to gain better access to mental health
treatment. She took an overnight job at a hospital so she could be
around during the day for her son. She works in a tuberculosis ward and
once was a 911 dispatcher.
Those experiences gave her another view of
the mentally ill – from medical and law enforcement perspectives. She
realized she could help her son by educating others.
Two years ago, she did her first session for
the Bexar County Sheriff's Office, which puts its personnel through
mandatory crisis intervention training aimed at teaching the best ways
to deal with the mentally ill.
The goal is to "de-escalate a situation and
get people the help they need before going hands on and taking them to
jail," says Cpl. Shannon Lunski, who helps lead the program. For these
cadets, Stephanie puts a face on the struggle.
She tells them about her long and frustrating
journey: Daniel was diagnosed with ADHD at age 6, his first manic
meltdown came at 10, hospitals kept refusing to admit him "because he
had not hurt himself and he had not hurt anybody, and he didn't have a
plan" to act – the legal threshold required for hospital admittance.
She plays a video of Daniel enduring an
episode of psychosis from May 1 of this year. His legs and arms shake
while he sits on a picnic table in the backyard. He places his head
between his knees. Then, he stands and paces. He swats the air. His head
darts back and forth, as if trying to shake the demons he sees and
hears.
"This doesn't happen all the time," she says.
"It happens when he has something really stressful going on at school
or he has a cycle. Sometimes, the cycle comes every two months;
sometimes they're more frequent. I'm happy when they're gone for five
months, but that hasn't happened for a while."
Stephanie's voice trembles. Some of the
cadets cry. "You guys are my psychotherapists," she tells them. "Not a
lot of people want to sit and hear you talk about mental illness."
She admits there were days when she wished
she could just give her son away. She's ashamed of that thought now, but
realizes she's only human.
She turned her sorrow into action when she
finally accepted Daniel's illness. It took time, and came only after she
realized his condition was getting worse.
She had an epiphany.
"I thought I hated my son," she says. "But then I realized it wasn't him that I hated. It was his bipolar disorder."
Stephanie Escamilla became an advocate for those with mental illness after her son's condition worsened.
She implores the cadets to show compassion when they arrive at a scene involving a disruptive child.
"You're going to be walking up, and what's going to be your first reaction?" she asks.
"It's a kid acting bad," one cadet says.
"You're going to be judgmental, right? Is that actually how you should approach that?"
The cadet shakes his head.
Think of families like hers, she tells them.
"Put yourselves in their shoes. You have officers come into your house,
would you want them to judge you?
"I tell you this because you're going to come
across homeless people like that, who are schizophrenic, who have not
been on meds and are hearing voices," she says. "Calm them down, talk to
them. Tell them: 'It's just a voice. The voice isn't going to hurt
you.'"
That's what she hopes someone would do for her son.
The diagnosis: 'I was really, really scared'
The boy just needs a good spanking.
Daniel needs a proper male role model.
You're a bad mother.
Stephanie has heard it all. Her mother, three
sisters and brother abandoned her when Daniel was first diagnosed. They
didn't believe Stephanie. There had to be another reason for his
behavior.
Friends told her, please, don't talk about mental illness around the children. But word leaked out. Kids taunted Daniel.
Hey, stupid! You're mental!
Once, Daniel was beaten by an acquaintance
while a friend shot video that was later posted on YouTube. It showed
Daniel getting punched in the face, then falling to the ground and being
kicked.
Some friends shunned Daniel and his mom. The phrase "mental illness" was met with fear, disbelief, prejudice, ignorance.
Stephanie herself had not understood the
early signs. At age 6, Daniel complained he heard voices. She downplayed
it. She told herself the walls were paper thin, that he was hearing
conversations throughout the home.
Then, everything changed.
On a fishing trip one weekend in March 2009,
Stephanie watched as Daniel pushed their lunch supplies, one by one, off
the top of a picnic table. Chips, cups, napkins. When she scolded him,
he apologized: I'm sorry. I'm just clumsy.
He kept the real reason to himself: Voices
urged him to shove his 3-year-old brother into the lake so he would
drown. Daniel pushed stuff off the table instead; it was his way of
deflecting the voices, of keeping his brother safe.
At school the following Monday, Daniel's
hallucinations intensified. He stabbed himself in the head with a pencil
because he was having more thoughts about hurting his brother. Finally,
he confided in his teacher. Only then did his mother learn the truth.
Mom, I have been having thoughts of wanting to hurt my brother, he told her, but don't worry, I don't want to harm him.
Stephanie shifted into overdrive. She stayed
home to monitor Daniel's behavior. She began trying to get him admitted
to a hospital for evaluation. It took five days but she succeeded. On
March 25, 2009, she went with him to Southwest Mental Health Center.
"I had never seen anything like I did that night," Stephanie recalls.
Daniel's mood changed every second. He was
happy, sitting next to his mother. Then, suddenly, he was under a table,
clinging to a leg and crying. He ran around the room, announced he
could fly. Then he stopped and looked at his mother: Mom, did you know I can see through doors?
To Daniel, all of it was real.
"Patient reports he started hearing voices
within the last week that he describes as multiple voices, mainly
telling him to hurt his brother and specifically to stab him with a
sharp object," the hospital evaluation said. "Also telling him to hurt
self. Prevents acting on these commands by hurting self or doing things
with other objects."
Daniel was hospitalized for two weeks. His diagnosis: type 1 bipolar disorder, compounded by episodes of psychosis.
Daniel takes five different medications to try to regulate his mood swings. Among the pills is lithium for his bipolar disorder.
Stephanie went to Barnes & Noble and
bought nearly every book they had on bipolar disorder. She learned to
understand what she had witnessed. Daniel's impulsive urges, his sudden
bursts of energy fit the description of mania; his extreme lows matched
the depression that accompanies bipolar disorder. The voices and visions
her son described met the definition for psychosis.
Stephanie also grappled with something the
hospital report hinted at: Guilt that her recent divorce from Daniel's
stepfather had scarred a boy who'd never known his own father.
Daniel suffered from a lack of self-esteem,
and he was "likely to feel he lacks control and things happen to him,"
the report said. "This could be influenced by the early 'loss' of his
biological father and more recently the reported relational loss with
his stepfather."
Stephanie renewed the pledge she'd made to
her son on the day he was born. "Daniel will never know how
heartbreaking it was to watch him spiral up and down in a matter of
seconds," she wrote in her journal, "but he will know that no matter how
hard it gets, I will always be there to pick him up."
Her son understood for the first time that he
suffered from mental illness. "I can tell you how I felt," Daniel says.
"I was really, really scared."
That year, Stephanie took the summer off to
spend time with her boys. She bonded with them over fishing. "I was the
only mom out there," she says. The other boys all had their fathers in
tow. Stephanie brags: "We caught more fish than anyone else."
But by year's end, Daniel was in the
hospital again. His episodes changed with every medication regimen. Drug
combinations that were meant to control his state of mind seemed only
to make his condition worse.
The frequency of hospitalizations soon picked up.
The year 2010 was marked by four, and in 2011 there were five, including a 90-day court-ordered commitment.
That was one of the toughest for Stephanie. The doctor suggested that route because outpatient therapy wasn't working.
Agreeing to a court commitment meant a loss of control. He'd be away for three months minimum.
In a way, she felt relief. Her son was where
he needed to be, getting professional care, and she had time to breathe.
She recalibrated and devised a long-term plan for Daniel. She taught a
class for medical assistants at a local trade school and continued
working full-time.
But she couldn't help but wonder: Am I doing the right thing?
She visited Daniel every day for the first two weeks. She fretted the staff would deem her a bad mother if she didn't show up.
But the visits were awful. Daniel hurled
insults at her, said he hated her. Once, he threw a chair at her during a
family session. He accused her of wanting to get rid of him. Every
time, she left the hospital more miserable than when she entered. "I
dreaded going there instead of being happy to see him."
She dubbed the stroll from the hospital to her car in the parking lot "the walk of shame."
It didn't help that her siblings weren't
supporting her. They thought she exaggerated Daniel's problems.
Initially, so did Jose.They met at the trade school, where Jose was
teaching, too. Stephanie told him up front about her son's illness.
If you want to run, she said, go right ahead.
They've been together two years now.
When a child suffers from an "invisible"
illness, Jose says, "You just have a hard time accepting that there's
something wrong."
"Once I understood better," he says, "that's when it got easier."
But he adds, "I don't think everyone can do it."
Jose runs his own air conditioning business
and can rush home when needed. He has filled a void in Daniel's life.
The first hospitalization occurred exactly one year after Daniel's
stepfather left. And every year since, that anniversary has triggered an
episode resulting in hospitalization.
It's taken time to build trust, but Daniel now calls Jose "Dad."
Not only has Jose not turned and run, but he
embraces the messy life of raising a teenager, one who happens to be
mentally ill. Many people, he says, don't view those with mental illness
as human; they're freaks, crazies, even monsters. Other people, Jose
says, have this Hollywood vision of mental illness: It's difficult but
then -- ta-da -- everything is fine.
"The reality is people have to live with it
for a lifetime," he says. "The illness doesn't end when the credits
roll. If you don't have the resolve or the stamina to handle it, you're
in a lot of trouble."
In real life, the script gets ripped up.
A suicide attempt, and understanding
On a day in late June, Uncle Joe's
custom-made barbecue pit, complete with a bottle opener the shape of
Texas, covers Stephanie's front lawn. Three massive smokers house a
Texas-sized feast: 80 pounds of brisket, platters of sausage links, nine
dozen ears of corn, and heaps of barbecued cabbage.
More than 100 relatives mingle in and around
Stephanie's house to celebrate the 63rd birthday of her mother, Rosa.
It's as much a goodbye party as it is a birthday celebration. Rosa's
cancer is progressing.
Daniel’s family attends a Catholic healing mass for his grandmother, Rosa, who is battling brain cancer.
The family lives in a modest four-bedroom
ranch in a working-class neighborhood in suburban San Antonio.
Stephanie's living room has four framed photographs on the wall,
including one of the children with this motto:
"Family: Other things may change us, but we begin and end as a family."
Outside, the children play on an inflatable
water slide. Relatives scarf up the food at tables covered with floral
prints. When supper is done, everyone's attention turns to a television
set on the patio. Images of a vibrant Rosa with her daughters and son
flash across the screen. Rosa sits nearby but is too weak to say much.
She waves to everyone and thanks them for their love.
Laughter fills the backyard. Tears roll down faces, too.
Among those captivated by the display is Daniel.
He almost left the family nine months
earlier. That's when he tried to kill himself. He'd gotten into an
argument with his mother about breaking curfew. She said he could no
longer be trusted. His response: Gulping down every pill he could get
his hands on.
Stephanie and Jose rushed him to the hospital. It took 10 men in the emergency room to hold Daniel down. Let me die! he screamed.
The suicide attempt turned the tide for Stephanie's family.
Her mother and sisters could no longer ignore
the severity of his illness. At the hospital, everyone wept except for
one person: Stephanie. "I didn't want him to see me break, because if I
broke down it would make his situation a lot worse."
On this night, after guests leave,
Stephanie's sisters talk about their guilt for abandoning her and their
ignorance of mental illness.
Lamar Enriquez is the oldest sister and knows
the pain of a loved one going untreated. Her husband of 13 years shot
himself in the head last year. "That's what scares me about Daniel," she
cries, "because he's only 14. I wouldn't want my sister to go through
what I went through."
Mari De La Cerda had an awakening after
Daniel twice went into psychosis while she was babysitting. "When it
happened, it was scary. Very scary, because I didn't know what was going
through his mind.
"I don't know how my sister handles it," she says. "But we're here for her. Now, we totally understand."
Adds Chel Ruiz, Stephanie's youngest sister:
"You have to reach that point and realize and accept that he does have a
problem. That's the hardest part."
The most striking story comes from a family
friend. His 11-year-old son told Daniel he planned to hang himself
because his mother left home.
Don't do it. You've got people who love you, Daniel told him. I love you and your daddy loves you.
The father fights back tears. "I thank God for him being my son's friend," he says. "The way I look at it, Daniel is an angel."
'I see demons flying everywhere'
Above Daniel's bed hang a crucifix, a drawing
of him swinging a baseball bat and a postcard from New York City. A
hand-written banner for his favorite television show scrawls across the
room. "The Walking Dead," it says.
Clothes overflow drawers. Five baseball mitts
sit in a carton on top of books and accumulated junk. Neatness isn't
Daniel's strong suit.
In that way – and others -- he's like most
teens. His passions are music, dancing, basketball, video games. Martial
arts is one of his favorite activities – it helps channel his thoughts
in a positive fashion. He hopes to become a UFC fighter one day.
Daniel also knows he's different from most other teens -- in a big way.
"I've seen like bodies on the floor when
they're not even there," he says. "If I look up in the sky and I'm
outside, it's like everything's just dark, like the sky is red and I see
demons flying everywhere.
"When I hear voices, it's hard to like deal with it because you're going crazy, because you don't know what to do."
His mental illness is a terrible thing, he
says, not just for him but his whole family. "I hate when it happens.
Like I hate it. I hate it," he says. "I don't like having a mental
illness because it hurts my mom, it hurts my brother and it hurts my
dad. It's just, I don't like it."
He's afraid he will have to deal with the
hallucinations for the rest of his life, because "I should be growing
out of it by now."
He doesn't want to harm people. He averts his
anxiety by running around the neighborhood, pacing in the backyard and
cutting his arm, which brings relief. He punches walls and kicks the
fence out back so as not to carry out the voices' commands.
Daniel dislikes going to the hospital, "but I have to get stable," he says.
"It's better than hurting someone."
Daniel and his youngest brother play together in the
family SUV. Daniel doesn’t like having his sibilings see his episodes.
“I hate it,” he says.
Five medications attempt to regulate his mood swings, control his anxiety, tamp down the episodes of psychosis.
The family takes safety precautions. Guns are
no longer kept in the house. Sharp knives are out of reach. Stephanie
sent her youngest son to live with his father for a year while she got
Daniel treatment. Now, with four children in the home, Daniel is not
left alone with the others. That requires extensive planning and
coordination.
Daniel's psychiatrist, Corey Hough, works with him to pinpoint what exactly causes his anxiety and triggers his episodes.
"One of our big goals is to get him to
identify when he's heading that direction, rather than wait until he's
already there and already feeling like he wants to hurt himself," says
Hough, a psychiatrist at the Clarity Child Guidance Center, the facility
where Daniel has been hospitalized the most.
Daniel's suicide attempt was a cry for help,
he says. "When you have individuals with bipolar and they have an
elevated mood and they're manic, they're very impulsive and reckless,"
he says. "Something doesn't go their way, and they'll go and drink a
bottle of pills. They don't really put any thought into it – and that's a
very risky situation and that's something Daniel has done."
School acts as his biggest stressor. Daniel worries about fitting in. He struggles to concentrate.
The start of the school year might bring
anxiety to any kid, Hough says, but for Daniel it means he worries about
it constantly. "It takes over a significant part of his day, just
thinking about what's going to happen," Hough says.
He describes Daniel as a "very sweet kid" who
is outgoing, friendly and personable. Most people with mental illness
deny they have a problem. The fact Daniel not only recognizes his wild
mood swings, but is also "very willing to discuss what's going on,"
signifies a major step toward getting better.
"To have to deal with some of the things he
has to deal with – the hallucinations, the thoughts of hurting himself,
the anxiety – none of those are pleasant feelings. And he's done a very
good job of articulating how he's feeling and communicating to myself
and his mom and to his family of what's going on."
What about his thoughts of harming siblings?
Hough explains it is "more of a control thing."
"Fantasizing in his head of hurting people
that piss him off helps make him feel better. It's not that he wants to
do it; he doesn't. It's his way of sort of coping with it and coping
with the moment."
What pushes a person across that edge, to act
on the voices' commands, remains the great unknown in psychiatry. "I
don't have a crystal ball," Hough says. "I can't say for sure what
happens when a patient leaves my office."
The protocol is to err on the side of
caution. A family must take measures around the home, and the
psychiatrist must recognize when hospitalization is needed.
Hough remains optimistic for Daniel. If Hough
can help him better identify the triggers and minimize his medication,
there will be success.
"I want to get him through high school," he says. "I'd like for him to go on and do what he'd like to do."
But that will take time.
'I'm going to hurt them, Mom'
Stephanie is resting in bed ahead of her overnight shift on a Friday night in August when Daniel walks in.
Two of his siblings have been teasing him. A
rage is building inside, he says. Stephanie tells Daniel to take some
melatonin to take the edge off his anxiety.
He leaves the room, takes the medicine but soon returns.
This time is different. A dead serious look
spreads across his face, and his pupils are dilated. Stephanie has never
seen her boy like this.
I'm going to hurt them, Mom, he says.
Stephanie springs from bed.
Well, baby, let's go to the hospital.
She gathers her stuff and calls the Laurel
Ridge Treatment Center, the closest hospital to the family's home. Bring
him as soon as possible, she's told. She hops into the family SUV.
Daniel gets in the passenger seat.
It's only the second time she's driven him to
the hospital by herself during an episode. She keeps an eye on the road
and one eye on her boy. He sits quietly in the front seat, but it's
clear he's still agitated.
She finally engages.
You had thoughts of hurting the kids. Do you still have those feelings?
Actually I still do, he says.
The drive becomes a blur.
Four days later, Stephanie returns to the
hospital for a family session with Daniel and his counselor. But first
she meets with the counselor alone. She speaks of her stress – caring
for her dying mother, trying to help her son, making ends meet.
The counselor reassures her that's enough pressure to make anyone implode.
"That's a lot to go through," the counselor
says. "You're not getting a break at all. You're go, go, go. You have to
be on 24/7. And it's like to the point of, 'Who is taking care of
you?'"
Stephanie utters: "Uh-huh."
"That has to be frustrating. I know it is," the counselor says.
Stephanie bursts into tears.
The counselor stresses the positive – that
Daniel is keenly aware of the things going on with him and that he seeks
his mother's help when he can't handle his thoughts. Not too many
children, especially those with mental illness, have that type of
relationship with a parent.
"You know, if you find any encouragement in the fact you're doing a great job with Daniel, he's a great kid."
Daniel enters the room and first explains what happened with the most recent episode.
"I guess I was mad that the kids were home because of the way they treat me."
How do they treat you?
"Well, they treat me like I'm stupid and then
they just do every little thing to bother me. They bring me into their
arguments, when I don't want to be in their arguments."
As he speaks, Stephanie cries.
"Are you OK?" he asks his mom.
"Yeah," she says.
Stephanie tells the counselor that she and
Jose have spoken with the children about the need to go easy on Daniel –
that normal sibling spats can easily get overblown. The family will
need to address it further.
"We can try it," Daniel says, "but honestly I don't think it will work."
Mother and son then have a heart-to-heart. She begins with the news she's received while he's been in the hospital.
"First of all, you passed into the eighth grade," she says.
"Aww, I did. Yes!"
"I'm just worried about you starting a new
grade," she continues, "and getting frustrated so easily with the work
and it being stressful at home. So we need to figure out how you're
going to be able to have a normal school life."
"I know I've said this before," Daniel says,
"but I know I didn't try last year. But I'm kind of tired of that, too.
Honestly, it's like since I came here, I've realized a lot of things.
I've gotten mad over stupid crap.
"I want it to stop."
"It only stops when it comes from you," his mother says. "You are the one that has to initiate stopping it."
"Yeah, that's what I'm going to do," Daniel
says. "I'm going to try to stop, and I'm going to try to work harder,
like the hardest I've ever done before, which is nothing actually."
The counselor advises him to draw up an action plan, and Daniel agrees. Stephanie bids farewell to her son.
Leaving Daniel behind in the hospital is no longer a walk of shame. It's become part of the healing process.
'He's not trying to be mean to you'
The day Daniel comes home, Stephanie and Jose
call a family meeting. First they talk with Daniel at the table before
calling the other three children into the room.
It's a tricky conversation. Jose and
Stephanie try to shield Daniel's siblings from the severity of their
brother's illness. They don't want them to know everything because then
they will be afraid of him.
"We have to figure out ways to discourage
behavior" that sets Daniel off, Stephanie told me the day before,
"without saying, 'You drive Daniel crazy.'"
Stephanie sits at the head of the table with
Daniel at the far end, Jose next to him. The other three children take
up their seats. Then, Jose begins.
"The certain comments you make, the certain things you say," Jose says. "You guys can't do it anymore."
They've had this conversation before and it must end now, Jose says.
"When he says, 'Don't touch me,' don't touch
him," Stephanie says. "When he tells you, 'Get out of my room,' you need
to just get out of his room. OK?
"He's not trying to be mean to you. He's not
trying to be rude. It's just sometimes he doesn't feel well. OK? It's
not your fault. It's no one's fault. Sometimes, he just has a bad day
and he's not in the mood to be picked on."
Jose: "The thing is you take it to a point
where you don't realize how upsetting that is, especially to Daniel. You
may get upset, but it's not as bad as Daniel gets."
"There's a difference," Stephanie says.
Jose: "And it has to do a lot with the way
Daniel thinks. You doing that to another person – it's still not right,
but it has far less of an effect on that person than it does Daniel."
The three siblings remain quiet.
Earlier, Daniel told his parents the other
children hate him. "That's how he feels. He really feels you guys don't
like him," Stephanie says.
"We can't have that anymore," adds Jose. "Do you guys get it? Are we going to have this conversation again?'"
One of his brothers interjects. "But Daniel has told me he hated me."
"No, I haven't," snaps Daniel.
"Yes, you have."
"I'm not going to get in an argument," Daniel responds. "I'm not going to even argue."
He tosses his hands in the air and then puts
them down. Daniel doesn't like having an episode in front of his
siblings. He looks for ways to divert his thoughts, and it's clear he's
trying to contain his agitation.
Stephanie works to calm him. "If that's the case, then I think you guys all should apologize to each other."
Daniel stands up and walks into the kitchen.
"And let bygones be bygones and start fresh," Stephanie continues.
Daniel heads toward the front door.
"Daniel!" Stephanie screams.
The door slams. Daniel is gone.
"You have to understand that you're not
better than anybody else," Jose tells the kids. "That's the biggest
thing: We always try to take very good care of you guys. Don't make
anybody feel bad. Don't make anybody feel that they're not as good as
you."
The meeting is already over when Daniel returns 10 minutes later. But worry will occupy Stephanie the rest of the night.
"If we're asleep and he does something, you know, that's just one of my fears," she says.
"I've never had that fear as bad as I have it now because he's getting older, bigger, stronger."
Another night, another episode
Ten minutes to go, then it's sangria and flamenco dancing.
The white Chevy Suburban eases to a halt at a
stoplight. It's been a long day – a Catholic healing Mass for
Stephanie's mother followed by dinner with cousins at a Mexican
restaurant. Stephanie and Jose are nearing a long-awaited night on the
town.
School starts in two days and already stress
is building in the household. "I need to get out," Stephanie said at the
start of the evening.
Daniel paces the backyard during an episode of psychosis
in August. His mother tries to distract him from the voices he hears.
She knows if the episode isn’t brought under control within about 20
minutes, it can last hours – perhaps even days.
The couple has deposited Jose's two children
with grandparents. Stephanie's other son is with his biological father. A
sitter is lined up for Daniel. All they have to do is drop him off at
home.
The SUV lurches forward.
From the back seat, Daniel calls for his mother. "I think I need my pills," he says.
Stephanie perks up. They're almost home, she
says, and he can take his medicine as soon as he walks through the door.
The family outing took hours longer than expected. Stephanie didn't
bring his nighttime dose.
Daniel's tone turns almost shrill. "I need them now."
Jose floors it. The Suburban hurtles down the highway – 65 mph, 70, 75.
The couple have been through this drill
before. They know it's key to distract Daniel from the voices he hears.
Jose asks him about the priest's sermon on the strength needed to reach
heaven.
"How do you get there?" Stephanie asks.
"You get there ... " Daniel places his hands on his head. "I don't know."
"My stomach hurts and my head hurts," he says. "I'm dizzy and everything's blurry."
"You've been in the car a little too long," Stephanie says.
"We're almost home," Jose says. "My head hurts, too. Less than 10 minutes away."
Stephanie: "What are you hearing?"
"Just some weird voice," Daniel says. "It
just sounds weird. It doesn't sound like what I used to hear. It's just
really, really different."
"Just remember who is in control, right?" Stephanie says.
"Yeah, I know, but it's just like I've never
heard this before," Daniel says, his voice rising. "It's creepy. It's
different. I can't get it out of my head. The VOICE!"
Jose whips in and out of traffic. He glances from the road to the rearview mirror.
Daniel grimaces and begins talking in a
strained tone. The demons are showing him something. "It's a picture of
an arm with cuts on it."
"Just take a deep breath," Stephanie says. "Just remember, you're the one in control."
The boy moans.
"Are you all right?" Stephanie says.
"I don't know," Daniel whines.
How to help
See where to turn for help with mental illness in children, and find more mental health resources at Impact Your World.
"We've gone through too many of these things," Stephanie says, "and every time you're all right. Right?"
"Yeah," he says.
Silence consumes the vehicle for 20 seconds. Then, Daniel screams.
"I'm seeing things." His voice is hesitant, almost hushed with worry.
"OK," his mom says. "What are you seeing?"
"I looked out the window, and I saw a face pop up."
Daniel curls into a fetal ball.
Moments later, Jose cuts the SUV down a side
street, hooks a left and pulls up to the house. The truck comes to a
halt in the family's front yard. The three jump out as if the vehicle is
on fire.
They have about 20 minutes to calm him, or the episode will last a couple of hours, perhaps even days.
Stephanie ushers Daniel through the front
door, into the living room, and onto the patio. Daniel sits in a rocking
chair. He sways back and forth, his legs and arms fidgety. "There's
things all around," he says.
Stephanie tries to soothe him, gives him his medication. "What do you think triggered it?"
"I don't know," he says.
"Do you want to walk around for a little bit?"
He rushes from the chair and paces in the
backyard. "I'm just trying to make it go away," he says. "It's weird.
It's like a conversation's going on."
He plops down at a picnic table. A neighbor's
dog barks from behind a wooden fence. Daniel douses his head with a
bottle of water. Stephanie and Jose ask him about a summer reading book,
"Moby Dick," to get him to think about something else – anything else.
"What do you remember?" Stephanie says.
"What they have is an old man who wanted revenge," Daniel says. "All he had was hate."
"OK," Jose says.
"Who'd he have hate towards?" Stephanie asks.
"Moby Dick, just because he took his leg off."
"Who's Moby Dick?" Stephanie says.
"The whale."
It's a little past 10 p.m., and the
temperature hangs in the 90s, the Texas heat adding to the intensity of
the moment. A few minutes pass, the medication kicks in and Daniel's
mood eases. He heads inside to bed.
Stephanie and Jose sigh. They've conquered
this episode just in time, right around the 20-minute mark. But they're
exhausted, exasperated. Stephanie's word is traumatized.
"It takes a lot out of you," Jose says.
Stephanie: "Yeah."
Jose: "Even when it's simple like that."
Just as Ahab's quest for the great white whale seemed futile at times, so does the family's quest for normalcy.
There will be no sangria or flamenco dancing tonight.
Epilogue
Daniel began eighth grade two days later, on
Monday, August 26. By the end of that week, anxiety overwhelmed him. He
went back into the hospital for a six-day stay.
But Daniel didn't give up on school. He returned to class.
Good news came with Daniel's midterm report
card in October. He received passing grades in all but one subject for
the first time since fourth grade.
The marks reflect Daniel's resolve, and that
buoys his mother. The report card, Stephanie says, is a "huge
accomplishment in our own mental health world."
Pilots, not computers, should fly planes
December 11, 2013 -- Updated 1806 GMT (0206 HKT)
In this handout photo released by
the National Transportation Safety Board, Asiana Airlines Flight 214
sits just off the runway at San Francisco International Airport on
Sunday, July 7. The Boeing 777 coming from Seoul, South Korea, crashed
on landing on Saturday, July 6. Three passengers, all girls, died as a
result of the first notable U.S. air crash in four years.
HIDE CAPTION
Plane crash-lands in San Francisco
STORY HIGHLIGHTS
- This week, public hearings take place on the crash of an Asiana Airlines Boeing 777
- Robert Mark: Have pilots become too dependent on computer systems to fly planes?
- He says it's a serious problem when pilots get overwhelmed by technology
- Mark: We need better cockpit designs and train pilots more on hands-on flying
Editor's note: Robert P. Mark is a pilot, award-winning journalist and publisher of Jetwhine.com,
a website about the aviation industry. He's been teaching people to fly
since 1974. He also teaches at Northwestern University's Medill School
of Journalism and is author of the upcoming book, "Loss of Control."
(CNN) -- As the National Transportation Safety Board
begins public hearings on Wednesday into the crash of an Asiana
Airlines Boeing 777 in San Francisco in July, one question is certain to
keep popping up: Have pilots become too dependent on computer systems
to fly their airplanes?
The simple answer is yes.
When pilots become
confused or overwhelmed by technology that was supposed to make their
jobs easier or when they find themselves unable to regain control of
their aircraft when a component in the computer system fails, the
aviation industry needs to seriously assess the problem.
Robert P. Mark
Modern airliners use
computers to handle just about every function imaginable -- from
starting the engines and monitoring the cabin environment for the right
temperature and pressure balance to handling the complex navigation
necessary to fly an airplane safely between South Korea and San
Francisco.
Shaking free of any of
the technology anywhere along the way is very difficult because so many
of the aircraft's systems depend upon each other to work together.
An airliner's automation
today can handle almost all of a pilot's duties more smoothly and with
better precision than any human. Computers have become so tightly
integrated into the operation of an airliner, however, that the real
problem is trying to carve out a few tasks the pilots can still call
their own. One of the last completely human tasks is landing the
airplane.
With computers being
tasked to perform so much of the work on each and every flight, pilots
find their jobs have changed dramatically. Whereas once they were
captains of the sky able to manipulate the flight controls to maneuver a
500,000-pound airplane through stormy skies and still plunk 300 people
down at the destination safely, they now find themselves to be mere
system monitors.
New details emerge in plane crash
A closer look at plane's evacuation
Today, pilots program the
computers before takeoff, making sure all the panel lights are green
and then watch as the computers fly the aircraft most of the way.
Is it any wonder that
with so little practice actually manually handling the aircraft's flight
controls and making many of the critical decisions that are now handed
off to the computers that the pilots often find their minds wandering?
We shouldn't be
surprised that this happens. We all grow easily bored when we're forced
to watch someone, or something, perform a task for hours on end,
especially when we've been told that the computer pilot in this case
probably flies better than we do anyway, at least most of the time.
Consider Asiana 214's arrival at San Francisco.
Facts uncovered during
the initial investigation pointed to the pilot's failure to notice that a
critical system called the auto-throttles was accidentally turned off.
Auto-throttles let the computers control how much power the aircraft's
engines produce to maintain a given airspeed. With the auto-throttle
switched off, the pilots thought the computers were controlling power
and airspeed, when in actuality, the computers were on standby.
Basically, it means that no one was actually controlling the aircraft's
altitude at that time.
Without enough engine
power, the aircraft's speed dropped too low to allow it to continue
flying and it struck a dike just short of the runway, ripping away the
landing gear. Three people died while over 180 people were injured.
During the final few
seconds of the approach to San Francisco, the pilots simply sat in the
cockpit, apparently mesmerized by the view of the bay, assuming the
computer was flying.
The big question of course is why didn't they notice the computers were on standby?
With the recent release of a study, "Operational Use of Flight Path Management Systems,"
the aviation industry has begun to identify weaknesses in our aviation
safety system, including potential problems in human-computer
interactions.
The report recommends
improving pilot training to include more hands-on flying practice and
more intensive classroom study about technology's shortcomings. It also
calls for better cockpit designs that reduce potentially confusing
messages, and up-to-date training to keep federal regulators ahead of
the technology curve.
The study has been
turned over to the FAA, but no timeline or next steps in the process
have been outlined. Without a defined plan of action soon, we may see
another crash on the horizon before too long.
Follow us on Twitter @CNNOpinion
Join us on Facebook/CNNOpinion
The opinions expressed in this commentary are solely those of Robert P. Mark.
As public hearings begin into the crash of Asiana Airlines Flight 214,
one pilot argues fliers are too reliant on computer systems.
FULL STORY
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The first officer on board Flight 214 said he noticed they were losing
altitude rapidly, but thought the pilot -- a trainee -- was correcting
it, according to information released Wednesday by crash investigators.
FULL STORY
- New Asiana crash video released
NTSB probes fatal Asiana Flight 214 crash
December 11, 2013 -- Updated 2104 GMT (0504 HKT)HIDE CAPTIONPlane crash-lands in San FranciscoSTORY HIGHLIGHTS- NTSB begins hearing on Asiana crash, which killed three teens in July in San Francisco
- First officer told investigators he noticed steep descent rate, but thought pilot was correcting it
- Trainee pilot was flying the Boeing 777 with an instructor beside him
- NTSB focuses on concern that pilot relied too much on autopilot and other automatic devices
Washington (CNN) -- The first officer aboard Asiana Flight 214 told investigators that he called out the plane's excessive sink rate -- its rate of descent -- "more than four times" in the two minutes before the plane crashed, according to information released by the National Transportation Safety Board on Wednesday as it began a marathon 11-hour hearing into the July accident in San Francisco, which killed three Chinese teenagers.
First Officer Bong Dongwon -- who was sitting in a jump seat behind Capt. Lee Kang Kuk, a trainee, and instructor Lee Jungmin -- said the plane was making a steeper descent than the allowable 1,000 feet per minute, so he alerted the pilots, calling out the sink rate.But he did not say anything more because they appeared to be correcting the sink rate, Bong told investigators.New video released of Asiana plane crash
Asiana flight officer: I warned pilots
"Since Bong advised of high sink rate several times, he was monitoring sink rate and saw that it was decreasing, '1,500, 1,400, going up,'" a summary of the interview says. "When he recognized this correction was going on, and after passing 500 feet, seeing the vertical speed was less than 1,000 (feet per minute), he decided not to advise anything."Video shows plane's moment of impact
Aircraft normally must have a stabilized approach at 1,000 feet of altitude before landing, but the interviews suggest the plane's speed and sink rate were both incorrect as it passed through critical points of its descent.Pilots cited in Asiana jet crash
A cockpit voice recorder transcript released Wednesday showed the pilot gave three "sink rate" warnings in succession about 52 seconds before impact -- the first two times in English, and the final time in Korean.Asiana 214's fateful last seconds
The NTSB is focusing on what it says may have been the pilot's overreliance on autopilot and other automation on the sophisticated Boeing 777 aircraft.Investigators asked the three-pilot crew about their understanding of auto-thrust, which controls the plane's power. The NTSB has previously said the pilots believed the auto-thrust was engaged, but it was not.The NTSB documents suggest two concurrent problems: The plane was descending too fast, and its forward speed was too slow.The plane's speed, which was at 170 knots just 73 seconds before impact, dropped below the target speed of 137 knots at roughly 38 seconds before impact, and plummeted as low as 103 knots just seconds before the plane's front landing gear and tail struck the seawall near the runway at San Francisco International Airport.And the NTSB had earlier said pilots were adjusting for yet another problem in the seconds before the crash: The plane was not lined up with the runway's center line.The pilots made their first reference to the plane's speed problem just seven seconds before the crash. The pilot called out a "go around" -- a command to abort the landing -- three seconds before impact.Information released at the opening of Wednesday's hearing also shows that investigators are concerned about the role Korean and airline culture played in the crash.Hear 911 calls from 777 plane crash
'He saw her leg hanging mid air'
Bong said the crew practiced "cockpit resource management," training that encourages subordinates to speak up about safety concerns to other crew members, despite their senior rank, experience or seniority. But when the student captain was asked whether he had contemplated an aborted landing as the plane descended, Lee Kang Kuk said it was a "very hard" decision to make, given the deference shown in Korean culture.By the time he pushed the throttle forward, just seconds before impact, he discovered the instructor pilot had already done so.Culture also kept the pilot flying from wearing sunglasses, the interviews suggest. That was a factor momentarily when the student captain saw a flash of light as the plane descended through 500 feet."Asked whether he wore sunglasses in the cockpit he said no, because it would have been considered impolite for him to wear them when he was flying with his PM. He said it was very important in their culture," the NTSB report says.The NTSB has said the pilot did not believe the flash of light was a factor in the crash, saying it was momentary and that the pilot was still able to see the controls.Three passengers died in the July 6 accident -- two in the crash, and a third who was killed by a foam truck that had responded to the scene. The accident was the first fatal commercial airline crash in the United States since February 2009.NTSB Chairman Deborah Hersman called that record "a testament to the steadily improving safety of commercial aviation," but said there are lessons to be learned."We will focus not only on the human-machine interface in highly automated aircraft, but also on the emergency response and cabin safety," Hersman said.Several hundred people packed the NTSB's hearing room in Washington, and others gathered at a viewing room near San Francisco.But survivor Ben Levy told CNN he was forfeiting an opportunity to watch the proceedings."I think something that I've done quickly after this plane crash has been to focus on work and family and things that matter to me," Levy said. "I'm extremely happy that something is being done to get to the bottom of what happened that day because it should not have happened."CNN's Dan Simon contributed to this report.COPY http://edition.cnn.com/2
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