In December, 1995, we were looking forward to Richard's Christmas visit. He was in the Navy and had completed Electronics Technician Core School as an honor graduate, first in his class with a 95 average. We were so proud.
      Richard arrived a few days before Christmas, but on Christmas Eve, we began to notice that when we would speak to him, it could take up to a full minute for him to respond. Sometimes, he would make a totally unrelated comment. It became obvious that he had something interfering with his thought process. We were enormously concerned, and the day after Christmas, we took Richard to Bethesda Naval Hospital, which transferred him to Walter Reed Army Medical Center. After about two months there, Richard was diagnosed with schizoaffective disorder and given a medical discharge from the Navy as a disabled veteran.
      Over the next three years, we went to various doctors who prescribed a wide variety of medications to help Richard. Some seemed to relieve his symptoms. But they came with a heavy price: profound side effects. Two medications he took resulted in a ravenous appetite; Richard ate almost non-stop and gained 100 pounds in three months. They also made him very restless and unable to sleep well, a condition known as akathesia; the only effective "therapy" seemed to be driving - all night long.
      In the Spring of 1999, things changed for Richard. As we look back to that time with the knowledge and experience we have gained since then, we realize that Richard grew weary with the effects of the medication. Add to this the fact that one of the characteristics of his mental illness is a lack of awareness of his own well being; Richard began to believe that he was not sick. Perhaps, as well, Richard found his psychotic and delusional world more comforting than the real world. Whatever the cause, in the end, Richard stopped taking his medication.
      In late May of 1999, as a result of his bizarre actions, increasing paranoia, and reclusiveness, we filed for an involuntary commitment for Richard. He was transferred to the Fayetteville Veterans Affairs Medical Center (VAMC) on May 27. Although he was still psychotic and delusional in late June, the staff told us they were going to have to release him "because they were not a long-term care facility." At our insistence, he was placed on "outpatient commitment" for six months and released on June 25. We hoped this would provide adequate supervision of Richard's medication regimen since he would be required to go to Fayetteville weekly for check-ups.
      One week later, Richard refused to go to Fayetteville, and the local police ended up escorting him from his home in Wilmington to his appointment. Observing his extreme state, the police left him at the hospital sure that he would be admitted. His medication level was never tested, and, incredibly, he was released to go home. His brother needed to be called to drive him home, but before he could get there, Richard disappeared. Three days later, he showed up in Wilmington. When asked how he got home, he said, "The Jewish Mafia took me to the bus station. I got a bus to Warsaw and M-1 invisible snipers took me to Wilmington where I caught a bus home."
      A local social worker at the Southeastern Mental Health Clinic (SEMHC) advised us to commit Richard again, and so, about two days after he returned home, he was admitted to the Salisbury VAMC. There the staff was concerned, open and supportive of our belief that Richard needed long-term treatment. After a hearing was held, it was agreed that he be hospitalized for treatment for up to 90 days.
      At the end of the three-month period, Richard seemed better than we had seen him in a long time. The hospital suggested he participate in an additional program to ensure his progress, and we hoped he would. But it turned out that participants needed to volunteer for the program. Once again, Richard's thinking was muddled by his illness; he didn't believe there was any reason he needed further treatment, and in early September he was released.
      For about six weeks, Richard seemed to be doing pretty well. Although we could always see the distractions going on in his mind, he took his medications at our regular suggestions. But before long, the pattern of paranoia, delusion, and withdrawal reemerged. And soon, taking his medication became a thing of the past.
      Richard informed us that he was taking a trip to Colorado to see his former girlfriends who lived with him. He was determined to do this, despite the fact that we had one of these women talk to him and explain that none of them actually lived in Colorado. But there was no reasoning with Richard - as there is none with anyone who has psychotic thoughts. He insisted they were there. He told us he had spoken with them, and then he attacked me, accusing me of tapping his phone when I explained that no phone calls to Colorado were on our phone bill.
      In mid November, we petitioned for involuntary commitment once again, and Richard was transported to Fayetteville VAMC.