Abigail Trafford (The Post)

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Welcome to Second Opinion, a weekly column and Health Talk discussion with Post Health columnist Abigail Trafford. This week, Trafford discusses the challenge of family members when a loved one has a mental illness.

In "A Beautiful Mind," Russell Crowe does for schizophrenia what Dustin Hoffman did for autism in "The Rain Man" -- both films made people with a severe mental illness sympathetic characters.

In reality, it is hard to love someone who is locked in their own world of delusions and hallucinations. But movies like "A Beautiful Mind" raise awareness of this frightening disease that affects more than two million Americans.

Have you seen "A Beautiful Mind?" Did it change your view of schizophrenia? Do you have someone in your family who has a mental illness? How do family members cope? Read Trafford's article "Second Opinion: An Uglier Reality" (Post, Jan. 16, 2002).

The transcript follows.

Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.

Abigail Trafford: Hello everybody. We're tackling a tough subject today: mental illness. What it's like to have it. What it's like to care for someone who has it. There are no easy answers. Treatments have gotten a lot better. But the struggle to manage the illness is acute. In the movie "A beautiful Mind," the hero is a man with schizophrenia. But the reality is a lot harsher than the movie suggests. Often forgotten are the families. Well, we're not forgetting them today. What are your views on mental illness? Do you have a story to share? Send us your comments and questions.

Arlington, Va.: In the movie, I learned that schizophrenia was degenerative, however in Today's Health section of the Post, it states that "roughly 15% of patients achieve long-term recovery without medication." Can you explain how this can be?

Abigail Trafford: There is no one kind of schizophrenia. That's what makes it so difficult to grasp. Some cases are severe, some mild. Some are episodic. Some are marked by continuous decline. As a result, the long-term outcomes vary enormously. In 30-year followup studies, researchers found that a certain percentage--10 to 15 percent--were able to maintain their recovery without drugs. In some people, the disease seems to stabilize. This appears to be the case with John Nash, the hero in the movie. Still, he benefited from treatment of episodes earlier in the course of his disease. But all in all, about 15 percent of patients ultimately recover. That also means that the vast majority--85 percent--need treatment. Treatment involves not just medications but therapy and social supports. Even so, a significant number fail to respond. Some lose their capacity for abstract thinking and social interaction. Suicide is the leading cause of premature death. So it's a complicated picture.

Alexandria, Va.: Ms. Trafford-
Thanks for your continued respect for mental health issues and people with mental illness and their families.
Some facts about Schizophrenia that might inform your discussion:
- Schizophrenia affects some 2.5 million adults in the U.S.- about 1 in 100 people. It knows no racial, cultural or economic boundaries.
- Schizophrenia is not split personality or multiple personality. It is a biological brain disease that impairs a person's ability to think clearly and relate to others. Someone with schizophrenia has difficulty distinguishing between what is real and what is imaginary, and can be unresponsive and withdrawn.
- The vast majority of people with shizophrenia are not violent and do not pose a danger to others. Schizophrenia is NOT caused by childhood experiences, poor parenting or lack of willpower, nor are the symptoms identical for each person.

- facts from the National Mental Health Association
For a free brochure on schizophrenia please call 800-969-NMHA (6642) or visit www.nmha.org.

Abigail Trafford: Thank you for this information from the National Mental Health Association.

Long Valley, N.J.: Thanks for today's article on the need for better mental health services and an infrastructure that can support all our neighbors who have a mental illness. But this requires money and the support of our government. Are there any signs in Washington that we can expect real attention to mental health issues and funding to back it up?

Abigail Trafford: If only we knew. . . . There's a lot of support for better mental health services. Many in Washington are aware of the need--Senators Pete Dominici and Wellstone, for example, have sponsored a bipartisan bill to put mental illnesses on a par with physical illness in health plans. But the legislation stalled. It's a very incomplete bill. And the nation's attention is focussed on other things. The economy and the war on terrorism have priority so it's unlikely that you're going to see any major health initiatives that require funding. I hope I'm wrong. There needs to be a completely new strategy to address mental health issues in this country.

Centreville, Va.: One of my relatives is recovering from suicidal depression which came on her after she was diagnosed with the lung disease COPD. She tried to kill herself twice by taking an overdose but both times she survived, thanks to her husband finding her in time to get her the medical care she needed to survive. She is taking antidepressants and has a therapist she sees once or twice a week. In your opinion, based on the limited information I have provided you with, what do you think her prognosis for recovery is? She is in her early 60's and lives with her husband in a small town where a lot of HIS family members live. It seems to me she's doing better now than she has in a while, but she doesn't socialize too much any more and complains of being "very tired" often.

Thank you!

Abigail Trafford: Hello Centreville and thanks for telling us this story. I am not a therapist and cannot comment on her case. But it sounds as though she is getting good medical attention and has the support of her husband and friends like you. That makes her very lucky. She's 60 years old and has a lot to look forward too. There's a new understanding in the psychiatric community of the special needs of older people. That's all good news for your relative.

Virginia: My husband, who is a social worker and works with dual diagnosed clients, and I are having a debate on seeing "A Beautiful Mind." (And, I've suggested that he go along.)

To me, what I have heard has basically put a more sanitized version of mental illness, the man's life (I'm blanking on his name) and is a sort of feel-good movie. And, while I enjoyed "The Awakening" -- I knew darn well what Oliver Sacks looked like and it wasn't Robin Williams! LOL.

Where he works he has heard a variety of pros and cons on the movie. I think he should go but for me, I'd rather reread the book again. I also think that this movie will make others think that schizophrenia can be easily overcome (if you think 15+ years of living like he did is easily overcome but you know what I mean).

Abigail Trafford: Hollywood does what Hollywood does best: it creates a reality that will draw in audiences! Of course "A beautiful mind" is a sanitized version of the life of John Nash. The biography of the same title is a much more thorough and riveting account. But I say, go to the movie because it starts the conversation about schizophrenia. For too long people just didn't want to talk about mental illness. Because of movies like this, the stigma is fading. That's a good thing. Once the conversation gets going, then we can talk about reality.

Baltimore, Md.: My grandmother is schizophrenic, only she never got the diagnosis/treatment that she needed...maybe ten years ago, she got old enough that they called it senile dementia, but she's not any more demented now than she's been her whole life. I have only met her once, but I found her weird & unpleasant to be around. I am continually surprised that my dad turned out normal, having a mother like that.

The destructive impact of this disease cannot be overestimated, & it is important that understanding is increased so that more people who have it get the treatment they need.

Abigail Trafford: I'm sorry about your grandmother. But why are you surprised your dad is normal? Most offspring are. It's true that there is a genetic component in certain kinds of mental illness that increases the risk. But the risks are still relatively small. What often hurts the children is the destructive impact of the disease on the whole family. Families can get very isolated and stressed out. They need support -- from neighbors and friends as well as the medical community. It's only recently that families have gotten any attention at all.

Re: John Nash movie: I can't believe how many people loved this movie. Then I realized that the people who liked it didn't really know much about schizophrenia. At least it raised awareness, but it bothers me how it glossed over how difficult it is to deal with the illness. I've watched a close friend degenerate since college and it's so painful. And it's also hard not to feel guilty over all the times I get so frustrated - because like you wisely wrote, it can be very hard to "like" someone in the throes of this illness. My friend is one of the few who became violent (due to paranoia) and he is in jail for murder. He was not allowed to plead insanity because the murder was premeditated. It's so upsetting to think how guilty sane people can be acquitted by reason of insanity in a "passion killing" yet someone so clearly ill cannot. We as a society have so far to go in de-stigmatizing mental illness.

Abigail Trafford: Bravo for your comments. It's very hard to be a friend of someone in the throes of this illness. But it is an illness. Those of us who understand this have to speak out for those who are sick.

Portland, Maine: I have not seen the movie, but wonder if those who are touched by schitzophrenia resent the pretty picture the movie portrays. It is hard to love someone who seems, and in some ways is, untouchable. Family members and friends give up. What more can be done to help those people who are homeless and alone as a result of mental illness?

Abigail Trafford: All you have to do is walk down the street in downtown anywhere and see how many homeless are mentally ill to know that there is a crisis in caring for those who are afflicted with these diseases. There are stories of successful treatment and meaningful lives. But there are also stories of despair and suffering. One of the hardest things for families to accept is that a person is too sick to be helped at home. As Wayne Fenton, acting deputy director of the National Institute of Mental health told me: "The idea that love can cure schizophrenia is not a new one. It's been tried by families and professionals for years. Love doesn't hurt, but it's not enough."

Dulles, Va.: In Response to Centreville, Va. - it is probably the dosage of anti-depressants that is making her "tired"; try lowering the dose. Re: how family members cope with mental illness. Growing up with a mentally ill parent is one of the most tragic things a child can be faced with because we have no other ways of measuring reality. It is not until we are well into our adulthood and after possibly many, many years of therapy that we can come to realize that the truths we were taugh were indeed "crazy" and damaging. Then, we must try to reconstruct. Even, at 49, the best advice I have been given, is to see myself as an alcoholic with my parent as the alcohol, which I can never go near. He is as toxic to me as that next drink. I am sorry I cannot maintain any relationship with my parent, but so be it. The times he can wonderful and giving cannot counteract the times he is abusive and hurtful, in other words, the times he is under the influence of his own mental torment.

Abigail Trafford: Thank you Dulles. You speak for a lot of people who have grown up in a household where a parent had a mental illness. Myself included. My mother was severely depressed and became addicted to prescription drugs and alcohol. Children are faced with tough choices.

New York, N.Y.: What do family members do about a person who shows bizarre symptoms before schizophrenia is diagnosed? What goes on during that symptomatic, prediagnosed period?

Abigail Trafford: Alas, one of the problems with schizophrenia is getting access to prompt and appropriate medical care. Studies show that it take 12 to 18 months from the onset of symptoms to a proper diagnosis. That would never happen in heart disease! I think this interim period of fear and uncertainty is very very hard on the patient and family. Perhaps the best thing is to get very demanding with the medical profession and try to get more immediate help. The trouble is that in the beginning, how do you tell that some fleeting bizarre behavior is a symptom of mental illness or a temporary blip of eccentricity? In "A Beautiful Mind", even before Nash had his first diagnosed episode, he was a little weird.

Alexandria, Va.: Dear Ms. Trafford,

I must say that I thoroughly enjoyed the movie. I think that it made several important points about schizophrenia that are often overlooked. First is the connection between Nash's intellectual capabilities and his illness. I am personally familiar with the specific type of schizophrenia that afflicts those with a particular type of intelligence. The second point that I am glad the filmmakers brought up is the absolute devastation that the cure inflicts. Only the very recent medications seem to avoid the mind-dulling effects of Thorozine.
The one thing that I thought odd about the movie was the way in which the disease was airbrushed. When Nash went out on paranoiac obsessions, he would be gone for days or weeks, not hours. The long, elaborately over-explained absences are often the first indications of schizophrenia that friends and family notice.
I have not yet read completely Nassar's biography of Nash, but I am puzzled be the claim that is repeated that Nash did not develop the disease until his thirties, when it is apparent that he demonstrated symptoms (social awkwardness and unresponsiveness) early in childhood. I think that the potential that Nash was able to manage his disease early in life, might lead to clues as to how he was able to overcome it later in life.
I only wish that I the book or movie had been made 25 years ago when someone close to me first developed symptoms.

Abigail Trafford: Thank you Alexandria. Take note researchers: what was it in Nash's early management of the disease that might be a clue to his later recovery????? We're looking for answers.

Montgomery County, Md.: As the Executive Director of NAMI (National Alliance for the Mentally Ill) of Montgomery County, I encounter many parents of children of all ages who have not had as easy a time as John Nash is portrayed as having in the film. Their recovery does not allow them to lead as productive lives without expensive psychotropic medications and a great number of services. Unfortunately, as you can see by the article on the front page of today's Washington Post, serious mental illnesses such as schizophrenia,bipolar disorder, clinical depression and others are not being given the same services as somatic illnesses.

Your recent article about your New Year's resolution was very encouraging.

washingtonpost.com: Second Opinion: Writing Off Depression (Post, Jan. 1, 2002)

Abigail Trafford: Thank you from the trenches. The National Alliance for the Mentally Ill is a great resource for families and all those in the community who want to improve services for the mentally ill.

Virginia: Many people with disabilities are parents. They have normal children. The movie seemed to indicated that people with disabilities are not normal in everything.
Sources are:
Birrane. "The Parental Rights of Disabled Parents." 10 Maryland Law Forum 7 (1987).

Levesque, Roger. "Maintaining Children's Relations with Mentally Disabled Parents: Recognizing Difference and the Difference That It Makes." 16 Children's Legal Rights Journal 14 (Spring 1996).

Odegard, Julie. "The Americans with Disabilities Act: Creating "Family Values" for Physically Disabled Parents." 11 Law & Inequality 533 (June 1993).

Stein. "Mommy has a Blue Wheelchair: Recognizing the Parental Rights of Individuals with Disabilities." 60 Brooklyn L Rev 1069 (1994).

Abigail Trafford: Thank you for these resources.

Washington, D.C.: I suspect my brother is suffering from depression. He hasn't worked in the last 19 months and doesn't seem to be trying to find work. He cashed in his 401k and has maxed out his credit cards and now depends on the family to support him. Furthermore, during the holidays he stayed with me and I noticed that he frequently stayed up until 3 or 4 a.m. and then slept until noon. He lives in Colorado and I have contacted a psychologist there who is willing to treat him. The problem is he won't go. Should I fly to CO and make him go? If the family withholds support he will end up in the street but at the same time he has to try to help himself. It's very frustrating because we are tired of giving him money if he isn't going to make an effort. He's 41 years old.
Thanks

Abigail Trafford: My heart goes out to you. This is the reality that many families face. It's what makes caring for someone with a mental illness so hard. If people show symptoms of heart disease, they are willing to go to the doctor and get treated. The cruelty of mental diseases is that for some people, becoming isolated, refusing help and not wanting to get treatment are symptoms of the illness. I'm not a professional, so I can't give specific advice to you. It sounds as though you are doing a lot for your brother. Is there a psychiatrist here whom you could consult to advise you on how to proceed? As a family member I know--you want to do everything you can to help. And then you have to understand that there are circumstances when you can't save a loved one.

Hold the phone a second: With all due respect to the NAMI executive director, Nash DID NOT have an easy life, even as portrayed in the film. He lost some 30 years of his life to his disease, a time during which he should/could have been raising his family and building a body of knowledge. The film does suggest this gap, though it does not take the tone of a documentary (this year this happened, that year that). Nash won a Nobel based on work he did when most people are just finishing their dissertations and trying to figure out how to teach the introductory course of whatever their field is. His disease represents a tremendous loss, and the film does show that.

Abigail Trafford: Yes--there was tremendous loss--in the movie and in his life.

Another comment: I'm the one with the friend in prison. I forgot to mention that another huge difficulty is to keep the schizophrenic on their medication. When it begins to help, many try to go off because of the side effects. And it can be impossible to get someone to go back on them when they are paranoid that you are trying to kill them with the pills. Ironically, my friend is more functional than ever now because he is forced to take his meds in prison. I hate that he's in there, but I'm pretty sure he'll go off them when (if) he gets released.

Abigail Trafford: This is a terrible dilemma. You describe it well.

Alexandria, Va.: I saw "A Beautiful Mind," and did enjoy it. Even though it is a sanitized--or at least simplified--version of a complex life, it is hardly pretty. What is enjoyable about it is the at least limited victory Nash was able to achieve. He lived long enough so that as an old man he got credit for truly seminal work he did in his 30s. He was also able to heal at least some of his relationships. It was hardly pretty, however, that as his fellow students and later colleagues climbed their life and career ladders, he was trying to keep from embarrassing them and himself, and that was almost the best he could hope for between relapses. The movie is also disturbing in a sense because the viewer is brought into Nash's delusions. This ain't no "Bridges of Madison County."

Abigail Trafford: Absolutely not a Bridges flick! Yet there is a sweetness in the marriage that comes through in move . . . and in the book.

Virginia: For those interested in reading more about how mental illness can affect family members, there are a number of good general (not disorder-specific) books out there--I recommend Victoria Secunda's "When Madness Comes Home" for a combination of sociological-type assessments and personal accounts, and "Mad House" (by Cleo I'm unsure of the last name) who grew up with schizophrenic siblings. Both are very useful.

Abigail Trafford: Thank you Virginia!

Chevy Chase, Md.: Dear Ms. Trafford,

First, I want to thank you for today's column and previous ones highlighting mental health and the problems of
persons with mental illness. I am a mental health "consumer" and a mental health and disabilities advocate. Presently,
I am serving on a Blue Ribbon Panel (along with Dr. Fenton) looking at the problems of the mental health system in
Maryland and in Montgomery county.

You raise a vexing issue in today's column: Can (and how?) persons with illnesses such as Schizophrenia truly be
integrated, in a meaningful way, into communities? I, too, noticed how, in "A Beautiful Mind", Nash benefited from
the Princeton "community." However, in my, fairly extensive experience, I have not seen significant or meaninful
community integration occur. This is certainly the rhetoric, but not, I fear the reality. Most persons I know with
serious mental illnesses live segregated, marginalized lives, living physically in the community, but not much beyond
this. In fact, as a friend pointed out, the very idea of "a community" itself is largely fiction - in reality, there is no "real"
community for most of us.

This experience has led me to think about the idea of creating "true" therapeutic, voluntary communities. Something
along these lines has been espoused by Dr. Sally Satel, a psychiatrist currently working at the American Enterprise
Institute, and auther of PC M.D. She refers to "model asylums", though "asylum" is probably a poor choice of
words, since it carries some negative historical baggage.

This is certainly not a "politically correct" idea, but I think it deserves consideration.

Sorry for the lengthy question, but I was wondering what your thoughts are on this idea of "community integration" of the mentally ill?

Abigail Trafford: You've hit on a key issue: How do you build a therapeutic community and integrate people with mental illness into the community. Your thoughts are right on. We need leadership, imagination. . . compassion and money.

Annapolis, Md.: My brother suffered from severe paranoia practically his entire life, which greatly impaired his ability to for relationships with other people (including his family). My parents were afraid to take him to see a professional because in those days the stigma was too much. It wasn't until he was diagnosed with a terminal illness and became clinically depressed that he began seeking treatment. In his last year on Earth, he finally understood what it was like to live like a real human being. I understand and sympathize with him in that I too suffer from paranoia, only in a much milder form that does not interfere in my ability to live a happy and fulfilling life.

Abigail Trafford: So many people have suffered so deeply from the stigma. I'm glad your brother came to understanding in the last year of his life. But tragic that it couldn't have happened sooner.

Oakton, Va.: Abby, seems like one of the main problems with mental illness is that years ago, most of the cases were kept in institutions where they at least could be provided for and treated. But during the Carter Administration, legislation was passed that effectively turned these cases out either on the street or back with their families. They could no longer be held in institutions against their will (with certain rare exceptions like John Hinckley). So what you ended up with, in effect, is "freedom to starve". Of course, if a person CAN cope with the outside world, by all means let him/her do so. But if that is not possible, then whether the person consents to it or not, I see no alternative but to place them back in institutions. Sometimes you can give a person too much freedom -- to the detriment of that person and to society as a whole. This has been one of the biggest detrimental effects of today's "political correctness".

Abigail Trafford: Remember when Hamlet tell Ophelia to get thee to a nunnery? The nunnery being an institution, the asylum. Some people with mental illnesses need the support of an institution. But most do not--IF there were supportive services and housing in the community to make sure that people can manage their illness and lead and independent life. The problem is that an infrastructure for the mentally ill is not in place. That leaves them free to starve and live on grates. So it's not a simple choice of institutionalize or de-institutionalize. It's the harder challenge of building an infrastructure to provide the care and housing that people with mental illness need.

Kennewick, Wash.: I have read that President Bush is about to sign a bill that requires parity for mental illness treatment. But I'm curious, why isn't that extended to Medicare?

Abigail Trafford: You've pointed out a glaring bit of discrimination in the federal Medicare problem. It covers only 50 percent of the charges as opposed to 80 percent of "physical"illnesses such as diabetes. That needs to be changed in Medicare. And as for President Bush signing the mental health parity bill. . . . Well first it has to be passed by Congress.

Vienna, Va.: How can you legally get prescription drugs without a prescription? The reason I ask is that there are a number of good, safe drugs that could easily be sold over-the-counter that are overregulated by a prescription-only system that is really not needed. This artificially-induced barrier is not only unnecessary but actually impedes the availability of these drugs at times when a person needs them but has to go through the hassles of an office visit and all of the paperwork just to authorize a refill.
Now, I am not saying that one should try to play doctor here. Of course one should not take a new drug without a doctor's advice, but when you KNOW you can safely take the drug the docror has already prescribed, why should you have to put up with of the hassles of getting prescription refills?
This is absolutely ludicrous, and the whole prescription system is badly in need of reform.

Abigail Trafford: Take your cause to the Food and Drug Administration. If there are some drugs that have proven so safe and effective that they should be available without prescription, I'd get up a petition for the FDA. Is there a Claritin equivalent to treat mental illness? The danger, of course, is that a drug that is able to treat depression or schizophrenia is also a drug with protential side effects and should be monitored by a physician.

OCD here: Thanks for highlighting schizophrenia. I just wanted to say that I've been living with OCD since about age 8 (am now 27) and it, too, can be a challenge, but is manageable with medication and psychotherapy that will help find other ways of coping. about 6 months ago I went off my medication (under the supervision of my doctor, of course) and am doing surprisingly well. To those out there who feel like a mental illness is a 'life sentence'-- it isn't. Things (chemical, life situations, etc.) can change and your body and illness might respond in kind. Most important are having understanding health practitioners who will work WITH you, friends, and supportive family.

Abigail Trafford: Thanks for your story.

Nunnery--not what you think!: Oops, Abigail. A "nunnery" to Shakespeare was slang for a brothel. As the context of the speech make clear, he actually was calling Ophelia a whore!
Not the most helpful of institutions in this case, but the rest of your point is well taken.

Abigail Trafford: Oops is right. that's not what I meant at all!!! I was thinking of a nice Gothic building in the countryside with music and prayers and companionship. . . . .

Virginia: One way to fight the stigma and discrimination so many with a mental illness face is to stop referring to PEOPLE with schizophrenia as "Schizophrenics." They are people, not a diagnosis and they HAVE a mental illness, they are not defined by one.

Abigail Trafford: Good point!

Alexandria, Va: Thanks. This is a great chat. I want to make a few points about the movie...
One is, that it really got to the hope of recovery that is available today. While the illness schizophrenia is still severe, the new medications help reduce the hallucinations and delusions. But unlike the old medicines, they also help improve an individual's mood, motivation and capacity for intimacy. That is key. Also, the community-based care programs are getting better and better. There is a lot of hope.
Also, the movie caused me to dream about a man I knew who died last year, Ken Steele. After he started taking the new medications he founded a new type of support group, a voter registration drive, a newspaper and wrote a book "The Day the Voices Stopped."
He did all that after he was treated for the illness. Thank you!

Abigail Trafford: Absolutely right. Thank you, Alexandria.

Silver Spring, Md.: My mother was diagnosed as paranoid schitzophrenic when I was 3 (I'm 28 now). I was raised by my father and only saw my mom on weekends - visits that were emotionally taxing on myself and my older sister. My mother never took her meds regularly so she never really improved - she lived in half-way housing and nursing homes the majority of her life until she died last year at age 54 from pulmonary hypertension. I am afraid to have children because I fear that they may have a mental illness like my mom, and I would never want to be responsible for passing on such a condition. Also, my sister has shown signs of a untreated mental illness since we were very young. I used to blame it on the effects of our parent's divorce but now I wonder if her mental problems were passed down from my mom. Thoughts?

Abigail Trafford: Consult a psychiatist who specializes in schizophrenia. There is a genetic component to this disease, but the risk is thought to be relatively small. The origins of schizophrenia are unknown. Each case is different, which is why you need to have a long talk with a professional about your mother and your personal risk. Good luck.

Maryland: The movie was based in the 1940s and 1950s. Was mental illness recognized and understanding during that time?

Abigail Trafford: There's been progress since Nash was treated with insulin shock treatments.

San Francisco, Calif.: I have a son who has shizophrenia and I must say, he is not hard to love. His symptoms are sometimes hard to cope with- but I love him as much now as I did before he got this brain disease.
Thanks you for educating the public about the realities of mental illness, and helping them see the son, daughter, mother, neighbor, and hero that lies beneath the hallucinations.
What do you think is the most common myth surrounding mental illness that causes so much fear from people who don't understand it?

Abigail Trafford: The most common myth? That people with a mental illness are dangerous. It's true that a very small percentage of patients are dangerous. But as advocats for the mentally ill point out, people withe mental illness are much more likely to be victims of a crime than perpetrators.

Lexington, Ky.: Last year's news of KY being among the states with good care for mental illness really intrigued me. Especially with states like California being far more progressive and Democratic being so far behind. My cousin is really languishing in CA from the poor services he receives. Lost paperwork; group homes where we was allowed to be harassed; inadquate treatment. It really saddens me that my cousin realizes that his life is not like his 4 brothers and sisters at all and, the people who are supposed to be helping him fail terribly.

Abigail Trafford: We've got a crisis in this country. Glad things are better in your state.

Hyattsville, Md.: How does a family member help a mentally ill 50-plus adult who refuses to seek medical help and to take prescribed medications? This person has never admitted that she has a mental problem. She hears voices, has been violent on two occasions, has been institulized two times, etc. It appears that the law is on her side if she refuses medical assistance. She lives in Texas. Over the years, I have very little help from the Texas mental health system. This relative lives alone.

Abigail Trafford: Patients have the right to refuse treatmnet. This is a very contentious area in mental health services.

Alexandria, Va.: Is schizophrenia a disease that has physical causes and physical symptoms like diabetes or cancer? Is there a chemical test for schizophrenia?

Abigail Trafford: Schizophrenia is a disorder of the brain. There's no chemical test to diagnose it the way you can detect high blood cholesterol levels for heart disease.

Abigail Trafford: We've gone over our time. Thank you for your stories. I think we've all helped each other. I'm sorry we couldn't get to all the questions. But we'll continue this conversation in coming months. Meanwhile, join me next week. The sugject: The common cold. It's misery!

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