NAMI North Carolina ‘Criticize Less, Understand More’

Guest Editorial

The Wendell Williamson Case: Criticize Less, Understand More

by Shirley Strobel, President, NAMI North Carolina

Released October 1, 1998

My family is among the one percent of all families whose child suffers from schizophrenia. Wendell Williamson’s family is another.

Williamson, then a law student at Carolina, killed two people in January 1995 when his untreated paranoid schizophrenia led him on a random shooting spree in downtown Chapel Hill. In November of that year, a jury found him innocent of murder by reason of insanity—a decision many found disappointing.

Since September 21, when a jury awarded Williamson $500,000 in a malpractice suit against the psychiatrist he went to for help at the UNC Student Health Services—Dr. Myron B. Liptzin, the disappointment has turned to anger and outrage. In interviews and letters to the editor, critics question the jurors’ intelligence and sanity and suggest justice would be better served if Williamson relocated from Broughton Hospital to Central Prison’s death row.

For families like mine and the Williamson’s—one of every hundred families in North Carolina—the criticisms hit home. Those of us who have made an effort to learn all we can about schizophrenia know the vast majority of our sons and daughters are not violent and never will be. However, if they suffer from paranoid schizophrenia, as do my own son and the Williamson’s son Wendell, we know a few will become violent—especially if their disease goes untreated.

All of us know, in the man-bites-dog world of news coverage, those few of our children who do become violent are the ones the remaining 99 percent will hear about and remember. They are the ones whose symptoms people will unfairly generalize to the entire population of people with some form of schizophrenia.

What the Jury Heard

Given that most people learned what they know about schizophrenia through the media, we who have experienced the disease firsthand understand how the negative stereotypes become ingrained in our culture.

In the Williamson malpractice suit, most of the outcry against the verdict is based entirely on news reports of the case. Those of us who know all the facts the jury considered, including those not covered by reporters, understand why the jury decided as they did.

For example, testimony revealed Liptzin read only the discharge summary for his patient instead of reviewing the complete medical records of Williamson’s 1992 hospitalization at UNC for psychiatric problems. Information in the full records, but not in the summary, included—

• A report of a psychological evaluation that predicated severe consequences, should Williamson fail to receive continuing care for his paranoid schizophrenia.
• A description of Williamson’s history of violent behavior, including self-injury and attempted suicide.
• A note that Williamson’s discharge from the hospital was contingent on his receiving continuing outpatient care.

The jury also learned of Liptzin’s failure to tell Williamson he was suffering from paranoid schizophrenia. Instead, the psychiatrist chose “delusional disorder—grandiose” as his diagnosis because he preferred not to label Williamson as a paranoid schizophrenic. As a result, the doctor misled Williamson about the severity of his problem and his critical, ongoing need for appropriate medicines and counseling.

Witnesses told jurors the purpose of UNC’s Student Health Service, where Williamson went to Liptzen for help, is to provide short-term treatment and referrals, but Liptzen did not refer Williamson to another clinician for follow-up care.

Jurors learned “ordinary care” required of psychiatrists includes a thorough diagnostic evaluation with a review of the patient’s medical records, reviewing and updating diagnoses, managing medications properly and making appropriate referrals. Based on the testimony they heard, the jury concluded Liptzin failed to meet the standard of care to ensure his seriously ill patient would receive appropriate follow-up care.

A Call to Action

Of course, we deplore the senseless and tragic deaths and injuries Wendell Williamson inflicted, but we also deplore the poor medical treatment he received for his illness. Unfortunately, in our struggles to get help for our own children through North Carolina’s mental health care system, we have found inadequate care to be the rule, not the exception.

Apparently, we North Carolinians are not alone. In a report released earlier this year by the Schizophrenia Patient Outcomes Research Team, researchers noted the quality of care for people with schizophrenia is inadequate throughout the nation. Investigators concluded, “current usual treatment practices likely fall substantially short of what would be recommended based on the best evidence of treatment efficacy.”

The problem is not that we do not know how to treat schizophrenia. It is that the 99 percent of our citizens whose lives are untouched by this disorder do not care enough to create a mental health care system able to provide effective treatment for the one percent. As we have seen, when the worst happens, people get interested and start speaking out. Unfortunately, most of them base their opinions entirely on inflammatory media reports and blame the person with the disease or his family for the system’s failure to provide adequate care.

Schizophrenia is a very serious, chronic brain disorder that will wax and wane throughout our children’s lifetimes. We know enough right now to treat schizophrenia effectively, but we have not yet created a system to deliver that treatment to the people who need it.

To be effective, our system should offer access to four levels of care:

• For those who are able to recognize their need for care and manage their own illnesses, our system needs to provide community-based care, including ongoing medical treatment, housing, rehabilitation and other support.
• For those less able to manage their own treatment, our system needs assertive community treatment programs that provide 24-hour-a-day outreach and crisis support.
• For people who do not respond to outreach and resist treatment, our system should make ongoing treatment a requirement for living in the community.
• For people in crisis, whose illnesses make them unable to recognize their urgent need for treatment, our system must provide, through involuntary inpatient commitment, short-term hospitalization to treat and stabilize acute psychiatric symptoms.

Our hearts go out to the families whose sons lost their lives on Franklin Street that day and to the Williamsons, who share with us the misfortune of being among the one percent of the population whose children have lost their future hopes and dreams to schizophrenia.

Tragic as the Williamson case so obviously is, the greater tragedy is that we, as a society, may well have prevented it. If we had taken steps to make North Carolina’s mental health care system truly effective back in 1992, when his symptoms first appeared, Wendell Williamson would most likely have received adequate, appropriate care, and his condition would not have deteriorated to the point that he turned to violence.

Sadly, we cannot change the past, but we can prevent future tragedies of this kind from occurring. First, many more of our leaders and citizens must recognize, and take seriously the potential for violent behavior by those whose severe and persistent mental illnesses go untreated. Then, as a matter of public health as well as moral obligation, we must allocate the resources needed to repair and strengthen our state’s system of mental health care.

Schizophrenia, like all major mental illnesses, is a disease—not a crime. Only when the majority of North Carolinians understand that can we shift our focus from punishment to prevention and take appropriate action.