By Kathy Horak - Folio Weekly

Crazy.
By
Kathy
Horak
A Tale
for the
New
Year.
Editor’s Note:
Kathy Horak, a writer and freelancer at numerous Jacksonville
publications, was a frequent contributor to Folio Weekly and
worked here briefly in the mid-‘90s. She submitted this story
(with this headline and the statistical sidebars) last December
in the hopes we would publish it anonymously.
Kathy took her life on June 5, 2009, after a lifelong struggle
with mental illness and addiction. Her family agreed that
this story be published posthumously in her name. It is their
hope that it will help someone else avoid a similar tragic end.
We are grateful for their generosity of spirit in sharing Kathy’s
last story.
Linda stands on a small square of grass outside the
locked ward of the Mental Health Center of Jacksonville,
near the Amtrak station and Martin Luther
King Jr. Boulevard. Clutching the high fence, she begins
to move through ballet-barre positions, her long blonde
hair swaying across her shoulders.
Only when she turns, gracefully, do I see again the
weathered face of her life of pain.
Linda and thousands like her traverse North Florida’s
mental health system every year — sometimes, year after
year. You may meet some of us, homeless in Hemming
Plaza. The recurrence of diseases such as major depression,
bipolar disorder and the hard-to-diagnose borderline
personality make insanity frustrating, never easily remedied,
seldom inexpensive. Add alcohol or drugs and craziness
may be our saddest plague.
Let me tell you something of Linda and Savannah and
Susan, of nurse Joyce and guardian Gloria and successful
salesman Russ. I met them during my year of being crazy.
Certified. Certifiably, desperately afraid.
Hi. I’m anonymous. And I’m an alcoholic.
“Our common welfare should come first. Personal recovery
depends on AA unity.”
This is the First Tradition of Alcoholics Anonymous,
the worldwide support group that helped restore me to
sanity and continues to be my lifeline, my tribe. Not until
I admitted I’d grown up with an alcoholic mother, and
that I, too, had the disease, could I begin to climb out
of the black pit of despair where I found razors, pills,
quarts of whiskey and how easy it is to make a noose
when you’re determined.
It was 5 a.m. early last March, a workday. I sat in my
boyfriend’s dark kitchen. My head pounded from the
hangover, of course, but the ache in my spirit eclipsed
anything I had experienced, including childbirth. One
thought coincided with the pounding: the Dames Point
Bridge is high enough. A recent Tampa Tribune article on
jumpers said you’ll crash into the water so hard, your ribs
“Insanity is frustrating, never easily remedied, seldom inexpensive. Add alcohol or drugs,
and craziness may be our saddest plague.”
will break and puncture your heart. Or your neck will
snap. It will hurt only briefly. And then, peace.
“Addicts,” jokes my friend Joan, a college chum and
25-year member of Narcotics Anonymous (NA), “are
people who really want to die. They just don’t want to be
around while it’s happening.”
Unfortunately, she is right. Or fortunately, perhaps,
since I am not dead.
I drove myself to St. Vincent’s because alongside my mental
images of bridges was an image of the cross on top of that
Riverside facility. “I need help,” I said to no one as I drove.
The emergency room intake girl admitted me, weeping
and crumpled in an old black coat. Another nurse called a
doctor; the doctor talked to me in the locked solitary-confinement
room and by 11 a.m., a private ambulance was
taking me to Ten Broeck, the drug and alcohol treatment
facility on Beach Boulevard. Thank God for insurance.
While I was still employed in corporate marketing, I had
Blue Cross. It made all the difference.
Mental illness costs taxpayers an estimated $193 billion
a year in lost earnings alone, according to a study funded
by the federal government’s National Institute of Mental
Health. And when you don’t have health insurance — or
the police are not sure — you end up at places like the
Mental Health Center, a facility I think of now as the
mental jail. Cops took me there when my girlfriend, out of
other ideas to help, called 911.
November 10-16, 2009 FOLIO WEEKLY 17
PHOTO COURTESY SARAH MALLAT

18 FOLIO WEEKLY November 10-16, 2009
“The ache in my
spirit eclipsed any
pain I had experienced,
including
childbirth.” (Kathy,
pictured here
with her boyfriend
Kenneth Balser
in 2007.) PHOTO COURTESY KENNETH BALSER
“For our group purpose there is but one
authority: a loving God as he may express
himself in our group conscience. Our leaders
are but trusted servants; they do not govern.”
— AA Tradition No. 2.
It’s obvious, once inside, that crazy people
need authority. In places like the mental
jail, I was grateful for it. Every night a
guard sat all night with Linda. The ballerina
had a bad temper; she screamed at
guards and inmates and the food service
worker who didn’t bring enough bananas
for 8 p.m. snack.
Knowing Linda would not attack me in
the night (as long as the guard didn’t fall
asleep or leave) made it possible for me to
sleep, finally. Due to alcohol and nicotine
and too much coffee during the struggle to
keep my high-paying job and my home, I
had been sleeping maybe four hours a night.
For months.
“The only requirement for AA membership is a
desire to stop drinking.” — Tradition No. 3
There’s a critical word: desire. Today at
AA meetings I occasionally meet people who
smell of alcohol. Could be they’re at the
meeting via a “nudge from the judge” —
forced into AA by a DUI, or a probation
officer, or sometimes a soul mate who threatens
to kick her out if she doesn’t get help.
At Ten Broeck I met an older gentleman
like that. Let’s call him Russ. Well-groomed,
well-spoken, Russ had been a successful
salesman. His wife put him there, he said.
CRAZY STATISTICS
We talked business in the evening hours
when staff had no planned activities, or
while standing in line for meds, or while
standing in line to be escorted to the dining
hall for a greasy breakfast.
Ten Broeck is owned by Psychiatric Solutions,
Inc., which describes itself as “the
largest operator of owned or leased freestanding
psychiatric inpatient facilities with
approximately 10,000 beds in 31 states,
Puerto Rico and the U.S. Virgin Islands.” Its
stock trades on NASDAQ as PSYS; in early
December 2008, its shares cost around $25
vs. a 52-week high of $40.90. Its five-year
share-price growth rate: 210 percent. Revenue
topped $1.7 billion in its most recent
year, according to Smart Money data.
Ten Broeck has changed owners six times
since its launch, according to its profile on
Hospital-Data.com. Accredited by the
JCAHO, or Joint Commission on Accreditation
of Healthcare Organizations, the psychiatric
facility accepts only Medicare and
privately insured patients — too bad for the
poor or disabled on Medicaid.
According to its website, “ … we all cope
with daily situations that can lead to feelings
of confusion, inadequacy, failure or hopelessness.
Because these feelings can become a
heavy burden at any age, Ten Broeck provides
a calm and safe setting for progressive,
individualized treatment for all ages.”
The company also says its “clinical staff
operates from a multidisciplinary team
approach developing an individualized plan
for each patient … the first step for a return
• One in four U.S. residents 18 and older suffer from a diagnosable mental disorder in a given
year. That’s 57.7 million people, or 26 percent of us, based on 2004 U.S. Census data.
• “Even though mental disorders are widespread,” the National Institute of Mental Health
says, “the main burden … is concentrated: 1 in 17 suffer from a serious mental illness.”
• Mental disorders are the leading cause of disability in the U.S. and Canada for people
ages 15-44.
• “Many people suffer from more than one type” of insanity at a given time – 45 percent
meet criteria for two or more disorders.
• Alcoholism accounts for 100,000 U.S. deaths each year, says Mayo Clinic.
• More than 90 percent of people who kill themselves have a diagnosable mental disorder –
most often depression or substance abuse. In 2004, 32,439 people (approximately
11 per 100,000) killed themselves.
• The highest suicide rate in the U.S. is among white men over 85.
• Though women attempt suicide two to three times as often as men, four times as many
men succeed.
• According to the NA website, Narcotics Anonymous in 2007 had “over 25,065 groups
holding over 43,900 weekly meetings in 127 countries.” �

to successful living. Our goal for each
patient is to create a healthy balance between
the mental, physical and spiritual … “
Well, the nice young man who admitted
me certainly helped my physical state, giving
me two of his cigarettes as we sat in a sunny
courtyard and he read me my rights. Yes,
mental patients have them. The list, on huge
posters in all three hospitals I visited during
last year’s grand tour, includes things like the
right to see a psychiatrist, to participate in
the development of one’s treatment plan and
to be secure in one’s person.
Except for belts, of course. And shoe
laces. And dental floss. Those things you
always surrender on admission, lest you hurt
yourself and subject authorities to messy liability.
Nothing said “crazy” quite like having
a nurse at Wekiva Springs hospital watch me
as I flossed. At least she let me.
AA’s Fourth, Fifth and Sixth Traditions:
“Each (AA) group should be autonomous
except in matters affecting other groups or AA
as a whole.”
“Each group has but one primary purpose:
to carry its message to the alcoholic who
still suffers.”
“An AA group ought never endorse, finance
or lend the AA name to any related facility
or outside enterprise, lest problems of money,
property or prestige divert us from our
primary purpose.”
Money. Property. Prestige. Those
things, those elusive apexes of our capitalist,
celebrity culture, they all still operate
on the inside. On my next stop, Wekiva
Springs Center for Women, I befriended a
woman who defined her stay as a respite
from raising two boys, the older one autistic.
I met Susan, a horse-trainer from
Ocala who seemed soothed by ECT,
today’s version of electroshock therapy.
And I met Savannah, beautifully 19 and
At Ten Broeck, a health care worker named
Joyce concluded one of the day’s group discussions
with this vital bit of advice: “Make
sure any meds the doc prescribes are covered
by Medicaid. That way you’ll be able to stay on
them after you’re discharged.”
Medications for mental illness are in
steady development. In Jacksonville, for
instance, an enterprise called CNS HealthCare
advertises regularly for participants in investigational
studies of treatments for depression
and bipolar disorders. One girl I met at Wekiva
happily reported how well her new meds
worked. She liked the doctor, too.
Unfortunately, in our wide-open-online culture,
your prescriptions can become a weapon
against you. Business Week detailed the situation
in a July 23, 2008, special report: “They
Know What’s In Your Medicine Cabinet.”
“That prescription you just picked up at the
drugstore could hurt your chances of getting
health insurance,” Chad Terhune reported.
“An untold number of people have been
rejected for medical coverage for a reason
they never could have guessed: Insurance
willowy, with flowing black hair and eyes
the color of the Caribbean.
None of us were junkies, we agreed
without saying, as we smoked on the
locked patio.
Savannah was an artist, she said, and I
agreed by the looks of her movements: languid,
fine. She made American Indian
dreamcatchers to sell at craft fairs. She had
done a little topless dancing, for the money.
My friend jokes, “Addicts
are people who really
want to die. They just
don’t want to be around
while it’s happening.”
Unfortunately, she is right.
Or fortunately, perhaps,
since I am not dead.
She most recently waitressed and moved
around the country with her husband, a
Navy man, and their little boy. The boy
misbehaved violently as he left with his dad
after family hour. Not even promised ice
cream mattered.
Wekiva is a pretty place, a many-winged
building set on several green acres off Salisbury
Road in an anonymous Southside
office park. According to its website, “The
average price for our highly regarded residential
services is $22,500, which is about $750
per day for a 30-day length of stay.”
The hospital also says, “While we are
committed to providing quality care to our
DRUGS AND INSURANCE COVERAGE
“They Know What’s In Your Medicine Cabinet”
companies are using huge, commercially
available prescription databases to screen out
applicants based on their drug purchases.”
“Prescription profiles could add another
hurdle, making it especially difficult for the 47
million Americans who lack insurance to
acquire coverage. Some 18 million people are
now covered by individual (vs. employer-sponsored)
policies.
“Most consumers and even many insurance
agents are unaware that Humana, UnitedHealth
Group, Aetna, Blue Cross plans and
other insurance giants have ready access to
applicants’ prescription histories. These online
reports, available in seconds from a pair of
little-known intermediary companies at a cost
of only about $15 per search, typically include
voluminous information going back five years
on dosage, refills and possible medical conditions.
The reports also provide a numerical
score predicting what a person may cost an
insurer in the future.”
One section header in particular epitomized
the problem as it relates to illness of the
mind: “Mental health is a red flag.” �
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November 10-16, 2009 FOLIO WEEKLY 19

Not until I admitted I’d grown
up with an alcoholic mother,
and that I, too, had the disease,
could I begin to climb out
of the black pit of despair
where I found razors, pills,
quarts of whiskey and how
easy it is to make a noose
patients, we will not compromise treatment
based on managed care limitations. In our
experience, it is unfortunate that many
insurance companies do not offer adequate
benefits for mental health or behavioral disorders
that require more than 4-6 days of
inpatient treatment.”
On nice days outside, Wekiva shift supervisor
Gloria turned us over to a physical therapist
for a walk through the parking lot and
grounds. I went back there
once a week for weeks after my third
time through. I have a 180 IQ, my mother
told me — but I am a very slow learner. And
defiant — the defining characteristic of most
addicts, according to a psychiatrist.
At Wekiva I learned lots of the important
acronyms in the mental health industry.
AMA or “against medical advice” means if I
left treatment before the doctor said I could,
insurance could refuse to pay. AMA also
stands for the American Medical Association,
of course, which officially classifies alcoholism
as a physical disease.
It’s not one that normal people necessarily
understand. And that’s why tribal participation
matters. Finally, I realized, I belong here.
Fellow AAs and NAs laugh at the wrong
time, like me. Many are workaholics, like
me. Some are painfully shy; others are offensively
overbearing — control freaks, certain
they and their God have it all figured out for
you, if only you would obey.
“Every AA group ought to be fully self-supporting,
declining outside contributions.”
— Tradition No. 7
“Alcoholics Anonymous should remain forever
non-professional, but our service centers may
employ special workers.” — Tradition No. 8
WHO CAN YOU CALL?
• Alcoholics Anonymous: (904) 399-8535
• Narcotics Anonymous: (904) 723-LOVE
• Ten Broeck: (904) 724-9202
• Wekiva Springs: (904) 296-3533
• Mental Health Center of Jacksonville:
(904) 695-9145
• Local Suicide Hotline: United Way, 211
or (904) 632-0600
Crazy.
when you’re determined. PHOTO COURTESY SARAH MALLAT
“AA as such ought never be organized, but
we may create service boards or committees
directly responsible to those they serve.”
— Tradition No. 9
At facilities like Ten Broeck and Wekiva and
the Mental Health Center of Jacksonville,
AA practitioners spent some of their
Christmas season.
At one recovery house, you could get a
steak dinner, or chicken, or a vegetable plate
for $15 or $20 and they’d use any profit to
make sure every inmate — um, patient —
received a holiday gift. And that’s the miracle
discovered by AA founder Bill W.: “We tried
to carry this message to the alcoholic who
still suffers and to practice [AA’s] principles
in all our affairs.”
Alcoholics Anonymous has no opinion on
outside issues; hence the AA name ought
never be drawn into public controversy.”
— Tradition No.10
“Our public relations policy is based on
attraction rather than promotion. We need
always maintain personal anonymity at the
level of press, radio and films.”
— Tradition No. 11
“Anonymity is the spiritual foundation of all
our traditions, ever reminding us to place principles
before personalities.”
— Tradition No. 12
It’s still December as I write this. Today,
instead of a Christmas card, the mailman
brought a $1,590 bill from Wekiva — leftovers
that Blue Cross did not cover.
I maxed out my mental health coverage
in 2008. And then my job was eliminated.
Still, I’m not dead. And I’m an absolute
believer in miracles.�
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November 10-16, 2009 FOLIO WEEKLY 21