Psychotic Episode in Public? Better Be Female, Hot and White.

This piece was co-written with Sally Littlefield.

On March 23, 41-year-old Daniel Prude ran out of his brother’s house in an erratic state, and his worried brother called the police to get him help. When the police arrived, they handcuffed Prude and put a controversial “spit hood” over his head, possibly due to his claims of having coronavirus. When he remained agitated, the officers pushed him to the ground, put a knee on his back and told him to “calm down.” After two minutes, Prude was silent and motionless, and a paramedic was called over to perform CPR. Prude died seven days later. The medical examiner’s report mentions acute intoxication by phencyclidine (PCP) as a contributing factor.

Sally Littlefield lives with schizoaffective disorder (a combination of schizophrenia and a mood disorder, in her case bipolar) and recently experienced a nine-month period of psychosis that included hospitalizations and encounters with first responders. She was interviewed by her mother for this piece.

Sophie Littlefield: Not every kid gets to spend the pandemic with their mom. How’s that working for you?

Sally Littlefield: It was hard when my illness forced me to move out of my apartment in San Francisco and stop working at my full-time, professional job. It’s been an adjustment to accept my new identity as a person living with a serious disability, but I’m fortunate to have a wide support system of family, friends and medical professionals. I’m happy to say I’m back on my feet and working full-time, and looking forward to living on my own again soon.

Sophie: So let’s talk about what happened to Daniel Prude. His family member recognized symptoms of psychosis and called the police to get him some help. The responding officers encountered a Black man behaving erratically. At some point in their attempts to subdue him, he said, “Give me that gun.”

Sally: It’s really easy for able-minded people to judge those with mental disabilities for how they respond to perceived threats, whether the threat is real or their perception is caused by their psychosis. But if you genuinely believed that your life was in danger, how would you react? Would you also try to grab a weapon and fight your way out of it? What if you believed the people restraining you would hurt or kill your loved ones if you didn’t stop them?

Misperceptions about mental illness don’t help. For instance, violence is not a symptom of schizophrenia, and many people who experience psychosis are never violent. When I had delusions that police officers or medical staff were trying to sexually assault or kill me, my response was to run and hide. Even if I had wanted to hurt someone, it can be very difficult to follow through on a threat of violence when you’re in a mentally incapacitated state. As I understand, Prude was naked and handcuffed when he demanded the gun. Just because someone says something violent does not mean they are an actual threat or should be treated as such.

Sophie: During the onset of your illness, you experienced something similar. What happened?

Sally: In the 24 hours leading up to my first hospitalization, I was handcuffed twice by police officers. The first time, police were called when I stole someone’s purse at a concert while in a deluded state, and they took me to a hospital. I was released several hours later, and while still suffering delusions, I drew the attention of a different set of officers. When I walked away from them after they told me to stop, they tackled me to the ground from behind and handcuffed me.

Sophie: In the state you were in that night, what do you think it would have been like to have a hood put over your head?

Sally: That night my delusions weren’t very scary, so I think I would have found it more amusing than threatening. In fact, the first time I was handcuffed that night, I thought it was a joke and asked the police officers if they were strippers. But at other times when I interacted with authority figures in a state of psychosis, being hooded would have made me think I was minutes away from being murdered.

During one hospital admission, I was strapped to a hospital bed in a public intake area, and had delusions that the hospital staff were about to rape me. A female hospital worker pulled my shirt and bra away from my chest, probably to make sure I wasn’t hiding any illicit substances or weapons, but the fact that she did so publicly without my consent meant I experienced her actions as a sexual assault. It can be truly terrifying when police or hospital staff carelessly handle you or restrain you when you’re in a state of psychosis.

Sophie: Daniel’s brother, speaking publicly about the officers’ behavior, said “I did not expect me reaching out for help for my brother to turn around 15 minutes later, he’s on life support.”

The EMT who administered CPR later told a police investigator that the officers’ actions appeared “necessary to keep Prude from running around the entire street.”

Sally: I think this is somewhat similar to when I was tackled solely for continuing to walk away from police officers. Just because someone is being defiant or behaving abnormally doesn’t mean they’re a threat to themselves or others, or need to be restrained. Police officers should use only the amount of force that is absolutely necessary for public safety.

Sophie: The medical examiner found PCP in Prude’s system. When people hear that a person in a case like this was using drugs, they sometimes believe the person is at fault.

Sally: I was also under the influence of substances when I was handcuffed and hospitalized. In my case, it was legally purchased marijuana, but marijuana can bring on psychosis and be pretty dangerous for someone with a psychotic disorder.

While using drugs can exacerbate the symptoms of one’s mental illness, I don’t think it’s fair to blame someone for their psychotic episode because they willingly took drugs that brought it on. When I was first hospitalized, nobody, myself included, knew that I was prone to experiencing psychosis. I had taken the lowest recommended dose of edible marijuana, a dose that I had taken many times before with no issues. My psychosis caused a delusion that graffiti on a bathroom stall was commanding me to take more doses, which I did.

Mentally ill people who take drugs, even those as dangerous as PCP, may not understand the possible effects of taking the drug. Furthermore, having a serious mental illness that involves psychosis takes a huge toll on you, because both the symptoms and profound stigma can feel unbearable at times. I know from personal experience how tempting it is to use substances to cope with judgement, accusations, blame and rejection. Judging people with mental illness for using risky substances to cope only increases their desire to use substances.

Sophie: We have another family member in his 20s who also experienced something similar. During a psychotic episode, police were called when he ordered a meal in a restaurant that he couldn’t pay for. They ended up tasing and arresting him. Why do you think he had a different outcome than you? Than Prude?

Sally: For one thing, I didn’t threaten violence against anyone and was fairly compliant when restrained. However, I don’t think you can overlook the impact of factors like gender and race. Men are socialized to react to threats with aggression and are more likely to be perceived as aggressive than women, who learn from a young age to be more submissive. In addition, Black people are more likely to be perceived as violent and threatening than white people.

I think that my situation would have ended very differently if I had been a 41-year-old Black man rather than a 23-year-old white woman. The night of my first hospitalization, I was wearing carefully applied makeup and a trendy outfit, and I assume the police thought I was just a harmless girl who partied too hard, rather than someone with a serious mental illness.

Sophie: How can we stop things like Prude’s death from happening?

Sally: I’d hope that police and medical staff would take the time to learn about psychosis for what it is — a serious medical condition that no one asks for and no one deserves. I often felt like police officers and medical staff were annoyed with me or taking my actions during psychosis personally. If police officers and medical staff treated people experiencing mental health conditions with compassion and understanding, I think the people with mental health conditions would trust them more and be more compliant.

Sophie: Eight months into your psychosis, when your symptoms caused me to suspect that you needed to go to the hospital, I called our county’s mobile crisis unit. A nurse, social worker and police officer — all trained to deal with people with mental illness — arrived within the hour. What do you remember about that night?

Sally: I remember a police officer calmly explaining to me that I was going to be transported to a hospital. I remember steadfastly refusing to go willingly, as I thought I was in danger of being raped or killed if I did. I was put into the ambulance by force, but only the lightest amount necessary — just pulling me by the hand. The EMTs and police officers were very kind and gentle with me, and that really helped make the experience less scary.

Sophie: I feel really lucky that we live in a county that offers so many resources, especially because you didn’t have private health insurance at that time.

Sally: Something I think about all the time is how easily my story could have ended tragically — if I wasn’t white, if I wasn’t a young woman, if we didn’t live in a county in a progressive part of the country that is relatively well-informed about mental illness. I think it can be tempting for people to look at someone like me who is working a full-time, professional job and is completely able-passing and ask why all people with mental illness aren’t able to achieve such positive outcomes. They may even consider it a personal failing if someone with severe mental illness struggles to manage their disorder and has adversarial encounters with law enforcement and hospital staff as a result.

People need to understand how factors such as race, class, age and gender can affect outcomes. They also must appreciate that when someone is treated poorly in the course of a mental health crisis, their mental health may deteriorate further and cause behavior that seems violent and threatening. The best way to deescalate a situation with someone in a mental health crisis is to be as kind and gentle as possible.

Sally Littlefield graduated with honors from U.C. Berkeley and began a career in the nonprofit sector before experiencing the onset of schizoaffective disorder. She has since returned to a full time position in a non-profit organization and uses her lived experience to educate, support, and advocate for others experiencing serious mental illness.

Sophie Littlefield is the author of over twenty novels in several genres.

This piece originally appeared on Medium. Learn more about us at sallylittlefield.com and sophielittlefield.com.