And once, when her daughter picked up a paring knife and warned, "If you don't give me something to eat, I'm going to stick this in you," Boehm decided that she had had enough. Heeding the advice of friends and a psychiatrist, she obtained a protection order.
Since then, her daughter has not hurt, harassed or threatened her.
What the police couldn't do for her, what the mental health system wouldn't do for her, Boehm ultimately did for herself.
"She's really afraid of (the protection order), because she knows she can go to jail," Boehm says of her daughter.
Over the last four days, The Inquirer has reported how parents of the seriously mentally ill have taken desperate measures to get help. Some have broken the law by lying to mental health and court officials to get their children committed to hospitals. Others have brought criminal charges against their own children, in hopes that judges would force treatment rather than send them to jail.
But a growing number of Philadelphia parents, Phyllis Boehm among them, have given up on the mental health system entirely and decided to seek protection for themselves.
Such parents, some of them frail and elderly, have been beaten, threatened and intimidated by their children - young adults who are seriously mentally ill.
A psychiatric commitment is issued when a mentally ill individual has actually taken steps to harm someone within the last 30 days. A protection order, however, can be issued when there is only a threat of harm and a history of violence. The orders serve to evict a mentally ill person and protect the family for up to a year - longer than a psychiatric commitment would. Violating the order can result in arrest and jail.
But, as essentially last-ditch measures, protection orders aren't intended to treat the mentally ill. They are intended only to protect family members
from their fury.
Sometimes, as in Boehm's case, they work; the mentally unstable child is aware enough, and fearful enough of jail, to stay away.
Other times, they don't work.
In either case, by the time most parents resort to this measure, their children have cycled in and out of treatment for years without showing improvement. In between hospitalizations, they typically refuse medication, deteriorate again and resume their dangerous behavior.
The parents "are beside themselves," said Common Pleas Court Judge Evelyn Trommer, who has issued many protection orders in Philadelphia. "They have carried this cross for years and years. I've seen fathers say, 'Judge, I'm at the end of my rope now. I'm afraid I may kill. I just don't know where to turn anymore. I've had him in and out and in and out of every institution.' "
Trommer has been on sick leave in recent months, but Judge Petrese Tucker says she has maintained Trommer's philosophy of issuing orders to protect
families of the violently mentally ill.
The state law that provides for protection orders was passed in 1976 and is often called the Spouse Abuse Act. Its intent was to protect battered wives by evicting their violent husbands or lovers. But Trommer has used the law to fashion remedies for families of the mentally ill.
On the basis of Trommer's estimates, in 1987 alone about 150 Philadelphia residents sought protection from someone who was mentally ill. Most of the plaintiffs were parents.
She said that 80 percent of the time, the protection orders are effective in breaking the pattern of violence. The orders are obeyed, said Trommer, ''simply because I'm a judge."
Still, the number of mentally ill who violate these orders and wind up in jail is increasing, according to psychiatrist Edward B. Guy, program director for mental health services in the Philadelphia prison system. Guy said: "It happens quite often. . . . It's everybody's general impression we are seeing more of these cases."
At times, Phyllis Boehm tried but failed to have her mentally ill daughter committed. Other times, she succeeded - only to have her daughter become menacing after she was released.
Boehm got the protection order on Aug. 7, 1987. But for her that was only partial success. Her daughter's mental illness, which dates back at least a decade, remains untreated.
Boehm, whose husband is confined to bed with multiple sclerosis, recalls the day, 11 years ago, when a high school counselor called to report that her daughter, then a senior, was running through the school corridors threatening people with a lead pipe.
Over the years, Boehm says, she has seen her daughter - a talented illustrator, pretty enough to be a model - so overmedicated that she has been in a near stupor or so out-of-control without any drugs that she has terrified her mother.
She quotes a former psychiatrist of her daughter's: "You have two choices here," the doctor once told her. "She can be violent or she can be passive. Which do you want?"
What Boehm wanted was help for her daughter, from whoever could give it. Her daughter had been in and out of mental hospitals. And when she was out, her mother says, she was clever about evading treatment. At the library, she would study the side-effects of psychotropic drugs, then falsely tell her doctor she was suffering from them and stop taking them. When sent to day treatment programs, she knew she had the right to leave - and did.
Ultimately, unmedicated and untreated, she would deteriorate again and become threatening and abusive, Boehm says, triggering the next hospitalization.
In 1985, Boehm's daughter moved out of the family's home, but she came back often - sometimes to claim assorted possessions; sometimes to bathe, naked, with a garden hose in the front yard, and sometimes to threaten her mother. Police were called to the Boehm residence nine times in 1986 and 1987, according to incident reports from the Eighth District in the Northeast.
More than once, Boehm says, officers suggested that she go over to the Rush center and attempt to commit her daughter involuntarily.
"So I go over to the center and sit for four hours and they don't feel she warrants being put in the hospital," Boehm says.
John Ciavardone, the center's director, said in an interview that the incident where Boehm's daughter broke the glass in the door was a hard call - ''a good example of where the commitment process has a few holes."
Boehm said staff at the Rush center appeared to think that she was overreacting to her daughter's behavior. She hoped, therefore, that the police would take an active role in helping to get the commitment, thus lending credibility to Boehm's own statements.
But she believes that the police were simply unwilling to get involved in what might have looked like a family dispute. Confronted with police officers, her daughter would behave perfectly rationally.
Boehm recounts the following exchange, which she says was typical:
Police: "There's nothing we can do. We can only tell her to leave."
Boehm: "She broke my door."
Police: "We didn't see her break the door."
Boehm: "She threatened me with a knife."
Police: "We didn't see her threaten you with the knife."
Officer William Clark, who responded to at least one of Boehm's calls, explained his inability under the law to file for a commitment for an incident he did not witness: "These people have rights, too. We can't . . . take action based on what (another) person says."
Eventually, after the incident with the paring knife, Boehm's daughter voluntarily entered Eastern Pennsylvania Psychiatric Institute. As her daughter's release drew near, Boehm gave in to her fear and reluctantly sought the protection order.
"I almost didn't do it," she recalls. "Finally, the psychiatrist said, 'I really believe you should do it.' And my friends were really afraid for me."
But if the order has given Boehm respite from her daughter's chaotic behavior, it cannot force her daughter into treatment, leaving Boehm in a limbo of frustration and worry.
"Now I'm just hoping that she can function with people," Boehm says wearily. "I have given up, which probably isn't too healthy either. I just want to have her function in society."
Police officers, psychiatrists, social workers and other mental health professionals are among those who encourage families to get protection orders in cases of recurring violence.
"It's a way of saying, 'No, there's nothing more we can do under the current system,' " said Barbara S. Blumenthal, who directs social workers on the adult unit at Eastern Pennsylvania Psychiatric Institute.
Stephen Sittenfield, a psychiatrist at Albert Einstein Medical Center, says he suggests the use of court orders even in some cases where a mentally ill relative is already committed. Once the commitment has expired, the protection order may continue to provide the family with some security.
"What we're able to do is limited," he said. 'And you need to find some ways to protect yourself."
At present, the use of protection orders appears limited to Philadelphia, according to Bonnie Menacker, former chairwoman of the state Bar Association's Family Law Section. But Menacker predicts that their use will spread once word gets around - just as in recent years the number of petitions has increased in Philadelphia.
John and Ruth Reid thought they were finally safe.
For 20 years, they had lived through the chaos and calm of their eldest son's mental illness.
There had been times when he would neither speak nor bathe for weeks. There had been times when he would curse them and steal from them and threaten to kill them. There had been times when he was, in his father's words, "like a roaring lion." His medical records at Mercy Catholic Medical Center's Misericordia Division indicate that he had been hospitalized 10 times since the age of 16, at times diagnosed with chronic schizophrenia, at other times with paranoid schizophrenia or bipolar disorder.
In August 1986, the Reids' son hurled their TV onto the floor, knocked over an aquarium, broke a lamp and threw a juice bottle that hit his father's head and broke a mirror. Shattered glass cut Reid on the right arm. Had it cut the left arm, weakened by repeated kidney dialysis, Reid says, he might have bled to death.
So, finally, late that summer, the Reids took the advice of police officers and secured a protection from abuse order, barring their son from their West Philadelphia rowhouse.
"I felt very bad about it," the son said in an interview much later. "I felt that I was neglected by my whole family, because I love my mom and dad. I don't know what made me do a thing like that."
John Reid didn't know either. He only knew that, for him, the order was not protection enough. Despite it, his son returned home again and again, banging on the door and threatening to break a window.
Reid, 63, found the stress to be too much.
"That just carried on, got on my nerves every night," Reid says. "You know, banging on the door, I couldn't sleep. And the doctor told me the dialysis was too much. . . . I got to have peace."
So, in May of 1987, tired of it all, Reid moved out of the house, his home for 30 years, and into an apartment in Yeadon, Delaware County. His wife felt she couldn't follow him.
"So if my wife wants to stay here," he said, meaning his own home, where he was an uneasy visitor, "she can stay here by herself."
By herself, Ruth Reid oversaw two households, her son's and husband's. She said she had little choice.
John Reid returned home about a year ago, after his son entered treatment and a boarding home in North Philadelphia.
"I'm taking my medication now," the son said in an interview this week. ''I realize if I don't, I might have a relapse."
Marie Piscitelli's son was in jail.
His crime: Coming home.
At 1:49 a.m. on Sunday, March 13, 1988, the 41-year-old man was arrested for violating protection order number 87-11-0892. His mother obtained the order in November 1987 because it seemed to her the only thing left to do.
"It's cruel," she said, "but it's the only way."
Piscitelli did not reach that conclusion swiftly or easily. Her decision to place her South Philadelphia rowhouse off-limits to her son followed years of coping with his threefold troubles - schizophrenia, severe drug abuse and mild retardation. His history included robbery, vandalism, threats, drug overdoses and the near-fatal stabbing of his sister 11 years ago.
Out of the hospital, his pattern was predictable and frightening: He would stop taking his medication, start using street drugs, come to his mother's house and harass her, and finally wind up in the hospital once again.
One month after his October 1987 release from Philadelphia State Hospital, known as Byberry, it happened just that way. He turned up on his mother's front stoop, shouting, pounding on the door, demanding money, threatening her and his terrified sister.
The next day, a Saturday, Piscitelli obtained an emergency protection order.
Her son's problems first became evident in the early 1970s, she said - about the time he began bringing home junkie friends, using cocaine and methadone, suffering overdoses for which he was hospitalized again and again.
Each time, after returning home, he seemed to be better for a while - but only for a while.
"Like, say, a couple months later?" she said. "He'd be sitting in a chair, looking very obnoxious. It was scary. I went back to the hospital and they said they couldn't do nothing because he had no violence . . . the hospital was there if he wanted to come in. But he didn't know he was sick."
Over the years, Marie Piscitelli said, her son's behavior grew more frightening. He took steak knives from the kitchen drawer and flung them, mumbletypeg-style, so they stuck in the dark-paneled living room wall. When she asked him not to, he seemed oblivious to her voice. Sometimes, he sat and stared for so long that his younger brother and sister "thought he was visualizing Helter Skelter," which he had been reading.
In 1975, according to court documents, he spent time in prison in Springfield, Mo., for robbing a post office.
Still, as far as Piscitelli could tell, his behavior remained merely threatening - until Holy Thursday, 1977.
That day, he stabbed his sister, Cathy, in the chest with a golden-handled stiletto. The weapon punctured her lung and put her in the hospital for a month. She recalls fragments of that morning: "I remember (the stiletto) shining gold, and then I was screaming. . . . I remember, I fell on the floor. And the pain. It was a terrible pain. And then he ran off."
There had been no warning. "I was just coming in to get coffee," she said. "He was just walking up and down. He didn't say anything. He just looked like he hated me. I know he didn't hate me. I don't think he knew who I was."
Police found him in the neighborhood, she said, still clutching the stiletto.
Court records also sketch a classic case of a seriously disturbed person who cycles in and out of the mental health system but never seems to get lasting help. He has a "history of auditory and visual hallucinations, with a belief that he thought he was God . . . belief that he was the reincarnation of Jefferson or Hitler or Christ. . . . Diagnosis: schizophrenia, paranoid type with a prognosis of poor."
In 1977 and 1981, documents show, he was committed to Byberry - the first time for 10 months, the second for five. In 1983, he spent two weeks in the Mount Sinai-Daroff Division of Albert Einstein Medical Center, now called Mount Sinai Hospital, after he "claimed voices were telling him to kill."
Over the last couple of years, his mother said, his drug habit has overwhelmed him:
"He started this kick of taking drugs all the time. There was no moderation. It was a dependency, and he thought we were supposed to loan him money. He broke the door, he broke my window, because he wanted money."
A residential drug rehab program failed, sometime around the spring of 1987, his mother said, because "he decided he couldn't take it anymore. He had to be out free."
When she was able to obtain psychiatric commitments, his hospitalizations were brief, and then the pattern of drug-taking and harassment would resume.
On Jan. 24, 1988, two months after Piscitelli got the protection order, Judge Trommer found Piscitelli's son guilty of terroristic threats and paroled him to a halfway house.
On March 13, he violated that parole and later Trommer sentenced Marie Piscitelli's son to 18 months in Philadelphia Industrial Correctional Center, a new drug-and-psychiatric facility near Holmesburg Prison, for violation of probation and contempt of court.
At the time, Piscitelli believed her son would violate the stay-away order again when his prison term ended.
"He understands," she said, "but then, he'll still come back."
In May, Piscitelli's son was released from jail and resumed his old habits, his mother said. He is taking cocaine, refusing treatment and "coming here 10, 12 times a day" to beg for money. When she called his parole officer, Piscitelli said, she was told that jail overcrowding prevented his re-arrest. When she took him, accompanied by police, to a hospital to be involuntarily committed, she said a doctor told her that her son's problem was drugs. When she applied for another protection order, she said she was turned down because her son had neither threatened anyone nor committed a violent act.
"So all day long," she said with a nod at her daughter, Cathy, "we have to watch for a face at the window."
At her son's sentencing hearing last year, Marie Piscitelli spent the lunch recess in a small room outside the courtroom, chain-smoking and chatting with another woman, a hairdresser who also has a schizophrenic son.
Neither woman wanted lunch, finding more comfort in this odd, new kinship. Together, they waited, occasionally whispering words of comfort to each other.
The hairdresser told her story to her new friend:
For one entire winter, she half-slept in her lemon yellow chair by the fireplace, house keys pocketed, the better to escape out the front door if she had to. Burn marks in the rug testify to the nights she nodded off, cigarette in hand.
Upstairs slept her son. She couldn't trust the silence.
He was mentally ill and growing more erratic all the time. He heard spirits talking to him. He imagined bombs in the chimney. He sat on the living room sofa with a knife at his side. He paced in rapid circles around the dining room table, "pulling his hair to get that feeling out of his head, whatever it was. He thought maybe demons were in his head. He would be mumbling something, like he was speaking the Chinese language . . . like he's talking to the demons."
She felt that she was always waiting for his next outburst, unpredictable and terrifying.
One night he went on a rampage, tearing the newel post from the stairwell, smashing the beveled glass in her china cabinet and battering the mahogany dining room table that had been her mother's. Other times, he yanked doors off their hinges, trashed TV sets, shoved her chair over so that she was wedged beneath a lamp table.
In late December of 1986, her son uncharacteristically begged her to get him to a doctor.
"He was getting paranoid and breaking stuff," she remembered. "He was pulling his hair out. He said, 'I'm sick, I need help.' "
So she took him to nearby Mercy Catholic Medical Center's Misericordia Division, where he became increasingly agitated as a mental health worker asked him questions he couldn't answer - his doctor's name, for instance. He had no doctor at the time.
When he began to scream and curse at the mental health worker, his mother said, the woman excused herself and returned with a guard. The guard opened the door and said, "I want you to leave." Banished from the hospital, he
went home untreated. His mother was appalled.
"He was sick," she says, her voice rising. "That's why he was yelling. He was sick, and they sent him home."
About a week later, after another frightening altercation with her son, who steadfastly refused to take the medications prescribed by hospital psychiatrists, the hairdresser sought an involuntary commitment for him - one of so many that she has lost count. Another mental health worker at Misericordia, familiar with the young man's pattern, told her, "I'll take him, but this is the last time. Get a protection order. What are you waiting for? Him to kill you?"
The hairdresser took the advice. In early January 1987 she sought legal protection from her son.
The protection order prohibited him, on penalty of arrest, from entering the house in which he had grown up. Despite the order, he came home after a week or two, and his mother took him in. He was hungry, she explained, and afraid - of being alone, of plots and bombs and such everyday things as electricity. He needed his mother.
But he overstayed her reluctant welcome.
One night in 1987, as the weather began to turn warm, terrified by his bizarre behavior, she pried the screen off a second-floor bedroom window and climbed onto her West Philadelphia rowhouse roof, cowering behind the chimney and thinking, "Oh, God, if he comes after me, I'll have to jump off the roof onto the lawn." But after 20 minutes or so, "things got quiet" and she climbed back into the house.
As a result, her son was charged with violating the protection order, defiant trespass, terroristic threats and criminal mischief. He was sent to the psychiatric unit of the Detention Center on Aug. 13 and paroled by Trommer on Nov. 12. The judge also renewed his mother's protection order for another year.
Two weeks later, at 6 on a Sunday morning, he returned to his mother's house again, in violation of the order a second time. He threatened to slap her, he ranted that "the atom bomb is after me" and he frightened her so badly that she fled the house - and called his parole officer.
On Dec. 2, 1987, police arrested him as a "probation absconder." He was placed in the Detention Center.
He called his mother from jail and threatened her. He called and blamed her for everything, present and past.
She spent long hours recalling that past, years when she had done everything she could for her son. A widow, she had doted on him. Cooked roast beef for him, and shrimp, his favorite meals. Bought him a brand-new Datsun. Plunked down $3,500 for welding school and sent him to electronics school, which he never finished.
His illness began in high school, taking on an ominous significance only in retrospect.
His diagnosis - paranoid schizophrenia - followed a frightening episode when he was about 21 and chased his parish priest with a knife. The Rev. Robert Chapman, now affiliated with Our Lady of Fatima in Secane, remembers all too well: "He reached into his ankle-length sock and pulled a knife. He said, 'I'm going to kill you.' "
A dozen years later, on April 14, 1988, his mother sat in the waiting room of Trommer's court and time dragged.
Her son stands 5-feet-10 to her 5-feet even, and she is terrified of him.
"I know he's my son and I love him, but it was unbearable," she said, her voice quavering. "He would look at me, and it would frighten me. I don't think he knew I was his mother. He would think, maybe, that I was the evil one."
During a brief hearing, Trommer found the hairdresser's 33-year-old son guilty of parole violation and ordered a psychiatric evaluation. At the end of May 1988, he was sent to Community Services Provider, a private residential facility in Delaware County. Such facilities, however, cannot force a person to stay against his or her will. After one week, the hairdresser's son left.
He went home to his mother.
She slid a $20 bill through the mail slot to him and called the director of the residential home, who, in turn, called police. The hairdresser's son is in Philadelphia Industrial Correctional Center awaiting sentencing on yet another charge of parole violation.
And what will his mother do the next time he is released?
"I couldn't call the police again," she said, thinking out loud. "I guess I'd have to let him in. I would leave. I couldn't call the police again. It never solves anything. It just seems useless, me being here. It doesn't do any good. They can't do this and they can't do that. So I'm the one that's going to be on the run."
WHERE FAMILIES IN THE AREA CAN GO FOR HELP
The Alliance for the Mentally Ill (AMI) of Pennsylvania is part of a nationwide organization that provides support for families with mentally ill relatives. Ten chapters are located in the Philadelphia area. The regional office - in Oreland, Montgomery County (572-1394) - represents seven chapters in Philadelphia and the surrounding counties. Other local chapters include: HANDS of AMI in Delaware County (789-1550); AMI of the Main Line (688-4434), and a support group for families of Norristown State Hospital patients (924-3489 or 248-4483.) Information is also available from AMI of Pennsylvania headquarters in Harrisburg, at 717-238-1514.