A Lawyer’s Slide Into Psychosis Was Captured in a WSJ Profile. He Tells Us His Story.

LOS ANGELES—Rob Dart isn’t the successful lawyer and father who left the people who love him two years ago to follow his delusions. That Rob lives in the memory of friends and in family photos.

This Rob, who arrives on time for our interview, is standing by the roadside under the blazing California sun, his eyes and hair competing in wildness, his grin difficult not to match.

In the past year, this Rob has been hospitalized, shot, housed, unhoused, a winner and a loser in court battles. Ultimately, he has shed every scrap of evidence of his life before illness: his connections to his son, family and most friends. He wanders the streets of greater Los Angeles, begging for change and lying down to sleep when he is tired. He believes people are controlling him via hypnosis, activated by a headlock.

Rob, 44, doesn’t believe he is sick. He has refused treatment repeatedly. During a hospitalization last year, he argued remotely before a judge from his hospital bed that he shouldn’t be committed. The judge agreed.

“I did want to leave the hospital, and I did not want to take the medications,” Rob said.

Rob’s situation isn’t that uncommon. Doctors said his behavior is consistent with anosognosia, a neurological condition in patients unaware of their neurological deficit or psychiatric state. More than half of patients with schizophrenia and 40% of patients with bipolar disorder demonstrate anosognosia or severe lack of insight, studies show.

They present a conundrum for society: how to balance individual rights with people’s basic health? Solving the nation’s mental-health crisis requires the participation of some people who don’t think they need help.

Hundreds of people responded to a Wall Street Journal profile of Rob with stories of their own fights to help people lost in their own delusions. Some of their loved ones found stability after years of chaos. But many family members said they have spent decades living in the grief of losing someone in plain sight.

“Is it a biochemical disorder? Is it neurodiversity? Is it eccentricity? And who gets to decide?” said Elyn Saks, a professor of law, psychology, psychiatry and behavioral sciences at the University of Southern California, who has schizophrenia.

Each person experiences delusions in their own way, Saks said, and medication doesn’t always erase them. Some people have delusions that last years. Others only experience delusions under severe stress. “Psychosis is not like an on/off switch, but a dimmer,” Saks said.

Rob draws no distinction between his current and former life. While friends and family say mental illness has taken everything from him, Rob says going off his medications has added context and texture to his experience of life.

“You realize you’re kind of the same person,” he said. “You just know more about yourself.”

Many states are trying to figure out how to help people like Rob. Nearly every state has laws allowing for court-ordered outpatient treatment.

Some states are building hospitals, or moving people from encampments to shelters. California is creating courts for mental health to move people who need help off the streets and into treatment. California and Washington are among states that have expanded laws allowing civil commitment for reasons other than violence.

States including Colorado and Florida recently gave people with mental illness extra tools to challenge commitments.

Civil commitments have risen nationwide. But evidence that commitment helps people recover is lacking. There isn’t enough public data to track commitments and draw conclusions about efficacy, said David Cohen, professor of social welfare at the UCLA Luskin School of Public Affairs. He said doctors are too quick to force medication to subdue patients.

“We try to deactivate people with antipsychotic drugs. We’ve lost the art of trying to figure out how to tackle this with the person in front of us,” Cohen said.

Most patients who have been hospitalized involuntarily say they felt they were left out of their own treatment decisions, studies show. When patients participate in decisions about their care, outcomes are better, said Schroeder Stribling, chief executive of Mental Health America, a mental-health advocacy network.

There aren’t enough practitioners to do that painstaking work. The U.S. has a shortage of more than 8,000 psychiatrists, leaving just a quarter of need met, according to KFF, the health policy research organization. The gap is even wider for people with psychotic disorders, who are treated by specialists in even shorter supply, mental-health professionals said. California needs 51 inpatient psychiatric beds per 100,000 adults, a 2021 Rand study found. The state has 15.

Patients are often asked to choose between their delusions and taking medications that leave them with tremors, sedation and sexual dysfunction. Rob said his medications made him gain weight. “It made me more afraid, less assertive, less confident,” he said. “Who wants to feel like that?”

He weaned himself off the drugs.

Rob slips lightly from cogency to delusion and back again. Over lunch at a diner, Rob talked about books and movies. About the pandemic, and working from home, and how inconsistent Starbucks employees are about free water and bathroom access. He’s funny. He asked enough probing questions to nearly derail the interview.

After nearly two hours, Rob looked up with a flash of self-consciousness. “Has the interview gone on too long?” he asked.

When he talked about the people working to destroy him, his grin vanished. He said he wants to get back to being a lawyer and believes people have taken his intellectual property.

He has refused to see his mother and sister. He believes they are among the people colluding to erase his memories. But he said he sometimes thinks about reconnecting with loved ones. “I’m not sure exactly how,” he said.

Write to Julie Wernau at [email protected]