The dark side of freedom: An Alaska hermit’s right to suffer and die alone

What should we do with the story of a man who for years lay dead of suicide in his Fairbanks home? Alaskans value privacy, but we also have a long tradition of looking out for one another.

Paul Pesika had lived well, once, as a respected political operative, outdoorsperson and leader of social service non-profit organizations. But paranoia infected his mind decades ago and he withdrew from friends and family, turning his house in a nice suburban neighborhood into a dark bunker.

Reporting in Fairbanks, ADN reporter Michelle Theriault Boots couldn't find anyone who had seen him since the late 1990s. He had chased everyone away to wrestle alone in the dark with terrifying thoughts and beliefs.

[He withdrew from his friends and neighbors. When he died in his Fairbanks house, no one noticed – for years.]

Worse than his terrible, lonely death is the thought of the fearsome mental illness that gripped him for so many years. He believed the government was sending transmissions into his mind. He expected to be abducted by intelligence agents.

It's hard to imagine enduring so much fear and suffering for so long.

But that's the freedom that we have as Alaskans. Our state led in the 1970s as courts and legislatures across the United States gave mental patients the right to refuse treatment unless they are dangers to themselves or others. As a complete recluse, Pesika, kept anyone from knowing if he was such a danger.

These new rights responded to abuses in mental hospitals, some legitimately awful, and some exaggerated into horror stories. The 1962 book and 1975 movie "One Flew Over the Cuckoo's Nest" helped create a cultural image of mental health workers as sadists. State hospitals shrank or closed.

Giving hospitals unfettered power over people's minds is a bad idea. We can see that from the current treatment of disempowered foster kids, as I have written before. But the broad right to refuse care isn't a solution either. The policies of the 1970s filled our streets and woods with mentally ill adults.

Dr. Aron Wolf, a psychiatrist for many years in Anchorage, has helped bring care to the homeless. But in some ways, he said, those patients are safer than a man like Pesika.

"This one was different, because he really kept to himself. If you're on the street, there really is a street society. They look out for each other," Wolf said.

[Fierce caring and new ideas bring housing after long mental illness]

But that doesn't mean Pesika's case was unusual, he said.

"No, it's not unusual. If you have the funds to do it, it's not unusual," Wolf said.

The situation has been called, "Rotting with your rights on."

A paper with that title pointed out the problem with these new rights in 1979. Drs. Paul Appelbaum and Thomas Gutheil studied the reasons patients refused medication. In the vast majority of cases, the illness explained the refusal—ranging from delusional beliefs to wordless violence.

Sometimes the illness doesn't want to be cured. But, for many people, the right to refuse medication is a sentence to suffer.

In 2007, a woman was released from a mental hospital in New Hampshire after a year of refusing treatment. She was supposed to live with her boyfriend, but he didn't exist—he was one of her fantasies. She didn't want hospital staff to contact her real family and privacy laws forced them to comply.

After her release, she broke into an abandoned house and lived there until she starved to death. The journal she left behind informed a powerful essay in the New Yorker, raising, eight years ago, the same debate we're having now about Pesika.

Even mild mental illness often comes with denial. The illness can redefine an outside cause as the source of the internal pain it is causing.

"Mental illness, the tragedy of it, is that it doesn't let you see reality," said Faith Myers, an advocate for the mentally ill in Anchorage and their rights, who herself lives with schizophrenia.

After five stints in Alaska Psychiatric Institute, all more than 15 years ago, Myers devotes herself to improving rights of patients and addressing the hospital's shortcomings, while taking medication.

"I have a purpose, I have a mission, and I'm frankly as sane as you are," she said.

Despite API's flaws, she said that if she had a friend or relative suffering from a severe mental illness, she would try to get them admitted.

But that's not easy.

"It takes a lot of effort to pursue someone who is bent on a downward path," she said. "If someone doesn't have relatives, and they close themselves off to society, and there's no one to reach out to them, it's really easy for them to slip through the cracks."

I'm sure most readers have either been mentally ill or have tried to help a family member with a mental illness. Epidemiologists say a fourth of us will have a mental illness at some point in our lives. But, nationally, community mental health services only reach about one-fifth of the people who need them.

Instead, we use the criminal justice system. A person whose mental health problem leads to crime could be lucky enough to come before a mental health court. Receiving treatment could be a condition of avoiding jail—overcoming the right to refuse.

Surely we can do better than that. We're in an epidemic of suicide. Poor souls wander our greenbelts. More hide in their homes, like Pesika, alone with fearsome delusions and pain.

Privacy is in our Alaska Constitution. Self-reliance is our creed. But sometimes caring means interfering and forcing the issue.

As a state, we need mental health services adequate to address the need. The Walker administration has tried to free up money through a bureaucratic federal process so it costs Alaskans nothing. That has taken years. Instead, we should act now and pay what it costs.

As individuals, we may not be able to save everyone like Pesika. He was barricaded with a gun, paranoid and scary. Without a provable threat, the police couldn't intervene.

But you may be able to save someone else.

The National Suicide Prevention Lifeline is 1-800-273-8255.

The 24-hour crisis line at the Providence Psychiatric Emergency Department is 907-563-3200.

The views expressed here are the writer's and are not necessarily endorsed by the Anchorage Daily News, which welcomes a broad range of viewpoints. To submit a piece for consideration, email commentary(at)adn.com. Send submissions shorter than 200 words to letters@adn.com or click here to submit via any web browser.