Starved in Jail | The New Yorker

Carlin Casey first considered the idea of human starvation when he was seven years old. Back then, in 1992, his mother, Mary, read aloud to him and his little sister, Karina, from an unusual bedtime story, Anne Frank’s “Diary of a Young Girl.” The family led a life of relative abundance. At their pueblo-style home in California’s Coachella Valley, Mary blasted Madonna in the kitchen as she made her kids burgers or big plates of spaghetti, lighting candles and burning essential oils (“for the vibes,” Carlin told me). Curled up in bed, listening to his mother describe Anne Frank’s privations, Carlin wondered, what was it like to experience a hunger so cutting? “Now, when I look back on it,” Carlin said recently, “I think maybe that was my mom’s way of trying to warn me—trying to prepare me for how cruel the world can be.”

The memory returned to Carlin years later, in August of 2022, when his then partner, Eric, drove him to Banner-University Medical Center, in Tucson, Arizona. The pair walked into the emergency room. There, Carlin found his mother, looking skeletal in a hospital bed, wearing a diaper. When he’d last seen her, that spring, Mary was a healthy hundred and forty-five pounds, her cheeks bright. Now she was so emaciated that Carlin gasped. “She looks like a famine victim,” he told Eric. He stepped closer.

Mary’s hair—once long and lustrous, a lifelong point of pride—was matted to her head, Carlin noticed. She weighed ninety-one pounds.

“What happened to you, Mom?” Carlin asked.

Mary could barely speak. She worried that Carlin wasn’t actually Carlin. She’d spent the whole night screaming in pain and fear. Her jailers, she believed, might come back for her. “You don’t understand,” she told her son, who she thought might be a robot, or a co-conspirator. “They’ll do whatever they want!”

Carlin told his mom that he would investigate. He’d figure out how she had wound up in such a dire condition, and he’d identify who, exactly, was responsible.

“They aren’t going to let you,” Mary replied. She tried to weep, but her body was too dehydrated to make tears.

Carlin had no idea he was stepping into a scandal that involved health-care corporations with, in at least one case, an annual revenue of roughly a billion dollars—a scandal that implicated core institutions of American public life and affected a shocking number of victims across the country. At its worst, the wrongdoing involved state-sponsored homicides of the most vulnerable citizens, covered up by private companies and county officials.

At the hospital, Carlin had a conviction he later came to regard as painfully naïve: that he could expose whatever horrible thing had happened to his mom, and put a stop to it.

“You wait and see,” he told Mary. Carlin trusted that he could bring about a reckoning.

More information can be found at Starved for Care.

Growing up, in San Diego, Mary Faith Casey could easily access delight. She’d accompany her mother, an amateur astronomer, to the planetarium, or spend long days with her older sister Michelle, climbing around the exhibits at the natural-history museum in Balboa Park, where their mom had a job playing reel-to-reel films. In high school, Mary grew interested in fashion. She’d sew miniskirts and halter-top dresses out of glittery fabrics she bought at a thrift shop, and she wore her shiny blond hair past her waist. Michelle noticed Mary’s depth of feeling. “She was a very sensitive, very kindhearted child, and empathetic to the point of extremes,” Michelle said. “She was also naïve to her physical beauty, so I often felt I needed to protect her.”

The girls’ mother, Phyllis, struggled with bipolar episodes, so Mary lived with her father, who’d served in the Air Force and worked in supercomputing. Mary’s siblings were scattered across various living arrangements. As Mary and Michelle grew older, they would visit their mom every other weekend in Pacific Beach, where the girls would walk to the ocean and sometimes hitchhike home without Phyllis seeming to mind. “It was Mary who fought to keep us together as a family,” Michelle said. “That was her rescuer instinct.”

When Mary reached her mid-twenties, her life took a glamorous turn. She fell in love with a handsome tennis player who coached celebrities at a local country club; they soon got married. The newlyweds designed a comfortable home, filled with Mexican pottery and delicate, cactus-patterned tile, and surrounded by bougainvillea blossoms and palm trees. Mary gave birth to Carlin in 1985, and to Karina four years later. The young couple went to parties at desert estates, for which Mary would blow-dry her feathered bangs and wear bedazzled jackets with shoulder pads. Through her husband’s tennis coaching, the two sparked a friendship with the Nike founder Phil Knight and his wife, who flew the couple to Europe on their private jet. In the summertime, the Caseys travelled to Coeur d’Alene, Idaho, where the kids splashed around in Hayden Lake and rode Jet Skis with their mom.

Mary’s personality began to palpably shift as the kids approached adolescence. Mary had brought her mother, who had suffered multiple mental-health crises, to live with the family; Phyllis then fell ill with metastatic lung cancer, and Mary served as her caretaker. Mary’s marriage deteriorated, and after her mother died, in 2000, she became severely depressed. Mary had experienced previous mental-health dips—two bouts of postpartum depression, for instance. But this time she began drinking heavily, and developed a new volatility from which she couldn’t seem to return. “Before, she’d have outbursts, but she could always get back into mom mode,” Michelle told me.

Mary and her husband divorced in the early two-thousands, when the kids were in their teens, and sold their house in the desert. Karina had gone to live with her dad, and Carlin with Mary’s younger sister Kaj. After her marriage ended, Mary fell for one physically abusive man after another. “It was self-punishment,” Michelle said. Mary lived off the funds from the sale of the house for a while, but soon she found herself sleeping in women’s shelters and hotels, and she landed in jail on vagrancy charges. She had been diagnosed as having bipolar disorder and was later diagnosed as having schizophrenia. At times, she went on medication and, to family members, seemed more like her old self. But she was bothered by the attendant weight gain and lethargy. “I feel half dead, and I can’t be creative,” she’d tell Michelle. So she’d let her medication slip. Initially, Mary would have a flash of pleasure as “the natural high of her mania returned,” Michelle told me; she could stay up late using her collection of gel pens to craft vibrantly colored cards for people she loved. Inevitably, though, the same cycle of addiction and incarceration would repeat.

From jail, Mary would send sweet letters to her kids, festooned with hearts and stickers. “I love you,” she’d write Karina, “with the heart of a lion.” She’d often include an earnest token of maternal care: a rectangular card that promised, “This coupon entitles Karina to mucho hugs and kisses,” or a “Prayer for Stress” that read, “Quiet my anxious thoughts.” Both her children struggled. When friends from high school asked Karina where her mom was, she’d keep it vague—“San Diego,” she’d say. She and Carlin held out hope that their “real mom” would return: the good-natured woman who’d sewn their Halloween costumes by hand (a green T. rex for Carlin one year, and a sequinned disco queen for Karina), and who, whenever they were sick, held a Gatorade bottle to their lips and a washcloth to their foreheads. “When she was on her medication, her daily life was completely different,” Karina told me. “We could tell right away when she’d been off it. She’d go into a tunnel, and we had to protect ourselves.”

By the time the pandemic began, Mary, in her early sixties, was homeless. Carlin, now in his thirties, had recently moved to Tucson, and Mary followed him there. Carlin found this stressful. “She was good at disturbing my peace,” he told me. She hallucinated that Carlin had been kidnapped and tried to break into his home to rescue him. Police arrived at the scene, interviewed Mary, and let her go, but she wound up in police custody again the next day, after assaulting a man who’d tried to help her. She was released on probation, the terms of which required her to maintain an approved residential address. But Mary lacked a job and slept in a tent encampment in a park. She hadn’t fully processed that, in Tucson, her homelessness could be treated as a crime.

On April 30th, 2022, a security guard at a local business plaza called the police to report Mary as a nuisance. The police found an outstanding warrant for Mary, tied to her failure to register her address. Officers arrested her on a probation violation and drove her to the Pima County Jail.

Mary declared her mental-health troubles to jail-intake officials. An administrator logged her as “alert,” “responsive,” and “cooperative,” and recorded her affect as “flat.” Soon afterward, she told a nurse that she was “extremely disappointed” with herself, and was suffering from severe depression. When Michelle, who lived in Encinitas, California, learned of her sister’s latest arrest, she reached out right away to Mary’s public defender, Darlene Edminson, saying, “Tell Mary we love her, and we’ll do what we can to help.” Michelle and Kaj felt certain that they’d hear from Mary soon. Instead, the family was met with “radio silence,” Michelle told me. “That was the beginning of the end.”

If you’ve ever considered calling for help during a loved one’s mental-health crisis, you’ll know the potential terror of getting law enforcement involved. People with untreated mental-health issues are sixteen times more likely to be killed during a police encounter than others approached by law enforcement, according to the Treatment Advocacy Center, a nonprofit that works on behalf of people with severe mental illness. Your friend or family member might get harmed by police, or they might get jailed in the midst of a psychiatric episode—a far more common outcome than a police killing, but one that can also prove lethal. “This could honestly happen to anyone,” Carlin told me. “Mental illness doesn’t care how wealthy you are.”

For decades, America relied heavily on psychiatric asylums to treat—or, in many cases, to warehouse and neglect—people with serious mental-health conditions. Then the grand project of “deinstitutionalization” began. In signing the 1963 Community Mental Health Act, President John F. Kennedy promised that dysfunctional asylums would be emptied out and replaced with a robust, well-funded network of outpatient-treatment providers and community behavioral-health services. But the funding for that vision never materialized. Instead, new policies criminalizing poverty and addiction swept up people in severe psychiatric distress, who often ended up in county jail—where, with the rise of the cash-bail system, they might languish for months or even years, simply awaiting their day in court. The number of people jailed pretrial has nearly quadrupled since the nineteen-eighties; people with mental-health issues tend to be detained significantly longer than the rest of the population. Today, the nation’s three largest mental-health providers are New York’s Rikers Island, L.A. County’s Twin Towers Jail, and Chicago’s Cook County Jail. According to a recent report by the Pima County administrator, more than half the people locked up at the local jail have, like Mary, a mental-health condition that requires medication.

After Mary was arrested, Michelle and Kaj bought her items from the commissary online: a tube of cocoa-butter lotion, a pack of playing cards, some Kraft jalapeño spread, a flour tortilla, and a pair of reading glasses. Mary’s family also tried to put money in her online account for virtual messaging, but they were told that she wasn’t eligible for the service. Weeks passed, and Mary remained incommunicado. She had entered some mysterious vortex.

In May, Mary’s jailers brought her to a court appearance, where she admitted to her failure to reside at an approved address; the court found her in violation of her probation and sent her back to jail to await sentencing. Her jailers didn’t bring her to subsequent mandatory court dates, including a hearing in late July, to determine if she was mentally competent to be sentenced.