MARACAY, Venezuela >> The voices tormenting Accel Simeone kept getting louder.
The country’s last supplies of antipsychotic medication were vanishing, and Simeone had gone weeks without the drug that controls his schizophrenia.
Reality was disintegrating with each passing day. The sounds in his head soon became people, with names. They were growing in number, crowding the tiny home he shared with his family, yelling obscenities into his ears.
Now the voices demanded that he kill his brother.
“I didn’t want to do it,” recalled Simeone, 25.
He took an electric grinder from the family’s garage. He switched it on.
But then, to spare his brother, he attacked himself instead, slicing into his own arm until his father raced in and grabbed the grinder from his bloody hands.
Venezuela’s economic collapse has already decimated its health system, leaving hospitals without antibiotics, surgeons without gloves and patients dying on emergency room tables.
Now, thousands of mental health patients — many of whom had been living relatively normal lives under medication — are drifting into despair and psychosis because the country has run out of the vast majority of psychiatric medicines, leaving families and doctors powerless to help them, medical experts say.
Mental institutions have released thousands of patients because they can no longer treat them, according to physicians. The patients still being cared for now suffer in crumbling wards that can barely even feed them. Doctors and nurses fear violent attacks and say they have little choice but to tie their patients to chairs, lock them up or strip them of their clothes to prevent suicides.
In the city of Barquisimeto, the scenes at El Pampero Psychiatric Hospital are those of nightmares.
Food shortages had left one older schizophrenic man emaciated, like a walking skeleton in a concentration camp. An epileptic man bereft of medication fell into repeated seizures, while another untreated patient lay strapped to a bed, bound at the ankles. An older woman with no drugs to control her schizophrenia crawled across the floor, past a hungry patient eating fruit that had fallen into a pool of open sewage.
But most patients around the country are in the hands of families like the Simeones, doctors say. Family members must choose between going to work and watching over their loved ones. It is a life of searching for increasingly rare drugs, desperately hoping their relatives do not harm themselves, or others, the moment someone looks away.
“When I heard that he could hurt his brother, that broke me,” said Evelin de Simeone, Accel’s mother, recounting the day in June her son grabbed the electric grinder.
Venezuela, the country with the largest oil reserves in the world, once produced most of its own pharmaceutical drugs. In the early 2000s, the president at the time, Hugo Chavez, began a broad nationalization of Venezuelan drugmakers in an effort to produce cheaper medicines. Foreign companies like Pfizer and Eli Lilly filled in the gaps by shipping drugs.
Then oil prices collapsed. The government began running out of hard currency, leaving it unable to import raw materials for the state-owned factories supplying Venezuelan hospitals. Many foreign drug companies stopped sending medicines because the government owed them so much money.
The consequence: About 85 percent of psychiatric medicines are now unavailable in Venezuela, according to the country’s top pharmaceutical trade group.
“The most elemental things are gone,” said Robert Lespinasse, a former president of the Venezuelan Society of Psychiatry. “It’s like being impotent.”
In El Pampero Hospital, the screams of Emiliana Rodriguez, a schizophrenic patient, echoed. She had little food and no medication for her glaucoma, leaving her hardly able to see. She could barely acknowledge those around her, but for a moment focused.
“I’m not crazy,” she said. “I’m hungry.”
For Accel Simeone, the family’s cinder-block home in the city of Maracay remains a refuge, even after he took to his arm with a grinder.
Soon after, a psychiatrist prescribed a different medication — one that could be found, at least that month — and the voices haunting Accel grew quieter.
It might have brought calm to the household if Gerardo Simeone, Accel’s brother, were not schizophrenic, too.
The Simeones were true believers in Chavez and his Socialist-inspired revolution.
Mario Simeone, the father, was the son of a refugee from World War II Italy who had married in Venezuela, but the hard work of his parents did little to raise his prospects. When he and Evelin married in the late 1980s, their first home, in a run-down barrio, had neither a table nor a bed.
Then Chavez took office in 1999, promising health care, education and jobs to reorient the country and its oil wealth toward the poor. The Simeones became loyal supporters.
Evelin de Simeone finished a law degree at a free, state-funded university and began a practice specializing in lawsuits and wills. Her husband, a curious tinkerer, opened a garage to fix vehicles. In 2005, the two bought a new home and filled it with appliances.
“Our refrigerator was always full,” Evelin de Simeone said.
But something was wrong with Accel. The affable young man, nicknamed El Gordo, had turned 18 and was starting to feel anxious, with a constant sense of being pursued. Voices told him that he was gay, or that they wanted to kill him for his money.
At 19, Accel attacked his father with a stick. A psychiatrist in Caracas immediately recognized the symptoms of schizophrenia and prescribed a number of drugs, then easy to obtain.
“Medication was the only way to win,” Evelin de Simeone said.
But the battle was only beginning. Accel’s younger brother Gerardo had long been the more talkative one, a joke teller who broke into long discourses about the history he learned at school. Then El Negro, as his family called him for his dark features, suddenly fell silent.
“What surprises life gives you,” Mario Simeone said of Gerardo’s schizophrenia. “Who would have known it would have hit the two boys?”
Outside the home, other changes were afoot. Chavez, who had cancer, died in 2013, leaving a lesser-known successor, Nicolas Maduro. The next year, oil prices began to decline drastically. The country found itself unable to pay for goods, services and imports.
Lines for food became frighteningly common in the Simeones’ neighborhood. Basics like cornmeal and rice were hard to come by. By 2015, inflation hit triple digits, decimating the family’s savings and often leaving Evelin and Mario without clients.
The shortages of medicine struck hard. Evelin de Simeone was spending long periods each week scouring pharmacies for olanzapine, an antipsychotic drug, having little luck. By April, she was dividing the remaining pills between her sons and reducing the doses to make them last.
“I said, ‘My God, neither of them will have any soon,’” she recalled.
Evelin, who had hardly been able to work in order to watch over the brothers, has quit work entirely. Mario fixes cars to pay for medication for his sons, when it can be found, lamenting how far the family’s fortunes have fallen.
He wanted someone to blame.
“This is a fanatic state,” he said. “If you really love a country, how could you leave it without food, work or medicine?”