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Do Unto Others

Years ago, I volunteered in the mental health clinic at Healthcare for the Homeless. At that time, the clinic was located in a crumbling, barely habitable house near downtown Albuquerque. The place was uncomfortably warm year-round, which magnified the smell of the place by a factor of ten, at least.

The odor of that place was one of forgotten humanity – unwashed people in their unwashed clothes with their unwashed belongings in tow. The reek of cigarette smoke drifted from the folds of their clothing. I learned, by a system of surreptitious glance-and-sniff, to know if a client was addicted to alcohol, heroin, meth, crack, a combination, or nothing at all (approximately 15% of the clients were, simply, severely mentally ill, with no co-morbid addiction).

They came to the clinic with an astonishing array of medical issues beyond mental illnesses and addictions. Chronic illnesses like diabetes are virtually impossible to manage on the streets. A minor infection can become gangrenous in a short time when people live with limited access to basic sanitary facilities. A simple case of the flu is likely to become pneumonia when a person is living rough.

Underfunded and understaffed, the people at the clinic did everything they could for their clients. It was mostly a hopeless task. A receptionist, a nurse, four counselors, and a handful of volunteers can’t do a whole hell of a lot in the face of the vast needs among the many people who need help. A few people got stabilized on their medicines and tried to get clean, but more often they continued to decline, living on the streets and cycling in and out of jail, detox centers, and psychiatric hospitals.

I should have hated it. I mean, my God, writing about it now, it sounds so depressing. In fact, though, I looked forward to my time there. I spent most of my time with the clients, going out to lunch and driving them to their appointments. The counselors would give me Wal-Mart gift cards and send me off with 2 or 3 clients to buy socks, underwear, and toiletries.

We had fun. I got to know them, the people they were, underneath the illnesses that ravaged their bodies and their lives. I grieved for them when they died, which wasn’t uncommon. Cause of death was usually overdose or suicide, but there were a few murders (people living with mental illness, out on the streets, and addicted to drugs to boot, are easy targets for violence) and several deaths due to illness or infection. Sometimes, I made sad phone calls to a family member, phone calls that were never a surprise.

One client, I’ll call him Hector, died of a heroin overdose. The staff at the clinic knew he was struggling with delusions and hallucinations, knew that he was using more and more heroin to cope with his rapidly disintegrating hold on reality, but they were helpless to do anything for him. So, in a skeevy hotel room, Hector injected himself one too many times and died there, alone.

At least once a day, one or more of the clients’ family members called to check on someone they loved – a son or daughter, parent, spouse, or sibling. I was in the office a few hours after we heard the news about Hector when the phone rang. The brand new receptionist answered the phone. It was Hector’s mother, calling to find out how he was doing.

“Oh, Hector?” the receptionist said into the phone, “Yeah, hang on a second. I’m pretty sure he’s dead.”

Just that. With those words, a woman found out that her boy was gone. I sat with her the next day and she reminisced about her son; how joyful his birth had been, how she baked his birthday cakes and helped him with his homework. She described how unbearably painful life became when schizophrenia entered their lives when Hector was a young adult, and how shocked she was to discover how little help there was for him. She told me about the years of anguished resignation she and her family had endured, knowing that Hector was existing in the most precarious of ways, but lacking the resources to do anything for him.

To that new receptionist, Hector wasn’t a person with a mother. He was an anonymous, smelly, scary man who talked to people she couldn’t see and had a habit of rubbing at the left side of his jaw until it was raw. (Soon thereafter, she found herself jobless.)

Culturally speaking, the receptionist’s attitude was typical. If that was not so, Jared Lee Loughner might not have had the chance to shoot 20 people, 6 of whom died, in Arizona last week.

I’ve heard, in some dozen or more news reports, that Jared Lee Loughner “fell through the cracks” of our nation’s mental health care system. I laughed aloud, but bitterly, the first time I heard it. Cracks?

Cracks?

You’ve got to be fucking kidding me.

There are no cracks in our mental health care system, because we barely have a system at all. Brian and I have every advantage in navigating the mental health care system. We are college educated; have no cultural or language barriers; live in a moderately large city; own reliable transportation; have the best health insurance; and we are, relatively speaking, mentally healthy. And still, even with all of that, we struggle mightily to get appropriate care for Carter. In some cases, the care he needs doesn’t exist at all.

In the shrill conversation that’s ensued since Jared Lee Loughner opened fire, we’ve heard again and again, “How could this happen?” How do we, who are living at the whims of the mental health care system, get the point across that this is typical. People who need care, especially the most desperate, don’t get it. The difference here is that Jared Lee Loughner didn’t just hurt himself and his family; he hurt strangers, “normal” people, “innocent” people.

I’m having a hard time with the fact that the death of “normal” people is what it took to get this issue onto the public agenda.

Jared Lee Loughner is our nightmare, lurking as one of several terrible possibilities on our horizon. The fact is that Carter’s illness is difficult to manage, and when he’s an adult (and even before; in NM, a 16 year old can refuse medications without parental consent), I can’t compel him to get treatment. His future is up for grabs.

Dear God, save me from the anguish that Jared Lee Loughner’s parents are feeling now.

I hate that people were hurt. I hate that people were killed. They are very far from the first casualties of our cultural ambiguity about people with mental illness, though. Far from it. People die of mental illness everyday. The bottom line seems to be, we don’t want to deal with “those” people, the ones who are weird and unpredictable and seem so unlike the rest of us. For generations, we locked them up in appalling, shameful institutions. Then, in that uniquely US American way, we threw the baby out with the bathwater and shut almost all of those institutions down and replaced them with…

Nothing.

Not a damn thing.

There were promises of community healthcare, but they have never been fulfilled, especially for the very sickest of people, the people suffering from schizophrenia, bipolar disorder, schizoaffective disorder, and severe depression. And, of course, people with fewer resources have less access to care.

Millions of people with mental illness could live satisfying, productive lives with appropriate support, and those who are too ill for such lives could at least be safe and comfortable in appropriate institutional care that protects their human dignity.

Instead, they are left to live or die in jails and prisons or on the streets. People with mental illness are rarely violent; I feel comfortable calling Jared Lee Loughner a tragic one-off, but that doesn’t mean the wholesale abandonment of our neediest citizens is OK. To say that this issue only matters because of the 20 people who were shot is to say that people who suffer from mental illness don’t matter. If you believe that, I suggest you not say it in my presence.

As you’ve heard me say before, there are no disposable people.

Or, if you prefer, from a person much wiser then me, “do unto other as you would have them do unto you.”

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23 comments to Do Unto Others

  • I really liked reading this. You are so right, and so much of it true. Thank you. I am going to share this. 🙂
    Bridget recently posted..Todays Positive Verse

  • Karen Rosenthal

    I so agreed with your blog. Shared with others. The inmates that I work with get better care than my children with the same disorders on the street. We have the cream of the crop insurances….New Hampshire got a D on the NAME report card. Overall, the country got a D! Not okay/ We must continue to lobby and speak to our politicians, school districts, Dr’s, and never stop advocating.!

  • I was at a conference a while ago and heard a twist on the golden rule that has stuck with me.

    “Do unto others as you would have them do unto others”

    My kid may treat me like shit some days, but as long as he’s not treating others that way I feel that I’m doing an okay job.
    cathy recently posted..It’s All About Me…

  • Thanks for writing this… I know it must be hard. (I’ve been reading your blog/Twitter for a little while).

    We have no mental healthcare. Unless you count jail (or jail like facilities). I spent a few months volunteering at a minimal security county jail, working with the guys. One kid was only 17, was in jail for drug possession. He carved messages into his skin, rarely talked, and couldn’t focus. Other guys purposely did minor crimes because they were medicated in jail, and couldn’t afford medication on the outside.

    I have bad eyes. Technically, I’m physically deficient. But it’s also normal. I can wear glasses without feeling ashamed. I can talk about going to the eye doctor and not worry about being fired, judged, or isolated. It should be that easy for mental health too. There’s no reason to be ashamed, and especially not because you seek out treatment.

  • The mentally ill in our society don’t get the care they need unless they have committed family who also have the financial and educational resources to get them the help they need…and even then, there are people who run out of steam, run out of money, run out of time and their kids get lost anyway. Yeah, you’re right…there aren’t “cracks” they fall through…its more like the system is a series of two-by-fours providing some way to cross this gaping maw of madness, and the lucky ones manage to continue criss-crossing on those narrow little boards…the rest just fall off into the chasm.

    Ugh, its awful, I’m having these conversations with the man in my life…who has raised a son already, a “normal” son. And I’m trying to help him understand that this life I live is not a life that many people would live voluntarily, that as much as he cares for ME, that caring for my children brings with it an entirely different set of challenges. It remains to be seen if he is up for it. And honestly, if he is not? I can’t hold it against him. There are days I’M NOT UP FOR IT, but I hear if I just lock them in the house and leave them to fend for themselves I could be in legal trouble…
    Barnmaven recently posted..The price of contentedness

  • katherine in va

    As usual, you’ve put into words my exact thoughts. With a family member that battles mental illness, I am all too aware of the lacking mental health system. There just has to be a better way and mental health needs to be taken much more seriously. Thank you for this post!

  • […] This post was mentioned on Twitter by Laura, Adrienne Jones, Emily Lu and others. Emily Lu said: Great post by @NoStylePoints: Jared Loughner did not "fall through the cracks" of our mental health care "system" http://bit.ly/fjqYNs […]

  • There are so many things I want to say to this, but anything I say would be echoing what you’ve already said, and so much more eloquently. There is so much about our society that is so broken. ::sigh::
    Miranda recently posted..I might be the laziest person I know

  • It’s my nightmare. I’ve watched so many parents and friends slip away. They aren’t cracks. They are canyons. And the few of us who make it through are standing on tiny precipices holding out our hands and trying to make room.
    Alex@LateEnough recently posted..Dawg- You Can’t Buy These Parenting Skills

  • CLARIFY: parents HURT and friends slip away — although parents slip away too.
    Alex@LateEnough recently posted..I Chose My Son Over Work Just Barely

  • It is so easy to care for the cute.

    We do care for the cute awfully well in this country.

    We should be better than that.
    Lori @ In Pursuit of Martha Points recently posted..The Merry Wives of Twitter

  • Ashley C

    I’ve been waiting for you to write this post. I’ve been reading your blog for a while now and I’m ashamed to admit that had I not been reading your blog and seeing the other side, the side that is familiar with mental illness, I’m not sure that I would have recognized the media’s one sided view that Jared slipped through the cracks. And for that I thank you. Thank you for opening my eyes to the truth and not what the media portrays.

  • Adrienne

    Just so glad you are back blogging.

    And also?

    You bring clarity and scrutiny on this subject like no other can.

    Thanks!

  • I was thinking of you today….I had a blog post in mind & was going to ask for your input on it when it was done. But, here I am in your comments instead. 🙂

    I was driving in to work and caught part of an interview on the radio with a woman discussing the shootings & mental health care. She was speaking about how there really is nothing that can be done for adults that are mentally ill but not legally considered “dangerous” to themselves or others. She was saying that she believes the rules lean too far toward individual rights for the mentally ill…in the sense that they can’t be compelled to seek treatment.

    I’m not sure how I feel about that. Particularly in light of what you’ve said here, if we were to make treatment of mental illness compulsory, where would these people go for said treatment?

    And I kind of got the impression from her tone that she didn’t really see these people as *people* but as liabilities. I feel uneasy about the idea of forcing treatment on anyone.

    Should it be available? Yes. Should it be forced? In general? I think no. I see that as a slippery slope…and also kind of encouraging the idea that the mentally ill are somehow a lesser class to whom different rules of humanity apply.

    At what point am I going to be forced to seek treatment/take medication/etc because I’m overweight? Making treatment available is not the same as making it compulsory, IMO. I think taking away the freedom of choice is dangerous.

    I’m very interested in your thoughts on the subject.
    WTH am I Doing recently posted..Feeling Cantankerous

    • Hmmm…how to organize my thoughts and write them down in fewer than 2000 words. 😉

      OK, first, I can’t accept a parallel between mental illness and overweight. I’m fat, and in no way does the size of my body impact my ability to make decisions about healthcare.

      Next, I’m referring only to serious mental illness. I’m mentally ill, but I don’t have a thought disorder (psychosis). When I’ve been too deeply depressed to function and family has stepped in to help, my illness doesn’t tell me that the doctors are monsters in disguise, or that the medicine is poison, or whatever. Delusional thinking changes everything about “freedom.”

      So, yes, forcing is a loaded concept, and we should be very, very careful with it. On the other hand, there are millions of people with mental illness in jails and prisons. So which is preferable? I certainly don’t have all the answers, but I do know that thought disorders are unique among medical issues. Consider people with Alzheimer’s. Is it more important to protect their freedoms, or their health and their lives?

      In a nutshell, it’s not an either/or question. Either we lock up all the people with mental illness (as in the past) OR we cut them lose and let them live unprotected, at the whim or their delusions and hallucinations (not to mention the people who would prey on them). It’s a complex issue, but we can’t decide not to face it because we’re afraid of a slippery slope. From my perspective, we’ve already slid down the slope and now we have to fix it.

  • This post made me sad but I guess that’s kind of the point. We SHOULD be sad that we, collectively, care so little for our fellow man! Excellent article … shared it on Twitter!
    Beth recently posted..A Reluctant Author- Depression- and a Crazy Chicken

  • What a powerful post. It made me think of a favorite song of mine, Under Bridges (http://rediscoveringdomesticity.com/2009/11/21/under-bridges-there-is-love/) about “being Jesus” to those that society casts off.

    Thank you for your compassion and your thoughts on the matter. I agree with PP – mandating care is a slippery slope, however, I don’t feel that is what you are suggesting, rather you are suggesting just having some sort of system in place at ALL to care for those with mental illnesses.

  • Thank you for writing this, for being so honest and straightforward about this. Bravo!

  • I read this post the other day when you first put it up, but I couldn’t comment from my phone. I wanted to say thank you for sharing and for the ways you tried to make a difference. When the NAMI state scores on the quality of care available for the mentally came out, I was stunned. How is this possible? Have we learned nothing yet on the importance of care? People are so quick to nod their head and cluck their tongues once they hear “mental illness” as if it is a reference to to a subhuman species. People? These are someone’s father, someone’s mother, sister, brother, son, daughter. Someone’s child. A real person’s child. My child. My child suffers from mental illness and every time I feel the sting of stigma my heart breaks for her.
    Mommylebron recently posted..Stream of Conscious- Guilt

  • Michelle

    It is so hard to read, but so true. I have a person in my life much like Carter. Sometimes you have written things I have let his mother read, just so she can know she is not alone. I came to the decision about 5 years ago that I would love this boy no matter what happens. I hope the trials U nd his family face are not ones of legal nature. Thank you for your blog.

  • Lilly Mcmillan

    And honestly, if he is not? Not okay/ We must continue to lobby and speak to our politicians, school districts, Dr’s, and never stop advocating.! I’m fat, and in no way does the size of my body impact my ability to make decisions about healthcare.

  • […] People with mental illness are rarely violent; I feel comfortable calling Jared Lee Loughner a tragi… […]

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