Pete
Here’s the thing.
I live in Berkeley, California. Every single day, as I drive by the corner of University and Shattuck, I pass a guy that is usually deeply engrossed in conversation with a companion or companions he is hallucinating are there with him. His hair is long, ragged, and in a sort of dirt-imposed dreadlock style. He appears not to have bathed in quite awhile. He is dressed in rags, his eyes alternate between vacant and haunted. He eats McDonald’s leftovers out of the garbage can, and rolls cigarettes from butts he collects.
Should he be institutionalized? I wouldn’t say he is an immediate threat to himself or others: he does feed himself, as I said, and he does not do things (at least that I’ve seen) that represent a threat of serious, acute (as opposed to chronic, cumulative) harm to himself or others.
I was driving by one day, and was suddenly sick at heart at the thought, “Tonight, he will sleep out in the rain. Huddled in some doorway, miserable and shivering.”
What could I do? It was 8 days til payday, and the balance in my bank account was 50 bucks and I was low on food, so I couldn’t get him a room, even if I’d stopped and convinced him somehow to accept it, and convinced a motel manager to let him stay.
His condition and circumstances demand attention. Lots of it.
He suffers terribly, every single day, because no one does anything for him, or at least no one does enough.
In my imagination, I can summon a very different world.
I can imagine a world where everyone in the neighborhood knows his name. I can imagine a world where lots of people greet him by name throughout the day. I can imagine a world where a steady stream of people say to him, gently and kindly, “Hey, Pete, how ya doin’? Man, you need to take your meds. What’s your doctor’s name again?”
I can imagine a world where his doctor gets a steady stream of calls, the gist of which is, “Doc, a bunch of us are concerned about Pete. He hasn’t been taking care of himself. What can we do to help?”
I can imagine a world that contains a place for him to live, that demands that he be provided a place to live, a place where kindly people will get after him about his meds, bathe him, give him loving kindness.
But that world has yet to be built. The carpenters that need to build it, you and I, are not busy enough.
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Matt, I have known others like him. I have talked with them and they have taught me to begin to “see” like they do. Before I could do that I had to learn their language and I am still learning it.
They live in a world that does not know love and they are the “prophets” that write on “subway walls…”. They see how harmful every facial expression and even thoughts (quantum physics) can be but they have been institutionalized and diagnosed as ill because they can’t “adjust” to the “normal” world of human relationships.
Must leave for work now. I do not have enough time and space to write more.
Fine post – the last line especially.
But this is only partially true: “He suffers terribly, every single day, because no one does anything for him, or at least no one does enough.”
The causes of his suffering are unknown, although are certainly some combination of personal, familial, and societal failings. That it is our obligation to engage him as a person is clear from Catholic teaching, although not everyone has the gift to do this in the moment it is required. That first realization that something is amiss (response of fear, discomfort), is the onset. If one’s conscience is well-formed, or if one just has that natural gift of love over fear, action comes naturally. For the rest of us it is a struggle to respond in a truly Christian way.
Often (although certainly not often enough), those who have that natural gift are able to draw others around them into setting up a local system of hospitality for those who are as troubled as your friend was. Last time I was in Berkeley there was a place like this – I forget the name of it, but it was a Catholic Worker house.
I would just posit that it is *always* on the personal and local level that these encounters and systems/homes/whatever should occur. It’s not a statement on this post necessarily, but I just think it needs to be said: it is not to the state to have this “response”, as the state cannot authentically have such a response.
The key aspects of Catholic Social Teaching demand this: solidarity and subsidiarity. We are not to outsource our responsibility to personally engage those around us who are suffering, to some government entity which, by its nature, must depersonalize the person in need, a person who has already been radically depersonalized.
I see this as complementary to the ideas forwarded in the post, not as in any way a refutation of any part of it. Again, well said in the post.
I think the first question is whether he would consent to being engaged or helped in the ways you are able to do. That is not always the case in these situations.
I would also be careful to avoid romanticising the dimensions of his life that might be illness. Ronald King’s comment serves best as a reminder to avoid pathologizing all that is not in the first standard deviation of a bell curve distribution, as it were, but people who work regularly with the poor understand there are genuine pathologies that don’t necessarily respond to engagement. I say this from a few years working as a Vincentian, and from years of dealing with people in my family who have special needs with both organic and behavioral dimensions.
I suffer from mental illness myself (depression and PTSD), and while I am insured now, I wasn’t for about 5 years between 2001 and 2005 – I went to Solano County Mental Health at that time, and they probably saved my life. Government-sponsored mental health care can be a Godsend (literally).
I understand concerns about subsidiarity, and I agree that it is wrong to just leave charity up to the government – “Isn’t there some kind of program to help ‘those people’?”
That said: if the choice is between government-sponsored mental health clinics and the current situation — Pete (and people like him) sleeping out in the rain and eating garbage — my preference is that he and they get help.
Here in Washington’s Capitol Hill neighborhood, there is guy named Roger. He closely resembles Pete, except that he does not evince any obvious symptoms of a full-blown psychosis. You can usually find him just north of our famous Eastern Market.
Roger was a fixture on these streets when I moved here nineteen years ago.
I have spent a lot of time considering Roger and others like him. If Roger really wanted to be off the streets, I think it could have been managed by now.
The point, of course, is not to blame the poor for their poverty, or the homeless for their vagrancy, but merely to suggest that much more is at work here than a lack of simple kindness. Stephen and Liam are both on to something.
Don’t get me wrong – like I said in the post, we all could be doing way, WAY more to help Pete and Roger; figuring out what the best way to do that is, is a challenge that urgently needs to be engaged.
Mental health costs money, and lots of it – just getting Pete a room is beyond my means, never mind meds, psychiatrists, and so on.
Rich folks can afford to buy those things for their family members. Poor people’s family members eat garbage and shiver in doorways. The means exist to comprehensively alleviate this suffering. Those means are (self-evidently) not being used. This is a glaring injustice.
I pray that our hearts are broken and we (and this definitely includes me) repent of our hard-heartedness.
And our sciences of mental health have not progressed at the speed with which our sciences of physical health have progressed. We are still at a stage where mental health diagnostics and treatment involve a much higher rate of boomeranging than with many dimensions of physical health. In a sense, it is as if mental health care is about 150 years behind physical health care: mental health has not yet reached the point that Pasteur reached in the realm of physical health.
Matt,
That is a beautiful way of putting it: pray that our hearts are broken so that we may authentically respond to those who are truly in need.
Luckily there are more options available to us than things being as they are now and leaving it to government to fix them. I understand the desire to get rich people to pay their share, but again, to use government to do this seems an offense to freedom, as it is to solidarity and subsidiarity. Not only this, but the anthropology employed in government-provided mental health care is likely to be radically different than that which is suggested by Catholic tradition, especially JPII. Why would we trust a government whose alternating leadership sees fit to start wars, to fund Planned Parenthood, and so on, to adequately deal with the real problems faced by Pete and those like him?
Like others here, I’ve spent time working with and getting to know those who have disconnected from what we might call normal, productive citizenship, and although the degrees of detachment certainly vary, many simply choose to do so. Those like Pete whose sense of freedom is all but destroyed can be invited into community, and in the right situation, perhaps begin healing.
The pope’s latest encyclical goes into great detail on the necessary relationship not only between truth and charity, but between charity, freedom and justice. It’s not too bad as a guidebook for encountering these issues on a wider scale, and it emphasizes the importance of keeping central the personhood of those being served. I just don’t trust the government to do this.
But “the Government” isn’t some other-than-you-and-me entity, is it? “The government” consists of our brothers and sisters, and can be used for any purpose we decide to use it for. You can list bad things the government has done, as you have; but it is also true that “the government” can do things we like, and which citizens readily identify with: “We” landed a man on the moon, “we” made sure old folks got health care, “we” won World War II, and so on.
I don’t accept the premise that “the government” is some alien “other” – “the government”, in a system like ours of democratically elected representatives, checks and balances, and so on, is really the same as “us.”
“Not only this, but the anthropology employed in government-provided mental health care is likely to be radically different than that which is suggested by Catholic tradition, especially JPII.”
This is true in one sense. But I hope it is not meant to be a means of broadly dismissing the legitimate advances in psychiatry and the truth that is present in other mental health fields.
Excellent. How and to what degree is “the government” us?
Actually, I think it is relatively uncontroversial to say, especially these days, that the government is something other-than-us. That’s not to say that “we” don’t have a role to play at all, but it seems clear that America has succumbed in large part to Plato’s analysis of democracy. “We” are extremely ill-informed and have helped create an extremely powerful government that is doing for us things that we should be doing for ourselves and for each other in local community. “We” don’t choose in our democratic process what is best for the common good, we choose that which flatters us the most, and that which promises to give us what we want. Thus, we choose to be lied to and give power to those who almost by definition of modern politics, are incapable of being honest about what they want to do and what they are actually doing. This isn’t me, and if you disagree, you may be the first person I’ve met who would do so.
This is absolutely not to say that there is no right place for government, local and national, but I’m skeptical that giving government more control, which is what we do when we ask government to do things for us, is such a good idea in all areas – in particular, in the area of concern to this post, caring for those with mental problems. There are things that are best left to a governing entity, properly kept in check by a well-informed and engaged populace. There are things, though, that we should absolutely not leave up to what is now the reality of US Government.
So I agree that the government isn’t necessarily radically detached from the populace, but I think it’s a false dichotomy to pose the alternative as the government actually being “us”. This leaves unasked questions about who “us” is, and if there is any intelligible definition of “us” other than human beings which happen to share citizenship in this nation.
Mark:
I’m not sure why you would think the clip would be considered dismissive of developments in the sciences. Certainly there is the truth of the sciences, which is never in conflict with the truth of revelation. It seems to me that there is room for complementarity there.
What about a national health plan that includes mental health, plus community mental health centers that will find housing, employment, therapy, medications and other social services needed by the mentally ill, combined with heavy advertising in the media for volunteers to help with looking after these folks?
There was a movement in the late sixties to de-institutionalize the mentally ill, with the idea being that local, neighborhood centers would best meet the needs of the mentally ill. What happened was, the mentally ill were de-institutionalized, but the community-based centers never got funded, so mental patients went from being tormented and oppressed in institutions to eating garbage, sleeping in doorways and being ignored on the streets. This is a disgrace.
This leaves unasked questions about who “us” is, and if there is any intelligible definition of “us” other than human beings which happen to share citizenship in this nation.
That’s an excellent point.
I think part of the blame is the governing ideology of the United States since Ronald Reagan: “The Government is the problem.”
Well, no. Or rather, it can be the problem, if it is doing tyrannical things like torturing people, or waging wars of choice, or (more to the point of the discussion) neglecting to provide mental health care that our society can easily afford to provide.
“The Government” is what we want it to be, and does what we want it (or allow it) to do. The fact that our government tortured people is ultimately our fault as much as it is Bush’s or Cheney’s or John Yoo’s.
We can repent of war and empire, and take care of our most vulnerable citizens, or we can glory in our might and descend into a hell of authoritarian militarism. Either way, each citizen is responsible for the choice, not some alien/other “the government”.
We can debate whether the view that the government is the problem has really been the governing ideology of the US since Reagan, or whether this is just a catchphrase adopted during campaigns and ditched on election day (Clinton in 96, Dubya in both terms, Obama didn’t even bother), but we can agree that government certainly can be the problem when it acts tyrannically.
But does the government only act tyrannically when it’s doing things that I don’t approve of? Or is there “good tyranny” and “bad tyranny”? If you give the government the power to administer health care for all(good tyranny), you may also give it the power to withhold health care and to pay for the destruction of the unborn (bad tyranny). You may like the idea of healthcare reform, but protest the latter and have your protest ignored or misrepresented, and thus not genuinely considered in the “democratic” process. In such a case, your culpability for the resulting abuses is certainly limited, just as one who protests against torture shares less responsibility for these abuses.
Certainly there are also degrees of responsibility when it comes to government action, the degree of responsibility correlating more or less with the free assent given. I’d rather take responsibility for myself, and those in my community, and support organizations that I know share my view of the human person and who serve those beyond my community than give my support to a government that is increasingly unaccountable to the people it was created to serve.
I suppose we can agree to disagree. I agree with your original post, and I would not argue for some extreme libertarianism, a view which is also not in line with Catholic teaching. But it seems to me that trusting the US government with caring for others is also contrary to what the Church suggests.
Stephen – I actually don’t think we’re that far apart (though I must say, the idea that the government doing social insurance is “tyranny,” whether “good” or “bad,” is a bit strange). If I abdicate my responsibilities to my community, my neighbors, and myself, because I want the federal government to do it all, then yes, that’s when the Church has problems with it.
But I envision sort of a hybrid: the feds do the heavy lifting in terms of the “social insurance” piece of the problem -i.e., use tax money to fund the local psychiatrists, social workers, LVNs, walk-in mental health clinics and the rest: we in the community can work to make sure that if some guy shows up on the street looking confused and disoriented, we point him to places that can help him, and maybe call a local number to make sure he doesn’t fall through the cracks.
I mean, I just made that up as I typed it; but people a lot smarter and wiser than I am could design a great system that both respects the privacy and freedom of the mentally ill on the one hand, but on the other provides plentiful help if he wants to come in from the cold.
It seems to me that this post provides the perfect occasion to reiterate a poem that was just quoted here, a while ago:
AS kingfishers catch fire, dragonflies dráw fláme;
As tumbled over rim in roundy wells
Stones ring; like each tucked string tells, each hung bell’s
Bow swung finds tongue to fling out broad its name;
Each mortal thing does one thing and the same:
Deals out that being indoors each one dwells;
Selves—goes itself; myself it speaks and spells,
Crying Whát I do is me: for that I came.
Í say móre: the just man justices;
Kéeps gráce: thát keeps all his goings graces;
Acts in God’s eye what in God’s eye he is—
Chríst—for Christ plays in ten thousand places,
Lovely in limbs, and lovely in eyes not his
To the Father through the features of men’s faces.
–Gerard Manley Hopkins
That “face” is not always the beautiful, refined face of the English aesthets that Hopkins and his friends were–as Gerard, the Jesuit worker in the slums of Victorian Britain well knew. That face is sometimes “Pete’s”–similar to the dazed, grimacing face of Christ in his passion.
You know, after haunting this sight now for well over a year–and perhaps a bit too often, as certain antagonists would doubtless agree–I am perfectly well aware of who, among its contributors, I should like to call “friends.” Those with compassion and love for “Pete” I consider “friends” because they reinforce my sense of what are my duties and obligations, as a follower of Jesus. Those who would rationalise away my obligation to help him, when and if I encounter him, are definitely not my “friends.”
One thing I want to add regarding the diagnosis of mental illness and the treatment of these diagnoses is that each person who I have seen over the last 30 years comes into my office in a state of crisis. This crisis begins with a crisis of identity that began at a preconscious and nonverbal stage of development that is related to the interplay of genetic predisposition and environmental influences that affects the instinctive emotional development of the human being’s awareness of safety, belonging and value. The quality of the attachment to the mother is critical in this instinctive area of development. The mother’s sense of safety in her environment will determine the quality of how she attaches to her child. Her sense of safety is related to the quality of her relationship to the child’s father. Her sense of self will determine her choice of her mate, however.
I think you’re right that we’re not that far apart. Although we differ in our beliefs on the role and nature of modern government and in our faith in government to do the right thing in most cases, we agree that it is us who have to respond to those among us who require help. This is to be Christ to one another, and to see Christ in one another.
But this has always been the debate, hasn’t it? Thanks for the exchange.
Like Matt, I (and members of my family) have had real struggles with mental health problems, and in my case government programs designed to help have made a huge difference in the quality of my life. Because of that, even if I were ideologically disposed to think that ‘government isn’t the solution- it is the problem’, I would never be able to say so with a clear conscience.
Has anyone here read ‘The Soloist’, or seen the movie (Jamie Foxx & Robert Downey Jr)? It is based on a true story about a reporter who found a mentally ill musician on the streets and got him into a program where they provided him with aid including his own room to live in.
Matt,
I actually agree with you that part of the problem here is that government-run facilities for people with mental illnesses were closed in the 60s and 70s and no other solution came to replace the old ones (which certainly had their problems.) We need those institutions back, though hopefully in a better form.
That said, your idea of people stopping by and remining Pete to go down to the clinic and take his meds rang off to me, and so being a “there’s a limit to how good we can make things in this world” kind of guy, I wanted to add some thoughts.
Here’s the thing: My younger brother is probably not that far off from Pete in some ways — though with a couple key differences which keep him off the street and make him easier to deal with. I’ll call him Tom here. Tom is 27, a tall and gangly guy who’s never held a normal job and probably never will. We know that he’s OCD and has serious depression, but there may be other issues at play too. If you see him in my mom’s neighborhood, he may be squatting on the sidewalk watching bugs walk by, or you may see him jesturing oddly and appearing to talk to someone you can’t see — though once you know him it turns out he’s talking to himself in an undertone and gesturing with his hands while holding interior conversations. He’s spend twenty minutes at a time washing his hands, but he will forget to cut his nails and hair (or even shower) indefinitely unless there’s someone to remind him. And if you put a hand on his shoulder he’s likely to leap away and shout. If you argue with him he’s likely to retreat into repeating some phrase like “I know I’m a burden. Why are you always mad at me?” over and over — often retreating to squat in a corner in order to do so.
If this sounds bad, that’s just the list of problems. Tom is a really nice and smart guy — aside from his absolute inability to play by the rest of the world’s rules — and a talented illustrator, though he works far too slowly and idiosyncratically to do that commercially. And so long as he’s left alone to do his odd things (which is very aggravating in itself at times) he’s not that hard to live with. One thing that sets him apart from many of the homeless (aside from having a family willing and able to put up with having him living with members of the family indefinitely) is that he does not drink or do drugs.
Now the reason I bring all this up is: The one thing that Tom absolutely will not accept is treatment for his mental problems. He refuses to admit that he suffers from OCD or depression, and when confronted insists that everyone hates him or that it’s everyone else acting irrationally. We’ve taken him to doctors, but he’ll lie about his symptoms — the one time when his scrupulous approach to morality does not kick in. Our family doctor even tried to trick him into taking anti-depressants at one point when he was really bad, but it was then we discovered he was looking up every medication he was prescribed in a medical manual to see what it was really for. It would basically take physicall coercion or forced institutionalization to make get treated — and that seems cruel given that he can live quite happily if one is simply willing to give him room and board and ignore his oddities.
And that’s dealing with someone who doesn’t have any substance related problems, is fairly smart despite his oddities, and never gets violent. Yet if Tom didn’t have family to live with (or if his family threw him out for bad behavior) I’m virtually certain that he would rather scrounge and live in a publically very odd way than accept meds for his mental problems (he has no problem with other medicines) or counseling. I would have to guess that some folks in Pete’s situation have much the same feelings, and may have some other anti-social tendencies to make their expressing of those feelings a lot harder to deal with.
So while it’s important that there be facilities that people can go to — the happy dream of being able to walk by and say, “Hey Pete, don’t forget your meds,” and then call his doctor for a friendly reminder might well not work at all. Life is often tragic in ways that administering extra money doesn’t help all that much.
So while it’s important that there be facilities that people can go to — the happy dream of being able to walk by and say, “Hey Pete, don’t forget your meds,” and then call his doctor for a friendly reminder might well not work at all. Life is often tragic in ways that administering extra money doesn’t help all that much.
I don’t really disagree – there are always going to be folks who refuse help, and that problem can’t be solved, as you say.
I do think we ought to make it as easy as possible to ask for help for those who do want it, however. And we need to we’re actually asking folks if they want that help, too.
Oops – should be “we need to make sure we’re actually asking…”
DarwinCatholic, One thing in particular stood out in your post and that is Tom stating that he knows he is a burden and asking why others are always mad at him. That is his truth. He knows he is a burden and he knows that people have been and continue to be mad at him.
Whatever the reason is he is aware and sensitive to the limits of love in human beings and is aware that nobody can explain the nature of his suffering to him without identifying him as the problem. He probably has known for a long time that he does not fit in like others do and attempting to fit in would create all sorts of anxiety that he cannot suppress from expression. He probably is aware of the potential for harm in every human being beginning with the knowledge that nobody really knows him but certainly can diagnose him. He is probably keenly aware of the complexity of human interactions and the underlying manipulations and social rules that are required to start and maintain some sort of a friendship. However, he knows he is incapable of this because he is incapable of dishonesty with himself and others in this type of relationship. The reason for this has yet to be identified. He probably had difficulty securely attaching to mom due to a high physical sensitivity to discomfort whether it be to his physical discomfort or mother’s emotional discomfort in not being able to comfort him. If this is so then his aversion to interpersonal relationships would have started prior to age 3 and then would evolve after that.
He is aware of the suffering of immediate family members in relationship to his suffering and then would carry around a sense of overwhelming shame and anger.
There might be one thing to consider just from a purely medical perspective to approach him for consideration. What has been discovered within the last two years is a genetic mutation of an enzyme that decreases the ability to convert folic acid or folate the the active ingredient L-methylfolate which is critical for healthy cell development. Even more importantly L-methylfolate is critical for the synthesis of neurotransmitters such as dopamine, seratonin, norepinephrine and others. L-methylfolate is the only chemical that can cross the blood-brain barrier. It is critical to have the proper balance of neurotransmitters in order to have a buffer in response to human ignorance about healthy human relationships.
It takes a 4 stage process to break down folate into L-methylfolate. There are 2 known mutations and there is a blood test to determine if mutations exist. The test is named MTHFR Polymorhpism. There is now a prescription that provides 7 times the minimum daily requirement and positive results are being reported. More testing is now in the process to add confirmation to what has been done.
Ronald – very interesting, and promising. when you get a chance, can you point us to some documentation on this. Peace, Kevin
Kevin, If you google L-methylfolate you will find a lot of articles. One article to start with is the CNS Spectrum from October, 2007 written by Stephen M. Stahl, MD, PhD at U of Cal-San Diego entitled Novel Therapeutics for Depression: L-methylfolate as a Trimonoamine Modulator and Antidepressant-Augmenting Agent.
Also google MTHFR and you will see articles written about the gene variants.
Hope this is helpful.
Ron
Question, what does it mean when it states “Your comment is awaiting moderation”? I never saw that before.
Ronald,
WordPress sometimes put things in moderation based upon a key word being used (put in as a word for moderation because it has been abused), or if multiple links are being used, or if its programming reads it as possible bot-response, and lets the blog un-moderate it. It happens to all of us.
Thanks Henry. I thought I committed a mortal sin.
Thnanks Ronald.
You’re welcome, Kevin.