This Problem Is Everywhere

This Problem Is Everywhere

A reader just pointed me to this account by an EMT in Louisiana, about the tragedy of mentally ill people for whom there is nowhere to go:

There is nothing wrong with his body; no illness to treat, no wounds to bind. It's his mind that is broken, and there is nothing that I, or all the psychiatrists in the world, or anyone short of God himself can do to repair it.

And the futility of it makes me resent him terribly, makes me dread seeing his face. And the shame that he might see the resentment on mine burns me like a torch.

And so I say nothing, sitting silently beside him, and I bear witness to his despair.

"Why won't they take me?" he sobs plaintively, clutching desperately at my arm. "Call Zeke," he begs. "Zeke's my friend. He'll make them put me in. I can't survive out here."

How bleak must his life be, that he regards the parish coroner as his savior? People only interact with a coroner when a relative has died, or when someone thinks they're crazy. Neither is a happy occasion.

The truth is that he's not sick enough to be locked away. He doesn't hallucinate, doesn't hear voices urging him to do bad things. He doesn't contemplate killing himself. He calls for the same reason he did last week, and last month, and a dozen times before that. He is simply a man for whom living independently and wrestling his demons are two tasks he will never, ever be able to manage simultaneously.

And he knows it.

He is too honest to game the system, too naive to understand that's what it may take. Should I tell him what to say, how to act so that he'll get at least a few days in a place of comfort, where people may at least pretend to care about his welfare? I certainly know the litany well enough. I could teach him the magic words.

But then, how will I justify it to myself, knowing that he'll be taking up bed space needed by someone who is truly a danger to himself or others? In post-Katrina Louisiana, psych beds are all too precious a commodity. Mentally ill patients here move through a vicious cycle of hospitalization, medication, discharge, decompensation, hospitalization, medication, discharge...

... fragile people stuck in a meaningless revolving door of all too many psychotropic medications and all too little meaningful therapy, and altogether nonexistent followup care. They warehouse them and dope them with Haldol and Thorazine until their reimbursement capitates, and then suddenly declare that they've made significant progress and are ready to be released again into the world, with a prescription for medications everyone knows they can't afford and outpatient appointments with a psychiatrist everyone knows they won't be able to keep.

And it isn't just post-Katrina. It is the situation in most of the United States. And as I have discovered, in trying to find a publisher for my book about this problem--no one seems to care. It just isn't important.