Cultural Survival Skills

Into The Darkness

She had walked about three miles in the dark and was lost before she found my office. It was cold and raining as she walked through the “wrong side of town” to seek my help. Her journey took her through tough streets where rapes, robberies and gang shootings happen almost every week.

She was a very slight waif of a young woman and she hid in an over-sized hooded sweat shirt.  Her head and face were recessed into the protection of the jacket’s dark hood. She had withdrawn from the world around her.

I expressed my concern that she had walked at night through a dangerous area of our city. She said that she wasn’t afraid because when she “walks at night no one can see her”. She sat in my room with her head bent down. The hood made it impossible for me to see her face, unless I bent low from my chair to look into its recesses. There I saw an expressionless mask with wide eyes that gazed at the floor.

With my hearing aids on their highest setting, I strained to hear her voice. At times she made sense, but often she did not. She said that she wanted to get better and “to be normal”. She said that she used to cut herself and that she had tried suicide many times. She said that she had been in mental hospitals frequently and that she was afraid of those places and hated them. She said that she is always nervous and cannot come out of her house during the day. She reported that she gets confused and scared and wanted to feel better. At times she was whispering. I asked if she was hearing voices: She said “yes, but there are many voices talking at the same time and I can’t make out what they are saying”.

My heart sunk and I felt a little sick as I told the lady that she appeared to be suffering a psychotic state. I said that I could not help her through counseling until she was on antipsychotic medication. Her voice became louder and very firm as she stated that she was not crazy and did not need any medication: “I just needed someone to talk to”.

I tried to explain that it would be unethical for me to provide counseling to her for a condition that required medication before counseling would be of any benefit. I told her I could not participate in prolonging her illness that was harming her.  I did my best to comfort her and softly spoke of my desire to help her get better. She began to mumble about cutting herself and she fumbled in her purse for something. For a moment I feared she was looking for a knife.

She finally found the tattered intake form that she had meticulously filled out and brought to give to our receptionist. She didn’t say anything more as she slowly stood to slouch within her hooded sweat shirt and shuffled slowly from my office. She lingered near the reception desk for a time and finally moved slowly out the front door into the dark, cold, and rainy night. I imagined what she must feel like as she walked her long way back to wherever she came from.

I normally do not loose sleep over my client’s problems. I could not do that and remain in practice for over 30 years.  However, I did not sleep well that night and I cannot forget that lost and pathetic young woman who walked out of my office and into the dark.

Both the poor lady and I were caught in the results of a terrible mistake that our American culture made following the discovery of antipsychotic medications in the 1950’s.

At that time close to six hundred thousand patients, daily,  were confined in our public mental institutions. The new neuroleptic medications frequently ( but not always) helped to control the active symptoms of many forms of psychosis. However, the medications did not cure the symptoms, which were prone to return when the patients encountered stressful conditions, especially if they had stopped taking their medications.

During the 1960’s, in the name of humane treatment of mental patients, the U.S. and other nations began the process of letting these patients out of mental hospitals. This process was called deinstitutionalization. By the year 2001 there were less than 60,000 patients confined to mental hospitals on any one day. Also, strict patient’s rights laws were enacted forbidding the hospitalization of mental patients against their will, unless they were a clear and present danger to themselves or others. This led to the bizarre practice of giving severely and profoundly mentally ill citizens the choice as to whether they should be hospitalized or not.

In other words, people who clearly were not in contact with reality were (and still are)  asked to make rational decisions about accepting treatment, which most often would improve their condition. Tragically their answer was and still is, very often: No!

This indefensible policy has contributed to the increase in social horrors  such as mass murders in our schools, killings and attempted killings of high profile entertainers, politicians, U.S. presidents and others: All too frequently by people who are very severely mentally ill and  who cannot control their actions.

It is also painful to see the severely mentally ill who are cold and starving in the streets, who seek shelter under bridges and train trestles or in cardboard boxes and other make-shift shelters all across America.

I will never forget a documentary that I watched of mental health workers putting sandwiches on a bench in a city park and hiding in bushes waiting to see if a starving psychotic man would eat them. The man thought that people were trying to poison him so he would not eat the food left for him. He ran away from the well-intentioned mental health workers. No one had the power to take him to a safe hospital environment where he could have been medicated and cared for. My perception was of a cultural practice that was just as psychotic as was the starving man it was designed to help.

There is yet another concern that has not been addressed. The psychotic woman, who I could not help, told me she had two children.

Think about this: schizophrenia is a bio-genetically-based mental disease that is heritable. After deinstitutionalization in America, the reproductive rate of schizophrenics increased to approximate that of the rest of our population.

The truth is that there is nothing humane about the way we treat our severely and profoundly mentally ill citizens…or their children. Our treatment of these suffering people is abusive.

The real motive, hidden behind false ideas of personal freedom and humane treatment, is primarily financial. Deinstitutionalization saves money in the short-term, pure and simple. But, in the long-term, as America is now learning, it has been a disastrous mistake.

This is another example of America’s avoidance of short-term expenses and trouble, at the cost of long-term cultural self-abuse and self-destruction.

V. Thomas Mawhinney, Ph.D., 10/30/09