In one of my previous jobs, I had frequented psychiatric wards, high-level group homes, and institutional settings that housed the people on the fringes of our society. Many of these souls had lost their voice to a system that saw them as nothing but numbers and diagnoses in a system largely devoid of grace. The patient’s “pathology” preceded their humanity, which somehow justified their prolonged imprisonment in these places of limbo.
In 2012, California issued a moratorium on all non-forensic developmental centers. What that means is that people with developmental disabilities that did not commit a crime would be released from institutions back into the community. This is a step in the right direction, but this transition must be intelligently and compassionately designed to ensure a high quality of life for those that are navigating the new world outside steel bars.
When I was more directly involved with this process, I was sent to conduct interviews and assessments of clients who were on the verge of transitioning from these institutionalized systems and re-integrated into society in some way. Many of the other individuals remained locked up for a petty crime they committed half a lifetime ago. Without advocates, these people remained forgotten in the anonymous abyss of this archaic system.
I myself had my fair share of paranoid and fearful moments where I felt “locked and trapped” inside my mind. In those instances, the only thing that shook me from the syrupy web of darkness was knowing I had the care of my loved ones. God was my only witness; my Spirit, the deeply-trenched anchor to my wild experience. Most of the people in the institutionalized system, however, hadn’t been offered such a gift. They live in a perpetual repeat of fear, trapped in the quicksand of their own mental labyrinth. That, my friend, is literal hell.
Turns out, many of the people I come across in “typical” society are more unwell than the people we deem “mentally-ill”. If that doesn’t give you pause, the next time you see a person on the streets, or a mugshot on TV, try to see if you can find your reflection painted on their irises. Let your heart be consumed by the stark intensity of seeing yourself through their eyes – quite literally. And then see where even the most marginalized of people share a common humanity with you. With us.
Then, we may ask: How can we treat a growing epidemic of psychological wounding in our communities through broken infrastructures? The old vessels were never designed to transport us from suffering to healing. At best, it was a way to manage what we never believed was fixable, and at worst, it was a feeble attempt at efficiently forgetting the unwanted – of castigating the problematic individuals rather than reforming them from their core.
Much of the traditional mental health system aims to “treat” people before treating them as people. This fundamental flaw manifests in myriad of ways, not the least of which is how pharmaceutically and pathologically-driven most managed care systems have become. The fuel that drives this machine consists of the very ingredients that caused the societal sickness in the first place: greed, profit, a gross negligence and ignorance of the most basic aspects of the human condition.
The allopathic model of medicine has convinced mental health professionals that their primary job is to relieve a specific set of symptoms rather than curiously and carefully investigating the root cause. When this happens, we fail to look at the dynamic relationship between pain and person – between inner experience and observable behavior – and thus fail to offer something of true value to the patient.
The question remains, how does one change something one fails to understand?
If the system’s mindset is fixated on survival, the lowest rung of Maslow’s needs, then there is little motivation left for the truly transformative and meaningful parts of mental well-being. We cannot claim we are fixing brokenness or making someone whole when the methods and medications often suppress creativity, feelings, and the basic connection each human has to themselves. These things do have their place and part in treatment, but they were never meant to be permanent solutions.
What we need instead is to exhaust our instincts – the ones that tempt us to categorize, judge, and box people in without concern for their unique, internal experiences. We must transcend the limitations of our intellect and connect with our hearts, our intuition. We might then begin to understand and see “the patient” as ourselves.
The change is already happening. Perhaps in small, even imperceptible ways. But meaningful ways, nonetheless. The paradigm shift starts with one thought, one feeling, one person. To literally feel, inside our body, the common humanity that we share with someone we might otherwise dismiss or despise. To love in a strategic yet open manner. To welcome the intensity of true human connection, along with all its radical ups and downs.
Dear Jaspr, thank you for finding us in our common humanity.
“Don’t ask what disease a person has. Rather, ask what person the disease has.” -Sir William Osler MD (1849-1919)
When you look in my eyes you see a grateful soul who was once psychotic, brought into hospital by family and treated under the protection of the Mental Health Act. My freedoms were briefly curtailed so I could be treated effectively in a safe place. My clarity of mind and autonomy were restored. On lifelong medications, I have resumed my roles within family and community. The alternative would have been abandonment and possible death. My life was deemed worthy of saving. I have family, physicians and a home.
Why not intervene on behalf of the folk who languish on the streets? Most severe mental illnesses can be treated with a combination of psychotherapy, medications and social supports. Especially the protection of a home. Cognitive remediation can address the decline associated with even well-treated schizophrenia. And yes, medications can have untoward effects.
The widespread de-institutionalization of vulnerable people is one of the reconsidered and regrettable quandaries of our times. In my city of Vancouver, Canada there is staggering and ever growing homelessness, untreated mental illness and substance use (HIV, Hep C and life threatening infections of the skin and heart valves). An epidemic of deaths from contaminated street drugs claimed more lives than from Covid and is still climbing. We are awaiting the government sanctioned provision of medically manufactured safe supply.
For folk with severe mental illness such as substance use and psychosis there is often lack of insight. If a person has a treatable mental illness and is in decline and is a harm to themselves and/or others they may be brought into care by ambulance or police. Stable folk may progress to supervised psychiatric care and treatment while living in the community. (Not unlike parole). However, community living has proven to be indisputably perilous for the marginalized folk living on the streets.
Some of the facilities that were closed many decades ago had been situated in rural areas away from public transit and the potential for relapse. On spacious farmland residents participated in gardening, animal husbandry, contributing to community living. Their trips off campus were supervised. They were alive and with a quality of life that certainly appeared to be better than someone in a paranoid psychosis shouting and fisting in anger at an unseen foe.Traumatic interactions with police, hypothermia and assault on the wet dark streets of our ghettos are only a few of the challenges of street living. Substance use involves a loss of control and compulsions to use despite negative consequences. Denial is an enormous barrier to accessing care.The suffering of withdrawal can be treated with long-acting opioid agonists. We have shelters, safe injection sites where overdoses can be treated, clean needles, detox and rehab facilities, medical clinics and roving nurses on the streets. But we lack the moral courage to interfere with the freedoms of our most disenfranchised folk. No one living in our ghettos wrote in a grade 5 essay that they wanted to grow up to be enslaved to substances, victims of poisoning and homeless on the streets.
“How we walk with the broken speaks louder than how we sit with the great.”