Some experiences with the mental health system in Alameda County and some stuff I saw when I was hobbling around the neighborhood.
When I was in my early twenties I could never make up my mind. Should I go to law school? Should I finish my Ph. D? Should I break up with my boyfriend? I used to make long lists of pros and cons. People said,
“Listen to your inner voice.”
I listened hard. I didn’t actually hear any voice out loud except late at night in bed. Sometimes it said, “You a**hole, why did you do those dumb things?”
I asked my graduate school adviser how he made decisions, or how he listened to his inner voice. He said, “When people tell me to listen to my inner voice, I say, which one?”
I think my adviser navigated life by means of outer voices, or, I guess, logic of some kind. He created algorithms to guide his own activities. He decided which problem was most important to the greatest number of people, then he decided what person or interest group was most able and likely to do anything about that problem, and then he addressed his arguments to that player. The world is not saved yet, though, I noticed.
Somewhat Useful Voices
After I started taking antidepressants, I began hearing voices once in a while. “Don’t worry.” “You know they are wrong.” They generally said useful things.
When I took too much of my antidepressant, though, it seems like an inner voice told me to persist with a ridiculous small claims lawsuit, which got everyone pissed off at me.
I had trouble making decisions until I was about 40, when I decided to have kids. I didn’t know, and couldn’t explain, why I wanted to have kids–still can’t–but it still seems to me to have been a good decision.
Sometimes when I’m writing or revising, an inner voice steers me. I ask it constantly whether I should chop this, move that, drop this train of thought for now, and it often replies. But as they say, don’t revise when you hate your work. Because it seems people think this inner voice might at times be evil, and tell me to make my writing worse, because it hates my writing and me.
How I Practiced Stopping My Ears to Some Voices and Hearing Others
When I was a Little League umpire, I often had to make a decision. “Undecided” is not an option. Ideally, you take a movie in your head of what happened on the play, rewind it and watch, and decide. I couldn’t always get the movie to play back. So I had to rely on my inner voice: I had to ask whoever was in my head at the moment whether the runner was out or safe. Fortunately, I always came up with something to say.
People who really like baseball may believe in magic. They believe that if they stare at the empty field long enough, something will happen; they even think their desires may influence events, influence reality. But a crowd looking at a field may also bring forth evil; a fight, a team sobbing in defeat, a crazed Little League parent who has to be dragged away by the police. A voice, at least on a baseball field, may be from a devil. It was my job as a Little League umpire to not listen to any inner voices but my own; to stop my ears to parents, managers, players, and, if any, devils.
D Hears Voices That Cause Trouble
D hears an inner voice. This voice may perhaps hate her and wish her to fail.
But–I wonder if this voice sounds the same to her as our voices sound to ourselves. She often loves her voice and believes it to be a source of creativity. And before it got so loud and weird, I believe it was a source of creativity–it gave us many new ideas and things to try as a family which I would never have thought of before.
Recently I have begun to think that her inner voice is a devil, or a speaking drug.
How Can You Tell a Source of Creativity from a Source of Craziness?
It’s hard to admit. All my life I have been giving my inner voice room to be itself, and other people’s inner voices the room to be themselves. But–the inner voice and the crazy voice are just two ends of the same stick, they seem to meet up in back. I’m not so different from my crazy friends.
Now I don’t generally hear a voice–but sometimes I feel compelled somehow to do something that I can’t explain or justify too well.
The other morning I was standing in line at the local discount grocery store to pay for a bag of rice. I was tired and cranky, not out of my mind surely, but not in my best possible mind. My daily routine had been upset recently, I forget by what. The cashier came out from behind the counter and scanned the handle of my shopping cart; there was a barcode glued on it. It bothered me. I had to ask: “Why did you do that?” “To track our carts,” she said.
Oh-kay. I guess they are the store’s carts. I kept quiet, but, “Do Not Track Me,” said a stubborn voice to itself. In the parking lot I found a sharpie and carefully drew several thick and thin lines into the bar code, to confuse any future scanners. I drove off leaving the altered cart in the parking lot. I drove off feeling a little surprised at this involuntary action I had taken, and apprehensive. I realized the store would know it was me that drew on the shopping cart handle with a sharpie. They would link the vanished cart number to my debit card. What I did was probably against the law, and could cause trouble for me, and no particular benefit. And if they asked me why I did it, I would have to say, “I don’t know. It was just something I had to do.”
A Voice Promises To Pick Up The Tab for a Soda
D was released from a psychiatric hospital and we were walking around in the City. We went into Whole Foods (a high-end grocery store) so we could to use the clean, spacious bathroom there, and so she could apply to work at an organic yogurt factory (I didn’t inquire closely as to how that would work). Reminded by a display of dollar sodas, she told me an anecdote about voices.
The last time she was in that Whole Foods ,she was thirsty and saw a display of sodas. She remembered she had no money. But a voice told her, “It’s all right, I’ve got it, it’s paid for.” So, gratefully, she opened the can and took a sip. Very quickly a security guard grabbed her, twisted her arm up behind her back, dragged her into some back room, threatened to call the cops, and told her never to come into the store again. Whoever had told her that, about the soda being paid for, was nowhere to be found. As is often the case with these voices that give you advice.
Our Voices Tell Us to Stand Up for a Principle
The other evening I was walking with D and she did something that may have changed our relationship forever. Then again it may have just changed it for a weekend.
It was dark, we were walking along the Bay Trail, in a semi-industrial area near the Oakport soccer field, and there were very few people around. All evening we had been discussing love. She had decided a guy she last talked to four or five weeks ago, who lives somewhere near 28th Street, is in love with her, because their minds met while one or the other of them were taking drugs recently, and she had further decided he is her boyfriend, although she hasn’t seen him for weeks and wasn’t sure she even liked him. She said she really really needed bus money to go see him, although she doesn’t know where he lives–she planned to just keep walking the geneeral area asking strangers where he lived.
She asked me to give her the eight bucks she had in her jacket when she last got committed to the psychiatric hospital. As I told her, and had been telling her for days, I had taken the money out of her jacket, and I wasn’t going to give her the money, because her family and I would provide for her needs until she gets admitted into the group home we are working on, and we don’t want her spending money on drugs.
I noticed during our walk that she had been walking close to me and sometimes bumping into me, but I figured it was my own clumsiness–I’m never sure what space to take up in a trail.
So in the dark she grabbed my shoulder bag and said, “You thief, you stole my money, it’s mine, give it to me, I need it.” Now I have my own issues, and really hate people taking away my purse. so I yanked on it, and yelled at her to let go, and wrestled with her and tried to shove her away, called her some kind of names, called 911, screamed and cried for her to come back from the freeway onramp I saw her walking onto. Eventually she gave me back my shoulder bag, saying she had removed $5 from it and was still waiting for the remaining $3, and consented to get back into my car and go to her cousin’s house where she belonged.
In a way, what she did makes sense. It’s all for love right? What is more important than love? Even if you are not sure about who you love or where he is staying. And principle! It is her money (she says it doesn’t matter how she got it, it’s hers). And no matter how much much gasoline and time and parking money I have spent visiting her and driving to various bureaucratic places, it is her money, and the law calls her an adult.
So, at least, by snatching my purse and going through it, she is standing up for herself, obeying her inner voice.
Another explanation I have heard (from my therapist) is that D is very ill and feels compelled to push anyone away who might help her. Her voices may be evil, self-destructive, generated by a part of her that hates herself and wants her to die on the street, a truly achievable possibility if she runs out of places to stay, which seems to be happening. Similarly, it has been suggested (by my therapist in fact) that there is some voice holding me myself back from succeeding at work and enjoying life and cleaning up my house. I wonder. Wondering, alas, needs to nothing but more wondering.
It’s a Matter of Degree, Not a Basic Difference
There is really no basic, basic difference between my crazy family members and me. I do what I feel like I have to do. I write letters to the head of the agency I work for, I call up my landlady and complain about the neighbors being evicted, I write screeds complaining about this or that hospital bill. I do this because I feel like I have to do it. I could say I’m doing it because I am fighting for justice against vast, nameless, formless, constellations of oppressors, but really I do it because I have to. The same way D calls up the police and reports everyone she knows for committing various crimes. You do it because you have to.
Some people are seriously mentally ill and need help to stay alive. You could say they are consumers out in the community making choices. Or you could say they are suffering and in danger. Read more at Voices of Mothers and Others.
Villa Fairmont, of course, is a locked group home for mentally ill people, run by Telecare Corporation. It’s easy to visit, but so very hard to get into as a place to live. I’ve spent less effort getting my other kids into college than I have spent getting D into Villa Fairmont.
I was leaving Villa Fairmont last night, having dropped off some samosas, hot dogs, pepsi and cigarettes for D and her friends and acquaintances there. A thin, well-dressed black lady in the parking lot asked if I knew the phone number of a cab company. She was wearing a “visitor” badge so I assumed she was the mother of a young inmate—many in their late teens and early twenties end up there after schizophrenia hits.
She borrowed my phone and pushed some buttons trying to look up a number on Google. I assured her my phone was unable to Google anything and we should ask the nurse’s station, which would surely have a number of a cab company. People leave Villa Fairmont once in a while, sometimes with relatives and sometimes in a cab. We went back into the building—there was a delay while she hungrily finished smoking her cigarette and tossed it—and the nurse at South Station told us she didn’t know the number of a cab company, we should Google it.
The lady said she wanted to go to Sausal Creek and I said I’d take her there because it’s three blocks from where I live. Problem solved? No. Walking back to the car, I realized this poor girl was a lot younger than I had thought—beautiful skin, a clean black stylish asymmetric cable sweater, carefully braided hair—and was part of that different world, because Sausal Creek (a government office that hands out prescriptions for antipsychotic meds if you wait around all day) is closed at 9 at night. They are open 9-5 weekdays at most. I had occasion to look into that on behalf of my friend at Villa. This girl—I’ll call her Takeena—must have heard of it as a place that takes care of schizophrenics, but there would be no help of any kind there until after Memorial Day.
When she retrieved a neat athletic bag and a big IKEA shopping bag overstuffed with clothes from the bushes, I realized she had no place to stay. And there is no place to stay at Sausal Creek. There’s an actual creek in that rather poor neighborhood, where cats sleep, but precious little flat ground for a person to sleep, and you would have to climb a fence, which I couldn’t see her doing with those clothes and that luggage.
I told her this and she said she wanted to go to Highland. Again, Highland is a place that takes care of schizophrenics, if you really push them to, they may send schizophrenics to John George, where they have a safe place to sleep. But again, there is no place to stay there.
I thought, of course about my house—if I lived by myself, and didn’t know what I know about mental illness, I would probably have offered her a night in the living room. She was calm and clean, her teeth and skin looked good (not ravaged by meth and homelessness), she wasn’t talking about being in a movie or having hundreds of thousands of dollars in a bank or being married to two men in other states, stuff I hear from D—but I knew enough to be wary.
I told her that if she wanted a place to stay I could drive her up to the back of Villa’s large, rather deserted medical complex, where I knew there were groves of trees, grassy fields, holes in the fence, and in general good conditions for passing the night undisturbed. I got no response.
She put her gear in the car and asked if I knew where Starbucks was, could I take her to a Starbucks. I told her I knew where about ten Starbucks were, there was one in the mall down at the bottom of the hill.
In the car she borrowed my phone again and called someone whose number she had memorized. “Do you have time to talk now? Oh, not now? That’s fine, I’ll call you later.” So sad. No doubt she was working up to asking for a place to stay, and the people at the other end didn’t want to get into that discussion. She put my phone back in the ashtray, and if the people at the other end called it back, they would never reach her.
The Starbucks was open—but mainly a driveup, catering to those unwilling to get out the car for a latte, in the corner of a giant parking lot, not ideally situated for homeless people. At least it had a little patio for her luggage.
As she got her bags together, she asked me if I had any spare money. I got $60 out of my wallet and folded it up and gave it to her and asked her to take care of herself.
Should I have? She might have spent it on meth, but obviously she had been outside a little while at least, a day, and hadn’t done meth that I could see. I suppose it would have paid for a single motel room—there are motels in that area, and a cab driver could have directed her to one. But in my experience homeless people consider motels a tremendous waste of money.
My wish is that Takeena borrowed someone else’s phone and finally found a friend or acquaintance that she hadn’t totally worn out with drama and didn’t want to sexually exploit her. Let’s hope so.
That’s just how my friend D might be when she gets out of Villa Fairmont—no phone, no plans, no money, everything in a bag, and all her friends sick and tired of her. The trouble with D is that she has learned that if you take meth, things will make sense for an hour or two. I fear when she gets out that she’ll get lost looking for some place she has been or heard of, and someone will offer her meth. It has happened before. I’m afraid she’ll be raped, lose her teeth, lose her health, lose her looks, as well as her mind. It’s worth avoiding. Too bad the County is doing as little as it can to avoid it.
I was surprised to get a call from somebody at the County who remembered her from a year ago. This person said they would keep an eye out for her, and, it seems, try to keep her from being arbitrarily discharged from Psychiatric Emergency Services again, if she shows up there again and they hear about it.
Sometimes I am very nice to these people who call; I left a message for Mr. Davis thanking him for listening to me the other day, and asking God to bless his heart. But after a few minutes of walking around with my cell phone listening to this inoffensive lady, I remembered how angry I was. I think in two years I have only once ever heard back from her agency, and I was in no way ready to start forgiving them. I told her, “Telecare Corporation is a bunch of whores!” (They discharge people for whatever reason, and say their discharge policies are a proprietary secret.) “The doctors at Psychiatric Emergency Services are a bunch of flatbacking whores!” (In fact they used to get bonuses for discharging people quickly.) “The County Conservator’s office is useless!”
She listened to me for quite a while and then started to interrupt by saying she wanted to ask me a question. “Just answer me this question,” she said. “How would you know when she is ready to be discharged?” I had a ready answer: “First of all, not until you have tried every drug you can try to address her delusions, including Clozaril. If you discharge her the way she is now, you shorten her life.”
After some ranting on my part she asked another question. “Tell me this. Do you understand we can’t keep her locked up forever?”
And how did I answer? I didn’t say “why not?” I know why not, they don’t have the beds because they don’t have the money. But I refuse to take that as an answer. “I can only save one kid at a time, it is all I can do. If you have to kick her out so other kids can have a chance–it’s not my job to save those other kids. It is all I can do to save the one I can.”
And looking back I wonder: Why is she asking me about forever? Diana won’t live forever. Sometimes I give her a month or two, sometimes a year.
She ended up staying a couple nights. Her speech gradually became easier to understand. Monday night, she walked around the block with me in the moonlight, laughing, twice.
On Tuesday, after I made many exasperated, righteously indignant calls to government agencies, a social worker came and talked to her as she lay in bed. Now that I think of it, she was visibly tired and cranky that day, and I think it was because it had been a couple days since she took meth; it’s hard for her to wait that long.
Mr. Davis asked her what had been happening with her and how long it had been since she used. She answered him freely, talking loud enough for him to hear (though not always loud enough for me to hear). She had been hanging out in the City, doing fine, until she went to a concert and the police pulled her out of the building, suspended her by her ankles, and hauled her away in an ambulance. They beat her, she said, and injured her unborn baby. She was still bleeding, she said. She said she intended to file a complaint against the San Francisco police in Contra Costa County, for reasons of venue that I of course couldn’t follow and didn’t believe.
Folks, it is hard for me to take her at her word about the baby. I don’t believe her because she has often talked about imaginary babies. Whenever she wants to know if she is pregnant, she looks hard at her pupils in the mirror and decides based on that. And to me, non-doctor that I am, she looks too skinny to be fertile. But people with a lot of experience talking to schizophrenics say you should affect to believe everything they say, and not argue with their delusions.
Mr. Davis suggested it might be a good idea to go to Highland Hospital and see if she and the baby were all right. I agreed. I asked if the social workers might be able to take her there, and I understood from what he said that there was a lack of resources for that. I don’t have a car, but I thought I might be able to nudge her along the mile-long walk, or take a bus. But she remembered how many times she has been 5150’d from Highland–that is, sent straight to the mental hospital–and she told me later, no thank you.
Now she told Mr. Davis something that was hard for me to hear, both physically difficult to hear–I am hard of hearing–and hard to take in. She mentioned a new deadly delusion (she already has at least one): she said that she had to take meth every day, at least a little bit, or her baby would die. She was crying as she said this. I wonder if my brain just shut her message out; I didn’t really understand what she had said until a few hours later, on the sidewalk, when it was very hot, and I was on the way to the supermarket to get ingredients for smoothies for her, and I sat down on a wall in front of the old-folks home, under the shade of a dracena tree, to rest, and I called somebody at the County, and I put together what it was that she had said.
She thinks she has to take meth every day or her baby will die.
I told a nice lady at the County that if this is what she really thinks, no social worker meeting with her once a week is going to be able to help her; it’s like bailing out the ocean with a teaspoon. Thinking out loud–how else can you do it–I told the nice lady that D is a danger to her imaginary unborn baby, and thus was eligible for a 5150. To be eligible for a 5150, a person has to be a danger to herself or others, and/or gravely disabled, though the police don’t care about “gravely disabled.” Certainly, D is a danger to her imaginary unborn baby, and surely the police will understand, if they hear about this belief, that she ought to be taken off the street, away from meth. That was my insight of the day.
I took my groceries home and took a nap. When I awoke D was dressed in a very, very short plaid skirt she had worn in high school, wearing my oversized Giants World Champions jacket, and asking me for more money, which often happens when she leaves my house. She was covered with C’s jewelry, which she had taken off of C’s desk and I had been letting her wear as a joke–rings, metal chains, bracelets. I believe it’s junk jewelry from the estate of one of my aged relatives, but C has been making it very clear over the phone that she really, really doesn’t want D taking her jewelry. I told D that she needed to leave all that jewelry here, as she had said twice that she would. She started to cry, almost to scream, that she had bought it all off of C, and paid her for it. “When?” I asked; D hasn’t talked to C in months or years, except by mistake. “I did! Believe me! It’s mine! Do you think I’m crazy! Deal with your own mental illness first! I’m leaving!” I said if she didn’t leave that jewelry here she would find it really hard to come back; but she left.
I followed her, though I walk pretty slow. I saw her get a soda pop at the corner store and walk off to the bus stop. She saw me following her and scowled. On her long, skinny legs, and with that XL ten-pound jacket, she looked like a heron or egret, unable to fly and very angry about that. She walked on, I walked on, talking to the police on the phone, in the hope, actually, that I could get the police to confront her and me about the jewelry, get in a screaming fight with her, and get her 5150’d that way. But the police said they could not take a report because I was not the owner of the jewelry. And I walked the wrong way up the bus route and thus lost sight of her.
I waited for the bus, she was not on it, I rode it down to Jefferson Park, I asked the homeless men there if they had seen any skinny whitegirl wearing a huge orange jacket, and I strolled down to Castro and 5th, to the tents under the freeway where I had found her before. I met old Ron, probably 60 who is still alive and still taking meth and still has a couple teeth. He hugged me; I felt the ribs all over his back, I told him he was so skinny he reminded me of Diana. He invited me to sit in his brown vinyl barcalounger under the freeway.
My feet hurt from walking in flipflops on the concrete. The barcalounger was clean and comfortable. It was a warm, moonlight night, a good night for anyone to have fun and take drugs. A shiny black Sienna drove up to the curb in front of me, with a clean, cheerful, young, strong black man for a driver. His visit to the homeless encampment had nothing to do with me; the driver got out and laughed and joked with Ron about something. It seemed to me that there was yet another person in the front seat of the car, behind the heavily tinted window: a leering, very-stoned-looking, rather microcephalic person of indeterminate race. I ignored them and looked up at the moon. A shape passed by far above, gray like a ghost, a full-sized eighteen-wheeler on the 880 freeway. We, far below, were between the lanes of that multi-stranded highway. Another truck passed on, just taking a couple seconds. If it were to fall in an earthquake, it would smash us; but Ron had been staying here under the freeway for months, years maybe under this and other freeways, and he lived yet, and recognized me although he hadn’t seen me for weeks, and wanted to sleep with me in fact, if that was what he was saying. I tried to take a picture of a truck with my phone but it didn’t come out.
When my feet quit hurting I started walking home. Daring to look more closely at the addled passenger inside the Sienna, I saw it was a rubber Halloween mask the driver had pulled over the headrest, as a joke for people like me: people expecting to see degenerates having fun.
I was ranting at the Alameda County Mental Health Board meeting. “Let me know when I’ve used my three minutes,” I tell them, and get started. I talked about the way the County puts my crazy girl in peril every time they decide to “honor her wishes” and let her wander untraced through the Bay Area shooting meth as an imaginary undercover agent.
A lady who spoke after me used her three minutes to represent a nonprofit working against “stigma.” Stigma, she said, was the number one problem in the mental health system today. She said, “I can’t imagine using the word ‘crazy,’ as that speaker did, to describe one of my own relatives.” If we all respected mental illness as just another way of being, she was saying, the problem–whatever it is–would be mostly resolved.
I’m trying to put my finger now on the number one problem, in our county where responsibility for mental illness is so divided. What’s D’s number one problem? Is it that her father molested her and so destroyed her ability to listen to her body when her mind isn’t working? Is it that she pushes everyone away who tries to help her? Is it that she loses her ID card and sells her phone? Is it that she doesn’t believe anything any well-intentioned human being says? Is it that our libertarian market-driven society has developed a universally available, cheaply produced substance that solves all her problems at once—according to her, and we have to honor her wishes, right? Because under the new model of public service, the customer–and they call her a customer of health-care services–is always right.
But if she paints her face with lipstick and shaving cream and goes out of the house with a really, really short skirt on, taking the BART direct to the Tenderloin where she is chased from one patch of pavement to another, and where the police treat her like a giant talking rat…I suppose reducing stigma is a good idea, maybe even the place to start. Maybe the police, or someone who works for San Francisco County, could ask her nicely why she wants to throw away her brain, body, and soul, and maybe she would answer.