By the time you see me in the hospital, you have no place else to go.  The system has failed you: you’ve alienated family and burned through your support systems.  Perhaps you’re in your first all-out psychotic break or stopped the meds that stabilize your moods, thoughts and behavior.  You could be dangerous – to yourself or someone you once knew and loved, or to a total stranger on the street.

Layers of symptoms interfere with negotiating the basics of daily living – shopping, cooking, paying bills, doing laundry, washing your face and brushing your teeth.

Juggling a job, partner, kids – all things being equal, this is hard enough when everything is great, let alone when you’re battling depression or voices that tell you to hurt someone, voices no one else hears.

It’s a major undertaking just to get out of bed and feed yourself.  Going to the pharmacy or market, making a phone call, knocking on a neighbor’s door, reaching out – these are impossible if you have to fend off menacing and terrifying command hallucinations. or believe the CIA is following you.  In full blown mania, patients may be so euphoric that food and clothing are unnecessary accouterments to life.

You’re beset by bizarre and mysterious somatic complaints for which no medical text can account.  Doctors don’t believe you.  You tell them you’re feet are on fire or that you have electrodes in your brain, that there are fingernails in your scrotum.  You believe the CIA is following you, that cameras are hidden in your walls, that the television is giving you orders.  You leave a trail of chaos in your wake for family and friends to clean up.  They don’t fully comprehend your ailment.  They believe that you have some control over your symptoms and that you’ve chosen to behave in ways that deliberately undermine their best intentions and efforts to save you.  They will doubt and deny and when they finally understand you, they’ll understand you’re a stranger with a familiar face.  

It’s shameful – you know that with what’s left of your ability to reason.  It’s shameful that the weakest and most confused among us are left to negotiate a labyrinth that leads inevitably to the emergency room, where you enter the maze, only to learn there isn’t a psychiatric bed for you.  There aren’t enough beds to start with, and you don’t have the right insurance.  

I apologize.  Society’s failings are compounded by our own.  I can name the agencies involved in educating us, but their programs fly in the face of how we feel when we encounter someone like you.  You’re different and we’re afraid.  You frighten us.  The reptilian brain still cowers in the cave or whispers aggressive thoughts.  There isn’t much to it, the oldest smallest region of our most mysterious organ.  Fight or flight is hard-wired into it.  Stigma lives there.  “Not in my backyard,” stigma whispers.

As self-congratulatory as Portland, Oregon may be, homeless schizophrenics are as common as Starbucks’ franchises.  You give off fumes acquired sleeping in doorways, huddled against the rain in clear plastic dry-cleaner bags, picked up from the exhaust of a million cars, from urinating wherever you can.  Your hobo skin is the product of time and layers of grime.  Your wear all that you own, shabby raiments layered on in no particular order. 

Walking down a tony street in Portland, I feel that same moment of panic and indecision as anyone else.  When you approach me yelling at someone I can’t see, do I cross the street?  Would that hurt your feelings?  Would you understand that I avoided you, recognize my rejection?

Our fears are not baseless.  Statistics in the May 19, 2009 issue of JAMA indicate that 28% of schizophrenics who also abuse alcohol and drugs are convicted of violent crimes, compared to 8% of those who do not have substance abuse problems and 5% of the general population. 

There are other statistics: 25% of the mentally ill population benefit substantially from medication; there are another 25% for whom medication does nothing; medication helps the remaining 50%, more or less.

This is mental illness and you are one of my patients.  Faces and names change; your symptoms do not.  I pull you up from the ground or down from the sky, I stand by as your newborn is removed from the delivery room by a social worker from the Department of Human Services.  I try to help you manage your demons.  You know how that goes.  Sometimes the magic works.  Sometimes it doesn’t.  And in any case, this probably won’t be your last visit here.  The ward, 3East, where you come to stay for a night or a fortnight, is shelter from the storm, a bed and a meal – three hots and a cot, an E-ticket ride at Disneyland, the card that fills the inside straight.  You’re with me as long as your insurance lasts and no longer.  Your oddly worded letters of thanks, your strangely drawn sketches take up a wall of my office. 

Rest now. 

I’ll  tell your story.

Evelyn Sharenov