Our Sidewalk Psychotics
Why do we ignore the troubled souls scattered across our streets, muttering to themselves in fear?
Almost 60 years ago, President Kennedy delivered his famous speech that advocated for community-based care for the mentally ill. “Reliance on the cold mercy of custodial isolation will be supplanted by the open warmth of community concern and capability,” he promised. But when you walk by a sidewalk psychotic, do you sense the warmth of community concern?
“And a madman looking for a fight." -- Van Morrison
When President Kennedy made that speech, it had been proven that two-thirds of those suffering schizophrenia could be effectively treated and released within six months. However, at the time, the average stay in a federal sanatorium for someone with schizophrenia was 11 years. I find that so hard to believe that I’m going to restate it—people who could recover in six months were being locked up for 11 years!
Basically, it was a system in which the government built large, under-staffed, impersonal institutions and imprisoned those with mental illness, hiding the pain and responsibility of their diseases from the community. Sounds awful, right? But are we doing any better today?
President Kennedy believed that moving from old, bleak and failed federal asylums to newer, better-staffed community health centers would be the answer. And he was partially right. I’ll be forever indebted to our local crisis center and its team of psychiatrists and nurses who supported our family through our struggle. But too many people continue to fall through the cracks.
And when they fall, where do many end up? In large, under-staffed, impersonal institutions—except that we now call them prisons. The L.A. county jail system, essentially the largest mental health facility in the U.S., holds over 5,000 inmates suffering some form of brain illness. Rykers Island, outside of New York City, confines over 4,000. Indeed, the Treatment Advocacy Center has estimated that over 383,200 inmates across the country suffer from mental illness.
I’ve never stepped foot in a prison, but I have spent countless hours with someone suffering psychosis, someone whose brain wasn’t functioning correctly. The paranoia meant that she saw threats everywhere, even in the most innocuous settings. The idea of locking someone like her into a small cell in such a threatening environment, surrounded by strangers and without any support? Unfathomable. A complete miscarriage of justice. And yet the government does this as a normal course of business.
But maybe those who end up in prison are the lucky ones. At least, they have some chance at recovery, no matter how small and how many nightmares accompany their experience. The others fall to our streets, lacking not only medical care but shelter, food and clothing. These are the ones we see muttering to themselves on the corners of our downtown intersections.
Having witnessed the remarkable recovery from psychosis that can be achieved with patience, care and treatment, the fact that we leave these sidewalk psychotics to suffer alone is inexcusable. Are we, as a society, so frightened of brain malfunction that we cannot find the compassion to lend support to our most sick? Have we seen too many horror movies?
Although some psychosis can turn dangerous, most of those suffering on the streets remain only confused and afraid. Each one of these people had a mother, most had families, but now they huddle in misery, alone and scared, the warmth of community nowhere to be found. But if we could overcome the stigma—if we could see them as victims of disease and not as something to be feared and ignored—they would have a good chance at recovery.
We wouldn’t turn on our backs on those with severe heart disease or cancer. Brain illness should be no different. As author Danielle Steele argues in her memoir, A Gift of Hope: Helping the Homeless: