Now that my ladder’s gone, I must lie down where all the ladders start, In the foul rag-and-bone shop of the heart. W.B. Yeats
My twin brother, Richard, was a freshman at St. John’s College in Annapolis, Maryland, beginning his study of the great books, when he was drafted into the army and sent to the battlefields of World War II. I was never to see him well again.
I have lived with madness. I have cowered while my brother, in uncontainable agony, tore pictures from the walls and flung chairs across the room. I have stood at the foot of a retaining wall while he walked a narrow ledge fifty feet above, weighing in his mind whether to jump or not. I have hovered out of sight while the police I had summoned came to take and put away the distraught human being who was the dearest friend I would ever have. I have learned what it is to wait through countless days and months and years for the return of someone held dear — so slow was I to understand that he would never come back again.
Because I have been a companion to Richard on his grievous walk, I know something of the heights and the depths of the human spirit. Because of the care of friends through his long ordeal, I know that unconditional love is a sublimity our human nature can attain.
Because of Richard’s treatment, I also know the inhumanity of which people are capable. I believe I would have borne more easily the dreadful election of my brother to a hell on earth had his suffering been caused only by psychic trauma or something gone wrong in the biochemistry of his body. As it was, other people’s indifference and ignorance added immeasurably to his distress.
Simone Weil, writing in Waiting for God about the fatigue she endured sharing the life of factory workers, said, “There I received forever the mark of a slave, like the branding of the red-hot iron the Romans put on the foreheads of their most despised slaves.” In the conference and visiting rooms of mental institutions, I too received the mark of a slave. Borrowing Weil’s words, “what I went through there marked me in so lasting a manner that still today,” whenever a nurse or orderly in one of these institutions speaks to me with kindness, “I receive it in my heart as a miracle and one that in all likelihood will not last.”
Richard was introduced to mental institutions when insulin and shock treatments were in their experimental heyday. Inappropriate and excessive use of these treatments dealt him the blow ensuring that he would never again plead for his home or protest his lot. The promiscuous administration of shock treatment was followed by the era of lobotomies, called “the ice-pick operation” because some doctors literally performed it with an ice pick. Although the procedure was pioneered in the hospital where Richard was a patient, we were able to resist the pressure put on families to agree to it. In that hospital alone, three thousand patients, like lambs dumb before their shearers, were submitted to the surgeon’s tool and were irrevocably the worse for it.
In the postwar years, many publications described the sordid and shameful conditions existing in most state mental institutions. Many of the stories were accompanied by shocking pictures of naked and gaunt men lying in hospital corridors, looking very much like the survivors of concentration camps. Despite the articles, nothing changed until the advent of the major tranquilizers. These drugs returned countless numbers of patients to meaningful and productive lives and played a large role in the program of deinstitutionalization that has become a national tragedy. Patients were released from state institutions by the thousands and dumped into communities that did not want them and had no way of caring for them. There are very few adult homes and community centers to support and supervise patients on drug therapy, and those that do exist are limited in the number of people they can serve. Now most articles on the mentally ill have the word homeless somewhere in their titles.
I n his recent book, Nowhere to Go: The Tragic Odyssey of the Homeless Mentally Ill, Dr. E. Fuller Torrey, a noted clinical and research psychiatrist, wrote:
Living on the streets or [in] shelters as a rational, sane person with a normally functioning brain must be a difficult task. To attempt to do so with a brain which is not functioning normally — with illogical thought processes, delusional ideas, and intermittent auditory hallucinations — must be a circle of hell unimagined even in medieval times.
My church has an infirmary for physically ill street people. I have asked some of them about how mentally ill persons fare in the streets. They tell disturbing stories. One person said:
They are like rats. They forage for leftovers. They find a place on top of a grate or in a subway entrance, and they never go far from that place — not even to bathe or change clothes. They don’t trust anybody, except maybe someone who has personally given them something. They are not rats, but they are living like rats.
The astonishing fact is that when politicians and “objective” observers speak and write about the homeless who sleep in our parks and doorways, they point out that a third or half of them are mentally ill — implying that homelessness in America is not as bad as it would seem because, after all, the figures include the mentally ill and they do not count for much. Also, these shocking numbers never include the seriously mentally ill who comprise as much as 20 percent of the prison population.
Then, too, more than 60 percent of mental patients live in the homes of relatives, where their needs take a devastating toll on the emotional life of families. A parent or a sibling is given for a lifetime the combined roles of doctor, nurse, social worker, advocate, provider, and caretaker. Almost always it is a crushing load, which may account for the reason most seriously ill mental patients are eventually abandoned by their families.
Yet how do you carry on when a loved one is sleeping on city streets or in an oppressive institution or in an unknown prison somewhere? In fact, how do any of us go on with life as usual when human beings are living on the streets and dying cruel deaths in institutions?
On winter nights when bitter winds make more stark the reality of homelessness, and even on the spring days of my heart when the world seems new and green, that question turns in me. In every age, the mentally ill have been mistreated and feared by society. Michel Foucault, in Madness and Civilization, describes a time when madmen were put on ships and entrusted to mariners. These “ships of fools” with their cargoes of lost souls sailed up and down the seas and canals of Europe. Foucault writes:
The cities and villages which had thus rid themselves of their crazed and crazy could now take pleasure in watching the exciting sideshow when a ship full of foreign lunatics would dock at their harbors.
The more common practice was to let the mentally ill wander through the villages, foraging for scraps of food. Since insanity was thought to make persons less than human, few people felt the need to see that the mentally ill were fed or warm; they were, after all, close to being animals. Not until the seventeenth century did Europe create large “houses of confinement,” where the poor, the unemployed, prisoners, and the insane were all housed together. These prisons were run by directors who were appointed for a lifetime and allowed to mete out punishment without accountability to anyone. Handcuffs, chains, and dungeons were widely used.
After the “houses of confinement” came Bedlam and other asylums. William Buchan, a mid-eighteenth-century physician, wrote, “These institutions as they are generally managed are far more likely to make a wise man mad than to restore a madman to his senses.” These asylums gave way to the modern mental institutions that in America would come to be called the “shame of the states.”
I hark back to those olden days, when the mentally ill wandered the streets or were subject to inhuman living conditions in custodial institutions, because today they fare no better. Instead of moving forward, we seem to be moving backward. Our streets and parks, together with dangerous and primitive shelters, have become our primary mental wards. Despite the emphasis on rehabilitative services in group homes, their establishment is resisted by most neighborhoods. The adult for-profit homes are often filthy, unsafe, and poorly supervised. Residents have been robbed, abused, and even murdered. One street person explained:
Most people running these homes are in it for the money. I know of someone who rents out twenty-one rooms and feeds everyone oatmeal and toast three times a day. There is no way to complain. The city does not even go in to inspect.
The “home” he was talking about made the front page when the bodies of former residents were uncovered beneath the front porch and in the yard.
Despite enlightened thought on the therapeutic needs of the mentally ill, very little has changed in the public’s response to insanity. In fact, the treatment of the mentally ill today might almost be called genocide, except that it occurs on such an unconscious level, and so slowly and subtly, as to be unrecognizable. Too few see the seriously mentally ill as sick and helpless people utterly dependent on the mercy of the community.
If it were not for my brother, I would in all likelihood be as unaware as the next person of the terrible plight of the mentally ill on our streets. Even while trying to become their advocate, I find myself not wanting to look into the faces of the crazed and unkempt. Sometimes when I think of reaching out to one of them, I feel a vague sense of fear, which, when I explore it, turns out to be more a fear of rejection than of violence. Strange that I, so secure in my life, should fear the rejection of a deranged person. Is my response peculiar to me, or is rejection always painful, even when it comes from a stranger or a strange one? How will I find out except by being willing to share the feeling with others, hold it outside myself to be looked at and explored?
I tell you about Richard in an effort to give the homeless mentally ill a human face. Though he sleeps in a bed at night and is fed, clothed, and cared for, it is easy for me to spot on buses and sidewalks those who, like him, have been so fearfully singled out by their illness. If he were on the streets, the peace he now has would quickly turn to terror, and perhaps in time to violence. But wouldn’t this be true of any one of us?
Of one thing I am certain: nothing will change for the homeless unless the public has a change of heart. Change is not dependent on our gathering more statistics or reading more learned journals or absorbing new findings, as important as these are. Change will come only from letting what we see and hear every day sink into our hearts. The task before us is no less than the education of our emotions.
Simone Weil may have put her finger directly on the problem of homelessness when she wrote that, except for very special people among us, “everybody despises the afflicted to some extent.” I have pondered the reasons for this “turning away” and want to offer a few that occur to me. Naming them has helped in the disarmament of my own heart.
The first reason we despise the homeless is that, as Weil writes, “affliction is anonymous before all things; it deprives its victims of their personality and makes them into things.” We do not see those bundles of rags on our streets as human beings engaged in an almost impossible struggle to live. And the greater a person’s affliction, the more likely we are to be repulsed. I have meditated on that fact so that it might become firmly fixed in my consciousness. When I am repelled by another, I want to be able to remember that I am in the company of one who knows abysmal suffering. I want to be halted in my scramble for more comfortable space.
A large part of our difficulty is that we are unaware of our ambivalence toward the afflicted. We are too attached to the image of ourselves as caring persons to admit that we are repelled by them. In reality we want them off the streets and out of our lives. Never mind that there is no place for them to go; they can always be put to sea in ships. We are not so far removed from the fifteenth century as we would like to think. But if we practice awareness of our feelings, dark dimensions in ourselves can be received into consciousness, where they can be transformed. Integral to that work is forgiving ourselves and forgiving each other for being less than we thought we were and less than we might be.
A second reason we turn from the mentally ill is that we don’t think they have feelings like the rest of us. This attitude was supposed to have changed by the end of the eighteenth century, but it is not very different today. We still cannot grasp the dreadful emptiness of those who have ceased trying to talk to us. We cannot imagine that their destructive behavior might be due to bewilderment, or fright, or depression. It’s hard to understand what it must be like to have a mind in disarray or attacked by its own voices.
The mentally ill are not able to tell us how their world feels to them, and we often refuse to imagine. We don’t think that they might enjoy some of the things that we enjoy, like eating, one of the primary pleasures of life. Little attention is given to what kind of food mentally ill people eat. We also act as if they do not know pain in the way we do. We find it an ordeal when we have one aching tooth, but we’re able to consider with equanimity the fact that most of the homeless have mouths full of broken, decaying teeth.
Third, the fact that the deranged on our streets are poor accounts more than we know for the distance we put between us and them. Mental health professionals have demonstrated little willingness to treat the seriously mentally ill who are poor. Psychologists M. Brewster Smith and Nicholas Hobbs suggest:
The relationship between the mental health helper and the helped has been governed by an affinity of the clean for the clean, the educated for the educated, the affluent for the affluent. Most of our therapeutic talent, often trained at public expense, has been invested not in solving our hard-core mental health problem — the psychotic of marginal competence and social status — but in treating the relatively well-to-do, educated neurotic, usually in an urban center.
Only occasionally does a poor person move any of us to generosity, and then only when he or she is like us. Recently, a woman was evicted from her high-priced condominium and left sitting on the sidewalk surrounded by books and expensive furniture. All kinds of help were offered. She was even on the six o’clock news. Yet on our inner city streets, poor people and their belongings receive scant attention except from scavengers. The nouveau pouvre woman was more like us. We were better able to believe that she might be poor through no fault of her own. Some of us even began to imagine what it might be like to be homeless. For a few moments we touched compassion in ourselves for a stranger and knew what a wondrously good feeling that is.
However, when the minds and bodies in pain belong to the ghetto poor, empathy is more difficult. How else can a homeless population in the midst of an affluent society be explained? Why are we not shocked and appalled each day as the ranks of the homeless grow? What we fail to appreciate is how large a price we pay in self-esteem for not being connected with our own great capacity to care.
A fourth reason that may keep us locked out of our own hearts is our sense of powerlessness. In 1950, I first began to dream of an organization made up of the families and friends of the mentally ill. I envisioned it as a strong force for improving the lot of the mentally ill, but I never did anything toward bringing that dream into being. Whenever I thought seriously about what I might do, I was overwhelmed with feelings of helplessness. How could I ever begin to organize the families of the mentally ill? I saw them only when we were huddled in gray hospital lobbies waiting for visiting hours to begin. How could we as a group find a voice when we were so afraid of the repercussions of speaking out?
I don’t know how the National Alliance for the Mentally Ill was conceived, but it came into existence in 1979 with three hundred members, made up of the families of the mentally ill. Now it has sixty thousand members and nine hundred chapters. Its existence bears witness to the fact that nothing that can be envisioned is impossible.
The most urgent need is for confidence in ourselves. Our civilization is severely wounded and crumbling, but it is not too late to exercise imagination and creativity. We are not helpless even in the face of mass misery. Though we cannot minimize the great forces against change, the fact is that all the homeless can have a home. The seriously mentally ill can have the care that is the right of every ill person.
Fifth, and probably underlying all the other reasons that we do not help the homeless, is that within most of us is a homeless one whom we keep out of sight and hearing; one who is not acceptable, whose problems might cause us to be rejected; one who wants to be included, cared for, and listened to; one whose story has not been heard. As long as there are mentally ill persons on our streets, we can project our smaller problems onto them. We can keep in place the camps of us and them.
We have the possibility, however, of choosing another way. We can begin to educate our feelings so that we choose for ourselves and others what is worthy and beautiful. Our intellects have given us the technology, plans, and strategy, but only our emotions can give us the impetus to move toward something different. To develop a mature emotional life, we will have to give as much attention to the training of our emotions as we give to the training of our minds. This is essential if we are to build inclusive cities in which both the well and the sick have a place, and if we are to experience what we have hardly known — the grandeur of being human.
Homelessness, like other social problems, has its origin not out there but in here. When we can become acquainted with our own pain and gather up in mercy all the unkempt selves that clutter the back alleys of our inner landscapes, we will be healed and become healers. We will be able to put ourselves in the struggle for the rights and dignity of us all.
This essay originally appeared in the January 1993 issue of Sojourners. We’re grateful for permission to reprint it.
— Ed.
