The Mentally Ill----TGIF!

To be honest, I really don’t expect anyone to read this, I am in need of a strong vent! And this is one place I can do that!

A few quotes that struck me as so apropro.

“The psychologist who did my intake at Dominican Hospital in 1994 told me that in many more traditional cultures, the schizoaffective people are the shamans. If you wonder why there are no more miracles as in the Biblical days, it's because we lock our prophets up in mental hospitals.”

“In many ways, I miss the visions. Not the squad car lights, but the many beautiful and inspiring things I saw. While living without visions is certainly more placid, it's not nearly so interesting.”

An interesting piece of trivia---Mental disturbance can be caused by heavy metal poisoning - the Mad Hatter in Alice in Wonderland was inspired by real hat makers who were sickened by the mercury used in the manufacture of felt hats.

I spent my day dealing with 3 clients suffering from schizophrenia, accompanied with other mental, emotional, and physical ailments, one never left his bed, I dealt with his mother (his main problem)---who wore me out so fast I was terrified I would lose patience with her, I was at the point of thinking—no wonder he can’t function, you won’t let him.----Another, not really schizophrenic, but more borderline disorder, along with physical defects, and mild retardation, then the final straw, visiting the home of a woman who I have never met in person, but whom I have had numerous telephone conversations with, knowing that within her illnesses, she possesses a brilliant mind, an amusing viewpoint of our world, even when she is delusional, she can look at it with humor. But not now, not today, not for the past few weeks. I had no idea what I would find.

Not really knowing what to expect, I had spent the past months speaking to her by telephone, on average at least once per week. If I had not read her file, I would not of known her diagnoses. I sometimes question the diagnoses anyway, so always try to approach meetings with an open-mind.

She has been going through a lot lately, so much that even a “normal” individual would be unable to assimilate in a calm, rational manner. A sister dying of breast cancer, another in stage 2 breast cancer, then she herself is diagnosed with a lump, a lump that tests positive for malignancy. She must make a decision….the doctor’s say they got it all, it is up to her whether she does a “wait and see”, or chooses chemotherapy.

She receives notice from her apartment complex management that they are not renewing her lease.

How would we “the normal” handle all this change, this information? Now consider that you are a barely functioning delusional schizophrenic, also suffering from diabetes, breast cancer, incontinence, obesity, and obsessive-compulsive disorder.

I start receiving 2 to 3 phone calls a week. Not of any substance really, a small complaint here, an appointment cancellation, a need for additional service. Sensing that really she just needs to talk, no one in her life but doctors and caseworkers. I respond, I return phone calls. The complaints become more accusatory. My housekeeper is lackadaisical, she doesn’t DO anything. She is breaking things and not telling me.

Accusations that I discuss with the housekeeper, now two sides, two sides that do not match.

I decide to make a home visit, as I am discussing the fact of the home visit coming up with a co-worker, I learn she became our client a few years ago, because she was in danger of being evicted from her home, due to the unsafe/unsanitary conditions within. Nice to know, wish someone had told me earlier.

I arrive at a low-income apartment complex, approximately 25 years old, typical 1970’s architecture. Entering the inner hall, I find apartment 112 easily, the door is ajar, I knock, I hear a quiet, “come in”

I gently push the door open, my first sight as the door slowly swings open is a living room filled with boxes inside white plastic bags, boxes stacked, boxes partially tipped over. It looks as if someone is moving in or out. As the door continues to open, I see her, at first she just looks at me, I introduce myself. She nods, says, “Yes.”

She is sitting at a rectangular dining room table, you cannot see the table top, the end closest to the door is stacked with stuff, I cannot even begin to imagine what all was in the stacks, the stacks are at least 2 feet high, leaning and sliding over one another. One bump of the table and they would go tumbling everywhere.

She is sitting at one end of the table, in her hands she has a ball of hair, her hair, it looks like the hair you would remove from a hairbrush when cleaning it. There are 3 other balls of hair in front of her. “I am going to make my own wig.” “My head is too large for the ones they sell.”

It takes me a brief moment to process what she has said, my senses are overloaded by all the clutter. I am eventually able to focus, as I completely enter the apartment. She never smiles, she is not flat faced, nor monotonal in speech, but she is also neither welcoming nor unwelcoming.

I asked if I may sit down. She gestures toward a dining chair opposite her. There is literally not one inch of clear table space. I feel as if I am in the midst of one of those I Spy children’s books. Interspersed on the table top and the other two chairs, are newspapers, junk mail, coupons (she calls herself the coupon queen—buying the things just because she possesses the coupon), dirty dishes, an old mayonnaise jar-- it still has streaks of mayonnaise on the inside walls-- but I can also see another jar within the larger. Crisscrossed across a dirty plate are a knife, fork and spoon, also dirty. On top of these are what must be dryer lint?, not sure. Then spools of thread, and a conglomeration of other things.

I asked what the housekeeper did that day.
“She cleaned the countertops in the kitchen, she did some dishes, she cleaned the floor, she vacuumed the carpet in the living room.”

I stand and look into the kitchen, there are fast food ketchup packages lying on the floor beneath the refrigerator door, a half full bag of potatoes lying on the floor beside a colander, several dirty dishes in the sink, a sink that is dingy, not shiny and clean. Very little of the counter top is visible as it too is filled with clutter.

She speaks up, “I did clean the bathroom today.”

“May I look?”

“Yes”

“Where is it?”

She points toward a hallway, “right down there.”

I walk down the hall, glancing into the bedroom as I do so, the bed is piled with clothing, coverlets, the floor covered in small pieces of paper trash, what looks like cracker or potato chip crumbs, every surface is covered/piled high with something.

When I reach the bathroom, I am almost afraid to turn on the light, but I do, I look at the floor first, deeming this to be the safest place for my eyes to land first. There are a few pieces of paper on the floor, a bag of Depends in the corner---not too bad, I can handle this---I check out the sink, it is clean, the toilet also clean, the bath tub is sparkling. I tell her it looks wonderful, she did an excellent job. I am wondering though, if she is capable of doing this, then why can’t she do the other rooms? But I do know why, the clutter is overwhelming.

I return to my seat at the table. Gathering my thoughts, I tell her that if I were her housekeeper, I would be overwhelmed, I would not know where to start, how to start. That it would be very difficult to know what she can handle getting rid of, and what must stay. She stares at me. I try to rephrase, I tell her she is a hoarder. She looks at me questioningly.
“You keep everything don’t you? You have difficulty knowing what to part with?”

“I was told to collect aluminum cans, to save them until the price gets higher, and to then sell them. The price is only $0.30 right now.”

Basically she is saying yes, and here is one of my reasons.

My senses are not adjusting, I am still overwhelmed. I stand, walk, rather try to walk into the living area, I cannot, the boxes block everything. I asked, “What is in all these boxes?’

“I was gathering things, do you know anyone who could use a bar stool?”

“No.”

“Too bad”

I return once again to the table, she is still playing with the ball of hair. It is at this time that I finally notice that the housekeeper’s vacuum cleaner is sitting beside the table.

I mention this.

“She is running errands for me.”

“But she should have been done and on her way home 30 minutes ago.”

“Really, well she told me she had time.”

“Tell me again, what did she do while she was here. How long has she been gone? How long was she here before you sent her on the errands?”

“She cleaned the countertops, she did the dishes (the sink is not even wet), she vacuumed the living room (there are small pieces of paper trash on the floor, the floor that can be seen).”

Biting my tongue, wanting to say, what is the relationship between the two of you, I see nothing that could have been done. But I don’t say it, I only think it.

I look around the room, the rooms, letting her see me observing. “Tell me again, what did they say when they said you were going to be evicted?”

“They are not really going to evict me, they are just refusing to renew my lease. It is such a bad time too, I will be in the middle of chemotherapy treatments.”

“Yes, that would not be an easy time to move.”

“ Glory, I want to help you, I want to make this work for you, but we have to do this together, we need to establish some goals here.”

“Yes, I know.”

At this point, we hear a knock, and the door opens, the housekeeper has returned from the shopping expedition. She is not surprised to see me, she recognized my car in the lot. I smile, greet her, and continue the conversation regarding the lease. Asking the client for a copy of it. Which I never do get, one more thing to remember for next week.

The housekeeper shoots me a look of exasperation, (she is nervous) she carries the bags of food to the kitchen. Starting to put things away. I can tell she knows exactly why I am there at that time, she also knows I am wondering why she is almost an hour behind schedule.

I am also observing the client, she is getting very agitated.Is it the feeling of too many people in the small crowded, cluttered area? Is it the tension we can feel emanating from the housekeeper?

The housekeeper shows her two different kinds of soda pop, “this is all they had, is that okay?’

“Did they accept the coupons for it?”

“Yes”

“Then it is fine.”

There are already at least 3 and a half cases of soda pop stacked in a corner of the kitchen.

All the while, I can see the anxiety building up in the client, her fingers twisting and turning the clump of hair in her hands.

The housekeep pulls out two half gallon containers of ice cream, shows them to Glory.

“Are these okay?’

“Yes, gimme!” reaching out like a small child, she grabs one container, pulls the lid off, quickly picks up the dirty spoon laying across the plate on the table, and begins spooning ice cream rapidly into her mouth.

I can see her calming, with each bite, she begins to relax a little more.

At this point, I ask her about the mayonaise jar sitting on the table. The housekeeper looks at me, shruggs her shoulders, her face telling---wait til you hear this.

Glory, a bit calmer now, slowing down her ice cream binge says, "It has poison in it."
"What kind of poison?"
"Malathion, do you know what that is?"
"Yes, it has been illegal for several years. Why do you have malathion?"
"I used it in the garden."

I am thinking you never leave this apartment except for appointments, and errands, you have no yard, no space to garden.

"Why is it in here?"

"Exactly because it is now illegal, I can't get rid of it, I can't just put it in the trash, I am too concientious to do that."

"So what are you going to do with it."

She looks at me, looks at the jar, I get the distinct feeling she is satisfied with its placement inside the larger sealed jar. I am also wondering if it is Malathion, but it very well could be.
Okay, this I will deal with next week also.

As she becomes to calmer, I explain that I would like to meet with her mental health casemanager, that we all need to come up with a plan for her. She agrees to this, or pretends to, I can tell she has no desire, but that she also knows that we are at a juncture, it is crunch time, she/we get things under control again, or her life will only become much worse.

I tell the housekeeper that I will schedule a time for her to come in to the office for some additional time, and we will try to work something out.

I tell Glory, it was a pleasure meeting her, and that I will speak with her next week.

I take my leave, and go out to the parking lot, waiting for the housekeeper. She is not surprised to find me waiting. I tell her the reason I was there, Glory had been complaining that she had not been doing anything. By this time I am mentally exhausted, my mind churning the problem over and over, how do I help her, what can be done, the director of the program is going to want to drop her as a client, the director will chastise the housekeeper.

For the first time, finally, the housekeeper opens up completely, “I feel like quitting!” “No, one is satisfied with my work!” “ I am out of medication!”

She then immediately tries to backpedal….”I am sorry, I shouldn’t have said that.”

“Yes, yes you should have, you have a right to say it, to feel it, you need to tell me when you feel that way.” “You need to tell me when you are out of your anti-depressant, I need to know when you are functioning poorly.”

She nods, tearfully.

“Most importantly you need to tell me when a client’s home gets to the point where you are having a hard time maintaining it, it is almost too late for Glory. We/I need to know when things start going badly. How many clients are now in this state? You are not getting paid nearly enough money to have to work under these conditions, but it also partly your fault for allowing this to continue without notifying me how quickly things were deteriorating.” (she has more of our mentally ill clients than anyone else, her personality is a soothing influence, even though her housekeeping skills are minimal—this will be a part of our discussion next week)

We discuss her own health issues for a moment, I send her home well past the time she should have been. Telling her I will come up with a set of goals, a plan of action for us to begin implementing next week.

As I climb into the car, heading home, my mind is racing, flipping this problem over and over in my brain. How, what, why, how, how, how, do I fix this?

I pick up the cell phone, call Glory, I feel a need to apologize to her, I was rather blunt with her, not letting her off the hook because of her illnesses, mental or physical. I told her I want to help her, how much time can she afford, how many days a week can she afford to have the housekeeper come in?

“My appointments, and public transporation take up so much of my time, I don’t know how I can have her in more than one day a week.”

“Just tell me, please, how many days can you afford, we will work around your appointments, we will find a way.”

“Three days, I think I could afford three days " (our service costs her $1.00 per hour).

“You saw my meds box didn’t you, the one with the strange things inside, covered with a towel, you didn’t understand what all that stuff was, you just thought it was a bunch of junk didn’t you.”

“No, I saw nothing like you described, I have a hard time observing small details when there is so much to take in.” She seemed to accept this.

“Glory, I am going to spend the weekend, trying to come up with a plan to help you, but, next week, if we can get it implemented, you must help. You cannot cancel appointments, I may have to send in two housekeepers, and myself the first two days. Can you do that? Can you handle that?”

“Yes.”

“Okay, I will talk to you the first of next week, and this weekend I would like you do something for me.”

“What?’

“Focus, try to focus on the things that are most important to you, so you can let me know next week. Okay?”

She sighs, “Yes, I will try.”

*Sigh* I am afraid that I do not have enough alcohol in the house to forget this one tonight.

Reality is not something that just happens to you.
Reality is something you make.

Most people never question the reality they experience. Most people are fortunate to have no reason to ever question it; their reality works well for them. The people who have reason to give up their reality are usually forced into it, either because they are insane, or because life just doesn't work for them. There is no satisfying measurable definition of sanity or insanity; instead, some people have a reality that works for them, and some people don't. Some people might be satisfied with their reality but society might not be satisfied with the behavior their reality causes them to exhibit, and so we sometimes commit the mentally ill involuntarily to mental hospitals.

Even if you don't feel the need to question your reality or make a new one, I assert it is worthwhile for you to understand this in the event you ever have to, or ever need to try to help someone make a new livable world for themselves. At the very least, it will help you to understand why some people are so difficult to get along with and help you relate to them. It's not simply that some people hold different opinions, it's that many people, not just the insane, live in a completely different world from the one you experience.

There is an objective reality, but we cannot experience it directly. It is also without significance or meaning. The reality we experience is drawn from the objective reality but sliced, diced, julienned and pureed by the food processor of our bodies, cultures and minds.