Wednesday, September 21, 2011
We all seek community, some more successfully than others.
Many people with serious psychiatric illness live in isolation. Their behaviors can drive away family and friends. When they are symptomatic, many of their actions are misunderstood. Because of the perception of the mentally ill as dangerous, the way they conduct themselves may be viewed as threatening or menacing. Landlords, neighbors and acquaintances fear that interactions may bring on negative consequences. When they are stable, the person with mental illness may have little understanding as to why they are shunned by those around them. In seeking companionship, they may compound the fear their behavior has created. Most of us want to be part of a community, either the geographic community we reside in or the community of interest that makes our lives fuller. My experience suggests that even those with the most serious illness are well intentioned in their hope to make their lives better.
I stood behind a column, peeking around it at the café that occupied the public space between stores. A short woman with dark hair in her late forties was moving from table to table, a coffee pot in her right hand and a large pad of paper in her left hand. She reached over and around patrons, pouring coffee in cups, bowls and glasses. Behind her an elderly woman began to rise from her chair, pushing herself away from her finished meal. “Sit down! You sit down!” the younger woman screamed as she turned, facing the tables behind her. “Don’t get up until I tell you to get up. Do you understand me?” The elderly woman regained her seat, clutching her purse in her lap. It was late morning. The café’s twenty tables were only half full. The rest were set for lunch. I could see two cooks and two waitresses crowded together in the small kitchen. They had closed the kitchen door and were staring at me from behind the pass through, one cook clutching a large knife.
Directly across from me and down the hallway, a police officer gave me a thumbs up. I held my hand up motioning him to wait and walked slowly toward the woman with the coffee pot. She put it down as I approached and turned to fully face me. “Rosa,” I said. “What’s going on?” “So they called you? Why is it that every time I get things straight in my head, every time I get my life together you show up?” She was an unattractive woman with a big nose, bulging eyes peering through large black framed glasses and hair that had not seen a comb in months. She had on a flowered knee length skirt with a dungaree shirt jammed into it. Over this she had a bright vest that someone had bought at a tourist shop in Central America. A backpack rested on her back, a paisley bag on her left shoulder, a waist pack cinched around her stout middle. A pair of torn black hightop sneakers without socks completed her outfit. “Why don’t you go away? Why don’t you just mind your own damn business and get the hell out of here?” she screamed. “Somebody called me. They were worried about you. When they call I have to come, you know that. Why don’t we go someplace else to talk? Everybody doesn’t need to know your business.” I could sense movement behind me as people began to leave their tables. “I hope you’re happy?” Rosa said as she leaned on the table closest to her, palms down, her notebook under her arm.
I looked over my shoulder to find the police officer escorting people down the hall. When I turned back, a mass of cheese, avocado and sprouts on toast exploded in my face, the small fat hand rubbing it into my nose and eyes. Moments later, Rosa was on the ground screaming at the cop wrestling her one cuffed hand behind her to join under the backpack with the other hand waving in front of his face.
I’d known Rosa for many years. I’d first met her in the 1970’s, when I coordinated programs for mental health patients being discharged from Willard Psychiatric Center during the late stages of deinstitutionalization. Rosa was a revolving door patient who would become briefly stable and discharged and never keep appointments or follow up with treatment. As she got older, she cooperated with treatment more often, but still had periods of bothersome bi-polar symptoms. Several months earlier Rosa had visited the psychiatrist in our office stating that she no longer needed medication. ‘I’ve been doing some research”, she had told the doctor, “And I believe that I have aged out of my illness.” She then presented copies of journal articles to support her proposition. She had a master’s degree in city planning and was able to use her academic background to articulate her case. What she presented was her decision. It was not open to discussion. When the doctor had me join them, she said, “He may be in charge here, but he is not the boss of me.”
The calls started to come in shortly thereafter: her grown daughter pleading “Isn’t there anything you can do? Can I sign a paper? Do we have to go through this all again? We know what’s going to happen. I’m the one who has to clean up her mess.” Her ex-husband stating, “If she shows up again I’m going to press charges. I don’t care how crazy she is, she can’t just show up at my house threatening my new wife. If she goes to jail, so be it.”
Rosa owned a beautiful home in a neighborhood of small ranch houses on a hill overlooking the city. I’d been there in the previous year to drop off a prescription that the doctor had forgotten to give her. The small inheritance she’d used to buy the house had also been spent on some nice antiques that she had restored. At the time she’d asked me in to take a tour and be dazzled by the views of Cornell and the valley below. “What do you think?” she’d asked, smiling. “I’m jealous,” I replied. Having seen Rosa years earlier stripped to her bra and panties on a foam pad in the isolation room at Willard, screaming and banging on a concrete wall, I was pleased to see the life she made for herself.
I visited again, after the calls began. When she opened the door, it appeared that a giant had picked up the house and shaken it like a snow globe. The rug was bunched up, the furniture overturned. Books pulled from bookcases, dishes dirty everywhere. “It took me a while, but I found it.” In her hand was a binder containing her master’s thesis. “Look at this,” she said guiding me to the kitchen table where a large piece of poster paper was unrolled. Books were piled on one corner; duct tape held the other three. A slide rule, protractor and plastic ruler, educational instruments long abandoned by academics, were at the bottom of the drawing. Her work showed a crude illustration of the valley as seen from her window. Near the top were wavy lines indicating the multiple rivers, streams and creeks flowing down the hills and into the lake. Each of them was well marked. At right angles to these lines were broad strokes made by magic markers that seemed to enter buildings erected on the top of the hill. “Well! What do you think?” she asked. “I don’t know what I’m looking at,” I replied. “Are you stupid? It’s the valley. See these?” she said indicating the wavy lines. “This is all water and water is power. You move the water from the streams and rivers, through the pipes and into the generator buildings. The wheels spin and the water falls downhill into the lake. The people who first lived here understood that. That is why they settled here. For the last 100 years we’ve ignored it. I’m the only one who understands it.” She walked over to the picture window. “Look at that! Ithaca doesn’t need to have one once of electricity come from the outside. I’ve solved it. That smelly coal plant up the lake can be torn down. It’s time for old to be new again.” She began to sing and dance. “It’s time for old to be new again; it’s time for old to be new again.”
“Rosa? Rosa, I need to talk to you. Your daughter called and…?” “Get out!” she yelled, not touching me, but moving me toward the door. “That little bitch is an ingrate. Her father raised her to hate me. He has always been jealous of my success and he can’t wait to see me fail. When people see what I’ve accomplished, what I’ve given back to this community, then he’ll have to apologize. Now get out and don’t come back and don’t tell anyone about my plan. I want to have an unveiling at City Hall when it’s all complete. If you tell anyone, anyone at all, I’ll sue you. Don’t think I won’t. The house shook when the door slammed.
Two days later I was at the city engineer’s office, a police officer at my side. “I’m going, I’m going.” Rosa said, gathering her things. “But you haven’t heard the last of me.” That afternoon, her ancient Volvo wagon was spotted parked sideways at the food co-op. Later, when I’d responded to the convenience store at the edge of town, the woman behind the counter said, “I don’t know what her problem is, but she better not bring it in here again.” Eventually I got a call from the woman who owned the café. She’d called just before Rosa had taken over her restaurant. “I don’t want her to get in trouble,” she’d said.
I sat across from Rosa at her hospital discharge meeting nearly a month later. “Sorry”, she said. “I know you’re trying to help. But sometimes you’re really a pain in the ass.”
The stories are my remembrances. Each of them is based on a true event in my work for Tompkins County Mental Health. I have changed the names and identifying information of every client, patient and co-worker except for Beau Saul, of the Ithaca Police Department, who I was fortunate enough to have as a partner. When confidentiality demanded it, I have changed details. The dialogue is my reconstruction of what was said at the time. I have felt honored to be let into the lives of so many individuals over the years. Their stories are a gift I have been given. Please enjoy them in the spirit with which they were written; to educate and inform.