There was an infestation of gypsy moths in New England this summer. It appears that, as caterpillars, they ate their way through 100,000 acres of woodland between the Quabbin Reservoir and Cape Cod; oak trees, cherry and pine found their leaves stripped. If you were outside in July, you were pestered by the mature males, flying around your head, your feet—you just had to keep your hands moving sometimes, just to throw off their rhythm. Of course, you could always just sit still and be mindful, living as we all do in the midst of one kind of change or another.
I was traveling by public transportation for the first two weeks, so I was outside quite a lot. I never quite got used to them, but I made my peace with their presence. What are you going to do? I found myself at a bus stop in the Jamaica Plain section of Boston one morning, waiting for the number 39 bus to take me to the 34 and on into Cambridge.
There were a couple of other folks waiting, too, it seemed. One was a young woman dressed for work, checking her watch from time to time. The other man—well, he was… different. He sat slouched back, his eyes closed, while he played what seemed to be an invisible saxophone, the toes of one foot rising and falling rhythmically to some interior tune. He had a dreamy kind of smile on his face. After a while, I took a seat at the other end of the bench and enjoyed the performance. A short while later, the tune reached its end—or he became conscious of being watched. He opened his eyes to the summer morning and the moths.
I don’t know the rhyme or rhythm to the flight of gypsy moths, but it’s staccato, if anything. They dart and swoop and occasionally land, but don’t seem to stay anywhere for more than a second or two. My companion was quite bothered by them. You could tell because he began stamping his feet, but the foot-stamping had little relation to the actual location of the moths. It was more a ragged expression of dissatisfaction.
“Damn moths!” They seemed to be in search of shade or safety because one landed under my sneaker, which was resting on its heel.
“Kill it!” he said.
“Well, I don’t think it’s trying to cause me any harm. Just looking for a place to rest, I guess.”
“Rest? Kill it! It’s under your shoe.”
“Yeah, I know.” Under my shoe must have been a desirable place to be because a second moth found its way under there where he kept company with the first.
“Kill ’em! There’s two down there now! Under your shoe!”
“Yeah, I know. They’re not bothering me, though. Maybe they’re just looking for a home. Where’s home for you?”
He looked at me for the first time. “I’m homeless,” he said.
“Where are you staying?”
“At the Shattuck, up the street.”
I knew the Shattuck Shelter from my days as a social worker working with the homeless population in Boston. “Are you on foot?” The Shattuck was about a mile away.
“Yeah, but I need a cane. Something’s wrong with my foot, and it hurts when I walk.”
“The Shattuck can get you a cane. They get donations and if there are none on site, your case worker can get a cane for you.”
“Yeah, but…” Which meant that either he was fed up with the system that had too much red tape or he had alienated someone or he was just giving in to the vicissitudes of life.
The bus pulled up. “Don’t forget to ask your case worker about that cane,” I said before getting on the bus. But, by then, he was on to another topic, another need, probably just the need to talk. He had forgotten about the moths. So had I.
Living in the real world. What’s that mean, actually? What is this thing we call the “real world”? I heard a lot about it when I was in high school and then again in college. Adults were obsessed with the term. What are you going to do when you graduate and have to go out into the real world?
It seemed the strangest concept. In the fourth grade, we were told that the word “artificial,” meant “man-made.” Yet everything that was referred to by the term “real world” seemed to have been man-made. A job, transportation to get back and forth from a job, the clothes you’d need to wear at your job, the house that you were to purchase somewhere down the road.
I think I would have been less bothered if they had asked, “What are you going to do when you get out into the artificial world?” Except that was the world I was already living in.
And then there were the words of Jesus: “Peace I leave with you, my peace I give unto you: not as the world giveth, give I to you. Let not your heart be troubled, neither let it be afraid.”
Professor Rollins, who taught me about the Gospel of John at a summer course at the Hartford Seminary, made the point that any time Jesus used the word “world,” it was in opposition to the way he was teaching, the way of peace—not the world’s peace, but a deeper peace, more real. So, it was always a double message—to follow Christian teachings and to prepare to live in the “real world.”
Does it ever change, I wonder, this split loyalty between what you believe in your heart and what you are taught to believe? It seems like the daily challenge is to try to reconcile your beliefs with the world that seems to hold such different beliefs.
Working with people who have become homeless seems to bring out this contradiction most starkly. They are confronted with a particular challenge in trying to live in the “real world,” a world whose rules change in ways that sometimes provide for them, but often leave them on their own.
The population I worked with for sixteen years in Boston were sometimes over the age of 60, but if they had been diagnosed with some sort of disability or other, which many of them had, they had to be at least age 45. “Elderly or disabled,” they were called. And, if you are wondering why someone aged 60 should be considered elderly, it’s probably because you haven’t been living in the shelter system for a few years.
George S. had lived for years in the back of the upholstery shop in which he worked. He considered it a blessing that the owner of the job let him sleep in a back room. I don’t know what his wages were, but it couldn’t have been much because he was unable to save even though he had no dependents and no bad habits, by which I mean the usual drinking, drugging, smoking, or gambling.
But, came the day the business closed, George found himself on the street with just a suitcase of belongings. He made his way to Franklin Park, the 500-acre public park in the city of Boston named after Benjamin Franklin who left money in his will for a “worthy cause” in the city. Not the safest place to bed down for the night, but the only thing he could think of under the circumstances.
Walking the streets one day, he came across someone who inquired about his situation. It turns out that he was unaware of the shelter system, never even knew it existed. Strange that that should be so, don’t you think? Though he’d been working for years as an upholsterer, he wasn’t quite ready, I guess, for the real world.
Alex was an African American man, age 60 or so, who was referred to us from the V.A. shelter. He was diagnosed as schizophrenic and presented himself in such a way that he frightened some of the other folks in the building. The building, itself, was set aside for the elderly, and our program was an attempt to “mainstream” the homeless population with their mental illness and drug abuse histories into the population at large. We weren’t always popular, and our folks were not always trusted.
Alex wore an Army jacket in all kinds of weather, and a stocking cap. He wore sunglasses even indoors, kept his hands jammed in his pockets and walked fairly rapidly through the lobby of the building where he was regarded with some alarm. He had been in the Army and claimed to have assisted troops in parachute jumps, but I was never quite clear how much in his stories was true and how much he just thought was true. (It’s the same with most of us, I guess, just a matter of degree.)
My job called for me to work closely with our folks from the intake to the presentation to the team that voted whether or not to take a chance on the applicants, based on whatever data I could gather, to the day they moved in till they day they left—if they ever left. The program was funded as “permanent housing with supports,” but the funding had to be renewed every year or two and we never knew if and when we’d lose funding completely. Something about living in the “real world.”
What did it mean that Alex was schizophrenic? It meant that he couldn’t always tell the difference between something that was “real,” i.e, demonstrably occurring in the world we inhabit together, or occurring only in his own mind—something that he was experiencing, but others were not. We could be thankful for two things: one, that Alex had insight into his condition. In other words, he was aware that he had to question the validity of some of his experiences. Two, he had medication to treat the disease and took it as prescribed—well, most of the time.
I grew to know Alex better than most because I met with him weekly to check in and go over his service plan to make sure that he was sticking to it. Also, because I was an important person in his life. He would stop by the desk just to make sure I was there, someone he could count on, someone he could check in with, someone to connect with.
It turned out that he was an innocent, a sweet-natured guy who had learned to disguise himself in dark glasses and a menacing demeanor to keep away the people he didn’t know, people he had learned not to trust. With reliable human connection, his own humanity could emerge. As he let himself be known, a kind of charm emerged. The elderly women who’d been afraid of him now gave him cigarette money to run errands for them.
Randall was referred to us from a social service program downtown. He also was a veteran, but was denied an honorable discharge due to his propensity to defy authority. The counselor who’d worked with him had only positive things to say, though, and the interview went well. It was a pleasure to meet with him weekly—at first. He was knowledgeable about a wide variety of topics, he was curious, he interacted well. It took just one thing, though, to throw him, then he became distrustful, wary, and evasive.
I don’t remember the details at this date, but at one of our meetings he divulged something about his marriage. He admitted that he had transgressed, and he expressed regret for having done so. When we met the next time, I encouraged him to explore the issue further in the service of healing and increasing his capacity to take responsibility. He looked surprised, said he didn’t remember making the comment, said that it didn’t sound like something he’d say, asked why he had to have these meetings with me, stated that he was intelligent enough to live independently without someone butting into his life.
I had to seek counsel from my supervisor as to what to do next. We ended up moving the meetings to once every two weeks, then once a month. Randall spent more time alone, but seemed to be content—to the extent that such people can be content. I regretted my attempt to encourage his self-development, but not my intention. In human dynamics there are boundaries between people, but they vary. What works for one will not work for another. Sometimes we’ll succeed; other times, we’ll stumble and fall. That’s one lesson to draw from living in the real world.
People become homeless for all kinds of reasons. Lack of resources is always at the heart of the matter, but the resources vary. Financial resources, of course, but also lack of social supports, family supports; a deficiency in intellectual capacity leading to a pattern of poor decisions; a lack of love in the earliest years that leads to an inability to trust. There is plenty of mental illness and plenty of drug abuse and more “dual diagnoses” than you would like to believe.
The system of care is inadequate at best. You really only understand the issues when you immerse yourself in them, and even then, you do so as an amateur, someone struggling to make sense of a myriad of issues at once, swimming while learning to swim. More of that in the real world that we ever feel comfortable with.
The story of the treatment of those who are mentally ill in this country is not an especially inspiring one. The first institution built to address the need was in 1773 in Williamsburg, Virginia. It was called the Public Hospital for Persons of Insane and Disordered Minds. No accusations of “politically correct” language there.
Sixty-eight years later, in 1841, Boston schoolteacher and Unitarian activist Dorothea Dix took a job teaching the inmates at the jail in East Cambridge, Massachusetts. She was appalled by the conditions in which the mentally ill were being kept and agitated for better treatment. Because of her efforts, 110 psychiatric hospitals were built across the country by 1880. She died in 1887.
It’s hard to know how much progress was made, though intentions certainly were good. The reporter Nellie Bly, on assignment for the New York World, pretended to be mad herself in order to be admitted into what was called The Women’s Lunatic Asylum in New York. Her expose was called “Ten Days in a Mad-House.” Her description of the conditions there led to a grand jury investigation that resulted in reforms.
In 1907, Indiana enacted a compulsory sterilization law that allowed the state to “prevent procreation of confirmed criminals, idiots, imbeciles, and rapists.” By 1940, more than 18,000 mentally ill people in more than 30 states had been “surgically sterilized.”
The first prefrontal lobotomy was performed in 1936. Electroshock therapy for people with schizophrenia and other mental illnesses was introduced in 1938. In 1954, Thorazine was marketed as the first anti-psychotic medication approved by the Food and Drug Administration. It quickly became a “go to” drug in mental institutions.
One hopes that many of these initiatives were adopted out of humane motives, as the best option that seemed to be available at the time. With our knowledge of how things work in the “real world,” though, I think we can be sure that whatever solution seemed easiest, quickest, and cheapest gleamed with the greatest appeal.
In 1963, President John F. Kennedy signed the Community Mental Health Act. It provided the federal funding that was necessary to construct “community-based preventive care and treatment facilities.” If an economic crisis and the Vietnam War had not coincided, perhaps the program would have been successful. It was never funded adequately, though.
When legislation approved the adoption of Medicaid in 1965, states were incentivized to move patients out of state mental hospitals and into nursing homes and general hospitals because Medicaid would not cover treatment for people in “institutions for mental disease.” So, people with “mental disease” had to move out of institutions designed to treat them to institutions not designed to treat them in order to get treated. One Flew Over the Cuckoo’s Nest meets Catch-22.
In 1980, President Jimmy Carter signed the Mental Health Systems Act, whose purpose was to “restructure the community mental-health-center program and improve services for people with chronic mental illness.” In 1981, though, President Ronald Reagan’s Omnibus Budget Reconciliation Act repealed the Carter community-based legislation and established block grants for states. This effectively ended the federal government’s role in providing services to the mentally ill. Federal funding of local efforts continued to drop. In 1985, community-based mental health programs derived only 16% of their funding from the federal government.
All of this is what falls under the heading of the “real world.” In another view of the real world, thousands—no, millions—of our fellow Americans suffer from mental illness or drug addiction. And, though we may disagree as to the extent that people should be held responsible for their use of drugs and alcohol, it’s clear that the vast majority of cases of mental illness cannot be blamed on those that suffer from the mental illness.
The question is care. Who cares? Who acts?
The best thing we can do, it seems, is to recognize but refuse to capitulate to the demands of the “real world.” If we involve ourselves in the lives of individual persons in need, we can make a difference in the lives of individuals.
For you, that may mean working in an after-school program, helping veterans get to their medical appointments, providing company to shut-ins and the elderly, making jail visitations, or finding ways to improve race relations one case at a time. One thing I’ve come to find out is that social change is slow and it doesn’t start at the center; it starts at the edges. And we all live at the edges. At the edges of the “real world.”
- www. motherjones.com/politics/2013/04/timeline-mental-health-america: Timeline: Deinstitutionalization and Its Consequences by Deanna Pan. April 29, 2013.
Presented by Rev. Peter Connolly at the Unitarian Universalist Church of Bowling Green, KY, on September 4, 2016.