The USA’s mentally ill are spiralling into the dark side
Rev. Neil O’Farrell and the man on the steps.
My husband and I buy health care coverage on the Maryland Health Exchange; i.e., Obamacare. However, that opportunity has not made itself felt universally. Health insurance reform, particularly for the destitute, hasn’t helped people living on our cities’ streets or in the forlorn “hollers” of rural America. Of all illnesses, mental illness is the most intractable within the population at large, but most starkly within impoverished communities. Mental illness doesn’t always respond to a pill or having a therapist on speed dial.
On the unforgiving pavement of urban ghettos and the underbrush of rural hamlets, mental illness runs its deathly course. Countless people are irretrievably mired in Bedlam. I don’t’ know why, but in my ministry I see more men mired in society’s underbelly than women. Statistically that makes no sense to me.
My church sits in a neighborhood where it’s not rare to encounter people bellowing at the top of their voices as they walk down the sidewalk—or weaving in the middle of the street. There is a prostitute that works a couple of blocks away, but often I see her sitting on the curb in a catatonic stupor. Her days are a desert of illegal work and illegal substances.
There is a man who sits on the front steps of the church almost every day, his head hanging down through his knees. I’ve sat down and talked with him countless times. He sees my clerical collar and wanly smiles, but as soon as I walk away, his head hangs low again.
The unforgiving streets of a blighted urban landscape, or sparsely populated zip codes, are no place for someone with mental illness.
I was home in ruggedly beautiful Appalachia a couple of weeks ago. The autumn trees were in full glory. I sat with my brother-in-law at his kitchen table and looked through an old high school yearbook. He started pointing out the number of persons who’d died imprisoned by drugs and alcohol, and diseases that were caused by bad lifestyles. Much of that carnage stems from untreated mental illness, not genetics or perversity.
Much addiction—perhaps the majority—is caused by people trying to self-medicate their mental illness into something they can manage. I know from experience, you can’t self-medicate mental illness. You need professional medical help and enough support and stability by healthy people in your life that you will try to navigate to the light side instead of being sucked down into the pit of the dark side.
And even then it may be a crap shoot. Again, I know this from personal experience and from what I see around me along hard-edged city streets and winding country roads. Robin Williams and his tragic death showed that it’s hard to win even under the best of circumstances.
If you are poor, uneducated, without access to good health care, living a life that is any way dis-helmed and adrift, your mental illness will invariably get the best of you.
Eventually you will die.
There are eight 12-step recovery groups that meet every week in a classroom of my church basement. Sometimes I sit in on the meetings. So many of those attending continue to live on the precarious edge of sobriety and mental illness. Using substances, including alcohol, to find a few moments’ reprieve from feelings of dread and powerlessness is to dance in one of the circles of hell.
Federal law says that our society must treat mental illness with the same degree of support that it treats physical illness, but I can’t believe anyone thinks this is in fact true. My internist is paid for through health insurance because he is in the network; my psychiatrist is paid for from my checkbook because he is out of the network. This is not parity. And I’m talking about someone with health care coverage. The impoverished don’t have health insurance.
I have a couple of advanced degrees including a doctorate in pastoral healthcare, and live in an upscale wooded, old streetcar suburb. I can manage medical anomalies and unanswerable questions. People living deep in cities or in the woods with mental illness can’t manage very much at all.
In America, the preponderance of mental illness is treated in emergency wards, or left untreated in prisons and jails. Most of the persons, obviously mentally ill around the church neighborhood, have an incarceration somewhere in their past. For a few moments’ reprieve, they drop into area hospital emergency wards, and leave with a prescription for something to dull the pain—two weeks’ worth of addictive drugs with a high street value that often must be sold to buy food. They take a couple of pills and sell the rest on the open market. That leaves their illness unabated; gritting their teeth and trying harder is nowhere near an effective, long-term treatment plan.
I have some political entrée, and I once raised some of these issues with the governor. He started to utter a platitude, ended up with a blank stare, then shrugged his shoulders, and turned away. I knew he knew what I was talking about, but the problem is so vast and intractable that it beggars effective solutions, or even pie in the sky.
In business, there is a term called slippage. This is a measurement of what is lost from sales because of breakage, loss, and pilferage. I see the death and the destruction of lives as society’s slippage of poverty stricken human beings because we can’t take even paltry steps to deal with mental illness.
Society looks elsewhere, at objects that are shinier. Meantime, folks like me spend time sitting on church steps trying to make life more bearable for the unkempt man who sits there with his head buried in his knees. And countless others just like him.
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