Goodbye, Valerie

I was in nursing school in the late 1960’s in Brooklyn. Part of our training rotation involved going to a huge mental institution called Manhattan State. It was my first up close and personal view of mental illness.

There were three tall buildings on an island in the river reached by bus. Staff members were instantly recognizable by the keys jangling at their waist. Those keys opened not only doors to units full of the mentally ill but they also opened the elevator doors on the top floors where the most uncontrollable patients were housed. This was a safety issue. Should a patient on one of those floors get to the elevator and press the button, the door still would not open without a key.

As student nurses, we stood out like inkblots on a white shirt. We were warned to be careful about our keys because patients might try to grab them.  I spent six weeks at this institution with a death grip on my key ring.

It was about this time that society started to change its position on mental illness. It was no longer viewed as a crime, so you could no longer be forced to accept treatment through incarceration, or be kept incarcerated indefinitely for no reason other than your illness. It was also decided that institutions such as Manhattan State were not the best way to treat people with these illnesses. The advent of drugs that controlled symptoms made the release of patients more palatable. Concomitant with that would be the development of community mental health centers to help the mentally ill remain stable while they lived among us.

As with the best-laid plans of mice and men, this idea didn’t quite work out as envisioned.  Patients were released and the infamous institutions that warehoused them became things of the past.  But we never did build all the community mental health centers needed to track all the people released.  And the drugs worked only for so long as the patients took them. All too frequently, the patients stopped taking them as soon as they felt better from being on them. Or they stopped taking them because they hated the side effects and, on some strange level, missed the companionship of the voices in their heads.

So now, families with mentally ill members face a lifetime of difficult choices.  Often, they become so burned out by the constant impact of the mentally ill member on the rest of the family that they stop answering the phone. They simply have no more to give. And they see no real solution in the future. They see only the pattern that has become so familiar and so dreaded.

Their ill family member gets so bad they have to be hospitalized because a judge deems them a danger to themselves or others.  Because mental illness is not a crime, this forced hospitalization is of very limited duration. The hospital puts the patient back on the meds that worked so well. The patient responds, the voices fade and the hospital has no reason to keep them any longer. The patient leaves, goes off the meds, get very ill again and the cycle begins anew. Throw in the occasional affinity to drinking and street drugs in some patients and you have a recipe for disaster. AIDS, hepatitis, physical abuse, sexual assaults…all these and many more horrors become the constant companions of the mentally ill on any city’s mean streets.

I don’t know what the answer to this problem is. But right now I am watching a family with a mentally ill member cope with that person’s imminent death, a death directly attributable to years on the streets. They did what they could but ultimately there was little they could do to stop this train wreck. Now they sit a deathwatch and wonder why society couldn’t do more to help them in the exhausting task of living with a chronically mentally ill person.

I’m not looking for a return to those horrible institutions. But between them and release to a world in which their only companions are the voices in their head and people who beat them and give them fatal diseases, there has to be something else.

It’s already too late for some families. But for others, the struggle continues.  I wish for them the peace of knowing their loved one is safe.  It’s a peace they are not likely to enjoy until we come up with a better solution for those members of our society who are so unable to help themselves.

Until then, goodbye Valerie.  I wish life had given you a much better deal.