Our Rag-Bone Hearts

Now that my ladder's gone,
I must lie down where all the ladders start,
In the foul rag-and-bone shop of the heart. —W.B. Yeats

THE LIFE OF A SCHIZOPHRENIC TWIN BROTHER informs my mind and heart as I ponder why it is that the mentally ill pile up on our streets and the streets of the world. Richard was a freshman at St. John's College in Annapolis, Maryland, beginning his study of the 100 great books, when he was drafted into the Army and sent to the battlefields of World War II. I was never to see him well again.

I have lived with madness.

I have cowered in other rooms while this brother in uncontainable agony of spirit tore pictures from the walls and flung chairs across the room.

I have stood at the foot of a retaining wall while he walked on a narrow ledge 50 feet above, weighing in his mind whether to jump or not to jump.

I have hovered out of sight while the police I had summoned came to take away and "put away" the distraught human being who was the dearest friend I would ever have.

From this brother of mine I have learned what it is to wait through countless days and months and years for the return of someone held dear—so slow was I to know that he would never come back again.

This brother has taught me everything profound that I know about prayer. He taught me liberation theology before there were words for it, making it a part of my blood and heartbeat. From him I know that Christianity is not Christianity unless it has a large and radical incarnational dimension.

Because I have companioned this brother on his grievous walk, I know something of the heights and the depths of the human spirit. Because of the care of friends through his long ordeal, I know that the superhuman love described in 1 Corinthians 13 is a sublimity our human nature can attain.

Because of this brother I also know the inhumanity of which sentient beings are capable. I believe I would have borne with less wounding the dreadful election of this brother to a hell on Earth had it been only psychic trauma or something gone wrong in the biochemistry of his body that caused his suffering. As it was, indifference and ignorance added immeasurably to his distress.

Simone Weil, speaking of the fatigue she endured sharing the life of factory workers, wrote in Waiting for God, "There I received forever the mark of a slave, like the branding of the red-hot iron the Romans put on the foreheads of their most despised slaves." In the conference and visiting rooms of mental institutions I too received the mark of a slave. Borrowing Simone's words, "What I went through there marked me in so lasting a manner that still today" whenever a nurse or orderly in one of these institutions speaks to me with kindness, and many do, "I receive it in my heart as a miracle and one that in all likelihood will not last."

RICHARD WAS INTRODUCED to concentration-camp-like mental institutions when insulin and shock treatments were in their experimental heyday. Inappropriate and excessive use of these treatments dealt him the blow that ensured his never again pleading for his home or protesting his lot.

The promiscuous administering of shock treatment was followed by the era of lobotomies, called "the ice pick operation" because in some places it was literally performed with an ice pick. Although the procedure was pioneered in the hospital where Richard was a patient, we were able to resist the pressure put on families to agree to it. In that one hospital alone 3,000 patients, like lambs before their shearers dumb, were submitted to the surgeon's tool and were irrevocably the worse for it.

In the postwar years, article after article described the sordid and shameful conditions existing in most state institutions. Many of the stories were accompanied by shocking pictures of naked and gaunt men lying in hospital corridors, looking very much like the survivors of concentration camps.

In the beginning those articles gave hope. Surely the outrage would not go on now that the public was being informed. But it did go on. So did the newspaper accounts—scores and scores of them, each telling a frightful tale.

Nothing changed until the advent of the major tranquilizers. These drugs returned countless numbers of patients to a meaningful and productive life and played a large role in a program of deinstitutionalization that has become a national tragedy. Patients were released from state institutions and dumped by the thousands onto communities that did not want them and had no way of caring for them. The adult homes and community centers that were to support and supervise patients on drug therapy are still not in place. The few that do exist are limited in the numbers they can serve and are unable to provide the structure that seriously ill persons need. Now most articles on the mentally ill have "homeless" somewhere in their titles.

In his recent book, Nowhere to Go: The Tragic Odyssey of the Homeless Mentally Ill, Dr. E. Fuller Torrey, a noted clinical and research psychiatrist, wrote:

Living on the streets or shelters as a rational, sane person with a normally functioning brain must be a difficult task. To attempt to do so with a brain which is not functioning normally—with illogical thought processes, delusional ideas, and intermittent auditory hallucinations—must be a circle of Hell unimagined even in medieval times.

My church has an infirmary for physically ill street people, called Christ House. I have asked some of them about how mentally ill persons fare in the streets. They tell disturbing stories. One person said:

They are like rats. They forage for the leftovers. They find a place on top of a grate or in a subway entrance and they never go far from that place--not even to bathe or change clothes. They don't trust anybody, except maybe someone who has personally given them something. They are not rats, but they are living like rats.

The astonishing fact is that when most politicians and even more objective observers speak and write about the homeless that sleep in our parks and doorways, they point out that a third or half of them are mentally ill, the implication being that homelessness in America is not so bad as it would seem. After all, the figures include the mentally ill and they do not count for much. Also, these shocking numbers never include the seriously mentally ill in jails and prisons where they comprise as high as 20 percent of the prison population.

Another part of the picture is that more than 60 percent of mental patients are living in the homes of relatives where their needs take a devastating toll on the emotional life of families. Once disdained by mental health professionals as perpetrators of all the ills besetting mental patients, a parent or sibling today is given for a lifetime the combined roles of doctor, nurse, social worker, advocate, provider, and caretaker. Almost always it is a crushing load, which may account for the reason most seriously ill mental patients are abandoned by families. While it is undoubtedly a matter of survival, how does one carry on in any important way when a person who is loved is sleeping on city streets or in an oppressive institution or an unknown prison somewhere?

In fact, how do any of us go on with life as usual when human beings in our cities are being cruelly killed the whole day long, month after month, year after year?

On winter nights when bitter winds make more stark the reality of homelessness, and on the spring days of my heart when the world seems new and green, that question turns in me. Simone Weil is the one who prods me to explore it. She is the one who helped me to see that the mentally ill are more than sufferers. They are the afflicted ones who have been struck by one of those blows that "leave a human being struggling on the ground like a half-crushed worm." Simone asserts that "The great enigma of human life is not suffering but affliction."

The afflicted ones in our society are the homeless, bleeding and dying on the streets of America--the dazed man sprawled on the sidewalk, the woman with the plastic bags mumbling to herself, the urine-soaked, vermin-infested bodies sprawled in parks and in unlighted doorways—the ones we cannot bear to look at or to smell, let alone take into our arms. They meet Simone Weil's definition of affliction in that, whatever the event that befell them, the life of each has been attacked in all its parts—social, psychological, and physical. Simone emphasizes the importance of the social dimension. Unless a person is shunned by society it is not affliction as she describes it.

IN EVERY AGE THE mentally ill have been mistreated and feared by society. Michael Foucault tells us in Madness and Civilization of a time when mad men were put on ships and entrusted to mariners. These Ships of Fools with their cargo of lost souls sailed up and down the seas and canals of Europe. Foucault writes: "The cities and villages which had thus rid themselves of their crazed and crazy could now take pleasure in watching the exciting sideshow when a ship full of foreign lunatics would dock at their harbors."

The more common practice was to let the mentally ill wander through the villages, foraging for scraps of food as they went. Since insanity was thought to make persons less than human, no one felt the need to see that they were covered or warmed. They were, after all, close to being animals. Not until the 17th century did Europe create large "houses of confinement" where the poor, the unemployed, prisoners, and the insane were all housed together. These places of confinement were under the authority of directors, who were appointed for a lifetime and allowed to mete out punishment and correction without accountability to anyone. Widely used were handcuffs, chains, and dungeons.

After the "houses of confinement" came Bedlam and other asylums. William Buchan, a mid-18th-century medical man, is quoted in Concepts of Insanity in the United States, 1789-1865: "These institutions, as they are generally managed, are far more likely to make a wise man mad than to restore a madman to his senses." The asylums gave way to the modern mental institutions that in America would come to be called the "shame of the states."

I hark back to those olden days when the mentally ill wandered the streets or were subjected to inhuman living conditions in custodial institutions because today they fare no better. Instead of moving forward we seem to be moving backward. Our streets and parks, together with dangerous and primitive shelters, have become our primary mental wards. Despite an emphasis on rehabilitative services, the establishment of group homes is resisted by most neighborhoods. The adult for-profit homes are often found to be filthy, unsafe, and poorly supervised. Residents have been robbed, abused, and even murdered. A street person at Christ House explained it this way:

On the street we try to take care of each other, but that does not include mental patients. Out there it is a matter of survival and they can't help you survive. All they know to do is panhandle, but even then someone will take their money from them. It is the same way in the adult homes. They are the ones who get stepped on. Most people running these homes are in it for the money. I know of someone who rents out 21 rooms and feeds everyone oatmeal and toast three times a day. There is no way to complain. The city does not even go in to inspect.

The "home" he was talking about made the front page when the bodies of former residents were uncovered beneath the front porch and in the yard.

Despite advances in psychiatry and enlightened thought on the therapeutic needs of the mentally ill, very little has changed in the public's response to insanity. In fact, what is going on today in the treatment of the mentally ill might almost be called genocide, except that it is on such an unconscious level, and so slow and subtle, as to be unrecognizable. Too few are seeing the seriously mentally ill as sick and helpless people utterly dependent on the mercy of the community.

If it were not for a brother, I would in all likelihood be as unaware as the next of the terrible plight of the mentally ill on our streets. Even while seeking to be their advocate I find myself not wanting to look into the faces of the crazed and unkempt. Sometimes when I think of reaching out to one of them I feel in myself a vague sense of fear which, when I explore it, turns out to be more a fear of rejection than of violence. Strange that I, so secure in my life, should fear the rejection of a deranged person. Is my response peculiar to me, or is rejection always painful, even when it comes from a stranger or a strange one? How will I find out except by being willing to share the feeling with others, hold it outside myself so that it can be looked at and explored?

I TELL YOU ABOUT a brother as my own small effort to give the homeless mentally ill a human face. Because he sleeps in a bed at night, is fed, clothed, and cared for, it is easy for me to spot on buses and sidewalks those who, like him, have been so fearfully singled out by their illness. If he were on the streets, the peace he now has would quickly turn to terror, and perhaps in time to violence. But when you stop to think about it, wouldn't this be true of any one of us?

Of one thing I am certain: Nothing will change for the homeless unless the public is given a new heart. Change is not dependent on our gathering more statistics or reading more learned journals or in absorbing new findings, as important as these are. Our failure is in not letting what we see and hear every day sink into our hearts. The task before us is no lesser one than the education of our emotions.

Simone Weil may have put her finger directly on the problem of homelessness and many of the problems besetting modern society when she wrote that except for very special people among us, "everybody despises the afflicted to some extent...."

I have pondered the reasons for this "turning away" and want to lift up a few that occur to me. Naming them has helped in the disarmament of my own heart. Understanding them better may be helpful in the development of a mature emotional life.

The first reason is the one that Simone so effectively cites: "Affliction is anonymous before all things; it deprives its victims of their personality and makes them into things." We do not see those bundles of rags on our streets as human beings engaged in an almost impossible struggle to live.

The greater a person's affliction the more likely we are to be repulsed. I have meditated on that fact so that it might become firmly fixed in my consciousness. When I am repelled by another I want to be able to remember that I am in the company of one who knows abysmal suffering. I want to be halted in my scramble for more comfortable space.

A large part of our difficulty is that we are unaware of our ambivalence toward the afflicted. We are too attached to the image of ourselves as caring persons to admit that we are repelled by the truly afflicted. In reality we want them off the streets and out of our lives. Never mind that there is no place for them to go. There is always the sea. They can be put to sea in boats. We are not so far removed from the 15th century as we would like to think. If we will practice awareness of our feelings, dark dimensions in ourselves can be received into consciousness where they can be looked at and transformed. Integral to that work is forgiving ourselves and forgiving each other for being less than we thought we were and less than we might be.

A second reason we turn from the mentally ill is that we do not think that they have feelings like the rest of us. This kind of attitude was supposed to have changed by the end of the 18th century, but in essence it is not very different today. We still cannot grasp the dreadful emptiness of those who have ceased trying to talk to us. We cannot imagine that their destructive behavior might be due to bewilderment, or mistreatment, or fright, or depression. When it is not one's own experience it is hard to understand what it must be like to have a mind in disarray or attacked by its own voices.

The mentally ill are not able to tell us how their world feels to them, which makes essential the exercising of imagination on our part. As it is now, we do not think that they might enjoy some of the things that we enjoy. Though eating is one of the primary pleasures of life, no attention is given to what kind of food mentally ill people eat. Of course, it is also true that we do not think that they know pain in the way we do. We find it an ordeal when we have one aching tooth, but are able to consider with equanimity the fact that most of the homeless have mouths full of broken, decaying teeth.

Third, the fact that the deranged on our streets are poor accounts more than we know for the distance we put between "us" and "them." Psychiatric professionals have demonstrated little willingness to treat the poor who are seriously mentally ill. This has been noted by research health professionals and is given considerable attention by Dr. E. Fuller Torrey in his writings. In Nowhere to Go Dr. Torrey cites these words from the findings of psychologists M. Brewster Smith and Nicholas Hobbs, both of whom were members of the Joint Commission on Mental Illness and Health:

The relationship between the mental health helper and the helped has been governed by an affinity of the clean for the clean, the educated for the educated, the affluent for the affluent. Most of our therapeutic talent, often trained at public expense, has been invested not in solving our hard-core mental health problem—the psychotic of marginal competence and social status--but in treating the relatively well-to-do educated neurotic, usually in an urban center....

Only occasionally does a poor person move any of us to generosity. Nevertheless, this did happen recently when a woman was evicted from her high-priced condominium and left sitting on the sidewalk surrounded by books and expensive furniture. All kinds of help were offered. She was even on the six o'clock news. On our inner-city streets poor people and their belongings receive scant attention except from scavengers. The "nouveau pouvre" woman was more like us. We were better able to believe that she might be poor through no fault of her own. Some of us even began to imagine what it might be like to be homeless. For a few moments we touched compassion in ourselves for someone who was not our own and knew what a wondrously good feeling that is.

When the minds and bodies in pain belong to the ghetto poor, empathy is much more difficult. How else can a homeless population in the midst of an affluent society be explained? Why are we not shocked and appalled each day as the ranks of the innocent homeless grow? What we fail to appreciate is how large a price we pay in self-esteem for not being connected with our own great capacity to care.

A fourth reason that may keep us locked out of our own hearts is our sense of powerlessness. In 1950 I first began to dream of an organization made up of the families and friends of the mentally ill. I thought and talked about it and envisioned it as a strong force for improving the lot of the mentally ill. I never did anything toward bringing that dream into being. Whenever I became serious about what I might do I was overwhelmed with feelings of helplessness. How could I begin to organize the families of the mentally ill when the only time I saw them was when we huddled in gray hospital lobbies waiting for visiting hours to begin? How could we as a group find a voice when we were so afraid of the repercussions of speaking out?

I don't know how the National Alliance for the Mentally Ill was birthed, but it is made up of the families of the mentally ill and came into existence in 1979 with 300 members. Now it has 60,000 members and 900 chapters. Its existence bears witness to the fact that nothing that can be envisioned is impossible. This organization has already been effective and has the potential of giving leadership for radical change.

The most urgent need is for confidence in ourselves. Our civilization is severely wounded and crumbling, but it is not too late to exercise imagination and creativity. Something new can still arrive in the world. We are not helpless even in the face of mass misery. Though we cannot minimize the great forces against change, the fact is that all the homeless can have a home. The seriously mentally ill can have the care that is the right of every ill person.

Fifth, and probably underlying all the other reasons that we cannot be a friend to those who have been made outcasts, is that in many of us is a homeless one that we keep out of sight and hearing; one who is not acceptable, whose problems might cause us to be rejected; one who wants to be included, cared for, and listened to; one whose story has not been heard.

While we have mentally ill persons on our streets we can project our smaller problems onto their larger ones. We do not have to explore the disease in ourselves. We can keep in place the camps of "we" and "they." We may even succeed in keeping our illnesses secret or in denying them altogether.

WE HAVE THE POSSIBILITY, however, of choosing another way. We can begin to educate our feelings so that we choose for ourselves and others what is worthy and beautiful. Our intellects have given us the technology, plans, and strategy for what needs to be done, but only our emotions can give us the fire and impetus to move toward something different. The development of a mature emotional life means that we will have to give as much attention to the training of our emotions as we give to the training of our minds. This is an essential requirement if we are to build inclusive cities in which the well and the sick have a place, and we can experience what we have hardly known—the grandeur of being human.

In the end homelessness, like other ills in the world, has its origin not "out there" but "in here." When we can become acquainted with our own pain and gather up in mercy all the unkempt selves that clutter up the back alleys of our inner landscapes, we will be healed and become healers.

Perhaps our most urgent need is time to reflect and to look inward to our own depths, and time to contemplate that reality that is outside this world and at the center of each of us. The direct result of that kind of activity will be an infusion of Spirit and creativity in ourselves and in the world. We will be able to put ourselves in the struggle for the rights and dignity of us all.

Elizabeth O'Connor, author of Servant Leaders, Servant Structures, was a Sojourners contributing editor and was on the staff of The Church of the Saviour in Washington, D.C. when this article appeared.