Let’s talk about healthcare, please.

I support the Affordable Care Act because I believe it will help our Gross Domestic Profit go up, and because I believe in social justice.  Let’s talk about it.

I spent a year working as the site supervisor for a homeless shelter, and then a year and a half as a “float” between several residential mental health facilities, so I’ve seen my share of people who have no choice but to rely on the state.  Any time an issue about state benefits come up, my mind immediately flashes back to my experiences there and I judge everything I hear not of how it affects me personally, but how it would change the situation for the people I have served.

Please, give me a few moments of your time.

Working with the homeless, I saw a side of the mental health industry that was chilling.  A large proportion of the guests at the homeless shelter had mental health problems.  Bipolar syndrome was a constant theme.  Why?  Because it, like schizophrenia, tends to manifest in adulthood rather than childhood.  The first symptoms don’t show up until someone is in their mid-twenties or later.  If you’re in college, in an office job, or in another supportive environment where you have a lot of hands-on supervision when the symptoms start to show, you have a good chance of being referred to help before it derails your life.  If, on the other hand, you are flipping burgers or nailing window panes on a factory floor, it’s far more likely that the first “incident” that lands you in front of someone who could help you isn’t going to be mild, it’ll be extreme.  More often than not the outbursts that can characterize mania (or the paranoia of schizophrenia) are misinterpreted as aggression or something more extreme.  There are books, and volumes, and scads, and rants, and epics of information on why it is that poor people with mental health problems seem to inevitably end up in jail or residential treatment for the rest of their lives.  But the truth is the answer is very straightforward:  right now, that’s just what the system is.  If you are poor, the only way you can stay medicated is if you are in jail or residential therapy indefinitely.  That means if you’re in your mid twenties and married with children when you first have an aggressive manic episode on a factory floor, not only is that the only route available to you, but it is the only route available to your family.

Ask yourself if that is just, or even necessary.  Is that the society you want to live in?

Addiction operates in much the same way.  White collar addicts can get chain prescriptions for pain killers, and there are many supports there to act as a barrier between the addict and extreme consequences.  For the poor, reality is again far more harsh.  Unless there is insurance coverage for treatment expenses, chances are treatment will happen when the addict is caught in an illegal action and sent to jail, or their children are taken away and rehab is proscribed by the state as a requirement for reunion.

Is that justice?  Is it necessary?  As the self-ascribed “greatest society”, is that how we should live?

Despite any issues that there may be with the Affordable Care Act, there are a few things it does which are absolutely necessary if there is to be any sense of social justice in the United States.  It makes it so that the poor can have preventative and maintenance mental health care, meaning that problems like bipolar disorder and schizophrenia can be treated before they become debilitating, and poor people with those illnesses can remain productive members of society and their families are not torn apart.  It also means that people with addictions can be helped before their addiction becomes so severe it becomes a legal matter instead of a personal one.  Even if you have absolutely no interest in those issues as a social justice matter, think about the expense.  How expensive is it to maintain treatment for bipolar disorder and schizophrenia through the jail system and residential programs as opposed to having insurance cover medications?  How expensive is it to treat addiction as a legal matter- court fees, jail costs, state paying for rehab- as opposed to treating it through insurance as a private matter?

The Affordable Care Act isn’t about coddling the poor, it is about saving money, saving lives, and keeping people economically stable and productive instead of burdening society with unnecessary expense and unnecessarily broken people.

If you don’t believe me, go to your nearest residential mental health treatment facility and talk to the people there about how they ended up in that situation.  Hear them talk about how schizophrenia made them homeless and years of going without medication or health care on the streets broke their bodies and caused so many complications they could no longer care for themselves or became suicidal, and the state remanded them to residential care.  Here them talk about how they ended up in jail because they punched their boss but now they know aggression is a symptom of their illness.  “I can’t live without the lorazepam, without it I am violent, but I can’t buy it unless I’m here, so the state says I’m a threat to others.”  Hear their stories, and realize that if we defund the Affordable Care Act, there are only two options open to the very poor who have abnormal mental conditions:  jail, or residential care.  Neither of those options are freedom.

Then ask yourself if that is the society you want to live in.  If you want my generation, and the generation of my children, to send a significant segment of their population to be jailed by the state either literally or with high doses of medication administered several times a day, because their brains are wired differently and we can’t be bothered the expense of keeping them productive.

Think about it.

And when you get that statement in the mail saying your copay is going up to provide full coverage, realize this:  every time a copay goes up, a bipolar factory worker gets to stay on his medication.  Indirectly, your money isn’t going to brigands or scum or people who can’t be bothered to get better jobs; actually, it is going to keep people working and improve the Gross Domestic Profit.

Everybody wins.

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Let me tell you what Hell is.

The text read:  “Im going to burn in hell ne way.”

*beep beep*

“Life is pain.  Why live?  Pain forever, then hell.  I want it over with.”

I got his address off of Facebook, we’d become friends only days before when he’d been given a copy of my novel.  I wasn’t sure what had inspired him to reach out to me.  All I knew was that I’d stayed home from church that day because I was sick, and here he was.  Reaching out.  Not wanting to die alone.

“Don’t be an idiot”, I texted him back.  “There is love.  There is hope.   If you go to hell I’m going with you.”

Painful seconds passed.

“I’m almost to your house,” I wrote.  “Calling you.”

I will never, ever, forget the pain in his voice when he answered his phone.  When we’d met a few days before, he had been the kindest, gentlest, most soft spoken person I’d ever known.  He had been so quick to laugh, and although he obviously was living with a great deal of pain his spirit shone through.  The voice I heard through the phone was almost robotic in it’s monotone and so desperately lacking in spirit.  “Just stay alive another minute,” I told him.  “I’m turning, where are you?”

He came out on the front porch and agreed to go with me.  I took him to a mental health clinic that was fortunately only a few blocks away.  Even so, it was one of the longest car rides of my life.

“God doesn’t hate you,” I said.  “God loves you.”

“You know what they say?”  He replied, “I would’ve never been gay unless God totally rejected me.”

“For F—‘s sake, you said you’ve known you were gay since you were six!  What did a six year old do to get wholly rejected by God?”

“It doesn’t matter, does it?”  He wiped away tears but it was like wiping at the Columbia, it just kept rushing out.  “I mean, I can’t not be gay and no one cares, I mean, they don’t care no matter what.  It’s like, ‘well sure you’re depressed, it’s what comes from sin.’ And like, ‘the wages of sin is death’ so like if I kill myself, that’s justice.  That’s justice.”

“And here I took you for someone pretty smart,” I responded.  “You know homosexual acts are listed right with gossip and idle talk and drunkenness.  If your suicide is justice half that freaking church needs to put a blade to their wrist.”

“I can’t believe you just said that.”

“Well I’m kind of pissed that you almost died on my watch.  I could say more.”

He just stared at me.

“God is love, right?  You remember my favorite passage.  It’s all over the book.  The people that won’t help you because you are gay can’t be speaking for God because it’s not loving to turn away from someone’s pain.  Whatever they said it doesn’t matter.”

“You didn’t hear them, Ell.  All of the verses, and it’s like, ‘hey, it’s in the Bible.  We’re just being obedient.'”

“Shut the eff up, man, or I’ll pull over and slap you.”

“Ell!”

“I don’t want to hear that crap in my car even if you are quoting someone else.  Forget it.”

“I don’t understand, I mean, I thought you were a Christian.”

“Of course I’m a Christian, that’s why I can recognize bull when I hear it.  The fruit of the spirit is goodness and patience and love and whatever the other ones are.”

“Ha!”

“I’m a little distracted by how pissed I am and can’t do the brain thing, forgive me.”

“What were you saying?”

“Love.  That’s the fruit of the spirit.  If the fruit of their obedience is your death, it’s not my God they are obeying.”

“Oh,” he said.

“And honestly I’m feeling more Christlike right now than I have in years.”

* * *

A few weeks later we would be emailing back and forth, and I would say this.  “What you said about Hell.  I can show you hell.  It’s a kid going to a church because he’s on the brink and he needs someone to love him, and they show him the door.  I don’t know where Jesus is right now, but he is weeping.  And he still loves you.  Don’t give up.”

Here’s the thing:  I don’t care what your personal conviction is about homosexuality.  What I care about is my friend, and other people like him.  Sadly, he’s not the only kid I’ve ever heard tell that story and I doubt he’ll be the last, even though I fervently pray it’s not the case.  I’ve talked enough blades off of wrists for my lifetime.

Here’s the thing:  gay people aren’t the enemy.  Homosexuality is never singled out in the Bible.  It always appears hand in hand with other sins:  hubris, for example.  Drunkenness and gluttony.  Idolatry.  Idle talk and gossip.  What infuriates me more than anything else in the whole debate about sexuality is that you see people saying “we can’t let gays get married because it goes against the Bible” but the same people aren’t trying to pass laws to outlaw idle chatter, gluttony, or even premarital sex.  How is it okay for Christian organizations to be pursuing keeping sodomy laws on the books while their employees chat about who Julie is dating on their breaks?

I’m sorry, guys, that may strike you as an extreme example but I am being completely serious.

The Bible doesn’t make a distinction between the sins it lists.  Being gay is no worse than being a gossip, and both things are equally condemned in the church.

But now I am writing to you that you must not associate with anyone who claims to be a brother or sister but is sexually immoral or greedy, an idolater or slanderer, a drunkard or swindler. Do not even eat with such people.  (1 Corinthians 5:11)

At the end of the day, what makes a sexually immoral person such a target as opposed to all of the other sins on the list?

And then we get into discussions about the law and about how opposing gay marriage is just obedience to God.  Let me tell you something:  God never once commanded us to make laws regarding the morality of people outside the church.  In fact, He said something more like:

What business is it of mine to judge those outside the church? Are you not to judge those inside? (1 Corinthians 5:12)

Their sin is none of our business.

The more Christians speak out against gay rights, the more they talk about the sin issue, the more they put out literature talking about how Gay people are sold to sin and more likely to abuse children and get drunk and have “depraved sexual relations” that “go against God”… the more I think about people like my friend, with the razor to their wrist, thinking that there is nothing to do but die.

Let me tell you what Hell is:

It’s a church so focused on sin that it’s forgotten how to love.

We have absolutely no business talking about the sexuality of those not in the church.

It goes against the Bible.

And for those inside the church, we should talk about it quietly, in confidence, not blast about it on the internet for every suicidal 19 year old gay boy to see.

Just.

Stop.

For the love of God, think about what you are doing.

a post in which I say nothing significant about mental health

I spent a year working in a residential treatment facility for people with chronic mental health problems.  I’ve been wanting to write about my experiences there for some time but feel at a loss for what to say.  I cared very deeply for our residents and never felt like there was enough that I could do for them.  I didn’t have any real training for how to care for their illnesses- my position though advertised as social work mostly involved keeping the toilets clean and the washer and dryer running, and cleaning up after meals.  We did have group therapy sessions that the aides would lead, but they were repetitive and weren’t therapy so much as a way to kill time.  Working there taught me so many important lessons, though.  It taught me about our society in a way that working at the homeless shelter didn’t and couldn’t, because at the shelter you could expect the guests to get on with their lives.  You could assign them the responsibility to grow and change.  The residents at the mental health facility, though, were helpless to control their own future.  Some of them were helpless to control when they slept and woke or even their own bladders.

We had many residents who were schizophrenic.  Some had severe personality and mood disorders.  Some had “undifferentiated symptoms” that regardless of a firm diagnosis were sufficient to get them sent to a treatment facility.  Some of them were judged a danger to themselves or others, so the state paid for them to live with us.  All of them had routine meetings with their supervising doctor every few months for medication monitoring.  The aides, like me, were in charge of taking down routine group notes and individual notes to monitor how the residents were doing, and reporting any suspicions about adverse reactions to medications or symptoms not responding to medications to the nurse who worked 9-5 or to the doctor, who was in the facility once every 4 weeks.

It’s important to understand that these people were heavily medicated, some taking as many as 25 pills a day, and they saw their doctor once a month for 15-20 minutes.  We had residents who were hospitalized because of severe adverse reactions.  We had one resident who had a medication discontinued because it lowered his white blood cell count to the point that it could kill him, he went nearly catatonic and had to be moved out of our facility.  We had residents who had narcotic medications that they could request at will who would daily take as many as they were allowed.  When the staff reported that there was a concern about addiction it was met with the equivalent of a shrug.  “This person is mentally ill, at least they are more or less stable, what do you want?”

I don’t really even know what I’m trying to say.  I admire all of my ex co-workers, I admire the company that I worked for and the job that they did.  The working budget was constantly being cut.  We never were fully staffed, and everyone worked overtime constantly.  I worked 12-16 hour shifts every weekend and went to school all week, and constantly felt guilty that I couldn’t work more.  We only had two aides on in the evenings and nights to care for 28 residents, and did the best that we could.

A lot of the residents were people who had lived in poverty for most of their lives.  Most of them didn’t get into the mental health system until their symptoms were so severe that their lives were unsustainable.  A few had accidents that left them with brain damage, so living with us was their only option.  One has to wonder what their lives might have been like if there had been earlier interventions.  For those with mood disorders that statistically respond well to talking therapy, there’s this question in the back of my mind of who they might have been if they’d been able to get that therapy. Was it inevitable that they would slowly implode to the point that their rights would be revoked, and they’d have to take pills every six hours for the rest of their lives just to stay stable enough to live in a facility where they would routinely act out just to get attention, and have the staff respond by upping their meds?

Meds which could kill them.

I want to say something really deep and powerful about the mental health field, about dependence on mind-altering medications, about poverty and mental health and the sick cycle it creates.  I want to say something powerful about how ignored the mentally ill are.  How reviled they sometimes are.  How helpless they are.

All I can say is that the budgets keep getting cut, and the patients have nowhere to go.

28 patients taken care of by two overworked aides with insufficient training being paid only slightly above minimum wage, and a doctor with a case load that rivals Atlas’s.  We like to call this fair country the land of opportunity.  With hard work and dedication, anyone can get ahead.

And the budgets keep getting cut.