Nate worries me, both for the world inside his brain and for the reasons why he keeps falling through the cracks, some as big as canyons, in Seattle's mental-health services. Nate's been diagnosed with schizophrenia. Sometimes I imagine him as a walking time bomb. I've watched him throw a chair, storm out of a room. I know he's attacked people when he's been scared. But most of the time he is docile, skittish, circling a sun that alternately burns and goes dark.
Nate has changed my view of the world and my work. Mostly, he's haunted all my pretensions of trying to help someone using the diminishing resources of social services. During the last three years, I ran a job training program for homeless youth. The training was based around writing zines. Most of the homeless kids who worked for me were in transition from the streets to the world of housing and regular work. Some kids didn't want to get off the streets, but wanted money. Some kids were on the edge, and by that I mean struggling with drug addiction, chronic mental illness, or intensive trauma from being abused. Sometimes all of these factors swirled together chaotically in the same kid--and for those kids the work training program was merely a trench, a temporary respite from the war they lived inside. That war was the window through which they saw the world looking back at them.
Nate was one of those kids. I tried to talk him into working for me the day he first walked into the youth center. He was looking for food, money, and distractions. I didn't know he'd just been released from jail. Months later, I found out about his convictions, his diagnosis.
At first all I knew was what Nate told me, what I saw in him. Nate was almost 20. He was awkward, angular, as angry as lots of other homeless kids. But he seemed more detached from his body than most, more unpredictable. He'd say strings of witty things, go catatonic, then recite lines of associative, nonsensical words. I thought he was on drugs, but that wasn't unusual or intolerable on the work-site. The job training program was the edge, a chance for getting stable: a first, and for some, a last stop.
The first clue I got about the real depth of Nate's complexity was when, on his second day of work, he showed me two pieces of identification. One of them, a University of Washington student card, showed a smiling young man, clean-shaven. He had been 18 then, but looked older because there were shadows around his eyes. In the second photo, taken about a year later, Nate resembled an emaciated Jerry Garcia. He had a wiry beard and long, oily hair. His expression was flat, perplexed, a little wild. He wore a fisherman's hat pulled low over his eyes. By that time, Nate was already homeless and had been to jail.
Nate never mentioned an illness. He said he had addictions--alcohol, pot, heroin. He said he would talk to me if I promised not to tell the people who were trying to force him to die. Nate didn't even like being contained within the four walls of a room. He liked doors left open.
At that point, I didn't believe mental illness existed. I thought it was a scam, a power game played by shrinks. I was adverse to how doctors arbitrarily diagnosed patients with mental illnesses based on a guidebook of observed symptoms (the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV). I was also politically adverse to medications or even anti-depressants that I thought were overused. I believed people could stop the symptoms of mental illness by making different choices. That idea worked well in existential theory, and I could apply it neatly to something like attention deficit disorder, a diagnosis so frequently given to unruly kids and unfocused adults that it has become absurd. But Nate's case was different. Being in his proximity was like entering a distant country with unfamiliar customs and language.
At the work training program, Nate stared into space for the first few weeks instead of working on his zine. I'd sit and talk to him. He was shy, funny, self-deprecating. He leafed through one zine obsessively. It was written by a couple of train-hopping kids. Nate idolized the zine, the lifestyle it explored. He'd say, "How could I make anything? Nothing else could be this good."
Then one day, abruptly, he opened his sketchbook. Inside, he was building an alphabet of sensual letters. He explained to me how W loves A, how the two letters lean into one another, almost touching. He sketched cushioned, brittle, and voluptuous letters. He made them spoon, belly to back. He made cartoon characters out of the alphabet--a man in a lampshade hood stood for the letter A.
While Nate was showing me his alphabets, he was lamenting that he couldn't master graffiti. It was odd: This kid had the will and brilliance to create, but in his own head he was stuck imagining that his arms and brain were useless. Trying to encourage him was tricky. He saw through every attempt at a premeditated bolstering of his ego. He'd say, "You're trying to make me feel good, but I already know what this is, and it's nothing."
For weeks, Nate offered up beautiful and intensely disturbing drawings. One sketch was a self-portrait, showing a man's face as a tangle of horns and bones. There was one swirling eye. Antennae sprung from its head. It was the demonic geometry of how Nate saw himself.
Nate's other self-portrait was of a joker marching down a bumblebee's back. In Nate's sketch, the joker is a smiling, carefree trickster with a bulging belly. Nate portraying himself as the fool--an emblem of naiveté on the back of an insect layered with complex symbolism--was haunting. Bumblebees stand for mathematical order, unpredictability, anger, fear, and creative abundance. They are the lovers of flowers, alchemists of sweet potions. And they sting. Bees are encoded to sleep underground all winter and fly in straight beelines back to their hives. The bee is also associated with the human mind: A bee under one's bonnet has traditionally signified eccentricity. The deeper I looked, the more I realized that Nate had found the perfect symbol, the bee with the fool, to illustrate his internal shift. At the deepest root of "bee," according to The Oxford English Dictionary, the word means "fear," stemming from the insect's relentless, frenetic humming.
Nate also kept a journal he showed me sometimes, in which he wrote tender, reflective paragraphs like the following: "Sometimes I go down among the stars and planets (Gods) and just sing the most beautiful music I can think of which turns out to be a Pearl Jam song. The first few notes are spectacular, but it sort of goes downhill from there. So much damned love in such an empty promise. What a diminutive attempt at the meaning of life."
Nate's displays of vulnerability, in his writing and artwork, made me feel protective of him. So did watching him struggle with intense social awkwardness. He couldn't figure out how to interact with other kids. His small talk lost its way. He'd miss cues. He'd stare too long at someone.
Other sections of Nate's journal were more troubled: "God let me write one coherent page that I may be able to decipher and publish it into my already questionable ethics please in the form of a prayer. Charles Manson and the Bundy's and at other times amen." I had seen and read more disturbing things than that from other kids who wrote to purge demons or release coiled-up anger. I didn't start really worrying until Nate began throwing himself into walls and desks. He'd smile, talk to himself, crash into things. His movements were puppet-like, compelled from voices or nerve impulses. I couldn't tell.
I pulled him aside and said, "Nate, you can't act like that at work. It makes people nervous." He just stared back, smiling, like he'd said the punch line to a joke that I was several hours too slow to catch. I suggested that he take a smoke break on the back porch. Someone told me later that coffee and cigarettes are like water and light to schizophrenics.
I started to ask people whom I trusted for advice about what was going on with Nate. I wasn't surprised that he refused to acknowledge his diagnosis. What person in the prime of life would choose to accept a label like "schizophrenic?" The word has the same sort of cultural stigma and historical darkness as "leprosy." We innately think of mental illness as an indication of impurity or sin. We make jokes, cross the street. It scares us. And since the schizophrenic is part of this culture, it follows that he is naturally repulsed by and scared of himself. Thus, schizophrenics are trapped twice: inside an illness and inside a cultural prejudice against that illness.
Even the word schizophrenia is a little deceptive. It literally means a split (schism) in the mind (phren). But the disease isn't about someone splitting into two neat selves. Having schizophrenia may be like having your brain physically change, so that whatever wall separates dreams from reality--and one's self from other selves--dissolves. Or maybe schizophrenia is a kind of awakening. Scientists claim that we use only 70 percent of our brains. What if that unused portion suddenly kicked into gear? Who would we become? What would that transition feel like?
There was another kid who participated briefly in my work training project who had schizophrenia. He'd had it for 10 years. He described how cans of Comet on store shelves talked to him. Dogs made speeches. Buildings yelled at him. He had no control over the super-animated world around him; his perception was much like living inside a cartoon, I guess. He cut himself a lot. Voices told him to do it. He tried to modulate voices and delusions with drugs and alcohol, which only complicated his symptoms and made him more vulnerable to being criminalized.
I was compelled, day after day, by Nate's embattled tenderness and his spiky trust. He gave me a sketch of Spiderman, swinging through an ad for whiskey and on through another photo of Native American warriors. Some days he saw me as an enemy, some days as an anchor.
I started to read everything I could get my hands on about schizophrenia. I collected stories from people who work with schizophrenics. I looked up the different varieties of schizophrenia in the DSM-IV but couldn't decide what variety best fit Nate. He had the characteristic symptoms: delusions, hallucinations, and derailed speech. Sometimes he was catatonic. Often, his demeanor--the way he talked and his expressions--was flat. And he had intense paranoia about being asked questions or being stared at. But he had also started drinking a lot, and I couldn't tell exactly what was causing what.
I bought more books: guidebooks for families, memoirs by schizophrenics, memoirs by people close to schizophrenics. I collected anecdotes. Lori Schiller, author of The Quiet Room, describes how her senses were heightened, how the visual world became crisper, more vibrant, when her schizophrenia hit. A therapist friend told me about sitting in a room full of schizophrenics once, early in his career. One of them claimed, "I'm God." Another answered, "Oh, that's good. I thought I was God, and now I don't have to worry about holding all that responsibility alone."
The book that helped me most in learning about schizophrenia, Memoirs of My Nervous Illness, was written in the early 1900s by a German jurist named Daniel Paul Schreber. The author mapped the shape of his own mind during bouts of schizophrenia, a kind of scientific journal from inside the illness. Schreber showed me that despite alienating people, schizophrenia might be a state of relentless light that only seems dark in the context of a world where it doesn't fit. Schreber talks about God speaking miracles through birds, and God's rays moving through his body, making him sensually a woman. Schreber speaks about himself as the center of the world. He reminds me of an exaggerated William Blake or Walt Whitman.
I was also intrigued by a 1937 textbook called Psychiatric Nursing (F. A. Davis Company), which gave an analysis of schizophrenia at that time. The book now seems primitive, comic even. It makes me wonder how archaic and subjective our comprehension of mental illness is now, and how we'll talk about it in another 63 years. This nursing textbook listed the causes of schizophrenia as war, marriage, worry over masturbation, and emotional stress caused by religious revivals. The book warns parents to keep watch over their teenager's sexual hygiene. Insulin shock--flooding patients' bodies with sugars to knock them out--was the most popular treatment of the day.
There is some controversy over whether schizophrenia is an ancient or modern illness. Some people claim it existed in Biblical times and in historical texts. Occasional cases were noted during the Middle Ages and up through the 1700s. The disease saw a dramatic increase between the early 1800s and the 1950s. There are currently about 1.8 million people living in the U.S. who have been diagnosed with schizophrenia.
The most popular treatment for schizophrenia today is medication. There is a new generation of anti-psychotic drugs, like olanzapine, replacing old standards like Thorazine and Haldol, drugs that made people drool and shuffle. Drug companies and medical experts like Dr. E. Fuller Torrey claim the new meds are safer and have fewer dangerous side effects. Some people who have taken anti-psychotics have developed tardive dyskinesia and other neurological conditions. Drugs for schizophrenia also tend to be costly.
Nate said, "There's nothing wrong with me, except that people won't leave me alone. I know what I need."
He'd talk about how street drugs were his door to freedom, how the jailhouse bars got into his veins. I'd listen. Eventually, we'd reach the end of language and lose one another. Or I'd run into my fear of his unpredictability and chaotic behavior. It was fear that separated us. Nate would lean over, hold his head in his hands. Laugh for no reason, at some joke whispered in his ears.
Sometimes I had the feeling that if I got too close to understanding him, I might get pulled into his world. I assume that lots of people feel this way. In a sense, sanity is based on our ability to shut out and order the illogical influences and chaos that threaten to derail us. Mentally ill people are a reminder of how mutable and permeable sanity can be. It's no wonder, albeit inexcusable, that we push people whose sanity bends to extremes away from us.
I've had a glimpse of my mind out of whack. It's not an attractive memory. Nate scraped at it. Remembering it helped me understand small fractions of what Nate faces constantly. When I was a little kid, I hallucinated, mostly late at night and first thing in the mornings. It was random. Numbers, faces, objects would be magnified on the walls. Sounds would be amplified. Whole frames of films would reproduce themselves in detail on the oblong mirror in my room. The hallucinations were initiated by a series of illnesses and high fevers, and culminated in a full-blown case of shingles. There were a couple of traumatic events, centered around alcoholism and abuse, crashing through my narrow life. I was six when the hallucinations started. Nine when they stopped. They scared the shit out of me.
There's more that goes on in our minds than we're willing to own and articulate. Random thoughts. Voices. We learn to keep our urges and odd feelings under wraps. The people we call mentally ill can't suppress the part of themselves that the rest of us try to control. We want creative chaos to come out in neater packages. We want art in a white room, in the context of walls. Words boxed in scaffolding.
I spent weeks trying to talk with Nate's case manager at a downtown clinic. There were volleys of frustrating phone messages back and forth. Finally, Nate's drug counselor, Sheila, called. Nate had signed a legal paper giving me permission to talk to her. She told me then that a court had mandated that Nate receive drug treatment. Sheila was worried about Nate as much as I was. She said the problem was that Nate wouldn't admit he was schizophrenic, and he refused medication.
Nate freaked when I told him I'd talked to Sheila. He threw a book at the wall. I asked him to leave the room.
He said, "Don't tell me where to be. You're not God."
He stood next to me, poised to strike; a pulse of fear ran between us. "Woman, be gone," he called out like an evangelist. His voice was deeper than usual.
I had some magical thought that Nate wouldn't hit me the way he later hit his brother's girlfriend. I just stood there repeating a phrase about the door being open. I didn't look at his eyes. He left. From that point on, I could trace the spiraling down of Nate. And the perimeters of my own fear as obstacle and guide.
De-institutionalizing the treatment of mental illness was a noble idea that has backfired in many ways. Hospitals and other facilities were closed in response to mismanagement and the abuse of patients. Movies like One Flew Over the Cuckoo's Nest and Titicut Follies marked and helped solidify the shift in how we looked at mental illness. But it was only a partial shift, an empty promise of compassion, a pact that we would as a society provide for, integrate, and make room for the mentally ill, or maybe erase mental illness. An impossible task.
President Kennedy emptied mental hospitals and shifted the money to community health clinics in the early 1960s. Since then, the money has gradually eked away, leaving mentally ill people to fend for themselves. Suddenly, they had to figure out how to attain resources the state once provided, however poorly--housing, food, income, health care, drug treatment. The programs that did continue or start up became overburdened (there are a couple of safe houses in Seattle where the mentally ill can live, but the waiting lists are often 600 names long). Also, the commitment standards changed drastically, until people could only be involuntarily committed if they were a danger to themselves or others. A compassionate idea, but one that doesn't work in all cases.
Beth, a friend who does street outreach to severely mentally ill people, thinks the most effective thing for schizophrenics is medication, but in order to get the meds, the patient has to volunteer. And here's where helping mentally ill people on the streets gets truly complicated: How do you honor the civil rights of those suffering from really skewed and often paranoid perspectives, and at the same time protect them from being thrown in jail or doing something dangerous?
Beth says, "Schizophrenics are the hardest people to get services for--the disease makes them avoid the help they need. It makes them paranoid." In Nate's case, he was suspicious of men and of rules that seemed arbitrary and stupid. Beth adds that in dealing with schizophrenics, you're competing with voices in their heads. It's like the person is wearing earphones with the music turned up full blast. Schizophrenics end up getting picked up a lot for trespassing or drinking in public, and often don't understand the charges against them. They stand up in court and plead not guilty even though they may have been caught in the act of stealing.
I had a sense that if Nate could just be in a safe place for a couple of weeks or a month, he would stabilize. A psychiatrist told me about a forest village, a compound for mentally ill people near the small town where she grew up. I didn't know if Nate would want to stay in a place like that. He might need to go through several cycles of safe, temporary containment and release before he finds a more permanent balance. Or he might continue cycling his entire life.
Nate started shooting heroin on top of drinking too much. At the job training program, he sat in a distracted manner at the computer, trying to figure out the answers to big philosophical questions, as if that were his real job. When I tried to talk to him, I felt like I was competing with the voices in Nate's head, and losing.
Sometimes when he looked at me, he looked through me, or else I became someone who embodied one of the voices he didn't like. I knew it wasn't personal, but when I started getting burned out at work, Nate's objectifications cut into me. I was starting to feel emotionally trashed. I was seeing more kids with serious drug and mental-health issues, and there were fewer resources available to help them. The youth center where I worked lost its mental-health and drug counselors. The rest of us filled in the gaps.
Nate pulled me aside one day, agitated. "I've figured the whole thing out," he said, "I'm God."
The idea was giving him a headache. He told me that the staff members downstairs were enemies of God. He started getting jumpy, rubbing his legs. I was acutely aware that Nate was scaring most of the other youth in the room. He was scaring me. I couldn't predict what he was going to do next. My stomach went into a knot. I didn't look at him. I didn't want my fear to escalate his fear.
I asked Nate to leave the room. He knocked over chairs and a globe as he went. He was like a hurricane that couldn't understand the nature of the torrent he was carrying. I thought about him hurting me, hurting someone else, jumping off a bridge (most young male schizophrenics end up killing themselves). I wanted him to have some space where he could crash, as God, into the wall of himself and then sleep. Nate came back an hour later. He sat down and drew a cartoon of a man, in armor, on a motorcycle.
Things got worse. Nate got more hyper-sensitive; street drugs complicated things. He walked into the work-site one day and offended every person in the room within five minutes, calling the kid with acne "zitface," mocking the transgendered girl for having a dick, calling the one black man in the room "nigga." Later he threw a CD case near a staff member's head and ran off when someone threatened to call the police.
I suspended Nate from the job site, then found out he had been kicked out of the community health clinic where he was living, for fighting. He continued to drop by at the back door of the work training program to check in. He looked worse every day. And I was torn up about having to kick him out of one of the last places where he could get services. But he seemed dangerous.
I went away for a month and forgot about all my work responsibilities--except for Nate, who had gotten under my skin. I couldn't figure out why this kid had decided to trust me, how far I was supposed to go in caring. He was someone else's kid, but he'd been abandoned by his family, and he was messed up--and social workers just eventually get burned out and end up abandoning the same abandoned kids again and again.
When I got home from my leave of absence, there was a voice-mail message from Sheila saying that Nate was in jail. He had stabbed his neighbor. It wasn't serious. The idea of Nate being locked up made me nervous. The King County Jail clerk recited Nate's crime, what floor he was on, and when I could visit. Nate was dressed in green cotton pants and shirt when I saw him. He looked confused, paranoid. A guard watched us from behind a glass booth as we talked. I asked Nate for his lawyer's name so I could link him up with Sheila. Nate didn't look at me right away. He couldn't figure out why I was there, what I wanted, or whether I was being sincere.
Eventually he opened up. He told me that he'd been drawing on the walls of his cell with a pencil, very intricate drawings. Cartoons. He'd almost covered one wall.
"But they wrote me up," Nate lamented. "I have to clean it by tomorrow." I asked Nate to bring by any new drawings and writings when he got out of jail. Three weeks later, he knocked on the back door of the youth center. He'd brought two manila folders, one containing the beginning stages of his zine.
I didn't open the other folder for a week. It was full of page after page of Arabic-like script with occasional phrases of English thrown in. It was the internal language of Nate, what I'd been trying to understand from the outside, unsuccessfully.
The pages were covered with letters of the alphabet, turning into waves, scratches, fruits of letters, falling into more waves. Vowels wearing skirts. Olives of alphabets. There were full, coherent lines amid the word salad, such as, "God swells powerfully under the many leather bonds that hold him."
There were also cartoon sketches with dialogues and individual words boxed like bubbles of conversation: "Hello, yes, yes, I sincerely apologize, that's my cue to rise." Everywhere throughout the folder, there were bees and references to bees, humming, and hives.
One sequence of words reminded me of Antonin Artaud, the French actor and playwright, who was schizophrenic: "This is it, this flavored lemonade, proca, preocre, abreast of the situation cuz my name is hon Kon Wong. I sling my shit like King Kong, sitting in the jailhouse."
Nate had also made a small, pocket-sized zine while he was in jail. At the center of it, he wrote a question that he was asking himself and all of us who were bordering him, trying to corral him toward a place where he could let go: "Just answer the fucking question bitch, what am I?"
After bringing me the packets, Nate maintained a constant rhythm of going in and out of jail, going on and off street drugs. I kept hearing rumors about his well-being. A social worker told me he was living in the bushes on the UW campus. Someone else said he'd moved to Canada. He disappeared. Months went by. I finally called the jail and found out that he was in a cell, on the docket for mental-health court.
I was curious about how mental-health court worked, and I wanted to see Nate, so I went to his hearing. The court is a glass-enclosed room, with a small attached room with benches. Nate was hunched over on the front bench, drawing on a scrap of paper. I tapped him on the shoulder; he startled, studied me, smiled. He looked like Rasputin again. I was relieved to see him, but ultra-cautious at the same time.
He said he was hungry. He talked in circles about jobs and lines and appointments: a whole week's schedule tied in knots. I met with Nate's court-appointed case manager, who seemed very patient with Nate's rant of non sequiturs about buses and rooms. Nate was a little cranky with all of us. He needed food, so I gave him a little money. Then he shifted again--he wanted to show me a labyrinth of drawings he'd done in a bound black book. He seemed like a child, lost and out of context in the formal and precise company of judges and lawyers.
When David Lee Walker was shot by a cop in Queen Anne a few months ago, I mixed Nate up with Walker in my head. I pictured Nate as the one stealing food from the store, Nate shooting off the gun, then waving the knife in the air. In my daydream, I imagined there was a street psychiatrist who showed up just in time to de-escalate Nate, talk him down from his delusional edge. The cops took him to a safe, temporary place--not jail--where he slept and got balanced again.
The next time Nate came to visit the youth center, we sat in a small room and talked. Nate sat closest to the door. He got mad whenever I spoke indirectly or made jokes. Conversations with Nate, more and more, required intensive mindfulness, like speaking about feelings in a foreign language. It got exhausting. I was careful not to look at his eyes much. He was talking to me about power and eating crow and pride, and I wasn't really following him.
"I'm lost, Nate," I interrupted him.
"I don't know if I'm violent or not," he said. "Can you tell me?"
An hour later, I saw Nate sitting in the main room of the youth center, feeding canned fruit to a two-year-old toddler. The child belonged to an 18-year-old woman. Nate was being amazingly patient and gentle.
I told one of the homeless kids in the program that I was quitting. She said, "And what about Nate? And what about all the other kids like him who feel safe around you? You can't go."
She hit a nerve, and I felt lousy about things, but I had exhausted whatever emotional capacity I had left. Somebody has undoubtedly taken my place. Maybe Nate will show up again at the youth center, five months down the line. Maybe by then there will be no one left there who remembers his story. There's been triple employee turnover in the last three years.
I keep the Bumblebee joker card as a talisman, a protection against Nate's disappearance. I don't want to see his face in the paper one day--to find out that he's in prison, stopped by a bullet, or at the bottom of the Aurora Bridge. With no one there to claim him.