Friday, January 27, 2012

Finger on the Pulse

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I resolve periodically to never again read the “comments” section of anything posted on the internet. Too much exposure to the unbridled id of our culture can, after all, make it hard to get up and go to work in the morning.

And then I slip for some reason, and find myself scrolling through the 172 comments on some political post on Facebook. And I resolve all over again to resist that temptation.

There is the well-worn story about six men in a dark room with an elephant, each asked to describe the animal from the part he touches in his hands. Political commentary on the internet, more than anything else in life, makes me wonder what part of the elephant folks are touching. For my part, it’s hard to imagine that the underclass, the aged, and the disabled that I see every day are the same underclass, aged and disabled that generate such contempt from certain vociferous people on the right end of our political spectrum. Because in America, the “freeloaders” so hated by those who would promote not just the survival but in fact the unencumbered freedom of the fittest among us, are mostly just these--the underclass, the aged, and the disabled. From what I read, the moral narrative goes something like “Those people are lazy, short-sighted, or drug-addicted, and I shouldn’t have to pull their weight.”

Yes, there are people in America who are lazy, short-sighted, or drug-addicted, and who leech off a society to which they would better contribute. But where in the dark room does one sit and with what fingers does one feel the elephant in order to think most of the folks along the financial margins are there through a process of their own election? It baffles me. I guess it’s because the thing I have elected in life is treating the mentally ill (and occasionally addicted) poor that my sense of proportion is so different. I am shoulder-to-shoulder every day with exactly this part of our citizenry, and after twenty years I harbor no hatred of them nor of the system that tries to provide for their care. And when they are the object of contempt, I not only take a contrary view, but I’m truly confused. Just as Ronald Reagan’s “welfare queen” was an apocryphal anecdote told over and over until I guess he actually believed it himself, it seems to me that this “culture of freeloading” so many are fed up with is more myth than reality. Yes, our Social Security and Medicare systems are a demographic time bomb in need of reform if they are going to survive. But a plague of miscreants? I am too intimately acquainted with the true causes of disability to easily buy any story that the majority of folks in our social safety net are just too willfully lazy or self-destructive to get themselves out.

Here’s the reality I know: One of my patients with schizophrenia, I’ll call him William, told me yesterday that he’d had a really good Christmas. About a year ago he got out of the state mental hospital on conditional release after several months’ detention, after getting arrested for some illegal behavior while in a grossly psychotic state of mind. What brought on this episode? Maybe he had stopped his meds, or maybe not. Any number of individuals with schizophrenia have a major break despite taking their meds, and despite the efforts of their doctors to catch the first signs of the episode in time to ward it off. When he improved again and came to live in a residential program, he tried for months to contact his girlfriend of 15 years, who is also someone with chronic mental illness who lives most of the time in one supervised housing program or another. When he first tried to locate her, after falling out of contact for a year, he found that she had moved, and no one at her residential program could tell him where. Finally, Christmas came, and he tried calling her mother’s house on Christmas Eve. Ordinarily, her mother doesn’t answer the phone if it’s from a number she doesn’t recognize, but on Christmas Eve his girlfriend was there visiting and picked up the phone. Since he’s found his girlfriend again, he’s been taking three buses every Saturday to the other side of the county so he can meet her at a McDonald’s for lunch.

Certainly, William is by any standard a person who lives on the margins of our society, and depends on Social Security and expensive psychiatric interventions to keep hide and hair together. But largely, his lot in life is not one he chose. One percent of every population in every culture on the planet will develop schizophrenia, so truly, there but for the grace of God go you, my friend, or your children, or your children’s children. And somehow, I think William’s commitment to his girlfriend, although they live without the benefit of marriage (since marriage would bring them an immediate decrease in benefits), is a bit more tried and true than the commitment Newt Gingrich has demonstrated to any of his three wives.

William’s story is not just a heart-warming anecdote I pull out, as antidote to the apocryphal Reagan story about his “welfare queen.” William is typical of the disabled folks I treat. Just like he’s typical, more or less, of the patients I see who have less profound mental illness, but still don’t work because of another condition, like their severe obstructive lung disease or arthritic knees or advanced age or frequent dialysis. Our agency runs a vocational program for anyone who’s willing and able-bodied and financially eligible, and I have seen dozens of markedly impaired individuals make their way gradually off disability and into the job market, with sufficient time, assistance, coaching, and encouragement. And enough of my attention, which, as it turns out, is costly. Rehabilitation of the mentally ill is expensive.

It seems as though there ought to be some lesson to be taken from the fact that I, who walk daily with the folks who are carried in our social safety net, do not harbor the contempt for them that one finds on the airwaves of talk radio and in the comment sections of online media. I pay taxes, too. And trust me, it’s not a matter of a knowing wink between me and the folks who enable me to keep my cushy gig sucking the teat of government largess. There’s got to be an easier bureaucratic job than the one I have battling schizophrenia with funding through Medicare and Medicaid. Schizophrenia is mostly the shits, and navigating Medicare and Medicaid is an exquisite torture for any soul.

I do not consider myself a Christian, but I definitely read once that the King shall answer and say to them, “Truly I say to you, inasmuch as you have done it to one of the least of these my brothers, you have done it to me.” Seems a little at odds with the narrative that the least among us are the worst among us, but then I guess I just don’t really get Christianity. At least not right-of-center Christianity.

So there you have it-—my part of the elephant. The lesson I take from the life I’ve seen is that it is important to speak out against the caricature that the poor and disabled are shiftless, and that caring for them is an erosion of moral justice. If your part of the elephant is truly different, I'm all ears. But Reagan’s “welfare queen” was always just a mythical creature, and I, for my part, will both model and advocate for charity and compassion in place of meanness and self-concern, for William, and for all of the Williams I know (which number in the thousands) probably until my last day on Earth. (After which, from what I hear, I’m off to burn in hell. But there's always that "what have you done to the least of these, my brothers" card...)