By Rudabeh Shahbazi
Assistant Perspectives Editor
The day my father came to see my new apartment had to be the night a homeless man collapsed on the sidewalk below my fifth story window, where he continued his drinking rampage, violently screaming obscenities at the top of his lungs, echoing through the streets and up my building. People yelled back at him to shut up. We couldn’t sleep. Finally, we called the police.
The next day as I walked to my apartment, I was stopped by a big-eyed, skinny-legged, smelly, dirty man who asked me to fetch him some ice.
It was not the remarkably innocent, childlike voice but his shaggy lion mane that led to me vaguely identifying him as the man from the night before. I asked him if he had been the one screaming. “Uhhh… I might’ve been,” he said, in a baby voice as if confessing to his mother that he stole the last cookie. Annoyed, I told him not to repeat the incident from the night before.
“I had to get those people away from me, the bad people,” he said. “The crackheads, the junkies, the bad people, the people in my head.”
So there it was. He had schizophrenia, the most common mental disorder among the homeless around the world. Schizophrenics make up almost one-third of the homeless population in America today, according to a study by eMedicine. At any given time there are more mentally ill people on the streets than in mental hospitals or institutions, comprising a higher population than the cities of Reno or Orlando. Still, many go undiagnosed.
Schizophrenia, a disease that interferes with a person’s perception and thought processes, does not allow for the rationality required to get them off the streets. Making a home is a learned skill that many persons with schizophrenia lack. They are usually too disorganized and paranoid to seek or accept help.
Since biblical times, schizophrenics were thought to be possessed and society stigmatized and penalized the destitute. Some of the same people who were hanged in witch trials in the 1600s are still tragically misunderstood today, and they are still persecuted by those who feel uncomfortable by their presence.
Suddenly the screaming guy outside was Joseph, the sick man who wasn’t able to acquire the healthcare he needed to get his life on track – the guy who used alcohol to self-medicate.
He didn’t choose to be on the streets – the mentally ill are at a dramatically higher risk of becoming and remaining homeless when they return from healthcare facilities. They frequently cycle in and out of the healthcare system, receiving intermittent treatment with little continuity of care. Paperwork complications, substance abuse and failure to take medication are major causes of homelessness. Even when the mentally ill manage to locate health services, the homeless often lack proper identification. In an alarming number of cases, mental disease precedes homelessness.
Joseph proceeded to identify himself as “Spiderman” and negated my two suggested locations to buy ice, warning that Thor inhabited one and Batman the other.
I asked him if he had any family. This answer came quickly. He had three kids and a wife. He gazed up at the sky in intense concentration, mumbling under his breath, commanding the people in his head to look up his family’s location. Suddenly he interrupted himself and shrieked in the fashion I recognized. “Get it out!” My frightened eyes met his, and he was no older than a toddler. No wonder he was scared, desperately pleading and screaming for the voices to leave him alone at night. I would have, too, when I was four.
Faced with more than double the death rate than usual and the increased threat of violent victimization, including physical assault, robbery and rape, these socially displaced people often become progressively disempowered and traumatized. More often homeless schizophrenics are the targets of street violence, not necessarily the source.
“Where do you live, Joseph?” I asked.
“Oh, right over there,” he said, “right over where the demons live.” The demons lived on my street some nights.
Lucky for Joseph he’s not a woman. Homeless women have a 22 percent greater chance of being raped, usually multiple times. Recent studies indicate nearly one-third of homeless women in Baltimore have been raped. In San Francisco, with some women being raped as many as 17 times, they are known to bundle up in multiple layers for the only protection they can afford themselves. Rape also exposes these women to a variety of deadly diseases, including AIDS, since many of the rapists are drug addicts among whom HIV infection is common.
Murder is the most horrific cause of mortality among those homeless individuals with untreated psychiatric illnesses. Too often these murders are particularly brutal and pointless, as with one 110-pound homeless schizophrenic in Des Moines, Iowa. After being robbed, beaten and killed, he was dragged to a fountain where his lifeless body was pounced upon, shattering his bones. A mentally ill homeless woman in Washington, D.C., was raped and then suffocated when an umbrella was forced down her throat.
Indeed, the homeless world is scary.
Some 26 million people nationwide have been homeless at some time in their lives. Their histories almost always reveal a combination of lack of care and physical or sexual abuse during childhood. My experience has been that, more often than not, they are intelligent, interesting people with vivid stories to tell. But they cannot realize their potential on their own. Many would like treatment but are unable to make the immediate decision.
They need prescription drugs and proper healthcare if there is any hope for them to lead a sober and responsible life. Theoretically, they are supposed to receive medication and rehabilitation services from the federally funded community mental health centers, but in most cases this does not happen. New York remains the only U.S. city to guarantee shelter on demand to any homeless person. Once again plight is ignored in the face of economics.
That day Spiderman became human. I excused myself, struck by my first encounter with a schizophrenic.
“Bye!” he said with a kind, enthused smile. “Say hi to Ace Ventura for me!”
He was delighted to have talked to someone who didn’t live in his head.
September 18, 2003
