By Graham Danzer
Seven months ago, Gina wrung her wrists and blinked her eyes heavily in the sunlight as she walked out the front gate of Pedora State Hospital. She had been psychiatrically hospitalized for 5 years, wearing a white gown, told when to eat, sleep and shower. She received virtually no human contact that wasn’t from doctors or other hospital staff. The other hospital residents being very out of touch with reality, thereby not always easy to forge relationships with. Gina was lonely, and truly hated the hospital, wanting desperately to get out.
Thanks to recent de-institutionalization legislation that required patients under long term involuntary hospitalization to be re-evaluated and granted a hearing every so often, Gina won her freedom. Despite being deaf except for hearing a multitude of voices, including demons who she believed took control of her spirit, never having had a job, and a propensity for methamphetamine abuse, Gina was determined according to state guidelines to be capable of self-government, at least in so far as no longer having met criteria for being gravely disabled. Gravely disabled being defined as one who is unable to provide food, clothing and / or shelter for themselves (http://www.gatewaypsychiatric.com/SFGH%20BEEC%20Course%20Material/grave_disability.htm).
The criteria for gravely disabled had been looser and easier to meet in the past, leading to significant numbers of the mentally ill being institutionalized in hospitals and other long term care facilities (http://en.wikipedia.org/wiki/Deinstitutionalization). In the 18th century and in the beginning of the 19th century, these overcrowded, understaffed facilities were notorious for abuse of the clients, under trained staff, and warehousing the poor. As these atrocities were exposed, progressive movements toward community based treatment have been often celebrated on the notion of freedom. More recent changes in the legislation came about allegedly on behalf of such legal premises’ as a client being allowed to live in a manner that involves the least restrictive alternative possible. The idea being in sync with the constitutional notion of individual freedom.
Seven months after winning her freedom, Gina screams unintelligibly at the walls around her after having been not often compliant with her psychiatric medications, her clothes caked in dirt, a nauseating smell emanating from her pores, and her written efforts at a conversation being saturated with fears of persecution, and her belief in having other personalities. The before and after hospitalization scenario begs not a question, but a conclusion to the notion of freedom. Freedom from undue restriction established, and then freedom to what? In Gina’s case, she has been granted freedom to deteriorate, to neglect her self-care, and to fall far out of touch with reality. Unclear whether such is due to organic psychiatric disability or her return to methamphetamine abuse. Gina has albeit made attempts to connect to ongoing care, largely the system’s cited criteria for why she has shown legally capable of self-government. Essentially that if she can present for services, she is demonstrating a minimum level of living competency so as to make involuntary hospitalization an unnecessary infringement on her freedom.
Unfortunately she has yet another issue in regards to her presenting for services, that being that she becomes obsessed with female counselors, case managers and the like, who can communicate with her through American Sign Language, and has shown an inability to refrain from stalking them. The simple solution thereby to pair her up with a male worker who knows ASL. The predicament being that male psychiatric social worker’s who know ASL are virtually unheard of. Likewise, Gina has been banned from every hearing-impaired capable agency in her locality for her stalking behavior. Unable to link to health care, mental health, or social service providers, Gina has cycled through short term acute hospitalizations and jail terms via behavioral health court, usually for stealing or disorderly conduct. Each time, she is released when she has shown a minimal ability to provide care for herself and a judge or otherwise authority has then ordered her release. The typical scenario is that people in Gina’s position do not want to be held in custody or otherwise be hospitalized given the infringement on their day-to-day life. Begging the question, at what point can Gina truly make decisions in her best interest, regardless of overcrowding and budget minded local officials? Pressed for public dollars, and hospitalizing Gina being expensive often holding high priority.
Nevertheless, when the Gina’s are institutionalized, they are fed, clothed, showered, granted a bed to sleep in and some level of medical, medication and other psychiatric treatment. Such care vastly improves their level of functioning, especially when they are held in an environment in which their belongings are often searched and surveillance is around the clock, making ongoing substance abuse difficult. When the Ginas of the inpatient system receive care abstain mostly or completely from substance use and improve to the point of being able to have a conversation without pulling out their hair or screaming at an indiscernible something, they are judged fit to self care and granted their freedom. Freedom from undue governmental restriction, freedom to deteriorate until they return to the system disheveled and psychotic, to start the cycle all over again.
During one of her regular multi-thousand dollar costing trips to emergency services, Gina was asked about the hospital. She responded adamantly “I don’t want to go back!” When asked about how she planned to take care of herself and her newfound freedom, she stated with conviction “I need to see Jenna.” Who is Jenna? Jenna is a counselor who practices ASL, and worked with Gina at a treatment center. Upon telephoning this treatment center, a message was relayed to a representative on Gina’s behalf that if Gina called or came anywhere near the treatment center or Jenna, the police would be 911’d.
Jenna having been acutely traumatized by Gina’s following her home from work, a shrine having been found in Gina’s litter compiled low-income housing space, the walls plastered with pictures of Jenna and tissue paper that Jenna blew her nose on framed on Jenna’s bed stand. All in showing of Gina’s paid homage to Jenna, among other symptoms of a dangerous obsession. Gina is grateful for freedom from undue infringement on her liberty. Jenna, a 23 year old self-proclaimed small town girl from the mountains in Montana and recent bachelor’s of social work graduate, makes her way to her car after work on that same day that Gina sat with a case worker asking Gina how she planned to take care of herself. Jenna sweating feverishly from symptoms of Post Traumatic Stress Disorder and looking wide eyed over her shoulder for any signs of being followed. Once she gets home, she locks all doors and windows and is scared to leave her house, jumping in terror when the phone rings. She has in a way institutionalized herself. If only she were as free as Gina.
Note: Graham Danzer is a writer who lives in San Francisco. Mr. Danzer also holds a master’s degree in Social Work. He is our new staff writer.
Also see Tara’s plight: A bitter twist