Cycles

This is a blurb I wrote a couple of years ago. It is loosely based off of a man I know. I just recently recalled it's contents as I see them unfolding before me again...

John's Cycle

"Give me my fuckin' money so I can get out of here. I wanna go to California and get outta here"...

John is a twenty-six year old black male. I know him well. I have observed him spiral over the past few years. John suffers from chronic schizophrenia, paranoid type. He is plagued with auditory hallucinations that torture him almost constantly. John once described his hallucinations, "like someone making announcements over the speaker in the lunchroom". He went on to explain, "It is like having someone inside my head monitoring things and talking about it all". For whatever reason, I treasure the moments that John describes his symptoms. Those brief instances, to me, represent hope that John will some day fully accept and acknowledge his illness.

Despite his young age, John has been in and out of state and local hospitals over a dozen times since he turned eighteen. When he is not hospitalized, John is often found incarcerated at the local county jail. Like many in his situation, John is angry. He seems confused regarding those symptoms he experiences that others do not share. He appears disappointed regarding his quality of life. He is resentful of the term "schizophrenia" and all of the stigma and factors that the label entails. He wishes to be "normal" and does not want to take medications. He does not want help. He does not want to be bothered. He wants a job. He wants a car. He wants freedom.

As with many schizophrenics, John's symptoms are persistent. He reports (on occasion) that his auditory hallucinations are always present, whether he takes his psychotropic medications or not. Despite his reports, it is very evident when John takes his medications versus when he enters the cycle of non-compliance. When on medications, John is organized, playful, and really quite charming. When off of the meds, he is guarded, irritable, and eventually frightening.

In January, John was released from jail (again). He spent the previous two months between there and the state hospital. It was the day after New Year's when I first spotted him. It was cold out. It was snowing. I was recently promoted to the position of Program Manager of the homeless program at the county's largest mental health agency. It was a position I was still learning - a job that daunted me. My new program's primary objective was to engage homeless mentally ill indivduals into outpatient mental health treatment. When I first saw John, I knew he fit that category. I was aware that he was in jail only a few days before when I last checked the county register. I also knew that he was homeless. I contemplated whether or not to leave John at peace in the snow. I cared about John and felt comfortable with him. Therefore, I decided to re-engage him into treatment through my new program.

John recognized me instantly and walked away as I approached him. In all honesty- I did not blame him. After all, I was actually present when the police detained him only a few months before. To John, I serve as a representative of a system that, from his perspective, failed him. I am just one of many whom have promised to help just to later allow the "voices" to stay with him. It took me twelve days to get John to allow me to talk to him. Each day, I searched the city for him. As a young black man wearing a bright blue stocking cap and brown fur-lined coat, John stood out in the predominantly white older neighborhood. When John did let me get near, he looked at me with suspicion. As I spoke, he seemed to stare through me. At times, he cocked his head to the side as if listening to someone else - someone I could not hear. Eventually, John became cold and hungry. It was then that he came with me inside to our offices.

I worked hard not to discuss mental health symptoms or medications with John. I instead spoke of mundane topics like cars, the Superbowl, etc. John began to trust me. A few weeks later, he agreed to see a psychiatrist. He also began to take medications. We re-applied for benefits on his behalf. In a few short months, John was back to the young man that everyone adored. He gained some weight, his smiles returned, and he acquired funding and a permanent place to live.

Unfortunately, John fell back into his old pattern. He became so organized that he once again realized how different his life is from others (including myself) his own age. He became frustrated again because, despite his efforts to take his medication regularly and to engage in case management services, he still heard his voices. John once again gave up on himself and the system. He also stopped taking his medications.

John decompensated slowly. One week, he presented as a bit distractible. The next week, he was a bit more giggly than normal. Then, he pulled it together. John presented as seemingly symptom-free for a few weeks. Then, he'd slip again. Occasionally, he would get into a minor scuffle with a peer, but he was redirectable and could pull it together again.

A few weeks ago, John slipped too far. I was called into the lobby by support staff when he and a peer began to fight. John screamed at another client as I entered the room. He was angry with the other man because he thought the man made a racial slur towards him (a common auditory hallucination he experienced). I stepped in between John and the other man and attempted to re-direct him. My words went unnoticed. I blocked John's attempts to hit the man with my body noting that John never actually tried to hit me. Moments later, in accordance with my typical luck, an elevator repairman walked into the room with a cart of metal pipes. John grabbed for a pipe, but I was able to knock it out of his hand before he struck anyone with it. Another client grabbed John at that moment and bear-hugged him until he stopped struggling. Support staff called 911.

John sat on a couch. I gave him a few moments to calm down and then tried to talk with him. I explained to John that I was worried about him and that he could not be in the facility if he could not control his behavior. John became angry and said, "You make me come here. You make me take meds" (He made this comment despite the fact that he refused meds for weeks). Once again, I represented an evil reality to John. In his mind, I again symbolized schizophrenia and the mental health system.

At that time, another supervisor arrived. I took the opportunity to separate myself from the situation, as it seemed as if John was agitated by my presence. As I walked away, John used some colorful terms to refer to me. Moments later, another man walked by. For some reason, John attacked the man. The other supervisor intervened and other clients grabbed a hold of John (as staff, we are not allowed to restrain anyone in our particular facility so we are limited in our interventions). Again, John appeared to calm down. However, he quickly ran out of the dayroom towards clinicians' offices. He grabbed his ears and bent down as if trying to muffle the "voices". The other supervisor slowly began to re-approach John in an effort to help him. John panicked and began running down the hall. About half way down, John saw another man. He grabbed a fire extinguisher off of the wall and threw at the other man's head. Luckily, the extinguisher just barely grazed the man's head before it hit the floor and took a chunk out of the tile. The two men began fighting each other until the police arrived and intervened.

The police arrested John for assault. He returned to jail. In a few weeks, representatives from the state hospital will visit John and conduct a competency evaluation. He will fail the evaluation and be returned to a psych ward...

... And the cycle continues ...