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Group Homes for the Mentally Ill

Compassionate Warehousing is NOT a home!



The group homes and residential care facilities in the U.S. are insults to the words home and care. They are utilitarian facilities in which groups of humans are compassionately warehoused. I have intimate experience of many of these waiting rooms for the dying. Financed by tax payers money, overseen by state governments, staffed by low-paid care-givers they exist throughout the country, some hidden away on the outskirts of town, some right in residential neighborhoods, possibly right next door to you.

I have grown to love many of the inmates and count them as my friends. In their company I have enjoyed many memorable experiences. Perhaps because it was the first group home I worked in, the Brentwood Home in Michigan stands out as I select one to write about, but also because it housed one of the most lovable and eccentric characters I’ve ever known. John Wayne resided in this six person rural house on five acres of nondescript ex-farm land, now carved up into mostly two acre lots. Much more on him later.

The two-story house featured living room, dining room, activity room, kitchen, seven bedrooms and an office for the rotating staff. The main entrance was through a large open porch which featured two hard benches, four plastic chairs and five large, water-filled plastic butt cans, which always seemed to be low on water and smoldering away.

Prior to being assigned a regular shift I was treated to a couple of daytime orientation shifts designed to introduce me to the six residents and to familiarize myself with their routines. The first thing that struck me was the almost complete lack of activity at the home. The daily regimen consisted of meals, medications, TV watching, smoking, a few minutes of chores and the highlight of the day, the morning store run. On my first day I went along with the two staff and six residents in the house van to the convenience store located two miles away. No one spoke during the ride. At the store the residents each made their purchases – three-liter bottles of cheap soda, candy bars, coffee, cigarettes, potato chips and then filed wordlessly back to their assigned seats. We were then driven an additional mile to a park where five of the six hurriedly smoked their cigarettes and inhaled their coffees and soft drinks while the sixth resident, a highly functioning 45-year-old, smartly dressed woman sat with the staff and asked questions pertaining to her bipolar diagnosis and made disparaging comments regarding her disgusting housemates.  The other five arranged themselves like shabbily-dressed sentries, standing apart, all facing in a slightly different direction so as to have at least the illusion of a private experience. With no direction from the bored-looking staff, we all quietly returned to our positions and rode home. This entire event was over in less than a half hour.

“What happens next?” asks the rookie. “That’s it til meds and lunch at noon!’ Two of the smokers hung out silently on the porch, chain-smoking and drinking coffee while non-smoker Joyce approached me to tell me her life story. I was so relieved to have something to do and an initial opening into the lives of these strangers. Joyce peppered me with questions relating to mental illness and the Catholic religion. The others had retreated to their bedrooms to wait out the morning. 

A few days later I was ready for my first regular shift. I had met and worked with all eight regular staff people and a couple of the per-diem people and was saddened to realize that the majority of them were callous lower-class functionaries who would be much more suited to warehouse work or any occupation where human contact was not paramount. The residents were viewed through the perspective of their limited insights as damaged mental defectives and were treated and spoken to in that annoying, sing-songy voice usually reserved for children and the elderly. Occasionally one of the residents would react to being treated thus and lash out physically. The injuries incurred were usually not terribly significant, but in each case the resident (patient) would be arrested, taken to the local ER, counseled by a crisis intervention specialist and either transferred to the state mental asylum for a “rest,” or in milder cases given a next day appointment with a psychiatrist who would usually increase the dosage of a medication or two. The injured staff would either quit the job or milk the paid leave of absence recovery time, take a refresher training in “How to keep out of harm’s way” and then return to the job and practice keeping out of the way.

My first revolutionary act occurred on the first overnight shift. From 7pm to 8:30pm I played pool with Nancy and Doug, I helped Dean get his laundry done and assisted the other staff with medication time. By 8:30pm all six were in their rooms and the other staff person was finishing up the day’s paperwork prior to retiring to the staff bedroom. Left alone at 9:30 or so I was faced with around nine hours of TV watching, a half-hour of paperwork and about an hour of tidying up the common areas. I spent some time touring the facility. Looking through the cupboards, refrigerator and freezer I found only one or two items that I, as a vegetarian health nut, would consider eating. Almost everything was highly processed. A few limp carrots and a package of hothouse pale pink tomatoes were the only items to accompany the four heads of iceberg lettuce scheduled for the next evening meal. Cans of chicken soup, wonder bread, endless packages of bologna, turkey loaf, salami and processed “cheese” spread. The freezer, in addition to housing plastic wrapped carcasses, contained several gallons of artificially flavored cheap ice cream and many packages of frozen popsicles and ice cream bars. So this was the life and treatment of the mentally ill in America: a sedentary, purposeless existence fueled by dead foods, psychotropic meds, sugared drinks, cigarettes and Maxwell House coffee. It was a wonder they were even alive.

And then there was the smell, that institutional smell, generated by body odor, cigarette fumes, cheap disinfectant cleaners and too many people in too small a space with the windows and doors closed and latched. There was nothing I could do about the diet right away, but I had about nine hours to deal with the smell. Glancing at the available cheap cleaning supplies I was happy to remember that prior to showing up for work I had picked up a few items at the local food co-op, one of them being a natural, lemon-scented all-purpose cleaner. I set to the task with the glee that only a fanatic knows. The kitchen, including stove and refrigerator took forever because everything was coated with grease. None of the indoor or outdoor plastic garbage containers had ever been scrubbed and there were life forms in them I could not identify. By one o’clock in the morning the smell of the place was much more to my liking as I began mopping the floor after thoroughly cleaning the bug-infested mop. By the third time through on the kitchen floor, the water in the bucket was only light grey instead of the black and dark grey of the first couple of tries. Had any of the staff ever cleaned here?

As I was preparing to tackle the other rooms, Joyce came out of her room wearing a plain cotton nightdress looking like a character out of Dickens. She wanted to talk about heaven and hell. I suggested that I would be happy to discuss the subject while I continued to work, and would she like to help? She continued talking about the afterlife for a minute and then in mid-sentence, as if my offer had just penetrated, brightened and said enthusiastically, “Yes, I can clean. I’m a good cleaner.”

And so Joyce and I cleaned. She scrubbed the woodwork and windowsills as I went through bucket after bucket until the linoleum floors glowed. Throughout the process she muttered constantly about her disgusting housemates. “They all smoke. Their clothes are dirty and torn. They take the Lord’s name in vain. None of them go to church. I don’t belong here.” By dawn’s early light our task was complete and I treated her to a cup of freshly ground, organic French roast coffee also gleaned from my food co-op purchases.

This was probably the most physical work she had done in years and the effects were quite dramatic. Although her conversation continued in the same religious vein, peppered with negative comments regarding her living situation, she was more focused, gentler, made better eye contact and took notice of the other person in the conversation, asking me about my life, my family, my thoughts. The “normal” person inside the  “madness” had been contacted through non-institutional interactions with the real world.

The others slowly drifted in looking for coffee and access to the world of smoking. Not one of them commented on or seemed to notice that there was a different smell in the air.

 

John Wayne

The biggest, baddest mental patient in the Wild West, John Wayne McIntosh stood out from his housemates in many ways. He was the tallest at 6’3”. He was the fattest at 360 pounds and growing. He was Schizophrenic, angry, delusional and had a tendency to attack when riled up.  I gave him a wide berth for my first month, always aware of his physical location and his rapidly flucuating mental and emotional states. I was fascinated by him. He was dirty, fat, slovenly and dressed in a manner that suggested the beginnings of a Halloween costume. In warm weather or cold he wore stained grey shorts over stained grey sweat pants, a white muscle shirt and a torn grey sweater. On his feet he wore stained sweat socks and Birkenstock sandals. In hot weather he did without the sweat pants and sweater and sometimes without the muscle shirt which presented a sight not for the timid. Getting him to bathe and change clothing usually required both staff, the residential manager, numerous threats and a reward of a 3-liter bottle of diet root beer. He had lucid moments in which a reality-based conversation could occur. My wife had a profound effect on him and during her visits to the group home John would sit like a large puppy dog and discuss cars, TV programs and state history and when he would begin to slide into “crazy talk land,” she would instantly bring him back with a gentle reminder that she wasn’t interested in that kind of talk. Their interactions would only last a few minutes, usually followed by John retiring to his room. I oftened wondered if his retreat was for the purpose of masturbation or if it was simply that his effort to be normal for 15 minutes had exhausted him.

John’s sexual orientation remains a question mark, for although he boasted of having sex three times with three different women, there was hardly a day that would pass without him fondly recalling a beautiful, muscled school-mate who had a large penis and blonde pubic hair. No amount of probing could get John to give any details of his early life. He would speak about his truncated military career only by saying that after a month and a half in Army basic training they asked him to leave. Shortly after returning from army life his behaviors rapidly became more bizarre until he was so out of control that the police escorted him into the mental “health” system. He was promptly assigned a ward in the state asylum. Shortly thereafter his brother was also rounded up and assigned a different ward in the same asylum. For years they existed a floor away, coming together only rarely, sitting together but facing away. After a dozen years the institutions began a slow transition to smaller facilities. This move was made in the hopes that a smaller more homelike environment would facilitate some sort of healing and provide opportunities for reintegration into our normal world.

For John that promise was just a pipe dream. He was damaged to such an extent that only a miracle could open the way back to our world. I believe in miracles. I’ve experienced miracles. I tried to conjure up a miracle for John but was not able to do it. So this will not be a success story, but it will be a story of love, and perhaps that is the real miracle. Somehow I fell in love with him.

After months of involvement in this group home I rose to the prominent position of manager of several group homes and began instituting various programs to help integrate residents into the surrounding community. For some it involved work programs, courses in life skills such as basic computer skills and exercise and sports programs. There were no programs for someone like John. He had no interest in aspiring to normal. He was the professional mental patient and was perfecting his craft. I never gave up on him however and managed to find one way to justify two hours of my time each week to his care.  That care was in the form of a two hour outing away from the institution. I wrote about it at the time and will repeat it here. Most of it is in the form a play because I found the best way to present John was by using his own special language.

 

TRAVELS WITH JOHN

John is one of my “clients.” The word client is the sanctioned label for the unfortunate people who are in “treatment” by our society. Other labels include patient, consumer, and for those living in group homes, resident. John refers to himself as a pup. He seldom refers to himself as a man, although he is rapidly approaching 50 years of age.

John was the youngest of eight children parented by a family of mentally ill people. The mother and grandmother were diagnosed as Schizophrenic. One of John’s “normal” sisters who visited him once a year provided me with a family history. She described her mother as a very concerned parent who made sure that all her kids were clean and well dressed. The family was poor, but she made sure they were well fed. She dealt with her philandering husband as best she could, sheltering them from his verbal and physical assaults. All would be well for months at a time and then she would have an episode. The eight children would be tucked in one night by a calm, loving mother and awake in the pre-dawn to a half-naked mad woman screaming obscenities at them. These episodes would last anywhere from a few hours to a few weeks, sometimes culminating with a visit from the police and a trip to the mental asylum. During her times of incarceration the family would be parented by the two oldest girls. John’s grandmother lived with them for a short time when he was only an infant. She was mad as a hatter and terribly obese. Hauled away to the mental asylum she was subjected to the “treatment” of the day, mostly electro-shock treatments and isolation. She ended her life by setting herself on fire. The father was described as a philandering alcoholic. He was never treated, but the general consensus was that he was bipolar in addition to being alcoholic. John’s brother Arthur is also in treatment with a diagnosis of paranoid Schizophrenia. Both brothers live in group homes in their childhood town.

John loves to eat. “I thought if it tasted good, it was good for me.” John’s philosophy has produced a 6’4”, 370 pound man child. His life is very small, consisting of meals, snacks, meds and doctor’s appointments. Twice a month he is taken to the local hospital for blood work to monitor the levels of the toxic chemicals coursing through his bloodstream. He actually looks forward to the trips to hospital – “An outing is an outing.”

One of the delights of my job is my almost weekly outings with John. I am 5’6” and weigh 140. John and I make quite a couple. John is now too large to be transported in regular cars. On our outings he rides in my pick-up truck which is strong enough to support his bulk, however if his weight gain persists he will soon be unable to wrap the seat belt around him. I pick him up at his group home Usually he waits for me in the smoke shack located a few feet from the front door. John never seems to inhale the smoke, but methodically smokes each one down to the filter. Left to his own devices he would smoke close to four packs a day. One of the primary reasons for my weekly visits is to provide a two hour break from this habit and an opportunity for exercise.

We are moving into the cold part of the year and John is dressed in his standard winter dress which consists of stained gray shorts over torn gray sweatpants. This is topped off by a brown crewneck sweater worn over a t-shirt. On his feet are dirty white socks and heavy-duty brown sandals. When the really cold weather hits he will opt to remain indoors rather than choose more appropriate clothing. His summer outfit is pretty near the same, with the exclusion of socks, sweater and sweatpants. He seems to be completely accepting of his grossly obese body, and during the summer will sun himself in the front yard wearing only a pair of shorts. This sight is not for the faint of heart.

 

A PLAY OF WORDS

The Players:

David – 60 year old mental health worker, short, well-dressed, athletic. An easy manner, light-hearted, but intense.

John: 49 year old Schizophrenic, tall, obese, shabbily dressed, bad teeth, poor hygiene. Smokes incessantly, bathes infrequently. Bright eyes, beautiful face.

John: sitting in the group home’s smoke shack. David arrives in his pickup truck. “Hi Dave.” John’s greeting is animated and enthusiastic.

David: John, my friend, how the hell are you?

John: Alright. John laughs, and then looks down at his knees. I took a shower.

David: Good… you look marvelous.

John: Thanks… Thirty seven billion dollars for every man, woman and child in Volusia County!

David: Sounds good…. When do I get my check?

John: (grins, then frowns and continues smoking) Everyone else gets married, why shouldn’t I? The question is not a question, just one of John’s many oft-repeated phrases.

David: Are you ready to go?

John: Where we going? Camden? When John speaks of Camden it is as if a small child is mentioning his favorite toy.

David: Sounds good to me.

John: Just let me finish my cigarette. Stares at David. You look tall and straight like an oak. John methodically finishes the cigarette and then tosses the smoldering filter into the over-filled butt can. Can I buy a soda, diet, 3-liter bottle… only one?

David: Opening the passenger door. Let’s not worry about food or drink. Let’s just enjoy the trip. David helps John fasten his seat belt and prepares to back out of the driveway.

John: SEAT BELT! John never allows any of his drivers to forget the fastening of their own seat belts.

David: Caught me again, didn’t you?

John: What?

They drive in silence for a few minutes, with John staring straight ahead. He always seems to be initially fearful of driving and will not allow any of his drivers to speed or tailgate. Once he becomes convinced that the driver is not about to violate any safety rules, he relaxes.

John: APB on PP. This is one of John’s pet phrases. It translates as All Points Bulletin on Pamela Peters. The woman in question is THE girl from John’s past who made the greatest impression on him. In his fantasy life he makes plans for their wedding. It is unclear whether he and Pamela were ever lovers. If so, she would be one of the three women with whom he claims to have had sexual relations. John claims to have had sex with three women, one time each. The wedding will be in the Guinness Book of World Records. I lost my brides by courting them too slow. Why shouldn’t I get married? Everyone else does? Cow town people can be mighty uppity.

John drones on in this manner for about five minutes while David listens with amused patience, awaiting a new phrase. None comes.

David: Hey John, I’m getting lonely over here. Let’s have a conversation.

John: Huh? John seems genuinely surprised to discover that there is another human being in the vicinity.

David: Talk to me…. Tell me something beautiful or wonderful or funny.

John: Why did God pick me to persecute and follow around?

David: That’s not beautiful OR funny, and besides I’m sure God didn’t single you out for persecution.

John: What?

David: Why do you think God is picking on you?

John: Beats me. What’s your gimmick?

David: I don’t have a gimmick. I’m here to help you. How am I doing so far?

John: Alright I guess.

David: John, what’s going on in your head? What’s it like in there?

John: I’m going to have a car someday, not to drive, but to have someone drive me around. It’s going to be blue – dark blue on the outside and light blue on the inside, with large fuzz balls hanging all over the inside. When the police stop me, it will be a good looking cop and he’ll ask who I am and I’ll give him one of a collection of nude photos and he’ll offer me a hundred dollars and then I’ll be on my way.

David: Unbelievable. Where the hell did that come from? There is no animosity in David’s remark… just genuine amazement.

John: Don’t swear! Although John can be quite crude and insulting to women and minorities, he NEVER uses profanity and doesn’t like to hear it from others.

David: John, you are truly amazing.

John: Smiling with gratitude. Thanks!

The town of Camden is reached. David parks the truck on the outskirts of town against John’s wish to be deposited in front of a store. This is David’s way of getting John to exercise. They leave the truck and begin the quarter mile walk to the center of town. Along the way John greets each and every person he meets. Among his greetings are: Happy Atomic Bomb, Howdy everybody, Hello, I’m straight out of the asylum, Hello ladies. Occasionally John will spot someone who is open and available, and to that person John will make the most unusual comments. The latest one was directed to a rather worried looking plain faced young woman. “Did they put a lot of pressure on you? When the woman responded and asked for clarification, John laughed shyly and stated that he understood how it was and that she should have a real nice day.

Following any encounter like that John seems to immediately forget the encounter.

As usual David has chosen a route through town that avoids all junk food places. John seems terrified to be left behind and obediently follows David through the town, down to the docks where they take a cigarette break, and then up through a small park and back to the center of town. By this time John is sweating profusely, huffing and puffing and threatening.

John: I’m telling. I’m going to sue!

David: Just a little bit further and we’ll be to the truck. You can make it.

During the remainder of the walk John is silent and focused on staying upright and alive. When they reach the truck he is clearly tuckered out. They ride in silence for a few minutes.

David: How do you feel?
John: Pretty good.

David: Can I get you to promise to do some exercise like this every day and cut down on your eating.

John: Alright! John always promises to change his ways. He NEVER does.

David: John!

John: John is snapped out of his inner world by the sharpness of David’s tone. What?

David: I love you man.

John: He looks hard and long at his traveling companion, and then laughs..Sirhan Sirhan, Lee Harvey Oswald, Kennedy, hoax, that’s the gimmick. It’s all a hoax.

 

It is always difficult dropping John off at the group home. The home is too small for this giant of mine. I often fantasize about bringing him home and setting him up with a little shack in the woods. The staff people are very good, but are getting burned out by the constant bad behaviors, and none of them have been able to enter and enjoy John’s inner world as I have.

For the remainder of the week he will spend his time efforting to ingest as much food, soda and cigarettes as he can. He will be taken shopping twice. He will bathe and change his clothing twice. He will have an outing with his case worker. He will go to the hospital for bloodwork, and if all goes well, one of the staff will manage to get him out for lunch at McDonalds or a shopping trip to Walmart.

In my absence John will inhale 560 cigarettes, 21 liters of diet soda and an enormous amount of junk food as he moves ever so steadily to his encounter with the grim reaper.

If I had my way I would, instead of kidnapping him for only two hours per week, take him out of his present situation and ever so gently place him in a truly therapeutic environment where his addictions could be dealt with and where he could be surrounded by love, music, fresh air, high energy foods and people who find him as fascinating and wonderful as I do.

 

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