the harrowing

pilgrims unbowed with eyes sewn shut

I am the wolf that became the lamb.

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If I close my eyes and spin up images to explore my last reading of Dante it’s never the inferno when I touch down but purgatory. The endless uphill slog ringed with fire on all sides. The fruit dangling just out of reach. The greedy shoved facedown in black muck. The slothful forced to run in endless circles. The pilgrims with boulders on their backs. The lost travelers kneeling before the statues of the sufferers. The unbowed with their eyes sewn shut.

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I haven’t read Dante in twenty years and by now his purgatorio and my own yellow spiral in the Jack Fell stories have merged and overlapped into a nightmare space that looks more like the real world by the day.

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I’ve been a high functioning bipolar addict skating the slippery razor’s edge of willful and careless danger to self for as long as I can remember. I’ve worked as a journalist and english professor and between the gaps dozens of jobs in the underbelly of the American mental healthcare system and yes the word system there is so oxymoronic it has no meaning at all. I’ve been a cog and counselor at group homes and halfway houses in Eugene and Olympia. Homeless shelters in Boulder and Denver and Sacramento. Needle exchange in Oakland. Teen runaway shelters and suicide hotline in Santa Barbara. Eleven years on the psych ward in Memphis. I’ve had a dozen friends perish by their own hand and I’ve been one of the lost pilgrims on the other side of the med window, too. I have tried like hell to keep my eyes open. To not look back.

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I went to work on the psych ward because I believed I might stop myself from slipping into crazy by going to work with true crazy.

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For decades we have watched droning news stories about the coming mental health crisis that is hopelessly and irrevocably entwined with the ever worsening homeless problem. The mental health crisis is not on the horizon, it’s a wall of fire on all sides. The homeless situation has gone from problem to apocalyptic nightmare. According to murky census numbers upward of a hundred thousand homeless American citizens are living on the streets in California. Maybe two hundred. Nobody can say for sure because nobody cares. The homeless sleep with one eye open in doorways and behind dumpsters. The homeless camp on sidewalks in tents and cardboard shacks. The homeless hunker beneath flaps of tarpaulin. The homeless squat in abandoned and half constructed buildings. The homeless live in vehicles with dead batteries and expired tags.

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The progressive left of which I am by all definitions a voice is the only demographic who gives a fuck and also the subset of society that chooses to make itself feel better somehow by dehumanizing the homeless with the meaningless and generic newspeak double plus slur unhoused. I have said this before and will keep saying it until the nonsense stops but if you use the word unhoused I’m sorry but you are making things worse and you know nothing about the real world troubles on the street.

The homeless universe aka skid row in Los Angeles comprises fifty-four city blocks. The first time you step out of the downtown LA train station and start walking you may as well be in Bangladesh. Rough head counts say there are up to twelve thousand humans sleeping rough within those 54 blocks.

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This is not urban myth.

There is endless video drone footage on the internet if you care to look for it. And the row will keep growing. Once upon a time it was only ten or twenty blocks. Eventually it will be eighty, then a hundred. Meanwhile another seven or eight thousand homeless thrash and dream uneasy on the streets of downtown San Francisco.

Again these are government census numbers.

It’s likely there are more like twenty thousand americans falling through the cracks from the sunset to the tenderloin and who really knows what goes down in the urban outback that is Golden Gate Park. However you slice it the once posh tourist destination and setting of countless beloved films is now a scene out of a low budget zombie flick reboot.

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If you have not yet seen footage of the homeless dead walking stumbling dying on their feet in Kensington PA, that is the endgame of homelessness multiplied by addiction and untreated psychosis compounded by first world chaos and disarray and the failure of human services and a sneak peek at what’s coming to every major city in every state red or blue if we fail to get a handle on this.

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Drive across the country along I-40 and look long and hard at the sprawl of urban human fuckery we have inflicted on ourselves in the interest of making the world friendly to automobiles. The infrastructure is crumbling everywhere around us, beneath us. The slow fast slow free fall into decay and disrepair is so omnipresent in the roads and sewage systems and exposed power lines we don’t even see it anymore. There’s a common notion or rule of thumb in the hard sciences that says simple complex systems are the most prone to failure, to the inevitable crash of system.

Every major city in this country is a hair trigger from the crushing snowball or butterfly effect of your nightmares and once it starts the system crash to black will not take much.

On the psych unit during the early days of covid and George Floyd, the early months of paranoia, the days of rumors of martial law swirling and apocalyptic runs on toilet paper and bottled water, the psych ward census first exploded then leveled off just as 911 calls in general dropped. The ER doctors and nurses I spoke to were uneasy edgy and overwhelmed already and everyone kept waiting for covid to explode in the homeless and psych populations because most of them were unmasked and had irregular access to soap and running water and tended to be oblivious to the ever shifting hand and fresh produce washing protocols.

The psych ward numbers remained high but steady at an ominous hum for half the summer then surged again and it was impossible to relax either way because a third of our active staff were always under quarantine.

The suicidal ideation and unease among us was electric, it was visible in the air.

On the unit we told each other just stay cool.

We told ourselves that as long as the state keeps the power grid up and folks still have wi-fi and air conditioning, we could ride it out.

We told ourselves that so long as everybody who doesn’t give a fuck about black white or blue lives and which deaths matter more than others, if they just stay inside and six feet apart and the protesters stay relatively civil, the worst of it would pass.

If the cops didn’t flinch and go Kent State on the mob, if they didn’t set everything on fire this too would pass.

Mind you these were the musings of both white and black staff in the deep south who never hold their breath waiting for the next George Floyd because there is always another George Floyd.

There would never not be another George Floyd.

If big brother doesn’t do anything stupid like send troops into the streets, this covid shit would pass.

But one of my crew would always point out that wi-fi and air conditioning are worthless if the ninety-nine percent can’t pay their light bills. The consensus among staff and patients alike was the government needed to keep those stim checks coming or things would get ugly.

The mirrorbots are already inducing psychosis. If all the jobs disappear then what.

If you accept those official homeless census numbers you might also consider the fact that those are hundreds of thousands of untreated psych patients.

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Everyone with a heart agrees the situation is untenable.

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If you surrender the urban center of a city to the homeless, the rest of the city will seal it off like a tumor, like a foreign object lodged under your skin. It may be blithely ignored for months or years or decades.

But eventually the tumor metastasizes. It grows. The foreign object must be extracted to avoid infection.

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If you search the phrase bodycam footage you will find thousands upon thousands of police encounters with American citizens suffering some form of psychotic break in every corner of the country. These mental health incidents are always the same and always either just another loop or the start of the inevitable slide toward either homelessness or lockup. Zoom out from the drone and bodycam footage and the questions that arise are simple.

Where will we put these people.

What will we do with them when we get them inside.

And who will take care of them.

Because at least two thirds of them will need to be medicated, possibly against their will. Some of them will need medical grade detox. And a great many of them have been living outside for so long they have gone feral.

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The rule of thumb in the first responder psych underbelly says two thirds of the homeless are either mentally ill or addicted to drugs and alcohol or both. In my experience that number is closer to eighty percent but my purpose here is not to split statistical hairs or deconstruct census numbers. Nor am I here to spin a whistleblower account of the deeply dysfunctional hellscape that is our psychiatric healthcare system.

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My purpose is to describe what happens when you round up the homeless to force them inside and lock the doors.

I didn’t plan it this way but I spent the strangest, most divisive most surreal decade in recent history working on an involuntary psych unit. From 2011 to the end of covid lockdown I watched the American machine unravel from the inside, from the underbelly of the inside. If you stand in the center of the psychiatric vortex watching the patients shuffle around in circles muttering to themselves and arguing with the internal voices, gnashing their teeth and throwing punches at shadows, you might imagine this is surely one of the rings of hell. It may also occur to you that in centuries and aeons past some of them would be regarded as saints or prophets. But this is today and this is America and these people have fallen through the cracks to live below the cracks. They are the lowest of the low, the loveless and the damned. They have fallen past the cracks to ghost the bottom below bottom and there is nowhere farther to fall.

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But what happens when you wrangle the homeless into a lockdown space.

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What does it mean to involuntarily commit hundreds of thousands potentially millions of humans to the care of the state.

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The nutshell answer is that a considerable amount of violence happens.

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Because there is never ever enough staff to physically and emotionally be present for that many patients.

Because every psych hospital in the game is run by capitalists just like every prison and those shitty rubber mats are just numbers to them.

Because what staff does show up every night is generally sleep deprived undervalued underpaid and stressed to the point of breaking.

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Because mingling freely among the psych and homeless populations are endless numbers of grifters criminals and predators.

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Because now the American right has seen fit to put in power a massively corrupt and incompetent administration obsessed not with gathering the homeless to give them shelter nor the giving of aid and relief to the uninsured mentally ill but to the chaotic and terror inducing roundup of the browns who do the jobs the rest of us don’t want and shipping them to a gulag in the everglades and then selling t-shirts to promote it.

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Because every time a doctor writes an order for medication, the involuntary patient has no recourse. The involuntary don’t have the option to refuse. If the order is written, psych ward staff are legally obligated to give that medication by whatever means necessary.

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Over those eleven years my lowball estimate is I participated in at least seven hundred physical holds, restraints, and takedowns. That total is likely nearer to a thousand but such a number sounds crazy and those additional three or four hundred were inconsequential or faded brief passing dustups that left no mark, no harm. Nothing to report but if you put hands on a patient or certainly if you go to the floor with one of them on camera there is paperwork involved. The one average year that I kept a count was 2017 and I’d done that paperwork more than a hundred times my the end of July.

In eleven years I personally dragged hundreds of patients to the seclusion room and shoved them inside. A cinderblock cell with a rubber mattress on heavy wood frame. Locked the steel door for their safety and mine then took a few long breaths and when they commenced to smashing their head against cinderblock, gathered backup to go in and put them in five point restraints.

These incidents are called therapeutic holds by hospital admin types as if it were a warm hug rather than a fight to the death.

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The average schizophrenic in a psychotic state is not violent.

They are paranoid and volatile to be sure but rarely attack first. But when surrounded by hospital staff and a hypodermic needle meant to chemically restrain, they will fight as if life and death are indeed on the table. And just as we train new staff to grasp that the snakes and giant birds and tall white aliens that patient X claims to see are real in their mind’s eye and ought to be treated as such, the idea that kill or be killed had taken hold in that patient’s mind was likewise just as real. But they are at least fighting psych staff who are trained not to hurt them. It should be noted too that the average psych tech makes $17 an hour. These are people answering a calling, people willing to do a job nobody else wants, and people who for whatever reason can’t or won’t find an easier, safer job elsewhere.

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I cut down three hanging attempts over the years. Two of them made it. I saw and did things in the name of protecting one patient from the others that compromised me. I rebooted my moral compass more times than I can measure. The slow build of cumulative ptsd is a funny thing. For years I regarded it like cholesterol or my credit score, another phantom ailment. I had my share of knocks over eleven years. Cracked and bruised ribs. Dislocated fingers. Fractured elbow. Torn left meniscus. Two concussions.

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I was knocked unconscious not once but twice while on the clock. It sounds absurd now to say that out loud. By then I had a touch of Stockholm syndrome or similar and had come to think this level of trauma and workplace violence was normal. My first year on the job we had one patient kill his roommate in between fifteen minute checks.

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Dude wouldn’t stop touching me, he said.

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And look. I was one of the lucky ones. I had far better reflexes than most of my fellow staff. I had been in real world street fights and bar brawls. I’d learned up close why you keep your back to a wall in strange settings. I had been jumped in the shower once and fought three assholes naked wet outnumbered slipsliding around a locker room and let’s just say that such a scene will wake you up and explain why your pop is always on about keeping your nut on a swivel. I had spent a dozen nights in various drunk tanks. I had stepped between two knife wielding hobos in the snow while on the clock at a homeless shelter in Boulder. I had been mugged a time or two and one of those times was tripping so confidently so wildly on some Owsley level tabs I disarmed the confused crackhead coming at me with an icepick like I was his prom date snatching the ugly corsage out of his ragged fist. I learned early being the smallest kid in every situation ever that when it’s on it’s on, the talking is done and if you want to win or at the very least walk away under your own power you fight dirty as hell.

I had learned early on there is no such thing as fighting like a gentleman.

I had also played soccer and baseball since I could walk. I knew how to run the floor and see the flow unfolding before the opposition did and to hit the open man before he knows he’s open. I knew how to run a triangle offense and a zone defense. I understood the give and go. I knew how to spread the floor. I knew how and when to hit the cutoff man and the difference it makes when you sail that throw into the backstop.

I knew how to take a bigger dude down at a full sprint with a smooth as butter yet vicious as butterfly knife slide tackle and pop back up like sonic the hedgehog come to life. I used that slide tackle a dozen times on those long hallways and it was never not a lifesaver.

I knew how to turn a double play and how to break one up.

The point being that the best crew to run the psych ward floor with were always the guys and girls who played some sort of hardcore organized sport in high school or college under the guidance of a no nonsense coach. I was a center midfielder and a second baseman in high school and I remember looking around at my crew one night and realizing I had two point guards, two quarterbacks and a centerfielder flanked by a decathlon runner and a middle linebacker, that it surely meant something or other and made a note of it.

The best staff were the ones who understood the triangle offense and saw the floor as a giant field or chessboard.

The best staff in Memphis tended to be athletes, ex-military, with some if not four years of college, and gang affiliated. This is a rabbit hole I’ve opened elsewhere and it’s not really my rabbit hole but I believe we should start remembering the fact or at the very least becoming remotely aware that cities like Memphis, Baltimore, Chicago, Atlanta, Little Rock, Saint Louis and obviously Los Angeles are in myriad ways held together by the gangs.

Nobody wants to know this. Nobody wants to acknowledge it.

But the sets hold our inner cities together. They protect their neighborhoods. The sets make sure everybody’s granny is cool during storm or blackout or social mayhem. Not the police. The police who are worth a damn are likewise affiliated. The crossover extends to the military as well. There is an endless and vast network of gen x younger boomer elder millenial age dudes out there who learned code of conduct and chain of command from coming up crips and bloods or little brothers nephews cousins of somebody connected to that life same as they had brothers and cousins uncles and dads in the army or navy.

How do you imagine most black men in a city like Memphis make it to their 30s without getting killed or locked up.

They know which stretch of purgatory is home turf and relatively safe and which is not, for one. And if they’re going to university to play ball on a full ride or study nursing or both, they have a set watching their back and keeping an eye on their mom’s house.

I realize too the gangs also control the crack and opioid pipeline through Memphis and they account for more than their share of crime and chaos but the underlying infrastructure of the psych and prison underground interwoven with the black market bootlegger sicario economy and how it serves the bigger more proper more legally endorsed overlying robberbarron economy and how it all ties into the wild west law of the jungle reality of skid row and the psych ward floor and the kids losing their minds on tik tok and how it’s all connected to everything else ought to be plain to see by now.

If not please keep reading.

This rabbit hole deserves a longer look and I do have a call me eight mile white nomad on crip turf post half story half essay that’s been lurking unfinished down my stack forever and I keep circling it and veering off because it is not my story to tell really, for pretty obvious reasons, but on the other hand I know a half dozen affiliated and still active guys from life and coworkers from the psych ward, crips bloods vice lords and disciples if you’re wondering, guys I trust with not just my life but my daughter’s life if it came to it, and that sort of trust is never not mutual and maybe that’s why I’m the one who has to talk about it.

Every time the suits and politicians start fearmongering about ms-13 and Tren de Aragua being terrorists I get uneasy because if feels like a very short hop skip jump to declaring all gang members terrorists.

I have guys in Memphis and Chicago that I consider family who based on tattoos and decades old arrest records could easily get lumped in to any sort of idiotic gangbanger terrorist dragnet data base cooked up by the bots and maga faithful at ICE and Homeland Security and if that stretch of the rubicon is crossed, I believe we may be in for an inner city nightmare like no other, one that will make the LA riots look like a snow day in hell.

They are already compiling a data base of folks to tag for no fly lists and whatever black mirror shit comes after.

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And yes I am aware that if we were having this conversation west of the rockies or in their shadows say Albuquerque, Bakersfield or Humboldt County then all of the above is no doubt true of any number of white gangs bikers hippie mafia aryan and nomad, in prison or not.

Likewise former military and not.

Likewise any number of spanish speaking Latin sets and not for nothing but it never hurts to remember that one reason there are so many pesky brown people in California, New Mexico, Texas and the rest of the no country for old men is that those states used to be Mexico.

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But this is Memphis. One thing about the south, even the craziest among us still have manners and a sliver of old world decorum.

Anyway. I was one of the lucky ones. I lost count of how many staff I saw get bitten hard enough to break skin and draw blood or have a handful of hair yanked out. I saw fellow staff take far worse injuries. I saw broken jaws and shattered occipital bones, and yes those are both plural.

I saw green stick fractures and dislocated shoulders.

I walked into and stopped more than one incident of sexual assault.

Three or four staff who I knew personally were choked unconscious on the clock.

I saw nurses techs and therapists get stomped on by patients in berserker mode. I watched all of the above happen to friends and coworkers on camera after the fact when they were by bad luck and circumstance caught somewhere in a blind corner or side hallway alone with no radio. I saw the same in real time when I was too far away to stop it, when I was already restraining another patient down the hall.

I saw the same in slow motion while I was doing compressions on a patient who stroked out in the shower.

I saw these incidents explode out of nowhere during the most peaceful early morning moments while checking patient X’s blood pressure or patient Z’s blood sugar.

To clarify, that number above is three staff but one of them was choked out twice.

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I was also a white man who grew up in the heart of Memphis.

I had friends going back to little league scattered all over north and south Memphis. I had bought and sold or delivered drugs in Orange Mound and Binghampton back in the day.

I had been arrested five times in the ‘90s.

I survived multiple long weekends in the infamous downtown prison tower at 201 Poplar where your paperwork disappeared for days at a time while you slept uneasy on a mat up on the fourth or fifth floor in a giant echoing thunderdome, a sprawling windowless gymnasium the size of four basketball courts. No guards in sight and the churn of a thousand prisoners in an open air scene out of pick your favorite fucked up prison gang movie.

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I didn’t plan this either but I was a reckless asshole often enough in my 20’s to know exactly what it was like to be on the receiving end of lockdown and strip search and I was always lucky. I had reflexes. I could slip a punch. I knew how to memorize a room. How to read body language and verbal tics and to memorize those details for future use. How to remember people’s stories and how to tell them stories in return. How to make people laugh. How to talk to people. I could navigate the world of the Memphis country clubs dive bars and drunk tanks as easily as I could walk the hood and hollers and not get shot.

I knew how to read a room.

How to deal with empty spaces and how to approach the scared the angry and the unloved, how to soothe the broken and the lost with my voice.

I also by genetic good fortune happened to be born with sharpish eyes and a growl and scowl that got me the nickname wolverine and yeah it was an oddly specific toolbox and skill set.

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I’ve said this elsewhere but for those new to the conversation, the ideal seven man crew on a psych ward floor in Memphis is five men two women with the widest reaching spin on the demographic dial you can manage. Black white gay straight military gang elder younger boomer gen Z spanish and ASL speaking and all religions welcome because whichever one you’re missing on a full moon Saturday night in Memphis that hole in your staff demographics might just be the difference between an okay night that blurs into haze and a long daynight bleeding into pure hell and come Sunday you will holler at whichever staff is in your book who might fill that hole and say hey what’s up we need you dude.

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I should also point out that seven to nine staff on the floor with 92 psychotic adult patients was about average. If there were more staff assigned to that unit it was to sit in the doorway of some patient who was so extraordinarily suicidal or violent they could not be left alone for a minute. It should also be noted that one of the most common ways to be fired from that job was to crack during a riot on the hall and come out of your chair to go help one of your friends.

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If you wake up on any inner city psych ward in America just know that you are on neutral turf. Think of the highlander, of Conor McCleod and the Kurgan eyeballing each other in a church or cemetery. The most vital rule to remember is that you do not ever throw gang signs on neutral turf because in a city like Memphis it is one of the easiest ways to start a riot on the hall.

Don’t throw gang signs.

Don’t talk shit and mind your business.

Don’t touch anybody.

Don’t eyeball anybody.

Don’t get naked in the dayroom.

Don’t say anything racist or overtly sexual and cooperate with staff best you can and you will be okay.

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I felt more sane and functional when I was on the psych unit floor than I did when out in the world. I started having freak panic attacks in public places. I had a touch of the classic first responder rescuer complex. More than a touch. I was cool and in control on the unit but unmoored self-destructing and dissociating in my personal life. Three of my fellow staff killed themselves during those years with opioids and booze. They were all younger than me and I tried to follow them down that black hole more than once.

I once described some of this to a lawyer met at the dog park. He told me he could have got me a half million dollars in workman’s comp for my assorted injuries and residual ptsd. But I would also have had to sign a nondisclosure agreement and never speak or write about any of the things I did or witnessed.

To be clear.

I’m not calling out the name of my former employer because I had and still have a family there. Some of my closest friends are there to this day, doing god’s work. And whatever we might say about the loathsome and predatory insurance companies and the massively broken healthcare system in this country, my former employer has three hundred and thirty beds that are filled every night with our most vulnerable and most dangerous neighbors. They are surely safer inside where they have access to a toilet and shower, three hot meals and fresh water, medication and medical staff trained to give them aid.

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Memphis and the greater Shelby County are roughly sixty forty black and white. If you did not grow up here it is easy to look from any random angle or vantage and see Memphis as a socioeconomic cauldron of despair. The extremes of wealth and poverty are indeed stark. The Memphis country clubs have an unsettling old world aristocratic vibe to say the least. Memphis is never not in or near the top three for homicide per capita. Likewise obesity and illiteracy. But this is also the city where King was killed. Where the Lorraine Motel is somberly lovingly maintained like a butterfly in amber.

Not unlike Graceland.

The people of Memphis have reverence for their ghosts if not their sins.

But they are far less racially divided than it may appear on television and certainly less so than elsewhere. We have had no riots here since MLK.

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This is not to say racism doesn’t flare hot and cold on the psych unit because it does. There are many psych patients who become devoutly racist when they cross over into mania and delusional paranoia such that you may wonder if hatred is baked deep into our marrow, our cellular memory. The staff who survive best on the job black and white are generally the folks who grew up going to Tennessee public schools. The people who figured out what was up and how to coexist by the fourth grade. The folks who learned how and when to fight and how to talk someone down. How to talk to people of all stripes is life or death critical on the psych ward floor because nothing muscles its way across demographic color and money lines like crazy and addiction.

The noise and hurly burly of the outside world were perhaps muted and faraway but its effects on patients and staff were always visible.

One thing never within doubt was that if not for the hospital, most if not all of our patients would either be in jail or on the street.

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The homeless problem is not a lack of affordable housing. That is an absurd and insensitive myth perpetuated by homeless advocates who are speaking for the upwardly mobile two percent of homeless persons who are legitimately just down on their luck. Because it is true that all it takes is one or two missed paychecks for some of us to end up sleeping in our cars.

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The homeless problem is a lack of adequate shelter compounded by a lack of psychiatric care.

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The softer word for zombie is undead. A reverse negative. Likewise the woke left wants to rebrand the homeless by the dead word unhoused. I’ve spent my adult life surfing the left of the political spectrum largely because the left has always professed to be more interested in protecting the right to choose. The right to choose abortion over unwanted pregnancy. The right to listen to satanic music. The right to hug trees. The right to free assembly. The right to burn the flag. The right to call a spade a spade if that’s your jam. The right to free speech.

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Free speech unfortunately does extend to the freedom to be racist, the right to be hateful. The right to be an asshole is on display far and wide.

Likewise the right to be stupid.

The right to carry a gun inside Walmart and the right to sleep outside are indeed sticky issues but pretty clearly protected by the bill of rights.

But does that document protect the right to be mentally ill.

The word unhoused does nothing but further dehumanize the already dehumanized. Because the word conjures nothing. The word homeless is at the very least still sympathetic because it summons to mind the image of someone sleeping in a cardboard box. To put this idiotic argument to rest just consider the word special. It used to mean special. Now it means handicapped or mentally retarded. The word special used to be a compliment. Now it’s a playground slur. A dozen years from now the phrases differently abled or unhoused person will be tagged as supremacist. Meanwhile none of these verbal gymnastics do anything to address the problems of shelter or mental health.

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Another myth that must be disabused is the idea that the homeless apocalypse is strictly a California problem. The vast majority of homeless people in California are not from California. They are from Tennessee and Texas and Georgia. They are from red states. They are from every other state in the union that would rather imagine that do unto others and the good Samaritan story apply only to friends and family and christian whites. The states that go out of their way to make the outside world unfriendly to homeless people. The states that spend millions of dollars embedding spikes and broken glass into any shady urban spot where the homeless might lay their heads.

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The primary reason there are no homeless encampments yet on the streets of Memphis is that our trespassing laws are enforced without sympathy. The deeper underlying reason is that every homeless person east of the Mississippi with the mental capacity to hitchhike or the means to buy a bus ticket to California heads west in search of sunny skies and organic soup kitchens and less draconian drug laws.

California is the farthest you can travel if you’re chasing the sun and running from demons in the east. It’s the wealthiest state. It’s the most progressive, most liberal state.

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California is the state where dreams and dreamers go to either become real or die.

And it is the only state where you can realistically sleep outside year round without getting killed by exposure to the elements.

I worked at the largest homeless shelter in Colorado from 1994 through 1997. The shelter in Boulder had 120 beds. The facility was simple. Imagine a horseshoe shaped roadside motel where all the doors open onto the parking lot. Knock out all the walls between the adjoining rooms and fill them with bunk beds. The business model was likewise simple. Open the gate at sunset and let the unwashed come in first come first serve. Free to all. Give them a hot meal and a place to store their backpack. Give them a kit of miniature hygiene items and a bed for the night. Give them a phantom phone number to use for job and apartment hunting.

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Don’t make them blow zero upon entry.

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I don’t mean to gloss over the negatives. There were occasional knife fights in the parking lot. There were incidents of sexual assault. There were dozens of times the police had to be called to help wrestle a psych patient. There were deaths by overdose on the property. But even a child can sort out the exponential logic that if there are a handful of such incidents inside a shelter, there are surely hundreds more in the urban wasteland of skid row.

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Every state has different laws regarding involuntary commitment. The infamous fifty-one fifty in California is the 401 in Tennessee. The common knowledge myth that the skid row nightmare out west exploded when Reagan shut down the state mental hospitals is only half true. It has also become evermore difficult to involuntarily commit a patient in California, due in part to increasingly murky definitions of danger and self-harm, compounded by endlessly more progressive concessions made to protect the rights of the mentally ill to free speech and the pursuit of happiness. If you choose to express yourself in San Francisco by shitting on the sidewalk with a chicken bucket on your head then smoke yourself into a fentanyl coma, that is considered free speech. It’s your god given human right to chase your happy place unhindered by the man.

Or so the logic goes.

But it remains easy as cake to unnecessarily 401 somebody in the state of Tennessee. It happens every day, hundreds if not thousands of times per day. It requires the scribbled signatures of two qualified healthcare professionals. Nurse, cop, doctor, therapist or social worker. If drunk patient X is sitting in an ER for hours waiting to have a laceration stitched up, and finally loses his or her shit and screams I’m gonna kill myself if somebody doesn’t get me some painkillers right the fuck now then boom, one signature.

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If patient Y is a homeless junkie who wants to get off the street because he owes the dope boys money and needs to lay low until the first of the month when his disability check comes in, he can walk up to the nearest police car and say hey I’m thinking about blowing up the mayor’s office.

Boom.

If patient Z is the wife in a domestic violence situation and says to her therapist sometimes I want to kill him in his sleep, and the therapist doesn’t care to split hyperbolic hairs, well.

Boom.

If patient zero is just emerging from a three-day blackout with a kitchen knife in hand when the police arrive for a welfare check, boom. And as mentioned elsewhere, once you have two signatures your fate is not your own.

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If any of the above land in the lobby of a Memphis psych hospital agitated and combative, the process moves along very quickly provided they have some form of health insurance. If not they will be transferred elsewhere. Meanwhile the chicken bucket guy with a fentanyl jones in Memphis would be hit with that first signature before he pulled up his pants. If you are sleeping outside in adverse weather or screaming at the sky or wandering in and out of traffic or aggressively panhandling or nodding off in an opioid trance in most of the civilized world, you are considered a danger to yourself.

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Once you have the first signature, you are almost guaranteed to get the second. Because no cop or social worker wants to pass on a second sig only to see that patient on the news 24 hours later walking into a church or an Ikea with a long gun.

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Because this is America.

That shit is on the news every night of the week.

Don’t get me wrong.

It’s relatively simple to be admitted to a psych facility as a voluntary patient, too. If a suicidal detoxing patient with private insurance enters a facility seeking help he or she will surely get it. Though they may first be sent to a nearby ER for med clearance if their vital signs are cruising at stroke altitude. Psych hospital admin hate it like poison when anybody dies on campus.

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If you’re working one unit and hear a code blue called overhead for another, your first thought is somebody is getting fired.

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Anyone having a psychotic break who walks through the front doors under their own power and asks for help dealing with the voices or the shadow forces haunting their corner of the realm, they too will be admitted without fail, provided they have insurance. If not, the hospitals will tie themselves into bureaucratic gordian knots in the effort to get that patient transferred elsewhere. I should point out too that elsewhere is never anywhere pleasant. Elsewhere is some city or state facility that adjoins a jail or prison and while those uninsured homeless patients are generally happy to just be inside out of the elements, they receive only the most minimal care in those facilities and are discharged to the street or shelter or jail as fast as possible. The private hospitals by contrast are always happy to max out the coverage of your private insurance so long as you don’t make noise about it, and if you make noise your situation tends to get worse.

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The majority of the homeless and section eight patients in Memphis are covered by TNCare, which typically provides for five to seven days of reboot time, or just long enough to stabilize on their meds.

They discharge and come back again and again.

If an incoming patient is actively seeking treatment and has no history of violence and makes no statements suicidal or homicidal, and remains calm, they may be tagged voluntary for the time being.

All well and good but not necessarily from the staff’s point of view. Because if that patient is allowed to walk onto the psych ward floor with voluntary status intact, staff are legally not allowed to put hands on them or medicate against their will until after they freak out and attack someone.

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The voluntary psychotic patient may see the color orange or hear the word poppyseed or see their grandmother’s face in a trick of light on a dead TV screen and proceed to flip the fuck out by trying to strangle whoever is standing behind them. That person might be the college sophomore suffering a manic episode. That person behind or next to them in line for pill call might be the elderly man with dementia who is too strong and too combative for the geriatric unit. It might be your daughter or your grandfather.

And one patient doesn’t necessarily have to attack another to create a dangerous situation.

Hours of screaming like a dopesick demon tends to make the other patients uneasy and may trigger ambient mayhem.

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The downstream ripple effects of easing the involuntary commitment laws are numerous. The most visible being that the manic paranoid hypersexual college freshman just hours or days into their first psychotic break who turns combative during assessment and the just turned 18 year old nonverbal autistic kid grown too strong and too violent for his family to deal with will both end up on the adult acute unit with the guy who was sleeping in a sewage tunnel with a machete yesterday, the guy screaming hellfire at traffic on Monday, and the feral meth addict who has been living outside for a decade.

Likewise they will be walking the same hall and ghosting the same communal dayroom as the serial rapist who lied on his way in the door, who claimed suicidal ideation and phantom voices in the motivated interest of getting himself committed to the psych ward for specific reasons.

Because we passed out shitty off-brand cigarettes multiple times per shift.

Because the food is better than the shit they serve in jail.

Because it is infinitely easy to learn the movements and routines of most psych ward staff and find the blind spots in those movements.

Because it is likewise easy as a whisper to cull one of the innocents from the pack and shove them into the laundry room or their own shower and it takes only a minute or ninety seconds at most to be violently raped when you’re wearing a hospital gown or disposable paper scrubs.

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The most worrisome problem is that the psych ward is literally crawling with predators and violent offenders who have figured out the magic words necessary to get themselves transferred from jail to the psych hospital. These patients take up an inordinate amount of staff time and attention because they are constantly bucking the system, acting as if the rules don’t apply to them, refusing their meds, physically and sexually threatening stealing from and preying on the other patients.

I could dive deeper into this particular rabbit hole but trust that anyone reading this far surely has enough perspective, enough street sense, or imagination enough to summon the worst case scenarios on their own, and because there is no best case really, is there.

All I will say is that prison rules apply and there were dozens of times when staff realized that if they didn’t do something the other patients would, and we were at least trained not to do lasting physical damage to any wolves among the sheep who needed and deserved intervention off camera, where the first warning would be the last warning. This was further complicated by the fact that everyone knew the patient in question was not psychotic but faking, and some doctors were loathe to just drug them into submission. These are not scenes I’m proud of but neither do I regret or apologize for them. And if my crew was ever preparing to take such action, I made sure that I was always in the room, especially if the perpetrator was a white guy and the other staff were all black.

To be clear as crystal, the directive to take such action more than once came from someone above me on the food chain. Nobody was getting fired for such incidents but if things spun out of control or into the hallway in view of cameras, if anybody was going to the ER for a Monday morning CT scan or possibly catching an assault charge, I wanted that person to be me.

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The ultimate 401 paradox sinks in a few days later when the voluntary patient decides the food sucks or the repetitive group therapy sessions are stupid or simply says to hell with this noise, I’m craving my drug of choice. If that patient asks calm and cool to be discharged against medical advice, he or she will then be required to sit down and wait up to twelve hours for an external psych assessor to arrive and then convince that assessor they present no danger to themselves or others. If the voluntary patient breathes even an ironic aside about self-harm or seeing shadow people or just cops to the very real itch to head down to the row to score some fentanyl, or starts raising hell because the secondary assessor is slow to arrive, they generally find themselves 401’d heartbeat quick.

Boom.

Look what you did. Now you’re involuntary.

Because you apparently don’t have your own best interests at heart. Or because you might walk across the street and buy a gun. All psych hospital employees have the tangled concepts of legal and medical liability and plausible deniability tattooed onto the undercarriage of their skulls. And above all because the hospital is in the business of keeping beds filled. Throw in the various legit scientific and philosophical arguments that free will is an illusion and the concepts voluntary and involuntary rapidly lose all meaning.

On the dystopian flipside. If an addict or alcoholic is on day eleven of voluntary detox and decides they’d like to stay for the full thirty days and want to be sure their private insurance continues to pay for their ongoing access to that rubber mattress, they are advised to lie to their doctor. To claim suicidal ideation, to say they hear voices urging them to harm self or neighbor.

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Over the years I advised dozens of patients it was in their best interest to deceive, to insist they were still suicidal and jonesing even if they were not. The implications are absurd, I know. After a few days of gingerly edging back to reality and honestly reporting that you’re suffering no tremors, no hallucinations, no active thoughts of self-harm, if you admit that you’re improving, the more ruthless insurance companies will cut bait and discharge you. To some sort of halfway house if you’re lucky, to the street if you aren’t.

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And when it comes time to discharge an involuntary patient, the final step is to convince them to sign a document consenting to psychiatric care, thereby converting them to voluntary status on their way out the door. Let that sink in for a minute. The involuntary patient becomes voluntary upon discharge.

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The fundamental trouble with psychiatry is that no one person perceives reality the same as anyone else. The existential dilemma confronted daily by psych ward staff is the very real need to enforce a consensual notion of reality in order to keep the unit safe for all patients and staff. But reality itself is spun up and defined by each individual consciousness and its accompanying soundtrack or internal narrative, which is by definition nonlinear, nonsensical, and not entirely verbal in composition. The other half being an endlessly shifting ethereal undefinable mashup of assorted sensory input and flashes of memory, fragments of downloaded imagery real and imagined.

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The patterns of light and shadow cast on the cave wall are chaotic and muddy.

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Quantum mechanics and neuroscience have next to zero explanation for how consciousness actually works, so the business of diagnosing psych patients and medicating them for being out of contact with said reality becomes a dodgy prospect at best, dangerous and negligent at worst.

Dislocation from time and space is the unholy common ground of psychotics, depressives, addicts and drunks. To make things more complicated, the world has entered the post truth era. The notion of alternative facts makes for a fascinating debate in the comment sections of countless websites. But on a psych ward floor it becomes an existential crucible.

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My last couple years at the hospital were spent mostly on the drug & alcohol unit, the high functioning depression and suicide unit. All of those patients were people with jobs, college students, and people recently discharged from the military. The constant stream of headlines and news stories seen over the past few years bleating about a mental health crisis are not mistaken. If anything they are naive and understated. We have an entire generation of overmedicated overstimulated depressed and suicidal kids and teens not yet old enough for the adult psych unit or the homeless shelter, but they will be soon.

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In Memphis the homeless who don’t care to venture out west have few options once they’ve burned all their bridges and can no longer crash on granny’s back porch. They can disappear into the Wolf River swamp. They can gather enough spare change to raise the nine dollars to pay for a bed for the night at the Mission shelter. They can commit a petty crime and be arrested. Or they can check into the psych ward. These are not solutions to the big picture apocalypse.

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The government claims there are a half million homeless people currently sleeping outside in this country. This is the same government that stops counting you as unemployed once you stop reporting to the unemployment bureau. If you factor in the ICE detention camps the actual number of homeless is likely upward of a million point five.

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The shelter in Boulder is still operating to this day. It now sleeps 160 homeless per night. It employs a staff of dozens. It relies on government grants and charitable donations to continue functioning. The two psych hospitals I worked in Memphis are for profit operations. They have hundreds of employees and a combined roughly 440 beds paid for by private and state insurance companies that are also in the game for profit.

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The going rate for a night’s rest on a rubber mattress at an American psych hospital is roughly $1500 aka more than a month’s rent, more than the average home mortgage.

The shelter in Boulder and the psych hospitals in Memphis are a combined six hundred beds, a tiny drop in the big bucket apocalypse. Those beds are perhaps not all occupied every night by actively homeless people. But everyone sleeping on the street or in a shelter has passed through the psych healthcare system. They are all on the homeless spectrum. If you concede that half if not two thirds of the homeless population would benefit from some level of involuntary psychiatric care or court ordered drug rehab, then we need at least a thousand more psych hospitals and a thousand more homeless shelters to make a dent in the apocalypse. Not to mention the staff necessary to operate them.

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To make the numbers more digestible call it twenty more psych hospitals and twenty more shelters per star on the flag.

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Do the simple math.

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If you accept the government numbers we need a half million beds. Not a half million affordable apartments. We need beds. The homeless need shelter. The mentally ill need psych nurses. They need uncomplicated access to healthcare. And more of them are coming untethered from reality every day. How we treat the lowest of the low in the most wealthy country in the world surely says something about the rest of us.

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I am the wolf that became the lamb and the harrowing is upon us. The homeless and the sick and the undocumented and those of us still with a roof and a paycheck are all of us living in purgatory. We are busy chasing the fruit beyond reach and somehow don’t see the ring of fire on all sides.

We are the slothful endlessly scrolling the flat circle, we are the unbowed.

The average Americans stuck in traffic somewhere on their way to one job or another that pays either far too little or obscenely too well are the pilgrims with their eyes sewn shut. They are us and we are them. If we let this slow moving apocalyptic train wreck continue unchecked, we shall be the loveless and the damned kneeling before the statues of the sufferers.

Those sufferers are our friends and neighbors.

All of the above is on my mind for pretty obvious reasons. Turn on the news for a minute. Maybe scroll around and check out all of the news both right and left. If you have never been to rehab or had a family member committed to psych ward, you may be one of the otherwise decent people like one of my daughter’s middle school teachers who once got into an actual out loud argument with a 7th grader after telling the class that insane asylums were a thing of the past and that scary psych wards as seen in the movies were no longer a problem, then being politely corrected by that seventh grade girl who is if nothing else her father’s daughter and trust me not a kid you want to argue facts or logic with.

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If you have never been to Europe or Canada or anywhere really in the so called first world where the healthcare is provided by the state and where mental illness and homelessness are handled differently, you may be numb to just how cruel and careless and self-defeating our system is. If you have only lived in but one region of this country it is perhaps not so easy to always grasp and visualize just how big how serious and how very real these intertwined and overlapping problems are.

All of the above ought to be on all of our minds.

It ought to be the first thing on our minds but isn’t, again for reasons that ought to require little explanation.

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Last thing. I don’t realistically believe we can ever properly solve these problems so long as psych healthcare and hospitals in general are operated for profit only. However, I do believe they can be managed and mitigated and made more humane. I have driven that stretch of I-40 between Memphis and the N. Carolina coast a half dozen times the past year or two and I’ve seen how many roadside motels are empty or going out of business. It would be absurdly simple and cost effective to recreate that Boulder homeless shelter model dozens if not hundreds of times in every state red or blue and allow the homeless and undocumented, the undiagnosed and the feral to walk inside voluntarily, if only we wanted to.

If we were not suddenly so preoccupied with spending endless resources on rounding up the people who rake our leaves and clean our toilets and pick our blueberries or work on our rooftops in the sun, we could take care of our most vulnerable people, our most broken lost and displaced souls, but this is America.

The land where the good Samaritan story has lost all meaning, where the obnoxious and evermore repeated till it means nothing phrase fuck around and find out was born.

Americans are never not dying to reap the whirlwind.

This business is ever on my mind of late because the vibes and tension and visual parallels to 2020 are unmistakable. Because the world itself is on a knife edge and we are never not one catastrophe from suddenly having another two or three or ten million refugees at the Texas border.

That is yet another thing.

The vibe shift and haphazard rebranding of migrants to illegals to the undocumented and asylum seekers is well meaning I’m sure, but for any number of basic wordsmith reasons and given our president’s relentless misunderstanding of the word asylum, the proper most apt word for the majority of the humans willing to slog through the Darien Gap to come try their luck at crossing into a city most Americans never care to visit such as El Paso TX is refugee.

The uphill climb out of purgatory in Dante is endless and terrible and none of us has any reason to believe what lies ahead for the American experiment will be any different. The wall of fire is on all sides and all of the above real world anxiety and fear and neighbor on neighbor brutality is only worse today than it was then, minus the covid. But soon enough it will be some other pandemic because we don’t believe in science or vaccines anymore.

And like anyone who is paying attention, when I shut my eyes and visualize what exactly it would take to scale this up to hundreds if not thousands more shelters, rehabs and government operated psych wards, it’s impossible not to see death camps in my head.

The whirlwind is ours. This is the world of our making.

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peace.

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note. the essays and PSA content on Involuntary are free to all and this stack would not exist without your love and support. I appreciate every one of you, please share like subscribe and donate to the cause by signing up as a founding member if you can.

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to the phineas poe faithful my heart is with jack fell and jude evers on the velvet stack

enter the velvet

I’d much rather be in there ghosting the yellow 24/7 but these are extraordinarily surreal and dangerous times and I can’t not write these chronicles of the collapse society and would much appreciate you hitting the share or restack button if you’re still with me.

much love from the velvet.

always peace.

fade.

*for more specific horrors encountered inside the walls of an american psychiatric hospital operated by a giant capitalist entity see the Eleven Year Loop and Among Jackals.