G
Gandalf Grey
Guest
Tomgram: Chip Ward on How the Public Library Became Heartbreak Hotel
By Tom Engelhardt
Created Apr 2 2007 - 9:19am
Back in the 1950s, when every domestic scandal and nightmare, political or
familial, wasn't the subject of a television show, the library was my
peephole into the mysteries of the adult universe. The key question, when it
came to interpreting the world back then, was this: Would the librarian who
ruled over the juvenile section free you to enter the pay dirt of the rest
of the library? Mine did. As a friend of mine, who arrived in this country
as an immigrant at age 11, used to say of her library years, "I started with
A." So did I. What an essential democratic institution the public library
is.
Of course, today, the condition of America's public libraries is, at best,
wildly variable [1]. Some urban libraries of just the sort I used to haunt
in my childhood have recently been losing out in the race for scarce tax
dollars. They often face cuts in their hours, while their systems close
branches and offer fewer services; others are carving out new roles for
themselves as on-line information providers, advisers, and bustling cultural
centers. So, while the bold architecture of the new main library in downtown
Seattle has become a popular tourist attraction, libraries throughout the
Katrina-ravaged Gulf Coast struggle to rebuild or just hang on.
Many public libraries are experimenting with new roles [2] beyond the
boundaries of story hour and homework help. Public access to the Internet
and computers, for instance, is transforming our libraries into de facto
e-government access points for such disparate services as disaster relief,
Medicare drug plans, and even benefits for children and families. The Salt
Lake City Public Library, the subject of today's Tomdispatch (and Library
Journal's "2006 Library of the Year"), prides itself, for instance, on being
a place [3] "where democracy happens." It houses an NPR radio affiliate and
a film center, as well as a coffee house and deli that encourage people to
linger and talk.
But even if you are lucky enough to have one of these "catalytic" libraries
in your neighborhood, rather than a branch that just shut down for lack of
funds, there's a public-library challenge-cum-nightmare that is rarely
acknowledged. As Chip Ward, a Tomdispatch regular [4] who just retired as
the assistant director of the Salt Lake City Public Library System, makes
clear below, public libraries have become de facto daytime shelters for the
nation's street people; while librarians are increasingly our unofficial
social workers for the homeless (and often the disturbed). It's a dirty
little secret that tells us all too much about the state of our nation
today. -- Tom
What They Didn't Teach Us in Library School: The Public Library as an Asylum
for the Homeless
By Chip Ward
Ophelia sits by the fireplace and mumbles softly, smiling and gesturing at
no one in particular. She gazes out the large window through the two pairs
of glasses she wears, one windshield-sized pair over a smaller set perched
precariously on her small nose. Perhaps four lenses help her see the
invisible other she is addressing. When her "nobody there" conversation
disturbs the reader seated beside her, Ophelia turns, chuckles at the
woman's discomfort, and explains, "Don't mind me, I'm dead. It's okay. I've
been dead for some time now." She pauses, then adds reassuringly, "It's not
so bad. You get used to it." Not at all reassured, the woman gathers her
belongings and moves quickly away. Ophelia shrugs. Verbal communication is
tricky. She prefers telepathy, but that's hard to do since the rest of us,
she informs me, "don't know the rules."
Margi is not so mellow. The "****ing Jews" have been at it again she tells a
staff member who asks her for the umpteenth time to settle down and stop
talking that way. "Communist!" she hisses and storms off, muttering that she
will "sue the boss." Margi is at least 70 and her behavior shows obvious
signs of dementia. The staff's efforts to find out her background are met
with angry diatribes and insults. She clutches a book on German grammar and
another on submarines that she reads upside down to "make things right."
Mick is having a bad day, too. He hasn't misbehaved but sits and stares,
glassy-eyed. This is usually the prelude to a seizure. His seizures are
easier to deal with than Bob's, for instance, because he usually has them
while seated and so rarely hits his head and bleeds, nor does he ever soil
his pants. Bob tends to pace restlessly all day and is often on the move
when, without warning, his seizures strike. The last time he went down, he
cut his head. The staff has learned to turn him over quickly after he hits
the floor, so that his urine does not stain the carpet.
John is trying hard not to be noticed. He has been in trouble lately for the
scabs and raw, wet spots that are spreading across his hands and face. Staff
members have wondered aloud if he is contagious and asked him to get himself
checked-out, but he refuses treatment. He knows he is still being tracked,
thanks to the implants the nurse slipped under his skin the last time he
surrendered to the clinic and its prescriptions. There are frequencies we
don't hear -- but he does. Thin whistles and a subtle beeping indicate he is
being followed, his eye movements tracked and recorded. He claims he falls
asleep in his chair by the stairway because "the little ones" poke him in
the legs with sharp objects that inject sleep-inducing potions.
Franklin sits quietly by the fireplace and reads a magazine about
celebrities. He is fastidiously dressed and might be mistaken for a
businessman or a professional. His demeanor is confident and normal. If you
watch him closely, though, you will see him slowly slip his hand into the
pocket of his sports jacket and furtively pull out a long, shiny carpenter's
nail. With it, he carefully pokes out the eyes of the celebs in any photo.
Then the nail is returned to his pocket, a faint smirk crossing his face as
he turns the page to pursue his next photo victim.
Scenes from a psych ward? Not at all. Welcome to the Salt Lake City Public
Library. Like every urban library in the nation, the City Library, as it is
called, is a de facto daytime shelter for the city's "homeless."
Where the Outcasts Are Inside
In bad weather -- hot, cold, or wet -- most of the homeless have nowhere to
go but public places. The local shelters push them out onto the streets at
six in the morning and, even when the weather is good, they are already
lining up by nine, when the library opens, because they want to sit down and
recover from the chilly dawn or use the restrooms. Fast-food restaurants,
hotel lobbies, office foyers, shopping malls, and other privately owned
businesses and properties do not tolerate their presence for long. Public
libraries, on the other hand, are open and accessible, tolerant, even
inviting and entertaining places for them to seek refuge from a world that
will not abide their often disheveled and odorous presentation, their odd
and sometimes obnoxious behaviors, and the awkward challenges they present
to those who encounter them.
Although the public may not have caught on, ask any urban library
administrator in the nation where the chronically homeless go during the day
and he or she will tell you about the struggles of America's public
librarians to cope with their unwanted and unappreciated role as the daytime
guardians of the down and out. In our public libraries, the outcasts are
inside.
"Homeless" is a misleading term. We have homeless people in America today,
in part, because we have no living wage, no universal healthcare,
disintegrating communities, and a large population of working poor who can
end up on the street if they lose one of their part-time jobs, experience an
illness or an accident, or have a domestic crisis. For them, homelessness is
generally temporary, probably a once-in-a-lifetime experience. There is
little to distinguish such people from the rest of us and we usually do not
notice their presence among us. Programs to help people in such
circumstances may be inadequate -- and it is a shame they are needed at
all -- but they usually work. For the people we point to on the street or in
public places and normally identify as homeless, however, homelessness is a
way of life and our best attempts to rescue them continually fail.
We commonly refer to them as "street people." We see them sleeping in parks,
huddled over grates on sidewalks, resting or sleeping on subway cars, passed
out in doorways, or panhandling with crude cardboard signs. Social workers
refer to them as the "chronically homeless." Although they make up only
about 10% of the total number of people who experience homelessness in a
given year, they soak up more than half the dollars we spend on programs to
address homelessness. There are at least 200,000 people across the nation
living more or less permanently on the street, enough to fill a thousand
public libraries every day.
Drunk as a Skunk
The term "chronically homeless" is also inadequate when it comes to
describing these individuals -- it only tells you that their homeless state
is frequent. It neither indicates why they are homeless and stay that way,
nor says anything about their most salient characteristic: Most of them are
mentally ill. The published data on how many homeless are considered
mentally ill by those who study them varies widely from 10% to 70%,
depending on whether all the homeless, or just the chronically homeless, are
included (and depending on how you define illness or disability). How, for
example, do you categorize alcoholics and drug addicts?
When Crash is sober, for instance, he reasons like you or me, converses
normally, and has a good sense of humor. Unfortunately, he is rarely sober.
In one of his better moments, he petitioned me to let him stay in the
library even though he was caught drinking -- an automatic six-month
suspension. "You know I'm a good guy and I don't bring that stuff into the
library," he pleads. "C'mon, give me another chance."
Crash is sitting in his wheelchair in the foyer outside my office where I
serve as the library's assistant director. It's hard for me to address Crash
without staring at the massive scar on his face -- a deep crease that neatly
divides it down the middle from scalp to chin. Unfortunately, his nose is
also divided and the sides do not match-up, giving him an asymmetrical
appearance like a Picasso painting on wheels.
"Alcoholics pass out in the library's chairs," I explain, "and if we can't
wake you up we have to call the paramedics. If you piss your pants or puke,
the custodians have to clean that up and they hate that. You guys fall down
and knock things over. You're unpredictable when you drink. You disrupt
others. Public intoxication is against the law..."
"Okay, okay," he interrupts me, "I get it. Hey, just thought I'd try and get
back in is all -- no hard feelings, man."
No hard feelings I assure him. He smiles and we shake hands. I wish I could
cut him some slack -- after dozens of confrontations with angry and
threatening drunks, I appreciate a cheerful drinker like Crash -- but I
can't afford to establish a precedent I can't keep. The rule is clear: no
drinking in the library and no exceptions. As he waits for the elevator
doors to open and take him down, I venture a question I've been holding onto
for awhile. "I know it's none of my business, but how did you get that
scar?"
"Car accident," he replies, "same one as put me in this wheelchair. That's
why they call me Crash."
"Were you drinking?" I ask.
He shakes his head and sighs. "Drunk as a skunk. drunk as a skunk." As the
elevator descends I think about just how hard it must be to be both
wheelchair-bound and homeless. I wonder about the commonly held notion that
alcoholics must "hit bottom" before they can rebound. Is there such a thing
as bottom for guys like Crash? Is he any more capable of controlling his
urge to drink than Ophelia can control the voices in her head?
Our condemnation of transient-style alcoholism is both hypocritical and
snobbish. If you are unhappy and caught without a prescription in America,
you self-medicate. Depressed lawyers do it with fine scotch. An unemployed
trucker might turn to beer or meth. Anxiety-ridden teachers or waitresses
might smoke pot or order just one more margarita. Indigent people who want
relief from their demons drink whatever is available and affordable or
swallow whatever pills come their way. Dr. Tichenor's mouthwash is a popular
choice for street alcoholics and "Doc Tich," as the brand is commonly known,
doesn't offer a pinot noir.
What Library School Didn't Cover
The strong odor of mouthwash on the breath of transient alcoholics who
shelter with us is often masked by the overwhelming odor of old sweat,
urine-stained pants, and the bad-dairy smell that unwashed bodies and
clothes give off. It can take your breath away long before you can smell
theirs.
The library wrestles with where to draw the line on odor. The law is
unclear. An aggressive patron in New Jersey successfully sued a public
library for banning him because of his body odor. That decision has had a
chilling effect on public libraries ever since. When library users complain
about the odor of transients, librarians usually respond that there isn't
much they can do about it. Lately, libraries are learning to write policies
on odor that are more specific and so can be defended in court, but such
rules are still hard to enforce because smell is such a subjective thing --
and humiliating someone by telling him he stinks is an awkward experience
that librarians prefer to avoid. None of this was covered in library school.
It's a chicken-or-egg world for the mentally-ill homeless. Are they on the
street because they are immobilized by severe depression or is deep
depression the consequence of being on the street? Any tendency towards a
psychological problem is aggravated and magnified by the constant stress,
social isolation, loss of self-esteem, despair, and relentless boredom of
street life. Imagine the degradation of waiting an hour in the cold rain to
get into a soup kitchen for a meal; the hassle of hunting endlessly for an
unpoliced spot to sleep; the constant fear of being robbed or attacked by
other street people; or the indignity of defecating in a vacant lot. It's a
combination that would probably drive a mentally healthy person to psychosis
and substance abuse. Street people, who suffer serious psychological
disorders, are often substance abusers, too, and the drug that a psychotic
person prefers, often matches the psychosis. I have learned, for example,
that bi-polar users prefer cocaine when in their manic phases and
schizophrenics gravitate, naturally enough, to hallucinogens.
Alcohol and drugs mix with depression, schizophrenia, bi-polar disorder, and
paranoia in complex ways, so it is hard to pull any given disorder apart and
understand just who this person in front of you, cursing or pleading or
thrashing on the floor, may be. Public librarians, of course, are not
trained to do this. We deal with behaviors that are symptomatic without
understanding why someone is suffering or what we can do about it. And even
if we did understand and had been trained for such situations, healing the
homeless is not our mission. Taxpayers expect us to provide library services
and leave the homeless to social workers. They give us resources only for
one mission, not two.
What about those social workers then? They turn out to be too few,
under-funded, over-worked, and overwhelmed. My initial unsuccessful attempts
to get the social workers who operate the "homeless van" to stop in and
assess a "regular" homeless patron who, we suspected, had suffered a stroke,
reminded me that they had more pressing priorities. In the dead of winter,
they struggle to get people sleeping in alleys or passed out on sidewalks
indoors so they don't freeze to death. Theirs is an everyday "life or death"
race. If a homeless guy is inside the library, then, "Hey, mission
accomplished."
Navigating the Archipelago of Despair
A workshop I attended on treating Native Americans for alcoholism
compellingly described how incorporating sweat lodges, healing ceremonies,
and other elements from Native American culture into established treatment
methods can improve their effectiveness for Native American patients. Of
course, the social worker added, it's essential to provide a halfway-house
option between rehab and release and that remains a huge problem. Typically,
he told us, his clients wait three to six months to get into a halfway-house
after rehab.
"And where do they go while they wait?" I asked, naively enough.
He shrugged and sighed. "Back with their drinking buddies in the park, under
the bridge, wherever."
The inadequacy of existing resources and the absurdity of the conditions
they endure are just part of the landscape, a given for social workers.
Public librarians can cooperate with (and learn from) them, but we
understand that they are overwhelmed and often unavailable. So, like it or
not, we are ushered into the ranks of auxiliary social workers with no
resources whatsoever.
Local hospitals are also uncertain allies. They have little room for the
indigent mentally ill for whose treatment they often can't get reimbursed.
So they deal with the crisis at hand, fork over some pills, and send the
hopeless homeless on their way.
A manager at a shelter-clinic told me that he keeps a stash of petty cash
handy because sometimes a taxi arrives at his door from one of the city's
hospitals, carrying an incoherent patient without ID or any possessions
other than the hospital gown he or she is wearing. When that happens, clinic
workers are instructed to rush for the cab before it can unload its
passenger and pay the driver to return to the hospital, puzzled cargo still
in hand.
Throughout the fragmented system of healthcare for homeless people, from
rehab to hospitals to jails, there are few ground rules or protocols for
discharging the mentally ill and next to no communication between healthcare
providers, police, social workers, and shelter managers in this archipelago
of despair. Public librarians are out of the loop altogether; our role in
providing daytime shelter for the homeless is ignored. When, in an attempt
to build my own useful network, I attended conferences on homeless issues, I
was always met with puzzlement and the question: "What are you doing here?"
"Where do you think they go during the day?" I would invariably answer.
"Oh, yeah, I guess that's right -- you deal with them, too," would be the
invariable response, always offered as if that never occurred to them
before.
Paramedics are caught in the middle of this dark carnival of confusion and
neglect. In the winter, when the transient population of the library
increases dramatically, we call them almost every day. Once, when I
apologized to a paramedic for calling twice, he responded, "Hey, no need to
explain or apologize." He swept his arm towards the other paramedics,
surrounding a portable gurney on which they would soon carry a disoriented
old man complaining of dizziness to the emergency room. "Look at us," he
said, "we're the mobile homeless clinic. This is what we do. All day long,
day after day, and mostly for the same people over and over."
Sanitizing Gels and Latex Gloves: Plying the Librarian's Trade
The cost of this mad system is staggering. Cities that have tracked
chronically homeless people for the police, jail, clinic, paramedic,
emergency room, and other hospital services they require, estimate that a
typical transient can cost taxpayers between $20,000 and $150,000 a year.
You could not design a more expensive, wasteful, or ineffective way to
provide healthcare to individuals who live on the street than by having
librarians like me dispense it through paramedics and emergency rooms. For
one thing, fragmented, episodic care consistently fails, no matter how many
times delivered. It is not only immoral to ignore people who are suffering
illness in our midst, it's downright stupid public policy. We do not spend
too little on the problems of the mentally disabled homeless, as is often
assumed, instead we spend extravagantly but foolishly.
And the costs could grow far beyond the measure of money. If an epidemic of
deadly flu were to strike, if an easily communicable strain of tuberculosis
or some other devastating disease emerges, paramedics will be overwhelmed by
their homeless clients who are at high risk for such illnesses. People who
drink until they pass out tend to aspirate and choke, and people who sleep
outdoors at night breathe cold, damp air. People who sleep in crowded
shelters breathe each other's air.
Serious respiratory problems among the chronically homeless in a shelter are
as common as beer guts at a racetrack. If an epidemic strikes, the
susceptibility of the homeless will translate into an increased risk of
exposure for the rest of us and, eerily enough, our public libraries could
become Ground Zeroes for the spread of killer flu. Librarians are reluctant
to make plans for handling such scenarios because we do not want to convey
the message that America's libraries are anything but the safe and welcoming
environments they remain today.
But here's the thing: It's not just about libraries. The chronically
homeless share bus stops, subways, park benches, handrails, restrooms,
drinking fountains, and fast-food booths with us or with others we encounter
daily, who also share the air we breathe and the surfaces we touch. When
sick or drunk, they vomit in public restrooms (if we are lucky). Having a
population that is at once vulnerable to disease and able to spread microbes
widely to others is simply foolish -- and unnecessary -- public policy, but
in the library we focus on more immediate risks. We offer our staff
hepatitis vaccinations and free tuberculosis checks. We place sanitizing
gels and latex gloves at every public desk. Who would guess that working in
a library could be a hazardous occupation?
In Place of Snake-Pit Hospitals, Snake-pit Jails
Ultimately, the indigent mentally ill are criminalized. If their presence in
our libraries is a common and growing problem that we librarians would like
the rest of society to be aware of, acknowledge, and commit themselves to
helping us solve, here is a secret we would like to keep to ourselves: We
are complicit. No matter how conscientiously and compassionately we try to
treat our mentally disturbed users -- and at the Salt Lake City Public
Library we work very hard to be fair, helpful, and tolerant -- librarians
often have no good choices and, in the end, we just call the cops.
Take, for example, the case of a young man who entered the library fuming
and spitting racial and ethnic slurs. He loudly asked some Hispanic
teenagers, who were doing their homework, when they crossed the border and
they reported his rude behavior. When a security guard approached, the young
man started yelling obscenities and then took a swing at him. To his credit,
the guard backed off and tried to calm him; but, on the next lunge, the
guard took the kid down, cuffed his hands behind his back, and called the
police. They recognized him. He had been let out of jail just two days
earlier. Putting him back there, staff members argued, obviously wasn't
going to make a difference. Shouldn't he be taken to a hospital for
treatment?
The police pointed out that he was simply too strong and violent to be
handled at a hospital, so he would have to go to jail. While waiting to be
taken away, the kid turned some corner in his mind and left sobbing.
His behavior was not a measure of his character or even of his civility, but
of how severe his psychosis had become without treatment and under the
stress of prison. The man was sick, not bad. If we accept that
schizophrenia, for instance, is not the result of a character flaw or a
personal failing but of some chemical imbalance in the brain -- an imbalance
that can strike regardless of a person's values, beliefs, upbringing, social
standing, or intent, just like any other disease -- then why do we apply a
kind of moral judgment we wouldn't use in other medical situations? We do
not, for example, jail a diabetic who is acting drunk because his body
chemistry has become so unbalanced that he is going into insulin shock, but
we frequently jail schizophrenics when their brain chemistries become so
unbalanced that they act out, as if punishment were the appropriate and
effective response to a mental disorder.
And the police aren't happy about their role either. Cities are responding
to such problems with mental health courts and the like for sorting out the
mentally disturbed from other prisoners. Salt Lake City now has a model
program, but nationally there is a long way to go.
According to the Department of Justice, there are about four times as many
people with mental illnesses incarcerated in America today as under
treatment in state mental hospitals. Some jails devote entire wings to the
mentally ill.
Jails, of course, are intended to control, intimidate, and humiliate. Such a
dehumanizing environment can be especially devastating for the mentally ill.
I am particularly wary when dealing with street people who are recently out
of jail because they are likely to be in an especially agitated state. Of
course, cops and jailers are no better trained or prepared than librarians
to handle people with serious psychological problems. This is a bond we
share -- our unacknowledged charge and our inevitable failure to meet it.
In the 1980s, during the Reagan administration, the discharged mentally ill
began to be "deinstitutionalized" from crowded hospitals with "snake pit"
conditions where they got inadequate treatment. They were supposed to be
integrated into local communities and cared for by local clinics. That was
the dream anyway, but such humane alternatives to indifferent
hospitalization failed to materialize.
The clinics were never built and the communities that were supposed to
embrace the mentally ill didn't get the memo. The safety net that was to
catch them proved to be chockfull of holes. Instead, they migrated to urban
psychiatric ghettoes -- alleys, parks, abandoned buildings, vacant lots, and
flophouses. As housing became more competitive and costly in the 1990s, they
were further compressed into the margins of society where their suffering
festered like an open wound. Now, it is up to the police to
re-institutionalize them -- but this time in snake-pit prisons where they
generally receive no treatment at all. So, in the last couple of decades, we
have exchanged revolving doors to padded cells for revolving doors to jail
cells with steel bars.
The cost of keeping a mentally-ill person in jail is not cheap. In Utah, it
turns out to be the yearly equivalent of tuition at an Ivy League college.
For that kind of taxpayer money, we could get our mentally ill off the
streets and into stable housing environments with enough leftover for the
kinds of support services most of them need to stay off the street. Again,
the right thing to do for them may also be the most practical choice for us.
We could solve the problem for less than it costs to manage it. In the
meanwhile, they will cycle between the jail and the library. Is it any
wonder that they crave a calm and entertaining environment after weeks,
months, or years of fear and noise in jail? From a taxpayer's perspective,
however, it seems cheaper to warehouse them in the library, between stints
in jail -- or simply to pay no attention to where they are at all.
Refusing Treatment
Even if treatment options were not so scarce and inadequate, many of the
mentally ill would not get treatment because they refuse to be treated.
Paranoia is rampant on the street and paranoid people do not willingly
submit to strange doctors and nurses who might "implant" something in
them -- or worse. The cops, paramedics, and social workers can't take a
person to the hospital just because he is ranting incoherently. He has to be
a danger to himself or others.
Committing the mentally ill, homeless or otherwise, to treatment facilities
against their wills is a civil liberties conundrum. As a political activist
with controversial ideas, I am sensitive to the issues raised when citizens
are forced into treatment. Images of Soviet dissidents getting dragged into
psych wards and drugged come immediately to mind. But when a person is
hallucinating and clearly upset, it is hard to accept, as I have often heard
from social workers and the police, that "nothing can be done."
Sid was in his twenties when he came to us -- a tall, lanky, blond kid with
a scraggly beard who walked around rumpled and slump-shouldered, his head
hung in a beaten-dog kind of way. He avoided eye-contact and was very quiet
most of the time. He liked to read graphic novels and comic books.
Occasionally, though, he would jump up and move quickly outside where he
would shout and twitch uncontrollably. He seemed to sense when his
Tourette's Syndrome would strike and wanted to spare us.
On his worst days, he was troubled by hallucinations and voices he would
answer in exasperated whispers. The police told me he had been raped by
other transients -- a common occurrence on the street, bound to aggravate
and complicate existing psychological disorders. When addressed directly,
Sid was unfailingly polite and soft-spoken. Sometimes, we saw him eating
scraps from garbage receptacles. The library staff worried about him,
replaced his clothes when they fell apart, and bought him food when he grew
thin and pale.
Sid, however, refused treatment. The case could be made that Sid was a
danger to himself. After all, he often wasn't coherent enough to acquire
food for himself. But nobody made that case. One day Sid disappeared. Staff
members looked for him on the street and asked other homeless patrons if
they had seen him. No one knew a thing and we never saw him again. I often
wonder what happened to him. I like to imagine that he was rescued by family
members who had been looking for him. It's far more likely that Sid's demons
led him to a bus and that he's wandering the margins of another alien city
where "nothing can be done."
We see so much despair of Sid's sort among the lost souls who shelter at the
library that, by winter's end -- our "homeless season" -- we often find
ourselves hard put to cope with our own feelings of depression and
frustration. As one library manager told me, "I struggle not to internalize
what I experience here, but there are days I just go home and burst out in
tears." She is considering leaving the profession.
Another colleague started out in social work and transitioned to a library
career when she found she couldn't handle the emotional stress of dealing
with her down-and-out clients. Imagine her surprise to rediscover her
feelings of despair while working in the library. "I deal with the same
clientele," she told me one day, "but now I have no way of making a
difference. I still go home feeling sad and discouraged that, in a nation as
rich and powerful as ours, we abandon mentally ill people on the streets and
then resent them for being sick in public."
There is hope, however. After decades of studies by various task forces,
followed by experiments by local governments, a consensus has emerged that
the most effective way to help chronically homeless people is to stabilize
them in housing first and then offer treatment. Social scientists and
policy-makers have concluded, logically enough, that it is hard to "get
better" while living in a stressful, demeaning, and unstable environment and
easier to recover when one feels safe and secure.
This "housing first" strategy isn't cheap, but it is far more realistic and
effective than requiring people to get better as a prerequisite for
housing -- and it costs much less than failing the way we do now. Salt Lake
County, like many local governments, has created a ten-year plan to end
homelessness based on housing-first principles. The wheel of reform is
moving slowly, however, and many people who need help now will suffer and
die on the street before things can turn their way (if they ever actually
do). And the librarians at the City Library and the good citizens of Salt
Lake will watch them struggle daily, while waiting for saner policies to
take hold.
Gaining the World and Losing Each Other
In the meantime, the Salt Lake City Public Library -- Library Journal's 2006
"Library of the Year" -- has created a place where the diverse ideas and
perspectives that sustain an open and inclusive civil society can be
expressed safely, where disparate citizens can discover common ground,
self-organize, and make wise choices together. We do not collect just books,
we also gather voices. We empower citizens and invite them to engage one
another in public dialogues. I like to think of our library as the civic
ballroom of our community where citizens can practice that awkward dance of
mutuality that is the very signature of a democratic culture.
And if the chronically homeless show up at the ball, looking worse than
Cinderella after midnight? Well, in a democratic culture, even disturbing
information is useful feedback. When the mentally ill whom we have thrown
onto the streets haunt our public places, their presence tells us something
important about the state of our union, our national character, our
priorities, and our capacity to care for one another. That information is no
less important than the information we provide through databases and books.
The presence of the impoverished mentally ill among us is not an eloquent
expression of civil discourse, like a lecture in the library's auditorium,
but it speaks volumes nonetheless.
The belief that we are responsible for each other's social, economic, and
political well-being, that we will care for our weakest members
compassionately, should be the keystone in the moral architecture of a
democratic culture. We will not stand by while our fellow citizens are
deprived of their fellowship and citizenship -- which is why we ended racial
segregation and practices like poll taxes that kept disenfranchised
Americans powerless. We will not let children starve. We do not consign
orphans to the streets like they do in Brazil or let children be sold into
prostitution as they do in Thailand. We are proud of our struggles to meet
people's basic needs and to encourage inclusion. Why, then, are the mentally
ill still such an exception to those fundamental standards?
America is proud of its hyper-individualism, our liberation from the bonds
of tribe and the social constraints of traditional societies. We glorify the
accomplishments of inventors, innovators, entrepreneurs, pioneers, and
artists. But while some individuals thrive and the cutting edge of our
technology is wondrous, the plight of the chronically homeless tells me that
our communities are also fragmented and disintegrating. We may have gained
the world and lost each other.
The Penan nomads of Sarawak, Borneo, members of an indigenous and primal
culture, have no technology or material comforts that compare with our
mighty achievements. They have one word for "he," "she," and "it." But they
have six words for "we." Sharing is an obligation and is expected, so they
have no phrase for "thank you." An American child is taught that
homelessness is regrettable but inevitable since some people are bound to
fail. A child of the Penan is taught that a poor man shames us all.
Ophelia is not so far off after all -- in a sense she is dead and has been
for some time. Hers is a kind of social death from shunning. She is
neglected, avoided, ignored, denied, overlooked, feared, detested, pitied,
and dismissed. She exists alone in a kind of social purgatory. She waits in
the library, day after day, gazing at us through multiple lenses and
mumbling to her invisible friends. She does not expect to be rescued or
redeemed. She is, as she says, "used to it."
She is our shame. What do you think about a culture that abandons suffering
people and expects them to fend for themselves on the street, then
criminalizes them for expressing the symptoms of illnesses they cannot
control? We pay lip service to this tragedy -- then look away fast. As a
library administrator, I hear the public express annoyance more often than
not: "What are they doing in here?" "Can't you control them?" Annoyance is
the cousin of arrogance, not shame.
We will let Ophelia and the others stay with us and we will be firm but
kind. We will wait for America to wake up and deal with its Ophelias
directly, deliberately, and compassionately. In the meantime, our patrons
will continue to complain about her and the others who seek shelter with us.
Yes, we know, we say to them; we hear you loud and clear. Be patient,
please, we are doing the best we can. Are you?
Chip Ward recently retired as the assistant director of the Salt Lake City
Public Library System to devote more time to political activism and writing.
He has led several successful campaigns to make polluters accountable and to
stop nuclear utilities from turning the Great Basin Desert into a
radioactive sacrifice zone. His books, Canaries on the Rim: Living Downwind
in the West [5] and Hope's Horizon: Three Visions for Healing the American
Land [6], encourage others to embrace their roles as citizens and to act now
to restore a democratic culture to America.
Copyright 2007 Chip Ward
--
NOTICE: This post contains copyrighted material the use of which has not
always been authorized by the copyright owner. I am making such material
available to advance understanding of
political, human rights, democracy, scientific, and social justice issues. I
believe this constitutes a 'fair use' of such copyrighted material as
provided for in section 107 of the US Copyright
Law. In accordance with Title 17 U.S.C. Section 107
"A little patience and we shall see the reign of witches pass over, their
spells dissolve, and the people recovering their true sight, restore their
government to its true principles. It is true that in the meantime we are
suffering deeply in spirit,
and incurring the horrors of a war and long oppressions of enormous public
debt. But if the game runs sometimes against us at home we must have
patience till luck turns, and then we shall have an opportunity of winning
back the principles we have lost, for this is a game where principles are at
stake."
-Thomas Jefferson
By Tom Engelhardt
Created Apr 2 2007 - 9:19am
Back in the 1950s, when every domestic scandal and nightmare, political or
familial, wasn't the subject of a television show, the library was my
peephole into the mysteries of the adult universe. The key question, when it
came to interpreting the world back then, was this: Would the librarian who
ruled over the juvenile section free you to enter the pay dirt of the rest
of the library? Mine did. As a friend of mine, who arrived in this country
as an immigrant at age 11, used to say of her library years, "I started with
A." So did I. What an essential democratic institution the public library
is.
Of course, today, the condition of America's public libraries is, at best,
wildly variable [1]. Some urban libraries of just the sort I used to haunt
in my childhood have recently been losing out in the race for scarce tax
dollars. They often face cuts in their hours, while their systems close
branches and offer fewer services; others are carving out new roles for
themselves as on-line information providers, advisers, and bustling cultural
centers. So, while the bold architecture of the new main library in downtown
Seattle has become a popular tourist attraction, libraries throughout the
Katrina-ravaged Gulf Coast struggle to rebuild or just hang on.
Many public libraries are experimenting with new roles [2] beyond the
boundaries of story hour and homework help. Public access to the Internet
and computers, for instance, is transforming our libraries into de facto
e-government access points for such disparate services as disaster relief,
Medicare drug plans, and even benefits for children and families. The Salt
Lake City Public Library, the subject of today's Tomdispatch (and Library
Journal's "2006 Library of the Year"), prides itself, for instance, on being
a place [3] "where democracy happens." It houses an NPR radio affiliate and
a film center, as well as a coffee house and deli that encourage people to
linger and talk.
But even if you are lucky enough to have one of these "catalytic" libraries
in your neighborhood, rather than a branch that just shut down for lack of
funds, there's a public-library challenge-cum-nightmare that is rarely
acknowledged. As Chip Ward, a Tomdispatch regular [4] who just retired as
the assistant director of the Salt Lake City Public Library System, makes
clear below, public libraries have become de facto daytime shelters for the
nation's street people; while librarians are increasingly our unofficial
social workers for the homeless (and often the disturbed). It's a dirty
little secret that tells us all too much about the state of our nation
today. -- Tom
What They Didn't Teach Us in Library School: The Public Library as an Asylum
for the Homeless
By Chip Ward
Ophelia sits by the fireplace and mumbles softly, smiling and gesturing at
no one in particular. She gazes out the large window through the two pairs
of glasses she wears, one windshield-sized pair over a smaller set perched
precariously on her small nose. Perhaps four lenses help her see the
invisible other she is addressing. When her "nobody there" conversation
disturbs the reader seated beside her, Ophelia turns, chuckles at the
woman's discomfort, and explains, "Don't mind me, I'm dead. It's okay. I've
been dead for some time now." She pauses, then adds reassuringly, "It's not
so bad. You get used to it." Not at all reassured, the woman gathers her
belongings and moves quickly away. Ophelia shrugs. Verbal communication is
tricky. She prefers telepathy, but that's hard to do since the rest of us,
she informs me, "don't know the rules."
Margi is not so mellow. The "****ing Jews" have been at it again she tells a
staff member who asks her for the umpteenth time to settle down and stop
talking that way. "Communist!" she hisses and storms off, muttering that she
will "sue the boss." Margi is at least 70 and her behavior shows obvious
signs of dementia. The staff's efforts to find out her background are met
with angry diatribes and insults. She clutches a book on German grammar and
another on submarines that she reads upside down to "make things right."
Mick is having a bad day, too. He hasn't misbehaved but sits and stares,
glassy-eyed. This is usually the prelude to a seizure. His seizures are
easier to deal with than Bob's, for instance, because he usually has them
while seated and so rarely hits his head and bleeds, nor does he ever soil
his pants. Bob tends to pace restlessly all day and is often on the move
when, without warning, his seizures strike. The last time he went down, he
cut his head. The staff has learned to turn him over quickly after he hits
the floor, so that his urine does not stain the carpet.
John is trying hard not to be noticed. He has been in trouble lately for the
scabs and raw, wet spots that are spreading across his hands and face. Staff
members have wondered aloud if he is contagious and asked him to get himself
checked-out, but he refuses treatment. He knows he is still being tracked,
thanks to the implants the nurse slipped under his skin the last time he
surrendered to the clinic and its prescriptions. There are frequencies we
don't hear -- but he does. Thin whistles and a subtle beeping indicate he is
being followed, his eye movements tracked and recorded. He claims he falls
asleep in his chair by the stairway because "the little ones" poke him in
the legs with sharp objects that inject sleep-inducing potions.
Franklin sits quietly by the fireplace and reads a magazine about
celebrities. He is fastidiously dressed and might be mistaken for a
businessman or a professional. His demeanor is confident and normal. If you
watch him closely, though, you will see him slowly slip his hand into the
pocket of his sports jacket and furtively pull out a long, shiny carpenter's
nail. With it, he carefully pokes out the eyes of the celebs in any photo.
Then the nail is returned to his pocket, a faint smirk crossing his face as
he turns the page to pursue his next photo victim.
Scenes from a psych ward? Not at all. Welcome to the Salt Lake City Public
Library. Like every urban library in the nation, the City Library, as it is
called, is a de facto daytime shelter for the city's "homeless."
Where the Outcasts Are Inside
In bad weather -- hot, cold, or wet -- most of the homeless have nowhere to
go but public places. The local shelters push them out onto the streets at
six in the morning and, even when the weather is good, they are already
lining up by nine, when the library opens, because they want to sit down and
recover from the chilly dawn or use the restrooms. Fast-food restaurants,
hotel lobbies, office foyers, shopping malls, and other privately owned
businesses and properties do not tolerate their presence for long. Public
libraries, on the other hand, are open and accessible, tolerant, even
inviting and entertaining places for them to seek refuge from a world that
will not abide their often disheveled and odorous presentation, their odd
and sometimes obnoxious behaviors, and the awkward challenges they present
to those who encounter them.
Although the public may not have caught on, ask any urban library
administrator in the nation where the chronically homeless go during the day
and he or she will tell you about the struggles of America's public
librarians to cope with their unwanted and unappreciated role as the daytime
guardians of the down and out. In our public libraries, the outcasts are
inside.
"Homeless" is a misleading term. We have homeless people in America today,
in part, because we have no living wage, no universal healthcare,
disintegrating communities, and a large population of working poor who can
end up on the street if they lose one of their part-time jobs, experience an
illness or an accident, or have a domestic crisis. For them, homelessness is
generally temporary, probably a once-in-a-lifetime experience. There is
little to distinguish such people from the rest of us and we usually do not
notice their presence among us. Programs to help people in such
circumstances may be inadequate -- and it is a shame they are needed at
all -- but they usually work. For the people we point to on the street or in
public places and normally identify as homeless, however, homelessness is a
way of life and our best attempts to rescue them continually fail.
We commonly refer to them as "street people." We see them sleeping in parks,
huddled over grates on sidewalks, resting or sleeping on subway cars, passed
out in doorways, or panhandling with crude cardboard signs. Social workers
refer to them as the "chronically homeless." Although they make up only
about 10% of the total number of people who experience homelessness in a
given year, they soak up more than half the dollars we spend on programs to
address homelessness. There are at least 200,000 people across the nation
living more or less permanently on the street, enough to fill a thousand
public libraries every day.
Drunk as a Skunk
The term "chronically homeless" is also inadequate when it comes to
describing these individuals -- it only tells you that their homeless state
is frequent. It neither indicates why they are homeless and stay that way,
nor says anything about their most salient characteristic: Most of them are
mentally ill. The published data on how many homeless are considered
mentally ill by those who study them varies widely from 10% to 70%,
depending on whether all the homeless, or just the chronically homeless, are
included (and depending on how you define illness or disability). How, for
example, do you categorize alcoholics and drug addicts?
When Crash is sober, for instance, he reasons like you or me, converses
normally, and has a good sense of humor. Unfortunately, he is rarely sober.
In one of his better moments, he petitioned me to let him stay in the
library even though he was caught drinking -- an automatic six-month
suspension. "You know I'm a good guy and I don't bring that stuff into the
library," he pleads. "C'mon, give me another chance."
Crash is sitting in his wheelchair in the foyer outside my office where I
serve as the library's assistant director. It's hard for me to address Crash
without staring at the massive scar on his face -- a deep crease that neatly
divides it down the middle from scalp to chin. Unfortunately, his nose is
also divided and the sides do not match-up, giving him an asymmetrical
appearance like a Picasso painting on wheels.
"Alcoholics pass out in the library's chairs," I explain, "and if we can't
wake you up we have to call the paramedics. If you piss your pants or puke,
the custodians have to clean that up and they hate that. You guys fall down
and knock things over. You're unpredictable when you drink. You disrupt
others. Public intoxication is against the law..."
"Okay, okay," he interrupts me, "I get it. Hey, just thought I'd try and get
back in is all -- no hard feelings, man."
No hard feelings I assure him. He smiles and we shake hands. I wish I could
cut him some slack -- after dozens of confrontations with angry and
threatening drunks, I appreciate a cheerful drinker like Crash -- but I
can't afford to establish a precedent I can't keep. The rule is clear: no
drinking in the library and no exceptions. As he waits for the elevator
doors to open and take him down, I venture a question I've been holding onto
for awhile. "I know it's none of my business, but how did you get that
scar?"
"Car accident," he replies, "same one as put me in this wheelchair. That's
why they call me Crash."
"Were you drinking?" I ask.
He shakes his head and sighs. "Drunk as a skunk. drunk as a skunk." As the
elevator descends I think about just how hard it must be to be both
wheelchair-bound and homeless. I wonder about the commonly held notion that
alcoholics must "hit bottom" before they can rebound. Is there such a thing
as bottom for guys like Crash? Is he any more capable of controlling his
urge to drink than Ophelia can control the voices in her head?
Our condemnation of transient-style alcoholism is both hypocritical and
snobbish. If you are unhappy and caught without a prescription in America,
you self-medicate. Depressed lawyers do it with fine scotch. An unemployed
trucker might turn to beer or meth. Anxiety-ridden teachers or waitresses
might smoke pot or order just one more margarita. Indigent people who want
relief from their demons drink whatever is available and affordable or
swallow whatever pills come their way. Dr. Tichenor's mouthwash is a popular
choice for street alcoholics and "Doc Tich," as the brand is commonly known,
doesn't offer a pinot noir.
What Library School Didn't Cover
The strong odor of mouthwash on the breath of transient alcoholics who
shelter with us is often masked by the overwhelming odor of old sweat,
urine-stained pants, and the bad-dairy smell that unwashed bodies and
clothes give off. It can take your breath away long before you can smell
theirs.
The library wrestles with where to draw the line on odor. The law is
unclear. An aggressive patron in New Jersey successfully sued a public
library for banning him because of his body odor. That decision has had a
chilling effect on public libraries ever since. When library users complain
about the odor of transients, librarians usually respond that there isn't
much they can do about it. Lately, libraries are learning to write policies
on odor that are more specific and so can be defended in court, but such
rules are still hard to enforce because smell is such a subjective thing --
and humiliating someone by telling him he stinks is an awkward experience
that librarians prefer to avoid. None of this was covered in library school.
It's a chicken-or-egg world for the mentally-ill homeless. Are they on the
street because they are immobilized by severe depression or is deep
depression the consequence of being on the street? Any tendency towards a
psychological problem is aggravated and magnified by the constant stress,
social isolation, loss of self-esteem, despair, and relentless boredom of
street life. Imagine the degradation of waiting an hour in the cold rain to
get into a soup kitchen for a meal; the hassle of hunting endlessly for an
unpoliced spot to sleep; the constant fear of being robbed or attacked by
other street people; or the indignity of defecating in a vacant lot. It's a
combination that would probably drive a mentally healthy person to psychosis
and substance abuse. Street people, who suffer serious psychological
disorders, are often substance abusers, too, and the drug that a psychotic
person prefers, often matches the psychosis. I have learned, for example,
that bi-polar users prefer cocaine when in their manic phases and
schizophrenics gravitate, naturally enough, to hallucinogens.
Alcohol and drugs mix with depression, schizophrenia, bi-polar disorder, and
paranoia in complex ways, so it is hard to pull any given disorder apart and
understand just who this person in front of you, cursing or pleading or
thrashing on the floor, may be. Public librarians, of course, are not
trained to do this. We deal with behaviors that are symptomatic without
understanding why someone is suffering or what we can do about it. And even
if we did understand and had been trained for such situations, healing the
homeless is not our mission. Taxpayers expect us to provide library services
and leave the homeless to social workers. They give us resources only for
one mission, not two.
What about those social workers then? They turn out to be too few,
under-funded, over-worked, and overwhelmed. My initial unsuccessful attempts
to get the social workers who operate the "homeless van" to stop in and
assess a "regular" homeless patron who, we suspected, had suffered a stroke,
reminded me that they had more pressing priorities. In the dead of winter,
they struggle to get people sleeping in alleys or passed out on sidewalks
indoors so they don't freeze to death. Theirs is an everyday "life or death"
race. If a homeless guy is inside the library, then, "Hey, mission
accomplished."
Navigating the Archipelago of Despair
A workshop I attended on treating Native Americans for alcoholism
compellingly described how incorporating sweat lodges, healing ceremonies,
and other elements from Native American culture into established treatment
methods can improve their effectiveness for Native American patients. Of
course, the social worker added, it's essential to provide a halfway-house
option between rehab and release and that remains a huge problem. Typically,
he told us, his clients wait three to six months to get into a halfway-house
after rehab.
"And where do they go while they wait?" I asked, naively enough.
He shrugged and sighed. "Back with their drinking buddies in the park, under
the bridge, wherever."
The inadequacy of existing resources and the absurdity of the conditions
they endure are just part of the landscape, a given for social workers.
Public librarians can cooperate with (and learn from) them, but we
understand that they are overwhelmed and often unavailable. So, like it or
not, we are ushered into the ranks of auxiliary social workers with no
resources whatsoever.
Local hospitals are also uncertain allies. They have little room for the
indigent mentally ill for whose treatment they often can't get reimbursed.
So they deal with the crisis at hand, fork over some pills, and send the
hopeless homeless on their way.
A manager at a shelter-clinic told me that he keeps a stash of petty cash
handy because sometimes a taxi arrives at his door from one of the city's
hospitals, carrying an incoherent patient without ID or any possessions
other than the hospital gown he or she is wearing. When that happens, clinic
workers are instructed to rush for the cab before it can unload its
passenger and pay the driver to return to the hospital, puzzled cargo still
in hand.
Throughout the fragmented system of healthcare for homeless people, from
rehab to hospitals to jails, there are few ground rules or protocols for
discharging the mentally ill and next to no communication between healthcare
providers, police, social workers, and shelter managers in this archipelago
of despair. Public librarians are out of the loop altogether; our role in
providing daytime shelter for the homeless is ignored. When, in an attempt
to build my own useful network, I attended conferences on homeless issues, I
was always met with puzzlement and the question: "What are you doing here?"
"Where do you think they go during the day?" I would invariably answer.
"Oh, yeah, I guess that's right -- you deal with them, too," would be the
invariable response, always offered as if that never occurred to them
before.
Paramedics are caught in the middle of this dark carnival of confusion and
neglect. In the winter, when the transient population of the library
increases dramatically, we call them almost every day. Once, when I
apologized to a paramedic for calling twice, he responded, "Hey, no need to
explain or apologize." He swept his arm towards the other paramedics,
surrounding a portable gurney on which they would soon carry a disoriented
old man complaining of dizziness to the emergency room. "Look at us," he
said, "we're the mobile homeless clinic. This is what we do. All day long,
day after day, and mostly for the same people over and over."
Sanitizing Gels and Latex Gloves: Plying the Librarian's Trade
The cost of this mad system is staggering. Cities that have tracked
chronically homeless people for the police, jail, clinic, paramedic,
emergency room, and other hospital services they require, estimate that a
typical transient can cost taxpayers between $20,000 and $150,000 a year.
You could not design a more expensive, wasteful, or ineffective way to
provide healthcare to individuals who live on the street than by having
librarians like me dispense it through paramedics and emergency rooms. For
one thing, fragmented, episodic care consistently fails, no matter how many
times delivered. It is not only immoral to ignore people who are suffering
illness in our midst, it's downright stupid public policy. We do not spend
too little on the problems of the mentally disabled homeless, as is often
assumed, instead we spend extravagantly but foolishly.
And the costs could grow far beyond the measure of money. If an epidemic of
deadly flu were to strike, if an easily communicable strain of tuberculosis
or some other devastating disease emerges, paramedics will be overwhelmed by
their homeless clients who are at high risk for such illnesses. People who
drink until they pass out tend to aspirate and choke, and people who sleep
outdoors at night breathe cold, damp air. People who sleep in crowded
shelters breathe each other's air.
Serious respiratory problems among the chronically homeless in a shelter are
as common as beer guts at a racetrack. If an epidemic strikes, the
susceptibility of the homeless will translate into an increased risk of
exposure for the rest of us and, eerily enough, our public libraries could
become Ground Zeroes for the spread of killer flu. Librarians are reluctant
to make plans for handling such scenarios because we do not want to convey
the message that America's libraries are anything but the safe and welcoming
environments they remain today.
But here's the thing: It's not just about libraries. The chronically
homeless share bus stops, subways, park benches, handrails, restrooms,
drinking fountains, and fast-food booths with us or with others we encounter
daily, who also share the air we breathe and the surfaces we touch. When
sick or drunk, they vomit in public restrooms (if we are lucky). Having a
population that is at once vulnerable to disease and able to spread microbes
widely to others is simply foolish -- and unnecessary -- public policy, but
in the library we focus on more immediate risks. We offer our staff
hepatitis vaccinations and free tuberculosis checks. We place sanitizing
gels and latex gloves at every public desk. Who would guess that working in
a library could be a hazardous occupation?
In Place of Snake-Pit Hospitals, Snake-pit Jails
Ultimately, the indigent mentally ill are criminalized. If their presence in
our libraries is a common and growing problem that we librarians would like
the rest of society to be aware of, acknowledge, and commit themselves to
helping us solve, here is a secret we would like to keep to ourselves: We
are complicit. No matter how conscientiously and compassionately we try to
treat our mentally disturbed users -- and at the Salt Lake City Public
Library we work very hard to be fair, helpful, and tolerant -- librarians
often have no good choices and, in the end, we just call the cops.
Take, for example, the case of a young man who entered the library fuming
and spitting racial and ethnic slurs. He loudly asked some Hispanic
teenagers, who were doing their homework, when they crossed the border and
they reported his rude behavior. When a security guard approached, the young
man started yelling obscenities and then took a swing at him. To his credit,
the guard backed off and tried to calm him; but, on the next lunge, the
guard took the kid down, cuffed his hands behind his back, and called the
police. They recognized him. He had been let out of jail just two days
earlier. Putting him back there, staff members argued, obviously wasn't
going to make a difference. Shouldn't he be taken to a hospital for
treatment?
The police pointed out that he was simply too strong and violent to be
handled at a hospital, so he would have to go to jail. While waiting to be
taken away, the kid turned some corner in his mind and left sobbing.
His behavior was not a measure of his character or even of his civility, but
of how severe his psychosis had become without treatment and under the
stress of prison. The man was sick, not bad. If we accept that
schizophrenia, for instance, is not the result of a character flaw or a
personal failing but of some chemical imbalance in the brain -- an imbalance
that can strike regardless of a person's values, beliefs, upbringing, social
standing, or intent, just like any other disease -- then why do we apply a
kind of moral judgment we wouldn't use in other medical situations? We do
not, for example, jail a diabetic who is acting drunk because his body
chemistry has become so unbalanced that he is going into insulin shock, but
we frequently jail schizophrenics when their brain chemistries become so
unbalanced that they act out, as if punishment were the appropriate and
effective response to a mental disorder.
And the police aren't happy about their role either. Cities are responding
to such problems with mental health courts and the like for sorting out the
mentally disturbed from other prisoners. Salt Lake City now has a model
program, but nationally there is a long way to go.
According to the Department of Justice, there are about four times as many
people with mental illnesses incarcerated in America today as under
treatment in state mental hospitals. Some jails devote entire wings to the
mentally ill.
Jails, of course, are intended to control, intimidate, and humiliate. Such a
dehumanizing environment can be especially devastating for the mentally ill.
I am particularly wary when dealing with street people who are recently out
of jail because they are likely to be in an especially agitated state. Of
course, cops and jailers are no better trained or prepared than librarians
to handle people with serious psychological problems. This is a bond we
share -- our unacknowledged charge and our inevitable failure to meet it.
In the 1980s, during the Reagan administration, the discharged mentally ill
began to be "deinstitutionalized" from crowded hospitals with "snake pit"
conditions where they got inadequate treatment. They were supposed to be
integrated into local communities and cared for by local clinics. That was
the dream anyway, but such humane alternatives to indifferent
hospitalization failed to materialize.
The clinics were never built and the communities that were supposed to
embrace the mentally ill didn't get the memo. The safety net that was to
catch them proved to be chockfull of holes. Instead, they migrated to urban
psychiatric ghettoes -- alleys, parks, abandoned buildings, vacant lots, and
flophouses. As housing became more competitive and costly in the 1990s, they
were further compressed into the margins of society where their suffering
festered like an open wound. Now, it is up to the police to
re-institutionalize them -- but this time in snake-pit prisons where they
generally receive no treatment at all. So, in the last couple of decades, we
have exchanged revolving doors to padded cells for revolving doors to jail
cells with steel bars.
The cost of keeping a mentally-ill person in jail is not cheap. In Utah, it
turns out to be the yearly equivalent of tuition at an Ivy League college.
For that kind of taxpayer money, we could get our mentally ill off the
streets and into stable housing environments with enough leftover for the
kinds of support services most of them need to stay off the street. Again,
the right thing to do for them may also be the most practical choice for us.
We could solve the problem for less than it costs to manage it. In the
meanwhile, they will cycle between the jail and the library. Is it any
wonder that they crave a calm and entertaining environment after weeks,
months, or years of fear and noise in jail? From a taxpayer's perspective,
however, it seems cheaper to warehouse them in the library, between stints
in jail -- or simply to pay no attention to where they are at all.
Refusing Treatment
Even if treatment options were not so scarce and inadequate, many of the
mentally ill would not get treatment because they refuse to be treated.
Paranoia is rampant on the street and paranoid people do not willingly
submit to strange doctors and nurses who might "implant" something in
them -- or worse. The cops, paramedics, and social workers can't take a
person to the hospital just because he is ranting incoherently. He has to be
a danger to himself or others.
Committing the mentally ill, homeless or otherwise, to treatment facilities
against their wills is a civil liberties conundrum. As a political activist
with controversial ideas, I am sensitive to the issues raised when citizens
are forced into treatment. Images of Soviet dissidents getting dragged into
psych wards and drugged come immediately to mind. But when a person is
hallucinating and clearly upset, it is hard to accept, as I have often heard
from social workers and the police, that "nothing can be done."
Sid was in his twenties when he came to us -- a tall, lanky, blond kid with
a scraggly beard who walked around rumpled and slump-shouldered, his head
hung in a beaten-dog kind of way. He avoided eye-contact and was very quiet
most of the time. He liked to read graphic novels and comic books.
Occasionally, though, he would jump up and move quickly outside where he
would shout and twitch uncontrollably. He seemed to sense when his
Tourette's Syndrome would strike and wanted to spare us.
On his worst days, he was troubled by hallucinations and voices he would
answer in exasperated whispers. The police told me he had been raped by
other transients -- a common occurrence on the street, bound to aggravate
and complicate existing psychological disorders. When addressed directly,
Sid was unfailingly polite and soft-spoken. Sometimes, we saw him eating
scraps from garbage receptacles. The library staff worried about him,
replaced his clothes when they fell apart, and bought him food when he grew
thin and pale.
Sid, however, refused treatment. The case could be made that Sid was a
danger to himself. After all, he often wasn't coherent enough to acquire
food for himself. But nobody made that case. One day Sid disappeared. Staff
members looked for him on the street and asked other homeless patrons if
they had seen him. No one knew a thing and we never saw him again. I often
wonder what happened to him. I like to imagine that he was rescued by family
members who had been looking for him. It's far more likely that Sid's demons
led him to a bus and that he's wandering the margins of another alien city
where "nothing can be done."
We see so much despair of Sid's sort among the lost souls who shelter at the
library that, by winter's end -- our "homeless season" -- we often find
ourselves hard put to cope with our own feelings of depression and
frustration. As one library manager told me, "I struggle not to internalize
what I experience here, but there are days I just go home and burst out in
tears." She is considering leaving the profession.
Another colleague started out in social work and transitioned to a library
career when she found she couldn't handle the emotional stress of dealing
with her down-and-out clients. Imagine her surprise to rediscover her
feelings of despair while working in the library. "I deal with the same
clientele," she told me one day, "but now I have no way of making a
difference. I still go home feeling sad and discouraged that, in a nation as
rich and powerful as ours, we abandon mentally ill people on the streets and
then resent them for being sick in public."
There is hope, however. After decades of studies by various task forces,
followed by experiments by local governments, a consensus has emerged that
the most effective way to help chronically homeless people is to stabilize
them in housing first and then offer treatment. Social scientists and
policy-makers have concluded, logically enough, that it is hard to "get
better" while living in a stressful, demeaning, and unstable environment and
easier to recover when one feels safe and secure.
This "housing first" strategy isn't cheap, but it is far more realistic and
effective than requiring people to get better as a prerequisite for
housing -- and it costs much less than failing the way we do now. Salt Lake
County, like many local governments, has created a ten-year plan to end
homelessness based on housing-first principles. The wheel of reform is
moving slowly, however, and many people who need help now will suffer and
die on the street before things can turn their way (if they ever actually
do). And the librarians at the City Library and the good citizens of Salt
Lake will watch them struggle daily, while waiting for saner policies to
take hold.
Gaining the World and Losing Each Other
In the meantime, the Salt Lake City Public Library -- Library Journal's 2006
"Library of the Year" -- has created a place where the diverse ideas and
perspectives that sustain an open and inclusive civil society can be
expressed safely, where disparate citizens can discover common ground,
self-organize, and make wise choices together. We do not collect just books,
we also gather voices. We empower citizens and invite them to engage one
another in public dialogues. I like to think of our library as the civic
ballroom of our community where citizens can practice that awkward dance of
mutuality that is the very signature of a democratic culture.
And if the chronically homeless show up at the ball, looking worse than
Cinderella after midnight? Well, in a democratic culture, even disturbing
information is useful feedback. When the mentally ill whom we have thrown
onto the streets haunt our public places, their presence tells us something
important about the state of our union, our national character, our
priorities, and our capacity to care for one another. That information is no
less important than the information we provide through databases and books.
The presence of the impoverished mentally ill among us is not an eloquent
expression of civil discourse, like a lecture in the library's auditorium,
but it speaks volumes nonetheless.
The belief that we are responsible for each other's social, economic, and
political well-being, that we will care for our weakest members
compassionately, should be the keystone in the moral architecture of a
democratic culture. We will not stand by while our fellow citizens are
deprived of their fellowship and citizenship -- which is why we ended racial
segregation and practices like poll taxes that kept disenfranchised
Americans powerless. We will not let children starve. We do not consign
orphans to the streets like they do in Brazil or let children be sold into
prostitution as they do in Thailand. We are proud of our struggles to meet
people's basic needs and to encourage inclusion. Why, then, are the mentally
ill still such an exception to those fundamental standards?
America is proud of its hyper-individualism, our liberation from the bonds
of tribe and the social constraints of traditional societies. We glorify the
accomplishments of inventors, innovators, entrepreneurs, pioneers, and
artists. But while some individuals thrive and the cutting edge of our
technology is wondrous, the plight of the chronically homeless tells me that
our communities are also fragmented and disintegrating. We may have gained
the world and lost each other.
The Penan nomads of Sarawak, Borneo, members of an indigenous and primal
culture, have no technology or material comforts that compare with our
mighty achievements. They have one word for "he," "she," and "it." But they
have six words for "we." Sharing is an obligation and is expected, so they
have no phrase for "thank you." An American child is taught that
homelessness is regrettable but inevitable since some people are bound to
fail. A child of the Penan is taught that a poor man shames us all.
Ophelia is not so far off after all -- in a sense she is dead and has been
for some time. Hers is a kind of social death from shunning. She is
neglected, avoided, ignored, denied, overlooked, feared, detested, pitied,
and dismissed. She exists alone in a kind of social purgatory. She waits in
the library, day after day, gazing at us through multiple lenses and
mumbling to her invisible friends. She does not expect to be rescued or
redeemed. She is, as she says, "used to it."
She is our shame. What do you think about a culture that abandons suffering
people and expects them to fend for themselves on the street, then
criminalizes them for expressing the symptoms of illnesses they cannot
control? We pay lip service to this tragedy -- then look away fast. As a
library administrator, I hear the public express annoyance more often than
not: "What are they doing in here?" "Can't you control them?" Annoyance is
the cousin of arrogance, not shame.
We will let Ophelia and the others stay with us and we will be firm but
kind. We will wait for America to wake up and deal with its Ophelias
directly, deliberately, and compassionately. In the meantime, our patrons
will continue to complain about her and the others who seek shelter with us.
Yes, we know, we say to them; we hear you loud and clear. Be patient,
please, we are doing the best we can. Are you?
Chip Ward recently retired as the assistant director of the Salt Lake City
Public Library System to devote more time to political activism and writing.
He has led several successful campaigns to make polluters accountable and to
stop nuclear utilities from turning the Great Basin Desert into a
radioactive sacrifice zone. His books, Canaries on the Rim: Living Downwind
in the West [5] and Hope's Horizon: Three Visions for Healing the American
Land [6], encourage others to embrace their roles as citizens and to act now
to restore a democratic culture to America.
Copyright 2007 Chip Ward
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"A little patience and we shall see the reign of witches pass over, their
spells dissolve, and the people recovering their true sight, restore their
government to its true principles. It is true that in the meantime we are
suffering deeply in spirit,
and incurring the horrors of a war and long oppressions of enormous public
debt. But if the game runs sometimes against us at home we must have
patience till luck turns, and then we shall have an opportunity of winning
back the principles we have lost, for this is a game where principles are at
stake."
-Thomas Jefferson