Deinstitutionalization for the Rest of Us

Everyone stared as Lorraine Ravensworth burst into the homeless day program with her red lips wide open and tongue protruding. She couldn’t control her tongue to form words, but her panicked eyes said it all, and Sarah, the program social worker, called 911. This inhumane tardive dyskinesia side effect of old-school antipsychotics is hard enough to handle in the privacy of a home, but it’s torture if you live on the streets. That’s one more reason Lorraine took advantage of the gaps created by deinstitutionalization to evade mental health treatment whenever possible.

Unfortunately, without the beneficial side of the medication, Lorraine lived in a world full of unreliable characters and plot twists. She never knew who she could trust.

“Social Security is trying to kill me,” she whispered to Sarah. “They have been for years.” Paradoxically, Lorraine depended upon her disability Social Security income to live. Succumbing to paranoid schizophrenia as a young adult, she had not held a job nor a spouse long enough to be eligible for anything over the minimum, and she needed every penny every month. She also needed the medical coverage, but, being suspicious of doctors and hospitals, providing her medical coverage proved a relative bargain for Uncle Sam.

Lorraine didn’t use her disability check for shelter and only occasionally for food. And she didn’t waste it on street drugs or alcohol – she wanted to keep her wits about her, scrambled as they might be.

However, the disability funds she received did support the cosmetics industry and the local drugstore. Lorraine liked to keep up her appearance. Even when she was too paranoid to sleep in the shelter and shower, she still applied her daily mask of “Sun Beige” foundation, covering her face from her hairline to her jawline, liberal rosy blush, “Certainly Red” lipstick, jet black eyeliner and mascara, and shimmering green eyeshadow a shade lighter than her eyes. Lorraine teased her drugstore auburn hair close to beehive height and added a hairband and clips to keep it in place. She liked to adorn her hairdo with seasonal objects when she could find them, such as tiny Christmas ornaments or fall and spring flowers. Once, in July, American flags with toothpick flagpoles flew from both sides of her head.

To complete the look, she sewed bright ribbons and trinkets to her clothes, anything she could find, like strings of discarded Christmas lights to the hems of her pants. Sometimes, she painted her ragged nails. Occasionally, she splurged on sparkling drugstore jewelry.

Despite her flamboyant appearance, Lorraine seemed to prefer her own company and most shelter residents left her alone. If someone new or desperate tried to borrow a few bucks, Lorraine’s fearful look, bearing her chipped yellow teeth like a trapped animal, scared them off.

Sarah’s job - to engage homeless individuals with mental illness and connect them with needed treatment – was part of the deinstitutionalization plan to redirect the funding stream for the closing state hospitals to programs in the community. But, communities did not want such programs and people in their backyards. And politicians, with their lofty plans, came and went, leaving the shuddered institutions. Outside the physical and chemical restraints of the psychiatric facilities, the easily herded sheep-like patients became skittish cats. Sarah had little to offer that they wanted other than someone to listen to their story and to see them as worthwhile for the moment.

Lorraine’s stories shapeshifted. They began as mundane human experiences -- issues of missing items, rude people, and unmet needs -- but then flashed back five or ten years when other characters popped in or time-traveled to fearful futures. Sarah tried to find the actionable piece of each puzzling story without asking for clarification. She learned that if she asked too many questions, Lorraine would shut down. She’d stare at Sarah with narrowed eyes that shifted back and forth, maybe listening to internal messages, before bolting from the office.

One month, out of nowhere, Lorraine’s disability checks stopped. At first, Sarah assumed the check had been lost in the mail. Social Security encouraged direct deposit, but Lorraine didn’t trust banks. Sarah once convinced her to open an account, but Lorraine closed it before the direct deposit could be processed. What a fiasco that had been and reinforced Lorraine’s suspicions. It was back to paper checks mailed to her P.O. box, which she checked multiple times a day.

With Lorraine at her desk, Sarah called Social Security to report the missing check, assuring Lorraine that it would be replaced. She put the call on speaker and expected a tedious walk through the bureaucratic maze but hit a brick wall with an apathetic nasal tone.

“The check was stopped because Lorraine Ravensworth is deceased.”

“She’s right here with me,” Sarah said, taking in the rosy-cheeked Lorraine.

“Our records indicate that Lorraine Ravensworth is deceased,” the representative repeated.

“I told you,” Lorraine said rather matter-of-factly, “They’ve been trying to kill me.”

After two months and several in-person visits to the Social Security office with hard-won documentation, the United States government finally resurrected Lorraine Ravensworth and resumed her disability benefits. Lorraine took the ordeal in stride, folding this real injustice into her ongoing persecution paranoia.

One afternoon, after cashing her disability check, Lorraine came in to speak with Sarah about the urgent matter of the Catholic Church stealing money from her mother when they lived in New York, which must have been forty years before. Lorraine said she knew that Tom at the check-cashing place was related to the priest because they looked alike and they might be trying to track her. She pointed out the security thread on the new twenty-dollar bill she had received as proof.

Sarah knew better than to confront Lorraine’s delusions, but she didn’t want to reinforce them either. She often offered a benign response to show she was at least listening.

“I’m sorry, Lorraine, but I don’t understand.”

Lorraine looked up and made solid eye contact. “Whenever you get confused,” she advised solemnly, “just remember your hair color.”