In Philadelphia there is an intersection called K & A, Kensington & Allegheny, that is the epicenter of drug tourism. That’s what they call it. People travel here for cheap, and powerful, opioids. Many never leave. Tents go up under the el. Young men stand hunched over, swaying in the street like trees in the yard before a thunderstorm rages, blocking traffic, mindless, senseless, gone. I’ve seen a woman hold a baby in her arms as she stuck a needle into a vein, hit her target, missed the baby. Teetered slowly, baby dangled. Until…
When we talked to our daughter about drugs we drove her through here. There was a light rain and headlights streaked the pocked asphalt. In the splaying glimmer wide eyes stared out from under tarps and cheap tents, poles bent, limbs twisted. This can happen to you, we told her. And once you take the shit nothing can save you. That’s no exaggeration. As we passed she turned and looked out the rear window. She held her hands to her head and slowly slid down the seat until all she could see was the roof of the car and the streetlights pulsing by. One after the other. Never changing. Just a morse code of death waiting. Just a total failure of the mental health system here and all over the country.
Every so often the city clears out the encampment, and unwittingly sends the dregs scattering into other neighborhoods where sometimes they come together into small pathetic communities. The new mayor is doing that now, and tents are popping up at night in our neighborhood in the carefully landscaped strip of Front Street that runs along 95. Bodies slump against the walls of the underpasses. Piles of shit too large for dogs lay around corners and between cars in the parking lot. No one picks them up. Maybe the rain. For a time you only saw the lost souls at night. But lately there are more, and they lay strewn about during the day and stagger down the sidewalk. Once a week late at night there’s a rustling outside as someone goes through the trash. Spent needles, orange and plastic, lie in the gutter by Old Swedes Church.
Sooner or later they’ll pitch camp and parade back to K & A. They always do.
A few days ago on my news feed I read an article about high-functioning depression and how psychiatrists are treating it. During my struggle with bipolar disorder I’ve been depressed alright. There was nothing high-functioning about it.
But there it was, and I Googled it. There are research papers on it. WebMD pages. And lots of lay articles. High-functioning depression. Symptoms: loss of purpose, exhaustion, hopelessness, dark moods, but still able to attend to all the activities that make for a normal life: Go to work, pack the kids’ lunches, pay the bills. Really? That’s sadness, heartbreak, even. But it’s not a mental illness. Normal emotions, they are. Everybody, at some point, experiences them. What to do? Join a club. Take a class. Call an old friend. Exercise. Stop scrolling. Go to church, for Christ’s sake.
But no, we’re compelled to pathologize what is normal, call it a mental illness, medicate it, grovel in it, and diminish the real problems of mental illness that consume the people at K & A. Every time we stretch the bounds of mental illness to include people who are troubled but otherwise OK we take away resources, focus, and empathy from the people with lives barely livable due to severe mental illness.
I’m sorry. I’ve laid on a gurney with an IV in my arm as a doctor fiddled with dials on a machine and one nurse wrapped a blood pressure cuff around my ankle while another slipped a piece of hard rubber between my teeth. I felt a soft pressure against my temples and then sleep. I came to stupefied, seemingly no better. A few days later, again. So am I angry that now people who are searching for meaning in life, and finding none, are called mentally ill? Yes.
Every time we treat someone from the very broad category of the ‘worried well’ we have less to attend to the those who are truly disabled by mental illness. Less research. Less medicine. Less doctors. Less hospitals. Less interest. I know psychiatry is not a zero-sum game. To some extent we can do both. But psychiatry is a business, and the big money is going after the biggest return. Big like the millions with health insurance and bank accounts and the nagging drive that life could be better. All the while there are no returns in the people trudging back to K & A. Or the people asleep at noon on the sidewalk. Or the people who cut themselves when they should be doing their homework. Or the people with emotional pain so bad it is debilitating. Or the people who quit calling in sick weeks ago and then just quit for good. Or the people who have ravaged it all, everything reckless, and have destroyed the people closest to them. Or the people who hear voices or see demons. Or the people who lay out all the pills in the house on the coffee table and fill a large glass with water and finally, impulsively, surrender.
We’re funny about all this. We’ll get all compassionate about people who come to a bump in the road and struggle to get over it, but still drive on a little duller, maybe, but still the embodiment of tenacity and effort as they approach emotional distress. We make commercials for new meds about them. We read their self-help books. Meanwhile, we somehow blame the people who really struggle with mental illness for their own loss, as if they’re responsible for schizophrenia or bipolar disorder or even, yes, addiction. Martin Buber wrote, “If we could see the demons that populate the world life would be unbearable.” The people at K & A have seen the demons. But too many of us see demons when we look at them. We have a habit of blaming the victim, which is why people with high-functioning depression are not victims at all. We don’t blame them the way we blame the man halted in the crosswalk who can’t make it to the other side. Who just gave up. No, those with so called high-functioning depression aren’t victims. They’re targets. They’re targets for a big industry using their anhedonia to drive revenue. They’re profit centers.
They are not mentally ill, unless all human emotion is mental illness, and they distract us all from those who are.
I have to re-read this a few more times, as there is a lot of depth, here and I want to fully appreciate all of if. I was actually afraid you were going into victim-blaming mode when I first starting reading it, but if I understood correctly, you did not do that. Maritn Buber -- ah, memories of my classes in Existential Philosophy! One thing though: if abortion and birth control were legal and accessible, and if men stopped raping at the level that they do, that suffering woman at K & A would not be holding that baby.