The parade was wrong on so many levels.
It was a sweltering, muggy July morning–the Friday before Independence Day. Each unit had been instructed in advance to assemble in a central parking lot of the large, sprawling state hospital that had been constructed about a century earlier. The lead staff scrambled with worried expressions upon harried and furrowed faces as they prepared their units to join in on the unprecedented affair. Clinical and nursing staff rushed to get the patients out to the meeting place on time. Some prompted the patients calmly, mindful of their sensory and cognitive deficits; others herded them impatiently and angrily, treating them as if they had all their mental faculties, as if they understood what was being shouted at them, as they themselves were treated as children and at home by their partners; some were oblivious and lost in the coma of compliance and routine; they simply followed.
As with any type of organized event at this particular institution, there was the obligatory ritual of bitching, moaning, eye rolling and complaining. As the individuals/consumers/patients were being escorted to the rallying point, the staff provided the subtext and chatter about the “better judgment” of those in Program Management and Administration; there were choice words and phrases about the Utter Fucking Incompetence Of Those Without Any Clinical Experience; a constant stream of expletives and mutterings about the motives and abilities of those who’d been promoted up through the channels of cronyism, politics, nepotism and God Knows What Else. And so they went: through the motions; they followed the orders and edicts and proscribed administrative directives sheepishly and blindly; they marched their (lack of) selves and their charges into the central courtyard. It was a well-oiled juggernaut of state servanthood: The pissed off and disgruntled well paid and under-worked ubiquitously scorned and envied state employees escorting the misunderstood demonized hallucinating, manic, stuporous, and blissfully ignorant residents of the Tenth Circle of Hell—a place so many of them powerlessly called home.
At the rallying point the scene to behold was the antithesis of clinical social work, a travesty of the fine art of psychology, a slap in the face of psychiatric medicine and nursing: Assembled in the parking lot and adorned in red white and blue make up was an army of the chronically mentally ill. In all of their smiling, dazed, unkempt, bobbing, rocking, swaying, hallucinating, blunted, manic, tardive drooling, ataxic, flat, and indifferent glory they stood awaiting further instructions. Staff darted to and fro, their faces a trademark imprint of frenetic, harried stress and impending doom. Some stood talking amongst each other. Some, on one-to-one duty with patients who might pose a danger to self or others, stood with clipboards and either studied their charges with cool indifference or chatted casually with their other staff. The Hospital Police Department stood nearby, affecting a pseudo menacing Show of Force, sizing up the crowd for trouble—and for new female hires. (The HPO were notorious for asking obvious questions, leering and lingering around their intended targets. “So—you’re a social worker, huh?” just as some of their targets were pathetically notorious for falling for such ploys.)
And then it began.
As if in slow motion, there was an undulating, nervous and anxious lurch of conflicted and chaotic human energy. It was barely 9 a.m. but already stifling and sticky in a Southern California greenhouse way. The air was thick with the odors of long term hospitalization: stale cigarettes, body odor, matted hair, halitosis, cheap aftershave, and generic mouthwash, all mingling with the unmistakable stench of musty, unwashed state issued clothing. There was the occasional scent of a staff person’s freshly laundered shirt, cologne, or hangover breath–aftermath of the previous evening’s attempts to kill the pain…perhaps to kill the agony of being part and parcel of the human folly unfolding here now, the agony of every day.
The parade shuffled in unison, as one large thrush. The lead group bore a long banner emblazoned with the season greetings of “Independence Day.” Some of the patients waved little plastic flags; some waved red, white and blue streamers. Some clutched their sole earthly possessions: ratty, worn towels, CD players, newspapers, tattered paperbacks, Bibles, purses, cigarette packages, a haphazard piece of fruit or empty cup; scraps of hope in the form of court writs, conservatorship renewals, notifications about court dates, drawings, magazines, toy dolls, and crumpled pieces of napkin and scrap paper, all of it the message in a bottle for someone to read. Some stood transfixed by stimuli unseen or unheard before being gently prompted along. They marched in throngs, and were arranged by unit. Some wore matching shirts, some carried banners emblazoned with “Support Our Troops!” Some marched and waved. Most just followed. And the patients did the same.The folly was replete with staff and administrative complicity: One of the junior members of Program Administration was in full Uncle Sam regalia, replete with a bone-white KFC Colonel goatee, face paint and a hideously teetering oversized top hat. He marched with a frozen, “Yes, Sir I will.” smile, so deftly apropos and barely masking the administrative incompetence beneath. The Suits and Ties had emerged from their buildings to wave and pay homage; they sipped cold designer water and Starbucks from the shade of the trees that flanked the Administration Building. (No doubt others stood in the tower windows from the confines of their offices, but this could not be verified and no one knew for sure.)
At the tail end of the procession was the shameful exclamation point to an inherently sad statement. A stake bed paddy wagon festooned with streamers and peppered with straw. Patients had been herded onto it pell-mell and according to how slow or noncompliant they might be. They clung to the sides of it, terrified, frozen, oblivious and hysterical in place as the rickety meandering heap pounced UP and OVER! speed bumps. Many were already suffering the effects and weirdness of multiple psychotropic agents flowing through a brain already marred, misfiring and maligned. Some perspired and giggled. Some mumbled and clung to the sides of the truck.
And so the parade went that day; it snaked around a mile of the state hospital grounds and the only ones that saw it were those who were a part of it; the only ones that participated were the ones who most resented doing so; the only ones who appreciated it were the ones who thought it would be a good idea to have one—so long as they weren’t a part of it. It was the least client-centered piece of therapy ever devised in the annals psychiatric treatment. It was a parade of human tragedy and administrative blindness, of bureaucratic ineptitude—a pre-contemplative display of an institution in flux, chaos and mismanagement. It was folly and foible and fixed. It was a silk hat on a dead pig from a foreclosed farm on dilapidated and raped land. It was genetically modified tomatoes thrown on the corporate whore in her scarlet letter designer dress. Had anyone actually taken the time to ask The Individuals, The Consumers, what they might want to do that day to honor those in power or march for a cause, the response may have been different: Fuck it. Fuck Independence Day. Lets order pizza. Lets drink beer. Lets go find a pool and lay in it. Lets turn on the sprinklers and get drenched. Lets open up a fire hydrant. Lets watch porn. Lets watch some war movies. Lets have a BBQ. Lets lay in our rooms with the air conditioners full blast and do nothing. Let’s act like drunken hillbillys on the lawn in the quad. Let US stand under the trees sip coffee and cold filtered purified water while you guys march in the ass heat and humidity and let US commend you.
Instead, like the rest of their lives, the rules were imposed, the results dictated by outcomes that had more to do with funding and regulations than with real standards of care or humanism. The dictates of their treatment plans were more akin to window dressing than problem solving. The motives the staff in charge of supervising them were more financial than intrinsic. Most of the staff there had little to no awareness of their own motives and impulses and didn’t need to know much past that, fuck you very much. Many of them, after all, went home every night to spin their wheels in the mud of their own creation; to the children they had out of desire to be taken care of; to a mate that resembled their parents; to homes that were battlegrounds and game zones and where the rules changed, where armor was donned unconsciously and where weapons were concealed, sharpened, fine tuned and hidden; to bottles and needles and pipes and cheeseburgers and donuts and porn and prostitutes and credit card debt and casinos; to loneliness and suicidal ideation and anomie not unlike the horror their patients experienced every day.
And some wondered that if only they’d listened; if only they’d realized that they were more alike the patients than different, that having the keys didn’t necessarily make you well adjusted by default. But they marched as the patients did—drooling thoughts out of ennui; babbling sports scores, reality TV shows, and Hollywood gossip; meandering their own delusions of competence, well adjustment and functionality; stumbling through the final years of careers they chose out of reasons not yet known; screaming at their children and spouses and pets; striking out at themselves and others in subtle, unconscious and barely veiled ways. They were their own parade, rallying behind incompetent leaders that waged war and dictated non-evidenced based policy and procedure.
They drove in the equally horrific parade of traffic every day, babbling into cell phones and mesmerized by the external stimuli of talk radio, incessant corporate chatter and advertising slogans and empty songs and tunes about fantasy, folly and fun. They were no different.
That was the tragedy and unto every nook and cranny of humanity—from Yale to jail, school to sea, dock to deck.
That was just the way it was. And that is what happened one day (and continues to happen every day) at a state psychiatric facility.
(ca. 2003.)
Difficult To Cure 
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