The findings of the President's New Freedom Commission on Mental Health
All names, except Emily's, have been changed.
In New Orleans, the hottest month is September, despite rumors circulating about July and August. Puddles stagnate on the mud and concrete driveway between two mansion–sized houses. The neighborhood is America old, just over one hundred years, reclaimed from one large plantation in the late 1800s, and is now one of the richest in the city. Through a dense swarm of small mosquitoes, Jean steps out of her apartment and yells in quick cadence to a plane flying overhead, "God dammit, leave me alone!"
Jean is probably in her late sixties, but the thick humid New Orleans air has kept her face from aging. It is smooth and supple, child–like, with alert and darting eyes. An old, modest blouse and calf–length pink skirt hang limply from her rotund and slightly stooped body. Her slippers are lined with brown plastic grocery bags from the Winn–Dixie by the river. She mumbles and paces frantically outside her apartment door. Jean offers a few more "God dammits!" for the neighbors' sake, and goes back into her small basement apartment. A two–inch roach scampers under her feet, avoiding trash, fallen paint chips and the termite–rotten step. The door slams. It shuts snugly in place because of the swollen wood frame, but will keep neither real nor imagined enemies from entering.
Though Jean's neighbors do not know if she has ever been diagnosed, most of them feel she is suffering from mental illness. She may be one of fifty–four million people in the United States who share this affliction. Nearly two–thirds of all states have cut funding for mental health services in the past three years. The President's New Freedom Commission on Mental Health released an interim report in 2002 stating that the nation's "public mental health system is in shambles," yet a depressed economy, increased spending on national security, state budget shortfalls, and persistent tax cuts have left mental health spending a low priority.
Jean lives in an apartment in a house not suitable for human habitation. The house was probably beautiful when the current landlady, Edna Duke, seventy–seven, purchased it more than forty years ago — immense and airy, with twelve–foot ceilings and elegant light fixtures. More than 6,000 square feet of living space spread over three towering floors fronted by a porch and typical New Orleans balcony. By the 1970s, Edna had divided the house into four apartments and its age was beginning to show. Today, the house, now divided into seven apartments, is beyond repair and literally beginning to fall into the earth. Edna is not doing anything about it.
Evidence of a healthy rat and roach infestation can be heard in the walls or seen on the screen–covered burglar doors after dusk.
Every room slopes downward from the center of the house. The roof leaks so profusely that the sheetrock ceilings often cave in. The wooden floors of the porch collapse if the weight of a step is not distributed over more than one board. That same porch, and the balcony directly above it, are solely supported by a column that has rotted at the foundation until only an inch diameter of solid wood remains. The house boasts neither heat nor air conditioning. Evidence of a healthy rat and roach infestation can be heard in the walls or seen on the screen–covered burglar doors after dusk.
Jean lives in a ground level apartment on the north side of the house. The rooms are smaller on this level. The apartment is hot and smells like urine. Stacks upon stacks of yellowed newspapers pile to the eight–foot ceilings; only a small path remains, running to her bedroom and the shower she is forced to share with an unrelated man, half her age, living in the apartment behind hers.
She lives a meager existence on state and federal funds. Because of this, she has worked out an arrangement with Edna to do small chores around the house for a couple of dollars a day. Edna does not pay minimum wage.
In the front room is the outline of a low, padded chair where Jean often spends late summer days snoring in the heat. This is the only time she feels safe enough to sleep. But this time is often interrupted by the demands of Edna. Edna does not knock on Jean's door, but instead yells through it in a loud, hostile and grating voice, "Jean, are you going to sweep the front sidewalk?"
Jean answers in an angry, muffled voice. "I'm asleep."
"So are you going to get up and sweep the sidewalk?"
"I'm asleep right now."
Edna gets louder and more irate, and begins bellowing in exasperation, "I just want an answer!"
"Is that what I asked you?" spoken at the same ludicrous volume, but now as if Jean were an impertinent child. "I can't get a damn answer out of you. Are you coming to sweep or aren't you?"
"No!" Jean finally opens the door, and the conversation continues to escalate until they both begin to scream at each other like cartoon parodies of themselves. They actually say, "BLAH–BLAH–BLAH–BLAH–BLAH–BLAH!"
Nights are the worst for Jean. The city is full of sounds — sirens, trains, cars, unknown enemies wandering down her alley. She rarely sleeps through the night and can be heard by neighbors at all hours ranting sporadic strings of “God dammits!” and “Get outs!” Often she will burst through her door into the night, screaming and yelling to whoever will listen.
"Who left this door open? God dammit! Who left this door open? Well, I know who left this door open . . . It's just one of many tricks that Edna Duke likes to play on me. God dammit! I tell you, she should either be in an asylum or in prison!"
In one of the most dangerous cities in America, Jean has no lock on her door. She claims she has asked Edna to fix it, but Edna will not fix anything by herself. She has her tenants front the money for repairs and then reimburses them once the work is done. Jean regularly borrows a couple of dollars from the neighbors at the end of each month, because she cannot make it through on her small stipend; it is inconceivable that she would be able to pay for a locksmith.
Many of Jean's most basic needs are not being met — including her need to feel secure — and she can do nothing about it. The neighbors call ACORN (the Association of Community Organizations for Reform Now), the nation's largest community organization for low and moderate–income families. They say that Jean's only recourse to change her living conditions would be to get a lawyer and take Edna to court. That costs money, and once again Jean is left without options. Everyone in the house lives at a level of squalor that would be illegal in most cities in the United States, but because of the apparent deterioration of Jean's physical and mental health and level of poverty, she is helpless in the fight for her rights.
As of 2000, the Supplemental Security Income benefits used by many elderly and mentally ill people do not cover the fair market rent for a one–bedroom apartment in fourteen states and sixty–nine cities across the country. Consequently, people like Jean are given two choices for housing: Either they must live in substandard and wretched slums, or they must live on the streets. One third of the homeless people in the United States have a serious mental illness.
She screams in agony often, waking those in the apartments around her, keeping her neighbors wondering if calling an ambulance will do any good.
Jean's condition visibly deteriorates over the course of the year. She begins to believe that Edna is spraying her in the night with a chemical that burns her abdomen. She screams in agony often, waking those in the apartments around her, keeping her neighbors wondering if calling an ambulance will do any good. Her bathroom–sharing neighbor, Bill, begs her to go see a doctor, but Jean becomes extremely agitated and denies she needs help. When this fails he asks her if she has any relatives.
"Relatives?" she asks, appalled at the question. "Do I have relatives? I have relatives who work for the federal government. I have relatives who are college professors!"
Pedigree is important to Jean. She claims she attended the prestigious New Orleans school for girls, the Academy of the Sacred Heart, and claims to have once owned quite an art collection (that was stolen). She thinks herself of higher education and breeding than Edna and often mumbles about the injustice of someone so high on the social scale being treated so horribly. She wears her family history as a badge of sanity — a relative of a college professor could not possibly be mentally ill.
Despite Jean's claims of a large and prosperous family, none of the members appear to look after her or even visit. Jean is alone. She steps below a second story window and yells up to a young woman, Emily, who lives in the apartment above. Her tone is conversational and sing–song.
People like Jean are given two choices for housing: Either they must live in substandard and wretched slums, or they must live on the streets.
"And new girl, I was thinking about the Emilys I know. You know my grandfather's name was Emilien. That's the masculine form of Emily. Did you know that?" Listing a string of other people by that name, she continues, "Emily, Emily, Emily…Emily died from a stroke, but I hope you won't die of a stroke. I will probably die of a stroke because stress causes strokes. The blood clots in the head. I'll probably have a stroke with all that's happening around here."
Emily is not even home.
By now, Jean has stopped washing her hair altogether. It has gone from a light feathery brown to a matted and clumped gray; occasionally an eight–inch spire will stick perfectly straight out from the side of her head. She begins to ask people to smell her neck for chemicals. Emily, Bill and numerous patrons of a local Mexican restaurant have been implored to do this but few feel sympathy enough to do so.
Bill's attempts to help Jean prompt her to become more suspicious; she now includes him on the list of people that are spraying her in the night. She begins to accuse him of running a cocaine lab in his apartment because of the loud music and strange smells emanating from the small hovel. In truth, the smells probably emanate from Bill's herbal tinctures, which he makes for a living.
Finally, taking a cue from the top local news story of the year, Jean convinces herself that Bill is the Baton Rouge serial killer. She asks Bill, "Have you ever been to a psychologist?"
Her tone is rather nonchalant, but traces of accusation and suspicion creep to the surface. It is as if Jean is trying to trick her neighbor into admitting that he is mentally ill. Eventually, Jean confronts Bill with her suspicions. Her words are clear, but frantic. "Why don't you just get it over with and stick a knife in me? That would be better than slowly killing me with the spraying and beating!"
One evening, after the local news, Jean slowly hobbles up the slippery steps to Emily's second level apartment, ignoring Edna, who sits on her porch watching a blaringly loud television. Jean desperately needs to use a phone, and Emily has one of only two in the entire house. Jean comes to Emily's door quite often, usually asking for money or to complain about Edna. Emily, while generous when the visits first began, has had enough. Being awakened nearly every night by Jean's bellows, and being privy, through thin, uninsulated walls, to her loud and lengthy arguments with Edna and others has become too much to deal with. She does not know how to help Jean and avoids answering her door when she can. But this time Jean sees her, and Emily has no choice but to answer. Emily reluctantly agrees to let her use the phone, not knowing what else to do.
From the next room, Emily hears Jean secretively say, "I'm calling about that thing I called about before, the reason you have this line."
Jean has called the Baton Rouge serial killer hotline; the number is given nightly on the local news. She tells them that she knows the identity of the serial killer. Jean feels it is her civic duty to protect the city, and herself, against the atrocities that Bill is surely committing. Jean tells the person on the line that the police should send a witness to New Orleans (over an hour's drive away) to positively identify him. She urgently implores them to come, but keeps her voice as low and whispery as possible. Either she is trying not to alarm Emily, or, more likely, she is worried that Emily will think she is crazy for even thinking such a thing.
Jean answers a few questions for the hotline operator and then, because she doesn't know how to, she calls for Emily to hang up the cordless phone. She says a polite and calm "thank you" and descends the steps into the dark and lonely night. Jean has done the only thing she thinks she can do to make herself safe. Perhaps tonight, her demons will haunt someone else.