Category: Nonfiction

Categories
Homelessness Nonfiction Policy Public health psychiatry

Who is Actually Unsafe?

Before she and I reached the gate in the chain-link fence, a man approached us from the opposite direction. A hoodie shaded his face and his hands were in his pockets.

When she and I got closer, we waved first, all smiles. This was intentional. Hello! We are harmless, but we are paying attention!

He slowed down and pulled the hoodie off of his head, revealing the AirPods in his ears and a tentative smile on his face.

He and my colleague started greeting each other at the same time. She deferred to him.

“I’m just out for a walk,” he said. The accent in his voice revealed that English was not his first language.

“So are we,” my colleague said. This was a lie.

“Oh,” he said, his face now soft and kind. “A worker, a government worker, told me yesterday to be careful when walking here. He said that there are dangerous people back there”—he pointed to the area behind the chain-link fence—“people who are homeless.”

“Oh, okay, thanks,” we replied. His intentions were kind; he was looking out for us. He continued on to the parking lot. 

When we arrived at the gate in the chain-link fence, we ignored the sign posted on it: DO NOT CROSS.


Despite years of doing homeless outreach, I still feel my heart beat a little faster and my shoulders tense a bit whenever I approach an encampment. It doesn’t matter if it’s tucked in a wooded area, under a freeway, or behind a building.

Nothing dangerous has ever happened to me when I’ve outreached more remote locations. Sites where I have been at risk of injury were almost all public places with plenty of people milling about, or in spaces where people are literally locked in.

I don’t ignore my anxiety—our emotions are sources of information—but continue to wonder how much of my unease is due to stigma.

She and I followed the worn footpath through the overgrown grass and were soon under a canopy of leafy trees. On one branch hung a jacket that had been singed by fire. As we approached the underpass, the vegetation receded. A small river was on one side; on the other was a slope of rocks and loose dirt that led up to the concrete base of the road.

A small tent was closer to the river. A larger structure was tucked further away, just underneath the roadway. Old clothing, food wrappers, worn blankets, and other detritus were scattered about, evidence of people who were once there. Maybe they had moved on?

We saw no signs of life.

“Outreach!” my colleague called out. The rumbling of the cars overhead muffled her voice.

The small tent shifted back and forth; we heard rustling sounds.

“Outreach, hello?” my colleague called to the small tent.

“Yes, I’m coming out,” a tired voice responded. Within a few minutes, the person inside unzipped the door flap. A young woman wearing a soiled sweatshirt adorned with the name of a law school peered out. Her face was thin and her limbs were slender.

She didn’t need anything, but accepted some snacks and water. She wasn’t the one we were looking for. We wondered if she had seen The Person?

“Yeah, from time to time,” she replied. “She might be up there.”

After thanking her, we plodded through the soft dirt and climbed over wobbling rocks to the larger structure. A multi-gallon clear barrel in front of the tent was about half full of water. Nearby were piles of blankets and clothes.

The tent was wide open. There were no blankets, sleeping bags, or pillows inside. At the back of the tent was The Person. She was sleeping directly on a tarp.

The Person is not well, but aside from sleeping underneath a road, she breaks no laws. She mumbles and often says things that only she understands. In stores she quickly picks up what she wants and pays with cash and coins. 

As far as we know, she’s lived outdoors for years. And now she is over 60 years old.

These two women are homeless, but they do not contribute to crime and disorder on America’s streets. They are not safety threats.

Who is truly unsafe: Us, or them?

Categories
Homelessness Nonfiction Public health psychiatry

Opening Doors.

For our first appointment, she didn’t come downstairs. The building staff, who described her as a high-priority patient, had predicted this.

After I knocked on her door, a gruff voice shouted back, “What do you want?!”

She eventually opened her door. Inside, the room was furnished with only a bed and nightstand. The mattress still looked brand new; no linens or blankets were on it. The only item on her nightstand was a lamp, the shade still wrapped in plastic. The walls were bare; her closet was empty. Blinds kept the sunlight out.

The only personal item in her room was a flattened cardboard box. It was next to her bed. Though she had lived in that unit for almost a full year, she was still sleeping on the floor. She preferred the cardboard to the mattress.

“I don’t need anything, I’m fine, I’m fine,” she grumbled. She pointed an arthritic finger at the door before announcing, “I’m leaving now.” I stepped to the side. She hobbled past me towards the elevator, mumbling to herself. She didn’t close the door to her apartment. I did.

That first appointment was a success! Not only did she open her door, but she also spoke to me. Sure, it was a short and superficial conversation. Her primary goal, it seemed, was to get away from me. But she didn’t yell at me, despite my introduction: “Hi, my name is Dr. Yang. I work as a psychiatrist. I just wanted to introduce myself. How are you doing?”

There was a fair chance that she would talk to me again in the future. I had two goals now: Create conditions so that she would (1) talk with me again and (2) tolerate a longer conversation with me. Maybe two to three minutes next time?

Back downstairs, I tapped out a quick note:

This is a 79yo woman with a historical diagnosis of schizophrenia. She reportedly has a history of street homelessness of at least twenty years, though housing staff believe that she had been homeless for longer. She finally moved into housing about a year ago….

Categories
Nonfiction

Why I Never Went Camping.

I have never gone camping.

During my short stint in Girl Scouts[1], my parents never allowed me to go on troop camping trips. During our family vacations to national parks, we always stayed in a motel in an outlying town. Though we loved the outdoors, we always slept indoors.

Now that I’m well into adulthood, I’m Too Old to go camping. Despite the pressures of living on the West Coast (the Best Coast!) and REI’s endless advertising efforts, I’m convinced my camping window has closed.

People wonder why. I usually quip, “My parents didn’t immigrate to the US so their only child would sleep outside!”

Both of my parents were born in China, but moved to Taiwan before their first birthdays. Their parents were able to get out of China before the Communists took over. In Taiwan they lived under a military dictatorship. Everyone was poor.

No one had plumbing in their homes. It was up to the sons to bring buckets of water from the town well back home. Balance was essential when using the outhouses. Meat was a luxury and served only on special occasions.

One of my grandmothers did not have the opportunity to attend any school.[2] She only started to learn how to read Chinese after she got married. Her husband was a teacher.

My mother attended school, but society expected her to be a beautiful and dutiful mother.

The educational opportunities in the United States exceeded the imaginations of both women. My grandmother was illiterate. My mother got an associate’s degree. I became a physician.

Such was the promise of the United States.

Only after my dad moved to Seattle did I learn about one of his favorite songs, Abraham, Martin And John, by Dion. Released in 1968, this song was a tribute to Abraham Lincoln, Martin Luther King, Jr., and John F. Kennedy. Dion mourned, “[They] freed a lot of people but it seems the good they die young.”

The result of the 2016 Presidential election was dispiriting for my father. The man who would become the 45th (and 47th) President was unlike Abraham, Martin, and John.

My parents didn’t immigrate to the United States for this sh!t. What drew them to the United States were the ideals of democracy, justice, and freedom.

Didn’t you love

The things that they stood for

Didn’t they try to

Find some good

For you and me

“They don’t make music like that anymore,” my dad lamented when he introduced me to Dion’s song. The music changed; the nation changed.

We write, rally, and protest to denounce the federal government’s cruel and unjust actions. We recognize the humanity in our friends and neighbors, even as the government fails to do the same. We advocate for people in our various and overlapping communities.

We also write, rally, and protest to honor the people who came before us. Our immigrant parents recognized the value of democracy, justice, and freedom. These were abstract ideas that existed only within the confines of their imaginations. In the United States these worthy ideals promised to manifest in three dimensions. They strived and worked so what seemed possible to them could be real for us.

(Thanks, Dad. I miss you.)

[1] I’m not sure why my mom enrolled me in Girl Scouts. I suspect she had two reasons: (1) Because I didn’t have siblings, she wanted me to have more friends. (2) This seemed like a very American activity. The pressure to assimilate was great. I eventually asked to drop out of Girl Scouts. Disappointed, she asked why. “I don’t fit in,” I said. At the time I could not articulate why I felt uncomfortable: All the other girls were white.

[2] I never got to meet this grandmother, as she died when my dad was only 21 years old. Despite her inability to read, she apparently picked up languages with ease. What she lacked in literacy, she made up for in emotional and social intelligence.

Categories
Consult-Liaison Nonfiction

Learning from Those Who Hear Voices.

When we learn that someone hears voices, we may assume that this person must be “crazy.” Some people who hear voices have a diagnosis of schizophrenia. Others hear voices because of past trauma or profound depression. Despite their symptoms, many of them cultivate peaceful lives. Their ways of coping can teach the rest of us something about cultivating sanity during times of cruelty and injustice.

When people share with me that they hear voices, I aim to ask as soon as possible, “If the voices suddenly disappeared and never came back, would you miss them?”

A small number of people pause before answering, “Yes.” They want to hear the voices of their parents, friends, and other loved ones again. Sometimes they don’t recognize the voices, but the things they say are hilarious.

Most people, though, offer an emphatic “no!” What they hear are constant attacks on their character (“you’re not worthy of love”), frightening instructions (“go punch that woman”), or unwanted chatter (play-by-play commentary of their lives). In desperate bids to shut the voices up, some people resort to stuffing their ears with cotton, screaming back, or drinking alcohol to drown them out. Sometimes they attempt suicide because they can’t tolerate the torment any longer.

However, many people find ways to manage the voices. They learn that increases in stress—hunger, not enough sleep, drug use—make the voices louder and meaner. While grieving the death of a loved one, the voices are noticeably overwhelming. More stability brings more symptom relief.

People who hear voices often have multiple healthful strategies to manage their voices. They’ve tried things and made discoveries. So when I ask, “What do you do now so the voices bother you less?”, they reply:

  • “I put on headphones and listen to music.”
  • “I put on headphones and sing so people think I’m listening to music.”
  • “I call my family or friends.”
  • “I go outside for a long walk and look at trees.”
  • “I go to church and pray to God to make them go away.”
  • “I find people to talk to.”
  • “I go to the library and look at maps.”
  • “I fix bikes with my friends.”

(And, for some people, “Take medicine.”)

While doing these activities, the voices may not go away completely. However, they quiet down enough to be ignored. They are small acts of defiance against despair. Any respite gives them some peace of mind. Furthermore, these activities are self-reinforcing: They improve the quality of their lives in other ways, so they learn to incorporate these activities into their daily routines.

You may not think this post about people hearing voices has anything to offer you. But, if you are seeking more peace of mind right now from things that seem out of your control, we can learn from our friends and neighbors who hear voices.

They, like you, largely do not want to cause problems for themselves or other people. The voices distress them, but they don’t give up in their pursuit for peace and sanity. Instead of waiting for someone else to make the world feel sane, they create their own quiet.

Persisting in the face of adversity reinforces our dignity as people. Maintaining our sanity is a form of resistance. Continuing to do good and refusing to do harm, even just within the limits of the six-foot radius that surrounds each of us, is an act of courage.

Categories
Nonfiction

A Guessing Game.

To keep the watermelon from rolling off the platform, I placed the bag holding it between my ankles. My fingers tapped words of grief into my phone while I waited at the International District/Chinatown light rail station. Around ten of us were waiting for the next train.

“Ni hao?” A male voice was asking me this tentative question. My head tilted up; who was talking to me? He waved at me, a smile on his lips.

“Ni hao?” he asked again, taking a few steps towards me. Without waiting a beat, he continued, “Are you Chinese? Am I right? Wait, let me guess: Filipino.”

Reader, my mind was worn and my body was weary. How should I have responded?

I look East Asian because, yes, I am Chinese American. That is something I cannot and do not wish to change.

I didn’t want to talk with him or anyone else. My heart was heavy with sadness.

He was also talking at me. Did he actually want to have a conversation? or simply the satisfaction of winning a guessing game?

My eyes remain fixed on his while I did the calculations. If I answer this stranger’s question, he will probably continue to talk. If I respond with snark, he might get mad. (That he wasn’t giving me the space to speak warned me that he might be impulsive. If he genuinely wanted to know my ethnicity, he could have asked me directly. In English.) Either way, we’d both be contributing to an interaction, something I didn’t want.

So, I said nothing, tilted my head back down at my phone, and resumed my text conversation with myself.

Reader, what do you think his reaction was?

“No, no,” he said, coming closer to me. “You’re wearing yellow sneakers and I’m yellow, too, I’m Filipino.”

I kept my eyes fixed on my phone and continued creating words, letter by letter.

“Oh, come on,” he whined, still approaching. “Don’t withhold from me!”

I started a new paragraph on my phone: a guy on the platform just started talking to me, greeted me with a “ni hao”

“You’re a BITCH!” he shouted. My peripheral vision spied that he was standing to my right, less than an arm’s length away.

Reader, what should I have done?

There were other people on the platform. A petite woman, who also appeared East Asian, was standing about six feet away from me to my left. She kept her eyes on her phone. There was also a handful of people on the opposite platform.

Pigeons fluttered between the rafters. Tiny feathers floated down onto the track.

don’t look up

he could hit you he’s close

don’t move

stay

“Fuck you,” he snarled.

Then, he started walking away. A few steps in he turned back and screamed, “FAGGOT!” He sauntered down the platform.

The only visible movement from my body was in my fingers: explained that it was the yellow I was wearing and he was yellow, too. When I continued to ignore him, he started calling me names

When the train arrived, I looked up. I got into a traincar and leaned against the opposite doors. He got into the same traincar and sat down about ten feet from me.

When the train started moving, he made small talk with people wearing jerseys for the visiting baseball team. He greeted them in English. They talked about the visiting team’s city. He told them to have a good time.

Was that really the same person?

I got off the train. He exited the train, too.

After waiting for him to board the escalator, I remained far behind him and watched him leave the station. Unsure of what to do next, I again chose stillness: I loitered in the station for over five minutes before I fell into the shadows directly behind a group of people around my age.

He had disappeared into the city crowds.

Part of the reason why I ask my colleagues, regardless of credential, to call me “Maria” instead “Dr. Yang” is because of events like this. Outside of the work setting my status automatically regresses towards the mean. People like this shouting man reveal just how low some think my status should be.

Like elsewhere in the country, events continue to occur in Seattle that show how much contempt some people have for Asians. The esteemed Wing Luke Museum was recently vandalized. The man who smashed multiple windows with a sledgehammer offered this explanation for his actions: “The Chinese are responsible for all this, they’ve ruined my life. … That’s why I came to Chinatown.” I don’t know who this person is, though descriptions of his speech suggest that he may have psychiatric symptoms. That offers no consolation. (I don’t think the use of racial slurs in of itself reflects mental illness.)

This isn’t the first time that someone has given me unwanted attention because of my ethnicity. (Presumably this was more about my gender, though this event nicely illustrates intersectionality). It won’t be the last time, either.

I don’t think of myself as a victim. What has changed, though, is that I walk through the world with greater vigilance. When I initially took up running, I did so to improve my aerobic fitness. These days, I want to maintain the ability to run a 5K so I can run away for self-preservation.

I think it is mostly luck that the shouting man did not strike me. Had he hit me, I would have been injured. I don’t feel great about my decision that day to remain rooted and still while ignoring him. However, I also believe that any other choice I could have made to limit our interaction would have had a similar result.

I don’t owe anyone my attention, just as no one owes me theirs.

But, such is the creeping toxicity of racism: You don’t actually know when you should be worried, so you always worry.