“There are bugs in my apartment”.
That is what John told us as we stood outside looking at his couch in the dumpster. We had found it for him maybe three months prior. It was not new but had been a good find. Now it had been cleaned with bleach, which had destroyed the upholstery, and over the weekend, John had decided it had to go. It was trash now, instead of “a great find”. I looked at Sally, and we just shook our heads.
“John let’s go inside,” she said.
Walking in the door, we were hit with the smell of bleach. John had bleach and water standing in his sink again. Looking at his hands, he had not yet burned them using bleach, so he was not engaged in self-harm, at least, not self-harm we could use. The kitchen did not have the usual stacks of dirty dishes we normally had to talk with our clients about. His bedroom had the normal scattering of clean and dirty clothes on the floor, which reminded me of an old roommate in college. We had not surprised him, so the adult magazines were not in sight, which was nice.
Sally and I had known John for over a year now. I still remembered our first visit with him, in a different apartment. Back then, we were both new to Case Management. Sally had 10 years more life experience than me, but no degree. I was an intelligent 23 year old, who knew he was going places, and this job was not what I was going to be doing in 10 years. Arrogant was a good word to use, however reality was that I really was all that, just maybe not the bag of chips. Sally put up with all of that and was like the big sister I had never had.
When we first met John, he was argumentative with his old case manager, and we watched as they got into a power struggle. Going in, I knew John suffered from delusions, and hallucinations, but this was the first time I had seen them in action. It was an eye-opening experience for us both. Over time, we would become used to odd behavior and thoughts.
John was on Sally’s caseload, but since he sounded more psychotic on the phone than normal, she asked me to come on the visit. Sally worked well with John, but he and I also got to know each other. Today, John was upset about the bugs he was sure were there. It was clear there was not much we could do to convince him there were not bugs in the apartment. The real goal on this visit was to make sure he was safe enough to stay put, and make sure he restarted his medication.
People are afraid of individuals with mental illness. What they think of is Norman Bates, or a mass killing. Schizophrenia is especially scary because it can cause such odd beliefs and behaviors. My experience has been that there is little to be afraid of from most individuals with mental illness. Certainly, John was not dangerous to anyone but himself. He lived most of the time afraid, expect when he was shooting off his mouth in anger. Many years later, he would end up beaten, and in a coma for days because of an argument he started.
We calmed John down and watched him take his meds for the day. Sally arranged a time to meet with him tomorrow, just to check in. She promised to take care of the bugs. I also reassured him that we would get the bugs out, and we would try to find a new sofa. We got him settled and then moved on to the next stop for the day, which were two people on my caseload who needed de-escalation over their roommate situation.
Back at the office, Sally received a call from the apartment complex. They were calling about John. With any one of our clients, we had releases of information to talk with the complex management. They knew who the case managers were for each client. For the clients who had us manage their money, it was usually me who dropped off all the rent checks each month. The complex said that John had called to complain about bugs but was very appropriate on the phone. They told us they would be happy to get the exterminator out to spray. Sally just sighed and told them that the “bugs” John was worried about were not insects but listening devices. John’s paranoia was in overdrive. He had taken apart the sofa looking for bugs. We hoped the mediation would help before he took something else apart.
It is a hard thing to be afraid all the time. The average life span of someone with Severe and Persistent Mental Illness is 25 years less than for other Americans. Constant stress is part of the reason. It is a population we do not serve well in America. I don’t know how to serve them better, but I wish that I did. To never feel at peace is a horrible thing, and it drives many to end their own lives.
I don’t know where John is now, or if he is even alive. I like to hope we helped him find some peace, and not just exist. I know I have helped some clients that way, but John was a hard case. But he was one of the first, and so I always wonder. I always liked him, as irritating as he could be. Without his illness, his intelligence could have done great things.
Sally left the agency before I became a therapist. She was a compassionate woman and worked with difficult people with patience and courage. It was an honor to work with her.
The names above have been changed to protect the identity of the individuals.
