AustinReviving our Interiors: Serving Mentally Ill Living on Our Streets

I’m standing in the middle of the St. Francis Day Shelter. There are some 150 homeless people around me. Some talk, some play cards, some stare off into space or sleep against the walls. Some just wait. It’s loud and smells of unbathed bodies. I see Daryl. I hardly recognize him as his hair has gone completely white. Two years ago when I was on the streets I talked with Daryl for three hours one night. He could barely finish a sentence. His thoughts were so disorganized, almost as if he were speaking in tongues. Now he is sitting not ten feet from me, wearing headphones, looking down at his legs, and making eye contact with no one. He is only 37. I feel a sharp and unexpected pain in my chest. I have no words, no thoughts, only this unnamable, direct pain. Unprepared, I cry. I cry and cannot recollect myself. Some time must have passed when another homeless man places his hand on my shoulder, quietly passes me a cup of coffee, and sits beside me silently and respectfully.
Since that time, my experience of Daryl’s suffering has not left my side. When a friend calls to tell me she loves me I wonder, who calls Daryl? When I take a bath, I wonder, can he clean himself? When I buy groceries, I see him alone, white-haired and discarded.
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We lay the cardboard we have collected on the cement. It is 18 degrees and snowing. Our clothes, boots, and sleeping bags aren’t warm enough. We barely sleep. Shauna, a young woman from our group, falls asleep only briefly and awakes to a man over her head rifling through her backpack. She is too scared to say anything. Soon after, he leaves. She doesn’t fall asleep again and spends the whole night shaking. I think of her often these days, as if she is still there, lying awake, cold and terrified.
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It is a cold morning, and I am begging for a cup of coffee. I ask at the outdoor carts on the mall. They are setting up shop and pretend not to notice me or say no without looking at me. I approach one last cart. A man behind me offers to buy me a cup of coffee. He is a homeless man, and we share a quiet cup of coffee while city workers clean garbage off the streets before us. Then, like many people living on the streets, he gets up and walks away, and I do not see him again.
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I am walking toward the Rescue Mission, which is a kitchen and shelter.  It has a large, lit cross beaming the words “Jesus Saves” onto the dirty, barren city block on which it resides. It is cold and dark. This is skid row. There are mattresses lining the street and people sleeping on them, as if in their own bedroom, while traffic hurries by. Drug addicts, sorrowful drunks, and a few loud teens gather near the door, waiting for dinner. There is a fight always on the verge of happening.

I see Raul, a man I met earlier that morning. “What the hell are you doing here, Annie? You don’t belong here. This is a hard place, it’s not for you. People here will beat one another just for being smaller. Like that guy right there,” as he points to a boy about 18. “His friend beat him unconscious one night just for being smaller. He was in the hospital for a week.” Raul laughs, and then says, “Yep, we’re the unloved ones, baby,” and laughs louder, almost a belly laugh. I want to laugh too. I want to join in, and I don’t know why.
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The next evening Shirley guides me to my dinner table at a church on the opposite side of town. She touches my arm and smiles. She is the coordinator of this soup kitchen, and her face is warm and lively. She is in her sixties and has a whistle that she blows when she wants everyone’s attention, not to be militant, but because her voice is too soft. She asks if we might pray together. She thanks God for bringing us together and prays that we may be warm. She asks us to remember that God is within us and loves us. There are no fights in this soup kitchen. No one is drunk.
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A few women in my group decide to go to a women’s shelter for lunch. It is fairly quiet inside. The women working there welcome us. When they call the numbers for lunch, I am separated from my group and go alone. I talk a bit with some of the women at my table, but most are not in the mood for conversation. When I was on the streets two years ago, I often initiated conversations. This time pressing people for conversation feels like using them to make my experience more meaningful. I am open, but take only the conversation that is offered and otherwise sit with the lack of connection.

In the middle of lunch, two gentlemen in suits enter with the woman from the front desk. She is giving them a tour. Instinctually, I drop my head. In the last two days I have developed an infection around my eyes. They sting and are dry and swollen. I usually pretend that I don’t care how I look, but in this moment I cannot hide how much I care. I am the dirtiest woman here, and I do not want these two men to see me this way. Their faces will change. Pity and confusion will overtake them, as it did for me when I saw Daryl. I cannot tolerate that reflection of myself.
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I am standing in the middle of the sidewalk. People pass me on both sides. Everyone is on their way to somewhere else. They are in a hurry, even more so when they spot me standing here. As soon as people notice me, they have to look at their watch, get something out of their bag, make a phone call, or busy themselves with an activity that allows them to look away from me.

I ask almost everyone for spare change. They tell me that they don’t have any change or that they are sorry. Some shrug their shoulders and say nothing. They are partly apologizing for my plight, but mostly it seems they are apologizing for the ways they feel awkward, confused, unable, or unwilling. Soon everyone passes and I am standing alone, holding my hefty bag and pink blanket, looking at peoples’ backs as they hurry off. Strangely, their backs look beautiful for a moment, moving under their clothing, almost in rhythm.
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I am wandering along the pedestrian mall. I am hungry. There is food all around me—vendors and restaurants. When I approach these places, I am shooed away. Looking down, I quietly ask a hot dog vendor, “How would you feel about giving me a hot dog, sir?” He says, “I’d love to, dear. Sometimes we all have to ask for help. It’s not easy. I’ve had to ask before. Don’t be afraid.” He touches my hand. The moment before his mercy is so different from the moment after.

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After my time on the streets, I return to the Network Coffee House, a small café for the homeless that offers friendship and coffee. I speak with Tom, a Vietnam veteran. He is a kind, odd man with a great sense of humor. We talk about the war, and he tells me that during his tour of duty, he was always accompanied by a German Shepherd. The dog saved his life countless times. She was his best friend. When his tour was over, the military shot her. Apparently, he couldn’t take her home because she had never known anything but war. He says that was the hardest part of it all.
Tom also describes that before the war and after the war feel like two different lives. When he returned from duty, his symptoms kicked in—night terrors, panic attacks, numbness, and a heaviness he can’t describe. He says that life no longer had any meaning.

Tom eventually asks about me, and I tell him I am a psychotherapist and that I work with people who’ve been traumatized, even some Vietnam vets. He pauses, looks at me for a bit in silence, then returns to his cigarette, and stares off into the sky. After a few pulls of his smoke, he asks me what I think is the hardest part about being a vet. I tell him that I don’t know because I have never experienced war. I don’t know how war sounds or how it smells. I’ve never seen a dead, bloody body. I say that my sense is that most vets are haunted by meaninglessness and a darkness they can’t quite shake. Nobody else quite understands how they feel, and words can’t touch it. He smiles and asks if he can roll me a cigarette. I tell him that I’ve been waiting for some hospitality.

Something is mended in this moment, something small and precious.
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Three months after my last time on the streets, I am walking downtown and see a homeless man begging. I turn and walk a different direction to avoid him. My heart quickens. The image of Daryl rocking all by himself in that big room flashes before me. My chest aches. I remember peeing behind a dumpster, praying to God that no one would see me. I cry. I don’t want to feel, and I am feeling anyway, and soon there is so much pain and affection mixed with so much resistance that it feels like something is tearing inside me—something gets in or gets out, something heartbreaking. I feel not just for my self, not just for Daryl, but for everyone. I feel love and it’s devastating.

Reflecting on My Subjective

My subjective experience of the streets (my individual interior) is essential to include because many of us (even those of us involved in social services) avoid the homeless, the pain they suffer, and the pain and impotency we feel in the face of their collective tragedy. But how can I serve well without a willingness to at least connect to their plight, without building an intersubjective bridge, a “we,” that discloses our experiences to each other?

Studies show that many of the chronically mentally ill living on the streets have only developed to or are operating from formal-operational or what is typically known as “rational” cognition.² Even more sadly, studies show that many may be at even lower levels of development, specifically at fulcrums 1 and 2 in the self line.³ The task for the self at fulcrum 1 is for consciousness to seat itself in the physical body (severe psychosis results when the self fails to negotiate this task). The task for the self at fulcrum 2 is for consciousness to seat itself in the emotional body (borderline results when the self fails to negotiate this task). Many of the mentally ill living on our streets never develop past fulcrum 1 or 2 (meaning that many do not develop past psychosis or borderline).4 At these lower levels of development, the streets fragment any budding sense of self, tax the few psychic resources available, strain relationships, destroy the physical body, and expose the vulnerable self to untold dangers. And although I am familiar with the experience of living on the streets, and I have shared many common experiences (I certainly understand the experience more than most!), there are some aspects of street life and mental illness that I will likely never fully understand.

Emerging Worldviews and National Mental Health Policy

On the streets I was angered by the suffering that I witnessed but decided to direct my anger. Instead of immediately looking for someone to blame (society, the government, the individual, the current administration, etc.) and formulating ill-informed strategies to “fix” the problem, I decided to simply relate to the phenomena and use my anger as motivation to understand this mess. What were the unique historical and politico-economic circumstances that led to our current situation? How have our beliefs shaped national policy? Were there any “good old days” when the chronically mentally ill lived in better conditions? Allow me to slip into the perspectives of the interior and exterior of the collective (i.e., the Lower-Left and Lower-Right quadrants).

In the 1960s, due to the success of psychotropic drugs and an emerging worldview that was categorically against institutionalization, national policy turned toward deinstitutionalization 5 of the mentally ill. Although the liberal left often attributes responsibility to the conservatives for turning the mentally ill out on the streets, the postmodern, deconstructionist worldview (primarily championed by the liberal left) played a large part in deinstitutionalization. &sup4; Deinstitutionalization began in the 60s, not the 80s, in part due to the emerging postmodern worldview that touted the evils of institutionalization and the social construction of mental illness. People actually asserted that insanity was merely a social construction that resulted in political marginalization. Institutional life was brutal. All mental illness, however, is not a social construct; that is an absolutization of the perspective of the Lower-Left quadrant.6
Upon closer inspection, it seems that institutional life contained different, yet just as many forms of suffering as homeless life.7

Indeed by the late 1950s and 1960s, institutions and institutional care had become anathema to be avoided at all costs. Exposes, sociological treatises, public commissions, and even organized psychiatry deplored asylum conditions and advocated change. State mental hospitals were described as isolated, dehumanizing “warehouses”—“snake pits” where unfortunate deviants were sequestered, or abused. Mental institutions were transformed in the public’s mind from medical treatment centers into factories for the manufacture of madness. 8 9

The 1963 Community Mental Health Centers Act passed by Congress mandated deinstitutionalization and dismantled the asylum system. 10 It provided federal subsidies for community mental health centers that would serve the “institutionally liberated.” 11 Unfortunately, the momentum behind deinstitutionalization was so powerful that it was initiated with little or no preparation. Herein lies the seed of our current problem. The responsibility for caring for these people fell to the states. 12

There was a wide divergence in the response to the needs of deinstitutionalized patients. Some states removed the patients from the hospitals and left the money to be used for inpatient acute care. Others removed money and left the patients in the institutions. Some patients returned to the community with excellent support systems: supported living arrangements, sheltered work experiences, and outpatient treatment. Others had no services available or did not have the ability or will to gain access to the mental health care system and the supportive services needed. The result was homelessness or marginal existence. 13

In the late 70s, President Carter’s administration attempted to remedy this situation by creating the Commission on Mental Health to assess national needs. “Yet the Commission’s final report offered at best a potpourri of diverse and sometimes conflicting recommendations.” 14 This report led to the passage of the Mental Health Systems Act immediately prior to the presidential election. Although complex and often contradictory, the law outlined a national system that would provide care and treatment in community settings. Before the policy could be implemented, Ronald Reagan was elected president. As Reagan’s administration was focused on reducing taxes and federal expenditures, he repealed most of the provisions of the Mental Health Systems Act, proposed a 25 percent cut in federal funding, and converted funding into a single block grant to the states. This block grant came without policy guidelines and few restrictions on the way the money was to be spent. This was a devastating blow to the life conditions of the mentally ill living in the United States. And while dismantling aspects of the asylum system may have been a good thing, failing to implement an adequate support system was, in my opinion, an obvious mistake.

The plight of the mentally ill was further exacerbated over the next two decades as the federal government began to step out of funding the construction of affordable housing and instead funded state and local-initiated housing projects. HUD (Housing and Urban Development), aside from partnering with these local initiatives, began handing out Section 8, or vouchers for homeless individuals so that they could supposedly find housing “anywhere.” “Anywhere” has turned out to be anything but. The move to Section 8 vouchers was an attempt to disperse the poor, lest they accumulate in poorly run, communist-block style housing (the ghetto). Few people on Section 8 have so dispersed into more affluent neighborhoods.

That there are so many mentally ill people living on our streets is, in part, a result of our level of collective moral development and the influence it has on the socio-economic structures we create.  Both Lawrence Kohlberg and Carol Gilligan demonstrated that as we develop morally we include progressively more people in our sphere of concern and care—from ourselves, to our family, to our tribe, our nation, and ultimately all beings. 15 As a society, our moral development has not evolved to a level where we care for all beings, let alone all of our own citizens. If we valued those suffering on the streets, we would do more to help them. I understand just how complex this task is, and there is no simple answer. More government isn’t necessarily the answer, but I do know that money and resources are necessary but not sufficient for this situation to turn around.

However, if policy makers and presidential administrations understood levels of development (more on this in the next section), they could use this understanding to garner support for their policies. (For example, you can interiorly motivate someone at a fairly self-involved level of development by selling your plan as one that will clean up the streets. You can promise the electorate that they will feel more secure and less pestered by homeless and mentally ill people. I do not personally share the belief that everyone has to care, out of the goodness of their heart, for the homeless. It just does not reflect the reality of where our citizenry is developmentally. If we wait for that kind of care, the mentally ill will be living on our streets for a long time.) Just how this money should be allocated and whether federal or state government should pay for it is the raging devil in the details.

Reflections on “We”

“Whoever you are: in the evening step out of your room, where you know everything…”
—Rainer Maria Rilke

I was now familiar with the experience of living on the streets. I was familiar with the data and history of mental illness, deinstitutionalization, the socio-economic structures surrounding this dilemma, and the various worldviews that had created those structures. So, what should I do?

I volunteered at a homeless shelter as a case manager for 15 to 20 hours a week for almost 2 years. This was difficult as I am impatient and easily frustrated with others. (Not to mention that bureaucracies drive me crazy.) I have seen the good, the bad, and the ugly of social service. I wish I could espouse my saintly successes, but I am no saint, nor am I particularly successful. Mostly it has been a struggle.

Through the perspective of the Lower-Left quadrant, shared meaning or “We” arises. In regards to this intersubjective “We,” I will discuss various levels of values development as they relate to service. I’ll address some of the gifts and limitations of each level in serving the homeless who are mentally ill and then offer a glimpse at an integrated (“Second-Tier”) level of service.

Spiral Dynamics, and developmental models of levels in general, are an essential tool in deciphering values and worldviews. Make no mistake, Spiral Dynamics and other developmental maps are no dry, abstract map, but a living, breathing doorway into the interiors of the people I serve. To serve the homeless more efficiently and lovingly, we must understand interior development.

Spiral Dynamics points to eight basic stages in values development. 16 The first six stages (Beige, Purple, Red, Blue, Orange, and Green) are called First Tier and are marked by the belief that their particular values are the only “right” values.  But after the sixth stage, an interesting shift happens. Research has found that individuals moving into more integral value structures come to appreciate the importance of all levels (particularly in their healthy manifestation). This marks the leap to Second-Tier (Yellow and Turquoise values). Second Tier understands that each and every level of development serves a useful, but limited, role in this world. I have seen healthy and unhealthy manifestations of many levels in my service work. Unfortunately, in the locations where I volunteered, I came up against many pathological manifestations of these various levels.

Many of the problems that I witness in the “We” space of social services arise from not understanding one’s own developmental position and not understanding the position of the person being served.

In serving the homeless, I seek to understand the worldview of the person I am serving in hopes of acting in accordance with it (skillful means). 17 I do not force my worldview upon them (because it simply does not work). Entering another’s worldview is a process that few service workers seem willing to undertake. Usually the service worker’s own level of development (most likely First-Tier) renders them unable to open to multiple perspectives and levels, leaving them convinced of the righteousness of their own. This section, therefore, emphasizes how little intersubjective space we share when serving the homeless.

If you inhabit a different level of development than the person you are serving, you must understand that if you remain within your own worldview—if you do not “come out of your room, where you know everything”—you are not sharing meaning. You may be speaking the same language, you may even be using the same words, but those words have different meanings within different worldviews. 18 We must understand the worldview of the other; we must speak their language, their meaning, in order to communicate with and interiorly motivate them.

Server

First and foremost, I would like to address the level of values development of the server. My experience of many people who work in social services is that their center of gravity hovers around the Blue (traditional, conformist), Orange (achievement, modern), or Green (relativistic, postmodern) value structure. These levels are all First Tier and, therefore, they all try to impose their values (the only correct values according to them) on the people they serve.  And although each value structure has good intentions, most often those intentions do not translate to the person they serve, because the server and the served generally do not occupy a shared worldview. The tragedy is that those served are flying at different altitudes than the server and they rarely even see each other.

Blue values rules, laws, codes, and conforming. Without Blue our society would be in some form of chaos.  They see the chaos of the streets and believe if they could just organize it and then enforce the rules, the problem would be solved—were it only so.
Many of the religious organizations led by individuals with Blue values have dedicated their lives to feeding and sheltering thousands of people. Their contribution and sacrifice to alleviate suffering is profound. Creating structure in a chaotic situation is, in and of itself, therapeutic. There are many things that healthy Blue leaders do well. Without these people, I can’t imagine where the homeless would be.

Yet Blue, as is the case with all First-Tier value structures, believes it can export its values and norms onto others and that the way to serve another is that which is right for Blue. They believe that if the individual would just conform to conventionality and follow the rules then everything would turn out right. Unfortunately, many people living on the streets (particularly the mentally ill) are far from developing to a point where they value conventionality and norms, which makes conforming problematic. For those rare few that even develop to Red (egocentric), conformity is actually seen as a weakness and a threat. It is extremely difficult for those living within a Red worldview to overcome their natural inoculation to conformity, which might allow them to grow.

Blue service workers tend to get fairly angry when their homeless clients don’t conform or follow the rules. This is their fundamental misunderstanding of the people they serve. Their clients are not conventionally minded. Most are not capable of recognizing the need to behave in ways that benefit the whole. They are still too self-centered. They are only capable of behaving in ways that benefit themselves in the immediate moment. They are not breaking the rules to hurt their case manager (nor are they self-sabotaging as case workers commonly believe).

For example, many Blue service workers present their program as a way to provide structure to organize the chaos of homeless people’s lives: “help them get their act together, and give them a chance to contribute to society.” But the level of development of their clientele is often not interested in “contributing to society.” In actuality, the impulsive self is Blue-phobic.

I am not suggesting that we dissolve our rules, but rather that Blue often demands their clients act from a level of development that those clients have not yet developed to. For many of the mentally ill who are also homeless, the “other” is just an obstacle or leverage to get what they want in the immediate, impulsive moment.  Instead, we must approach these lower levels of development in a way that interiorly motivates them. Otherwise, we are flying at different altitudes.

When Blue workers don’t achieve their desired result and when service workers themselves come under stress, I’ve often seen their strategy regress to an unhealthy manifestation of Red: a kind of boot-camp mentality. In a more healthy manifestation, we could use Red energy to remain non-reactive, yet firm in our authority and power. (Once a male client told me that he was undressing me with his eyes. I dropped my awareness into my solar plexus, stood up, moved close to him, looked him straight in the eyes, and in an even, no-nonsense voice, said, “I understand you have needs, but you will never speak to me that way again.” I never had any problems with that man again. So we can have power without annihilating another’s basic goodness.) 19 But mostly I’ve seen Red turn sour and service workers resort to bullying their homeless clients. (I once had a supervisor call a meeting with a group of women living in a homeless shelter. She yelled at them and said they wouldn’t be in this mess if they had anyone outside that loved them, so they had better follow her rules or they would be out on the street.) We must see this expression for the regression that it is and not idealize it as a reversion to a time when “values were stronger.” A better approach would have been to say, “I understand how difficult it can be to raise children, look for a job, and follow all the rules of this house. Nonetheless, this house does have rules, and if you want to continue living here you must follow the rules.” We must enforce the rules with clarity and neutrality and leave most of our anger behind.

It is rare to find Orange (achievement, modern) service workers in this particular field. Orange is an achievement-oriented structure. There are few success stories in working with the chronically mentally ill, and this creates dissonance in Orange’s worldview that we can succeed at almost anything if we try hard enough. There is also little money in social services, and this can be very important to someone at an Orange level of development.

I did, however, encounter a few service workers at this level of values. I found these workers often asked their clients to apply rational methods to their irrational minds and then lost empathy when their clients failed to succeed. Cognitive behavioral modification, the method of choice for many Orange service workers, is an essential tool and can be successful for people struggling in the later phases of fulcrum 2. However, cognitive behavioral approaches require the capacity to observe one’s thoughts and a certain degree of will to alter or reframe them. Many clients struggling along at fulcrums 1 and 2 have no such capacity, nor do they have the capacity to learn it.  When this method does not work, Orange service workers often became overtly frustrated and angered.

Those service workers hovering around a Green center of gravity honor relationship and sensitivity and restore dignity to the mentally ill living on the streets. Green attempts to understand and empathize with the plight of the homeless. I know in my own case, after living on the streets for a few days, any attempt to see me as a fellow human being worthy of compassion is a remarkable contribution.

People whose center of gravity is at Green believe that we should all have an equal voice. In fact, Green thinks we actually are equal. Although we all should have equal rights under the law and be properly cared for, we are not all equal. Often I hear people I work with say, “We are really just the same as they are.” The ability to perceive another, resonate with that other, and imagine that you have many human issues in common only arises at a well-formed rational and postrational level of development. If you don’t believe you are more developed in at least some areas, hang out with a person living on the streets for seven hours straight. You’ll most likely realize just how different your worldviews are.

Don’t get me wrong, I’ve met fantastic people living on the streets. They are as worthy of love as I am. Plus, they crack great jokes about cops and social service workers (some of the best I’ve heard). Occasionally I share a smoke with them and enjoy the wide, open sky. But bring up existential angst, helping others, or caring for all beings, and you will most likely lose them.

Precisely because of their belief that we are all the same, I find that individuals at Green often fall prey to the pre/trans or pre/post fallacy. In other words, Green confuses prerational states with postrational states because they are both non-rational. Because Green flattens and rejects vertical development, they don’t distinguish between pre- and postconventional. For example, a Green co-worker might easily confuse a schizophrenic’s prerational sweetness with postrational revelation or his kindness with enlightened compassion (it was this confusion that fueled the liberal left’s thinking behind the deinstitutionalization movement). 20 Obviously, this makes the client no less worthy of love and care. But if you don’t understand where your clients are developmentally, you will be less able to serve them well.

Another popular myth among Green is that any of us could fall through the cracks and end up on the streets. Make no mistake, there is a housing crisis in the United States, but the Green value structure makes it seem like perfectly well-adapted people become permanently homeless and float from shelter to shelter. There are areas of the country where this does happen, however, I have not seen this in Denver. I have never seen that well-adjusted person permanently float from soup kitchen to soup kitchen. This doesn’t mean that it doesn’t happen, but it is certainly uncommon. I’ve seen fairly well-adjusted people in transitional programs, and they usually get some form of housing with minimal government support. This in no way justifies or rationalizes the severe cutbacks in mental health and housing.

Green leaders also make certain governance choices that reflect these confusions. For example, I went to a conference on homelessness, and a man who ran a very sincere program in Denver said that his organization had created two boards of directors—one composed of homeless people and another of social service workers. Supposedly, the homeless (most of whom were heavily medicated) had an equal voice. The homeless board passed a resolution stating that the doctors should be mandated to try all the medications that they prescribe. On one hand, I find this amusing and for all the insensitive doctors out there this seems like just desserts. But there are countless doctors working long hours for little pay doing their best with a very disturbed population (some patients never respond to medication or are so paranoid they refuse to take it). It is essential to grant people basic dignity and equal rights before the law; it is confused to offer them leadership positions.

Green leaders and service workers also tend to eliminate rules that actually hold together far less structured psyches (the impulsive self needs rules and boundaries), all the while stating, “love is all we need.”  (Blue workers tend to over-regulate, Green workers tend to under-regulate.) There are some people who will likely never escape the delusional states that hold them captive, no matter how much love we give them. And, although I am a big fan of love, what kind of love? Saccharin and permissive love in these cases actually seems faint-hearted. Instead, I feel that structured, non-punitive love is needed for protection (and not just to control, as is often the case), and that means holding boundaries, setting limits, establishing rules, and enforcing them with tremendous kindness and neutrality.

The main point I want to reiterate is that individuals embedded in First-Tier value structures (e.g., Blue, Orange, or Green) fail to reflect on their own level of development and fail to understand the level of development of their client. For example, most service workers at First Tier never translate their message or their intention into the language of their clients. They do not create programs and outreach that interiorly motivate their client’s level of development, so their clients never fully buy in. Therefore, there is no “We” and thus no shared understanding.
Granted, there are some clients who will not buy in no matter the approach. Most forms of psychosis, sociopathic personalities, and antisocial personalities are resistant to most forms of “We.” In these cases, society is faced with the more difficult ethical dilemmas involved with caring for the person or protecting the communes from this person.

The Lure of Transformation: Enlightened Mind or Ego’s Prop?

For those of us service workers who think we have taken that highly touted leap into multiplicity and are showing signs of integral (Second Tier), let’s take a closer look….
Despite Rilke’s urgings, many of us, developmentally speaking, have been simply unable to “step out of our room, where we know everything….” Indeed, reflecting on one’s perspective, even admitting that there is a room to step out of, is the initial signature of integral (or Second-Tier) consciousness.

For myself, I have glimpses—two steps forward, one step back—into truly holding multiple perspectives. I often think that if I could just get other service workers to understand an integral perspective… and if I can’t, maybe I should just force-feed it to them. Shoving my broader perspective down their throats does seem a bit narrow minded. Such thoughts are signs that my egoic self has not fully surrendered. 21 But then I practice. I step back and witness my self-contraction, and experience the pain of that contraction in the hopes that, if I truly bear witness to it, it will melt my relative heart a bit and loosen ego’s grasp on the Absolute space that is always there. Hey, a girl can only hope.

I find that there is a certain acceptance for “what is” at an integrated level of development. I am not going to change anyone. Rather I should support people in developing healthy ways to be exactly where they are. Development and transformation are slow and hard won and are largely dependent on the other’s interior, not my own (so the belief in the all-powerful self also dissolves a bit). I can influence at times, I can create conditions, but I influence what is already ripe: I align with a moving potential.

But I think it is safe to admit that most of us have these egoic fantasies. At one time or another, part of me really believed that I was going to save someone or that someone was going to save me. In moments I continue to believe that I am invincible, that I really should have everything I want, and that my chest will never sag. In fact, I think it was last week. Now I just try to recognize that adorable, yet limited part for what it is: confused.

Served

Now let’s talk about the level of development of those being served. Most people living on or near the streets, particularly the mentally ill, are at a Beige, Purple, or Red value structure. I need to understand “where” a person is before I know how to be of service. I’ve heard a lot of techniques to decipher someone’s level of development (ask them their favorite song or their favorite movie, etc.). Frankly, none of them interest me. As a feminine type, I like to take my time getting to know another being. Incidentally, people living on the streets have a lot of time on their hands. They wait around all day for various meals and services (an experience I’ve shared the few times I have lived on the streets). Waiting is a chronic condition of the streets. They are in no hurry. If I were to approach them hurriedly asking a bunch of questions trying to decipher their level of development, they would humor me to some extent and then crack a joke when I left.

I take my time and relate to people from “don’t know mind.” 22 This doesn’t mean that I feign stupidity or set aside my knowledge and experience. I just don’t jump to a lot of conclusions or strategies. I don’t initially strategize about how to get someone on medication or into drug and alcohol treatment (important steps in the Upper and Lower-Right quadrants). I just relate to them. If my mind starts trying to solve the issue before I have even related to the issue, then I slow down.

When I do spend a lot of time strategizing about how to relieve suffering, it is precisely because I do not want to feel that suffering. Sadly, as a result, the being before me suffers alone. Certainly the call of service is to alleviate suffering by any means necessary, but for the feminine server (the feminine type), I am sure that the more urgent call is to ensure that no one in my presence suffers alone.

The homeless and the mentally ill are mostly ignored. They are lonely. Many rarely see their families. Many have no family. Friendship can be transient and even service workers often hurry their clients due to their overwhelming caseload. So my main practice is to slow down, listen to the contents of these people’s hearts (no matter how distorted), and attempt to connect. 23

Below is my experience of one day of service in which I actually could slow down, listen, and perhaps even translate. I do not have long-term relationships with any of these clients. All, with the exception of Leonard, are on medication and see a psychiatrist. Appropriately, it all began with a dream before I went to work.

I-Thou: Twenty-four Hour Lament

Late one night, I dreamt that there were a hundred Daryls waiting in the clinic lobby–each wearing a fluorescent green baseball cap covering long, white hair; a grungy, navy blue, hooded sweatshirt; and old dirty jeans. All of them wear headphones, rock in place, and look at the ground. The hallway and the stairwell to the street are lined with Daryls. It’s cold and damp outside. Daryls crowd the streets, each oblivious to the other, staring at the ground.

I walk to the curb and pull my cell phone from my pocket as the Daryls crowd around. This Daryl is diabetic and has gone without insulin for a week. I tell him that he has been on my mind. We call the doctor to schedule an appointment. I give him a bus pass and a pat on the shoulder. This Daryl has forgotten to eat for days. I tell him there is some warm soup down the road waiting for him and ask another Daryl to accompany him and make sure he gets some food. This Daryl thinks that engineers from Lockheed Martin are under his building and are making his room too hot. He has not slept in days and believes he is burned all over. He is terrified. I say, “Daryl, you must be so frightened. Sit here on the curb, where it’s cool. There are no engineers on this curb, sweetie. I double-checked this morning. No one will burn you. Just breathe in the cool, damp air.” He smiles. I call the psychiatrist to get him some Risperdal. This Daryl has foot pain and a swollen, bruised ankle. He can’t remember what happened. He’s totally lost. I speak gently, “Daryl, my name is Annie. I know you. We’ve spoken before. You’ve hurt your ankle and it’s painful. It’s okay that you don’t remember how it happened. We can get it fixed just the same. You just rest now.” I take his hand and invite him to join me on the curb while I call the doctor.

The crowd grows larger as the morning passes.

The dream releases me onto my bed in the barely blue of the early morning and beneath a ceilingless sky. I cry without resistance against my pillow. I feel relaxed as this wordless ache moves me. When it passes, I feel innocent—yet far from naïve.

Tim

> That morning I meet with Tim. He is well dressed, neat, and clean. He won’t risk eye contact with me. If there are pauses in our conversation, he fills them instantly, usually with a seemingly inconsequential question, as though any space between us would open feelings in him that he can’t stand. He supported his wife and daughter before he had an accident on the job that crushed both his arms. He lost his job and suffered debilitating pain. Depression set in and grew steadily worse. His wife left him, and he lost his house.

I read his file this morning—it’s disturbing. I imagine him on one of those car bench seats made of old vinyl, the slight smell of oil, a blue dashboard, his plaid, flannel shirt, the silent darkness surrounding him, and the gun. It’s on the seat next to him, then the dash, then the seat, then his lap—that blackened, slightly shiny relief just lying there. I feel its cold, dense weight in my own hand. That he wasn’t able to shoot himself and instead drove to the hospital probably makes him feel all the more impotent.

I speak kindly to him, hoping to lift him out of his nothingness for a moment, but he hardly notices me. This is not the life he wanted. He wants to be that other Tim, wants me to see that other Tim—the man who worked and supported a family—not the Tim that sits here now. He had another, better life before, but so many days have passed since then that it’s hard to remember what he was like, and the contrast is too painful. 

I breathe in his defensiveness, exhale, lean forward, and say, “You’re really lonely, huh.” He looks down, bites his lower lip, looks at me briefly with great sadness in his eyes, and then looks away and nods. “I’m lonely too, Tim,” and I reach for his hand. We hold hands without looking at one another. He runs his thumb along the inside of my palm, almost instinctually, tightening the intensity of his grip. Then, unable to totally accept my kindness, he cracks a joke, nervously retracts his hand, and walks toward the door, saying that he will see me when he sees me. His face expresses thanks as he leaves.

Leonard

After lunch a fellow caseworker, Deborah, and I drive to visit Leonard. Leonard and I have never met. Deborah reports that Leonard is in his mid-thirties and is schizophrenic. A number of months ago he decided to stop taking his medication. He was interested in Scientology and to become involved he could not be on any meds. She didn’t understand all the details. She says that since Leonard stopped taking his medication, he reports some auditory hallucinations but says he can ignore them. He rarely leaves his apartment.

She tells me that Leonard does not talk. He never says more than, “Fine, just fine.” Leonard’s tiny room is heavy with smoke. All the windows are closed. There is a small single bed and a table buried in papers and trinkets. The trash can sits nearly in the middle of the room and is stuffed past the brim with garbage. With a quiet gesture, Leonard turns off the TV, places his lunch to the side, and sits before us on the edge of his bed, almost formally.

He is about 6’2” and thick down the middle. He wears friendly, old black jeans, a faded black t-shirt, and has long, light brown hair. His eyes are blue and clear. For me, these details reveal aspects of Leonard that could easily go unnoticed. His shirt is well worn, comforting, and familiar. I doubt it is a giveaway item from a shelter. The way it is broken in and the comfort and familiarity I imagine he feels when wearing it suggest that he has kept it for many years. I imagine that he picked this shirt out, not that it was given to him. Similarly his jeans fit him well, which is not usually the case with hand-me-downs. These details suggest that perhaps Leonard is not oblivious to his environment. He doesn’t strike me as the kind of man that says, “just fine,” because that is his experience. These details, real or imagined, suggest that he says, “just fine,” because he does not like these people and does not want them to intrude in his private, difficult life, so he is “just fine” when he talks to them. Besides, there are only a handful of uninteresting questions to which one could respond, “just fine.” I suspect there isn’t a bathroom in this room, but I don’t ask. I usually don’t ask a lot of questions. I am a guest here and probably an unwelcome one. Asking a lot of questions seems intrusive, and I sense that the more questions I ask, the more I will lose Leonard’s interest. Deborah introduces me.

“I’ve heard that you’re into Scientology.” He looks at me and nods. “I don’t know anything about Scientology, other than John Travolta is into it. Could you tell me about it?”

He looks at me, walks around to the other side of his bed, and hands me a large hardcover book on Scientology. I thank him. And then Leonard talks—for about fifteen minutes. The book is illustrated and I admire the pictures, or read a quote out loud that strikes me whenever Leonard pauses. This reassures him and he talks more.  “When you become involved in Scientology you talk to a trained ‘auditor’ and tell them about all the painful stuff you’ve been through. You’re suppose to feel it, you know, the pain, the old stuff, so that it doesn’t block your spiritual development. When you are going through the auditing process, they want you to be in a clear mental state. That’s why I stopped taking meds.”

“This means a lot to you.”

“Yeah, it’s hard, but worth it.”

“I think I can understand that because I’m a Buddhist, and when I meditate really painful feelings come up. I pause for a moment, tracking for a reaction, but I can’t read him. “Is it okay with you, Leonard, that I’m a Buddhist?”

“Yeah, Scientology embraces all religions. It’s non-sectarian.” I smile. He smiles in return.

“It seems like Scientology has treated you really well. What draws you to it, Leonard?” He tilts his head slightly to the side, takes a deep breath, and sits thinking. “Well, Scientology believes that we are all basically good and that we can better ourselves spiritually in this life.”

My mind falls open. I stare at this man through the winding trail of his cigarette smoke. The room is still. We look at each other, half smiling. Then the sun catches the windshield of a parked car across the street, and the light flashes in my face, making it difficult to see. I breathe in the beauty—the silence, the light illuminating Leonard from behind, the hammock of cigarette smoke swirling in the space above him. I feel as though I might cry but worry that Deborah would judge me unfit. “That’s beautiful, Leonard. I believe that too. Maybe sometime I can go to a meeting with you.” He nods his head

It’s not that I believe that Leonard is enlightened, but he is kind, despite the hard blows that life has dealt him. Given that it is unlikely that Leonard will ever transcend his condition, I see his kindness as healthy, and it seems that his connection to Scientology encourages this kindness. It seems that his choice to not medicate satisfies him, and he is not a danger to himself or others. His kindness in the face of being pressured by social services and having to deal with auditory hallucinations is a powerful teaching. We have another client to visit, and it is time for us to leave. I stand, thank him for his teachings, and bow. Outside, it is sunny and cold.

Tamara

Deborah and I drive to visit Tamara at Fort Logan psychiatric state hospital. Fort Logan is a transient home to only the most intractable cases, although they occasionally admit people for a 72-hour suicide watch. Tamara belongs to the intractables. She is the most delusional person I have ever known. The first time we met, she told me that Bosnia was going to cut my head off, put it in a blender, make a smoothie out of it, and give it to me to drink. 

Fort Logan is an old style psychiatric hospital. It has the feel of a former military outpost. The military is gone, having ceded the land to the state in the 60s, but its sensibilities remain. Today it is cold. The grass throughout the grounds has turned a burnt, barren wheat, and the dark gray tree branches stand leafless and twisted. Tamara has been placed at Fort Logan against her will because she is a danger to herself. The last time I saw Tamara, over two months ago, she was being released from another psychiatric care unit, Denver General, because they could not hold her any longer against her will. At the time of her release, she told me that the staff would kidnap the patients each night and take them to the basement and torture them. She escaped the torture by not drinking the milk they gave her with dinner. She tried to warn the other patients not to drink the milk, but they ignored her.  She didn’t want to draw the staff’s attention, “but after the knight was raped with a broomstick, I felt things had really gotten out of control.” Clearly, she was not fit to live on her own. Now, within the confines of Fort Logan, in a breathless rant Tamara recounts the plot against her life and takes out her pad of yellow legal paper on which she has noted the evidence. “Two men are trying to kill me because I inherited Wendy’s restaurants, Las Vegas, and Mel Torme, and one was outside the window last night with a glow stick, but I hid behind the bed, because I know better. I’m not stupid, I don’t drink the milk.”  She talks so fast, spinning one plot after the other until they all become confused.

In the midst of Tamara’s rant, my attention wanders to a woman is sitting on the couch to the side of us. She is young—about 22. The afternoon sun falls through the window and lights her dark, richly brown hair. Her face is beautiful. She rocks intensely, but slowly, and enjoys a conversation with a hallucination, as though she were having coffee with an old friend. They are catching up, I imagine, sharing all the funny and embarrassing details of their lives. She laughs, occasionally shooting me a sidelong glance. She is the first person I’ve heard laugh all day. I smile. She smiles in return.

Then the man on duty tells her to go to her room because it’s naptime. She ignores him and continues enjoying her conversation. He calls out again, telling her to return to her room. She ignores him. He rises from behind the desk, walks across the hall to the couch, and holds out his hand. She stops laughing, drops her head just slightly, does not look at him, and passively allows him to escort her away. I feel conflicted because I appreciate the way this man is kindly enforcing the rules, and yet it seems sad that she must go to her room, as she is the only person I’ve heard laugh all day. Moments later, she sneaks around the corner on the tips of her feet, quietly, like a child, and settles back down on the couch and begins to laugh, but muffled now, guarding her small patch of happiness from the man behind the desk.

I try to listen to Tamara, who still reads aloud without pause from her notepad, citing her inheritance and describing the perpetrators. Deborah finally asks, “Who are these men?” For the first time, Tamara lifts her head, looks at Deborah as though she’s stupid, and says, “Donald Trump and Genghis Khan, who else?” I burst out laughing, feeling completely unprofessional, but I can’t contain myself. If Tamara notices, I can’t tell, she’s busy reading. The woman on the couch sees me laugh and laughs harder, rolling onto her back in a fit of delight, silently squeezing her knees while Tamara drones down the list of her inheritance: “Palm Springs, alcohol, Barbie dolls, Burger King, Kosovo, Prince Charles, Kaiser Permanente…”

Shortly, it’s time to leave. Tamara tells us that we haven’t heard the worst of it yet and asks me to take her evidence to the judge. He will know what to do with it because he does not drink the milk. She reaches her hand out to me. I look at her forearm and wrist. Suddenly, I see her as a young girl holding out her hand to me on the playground. I want to pick her up and toss her in the air and tell her that I love her and that everything is going to turn out all right. I want that small Tamara, the child that her mother gave birth to, before the milk and Genghis Khan, before Fort Logan. But this is an adult’s wrist, and everything has turned out wrong. I look at her, take a deep breath, and collect her scraps of yellow legal paper. “I will guard this evidence with my life, Tamara, until I can hand it directly to the judge.” She relaxes, nods knowingly, as though we share a secret, and thanks me. 24 I wave goodbye to the young woman on the couch. She waves, smiles, and silently laughs.

Deborah and I drive to 7-11 to get some coffee. The evening is coming on softly, and the wind starts up. I stand in the parking lot next to the highway and watch the line of cars with their headlights all in a row pour out of the city. I zip up my jacket and think of Tamara as that young child on a playground and of that young woman sneaking around the corner like a child with her muffled laugh and the sun in her hair. I sense that these women are telling me something but I can’t pin it down: it is open and fleeting, like a dream that you wake from but can’t recall.

Release

Throughout this article I’ve stressed the need to explore the phenomena of the mentally ill living on our streets through the perspectives offered by the four quadrants. I’ve also discussed the level of development of those serving and those being served and how these levels are rarely flying at the same altitude. Make no mistake, programs serving the mentally ill on the streets are desperately underfunded, but without an Integral vision, one that considers all quadrants and various levels of development, throwing money at the problem will not be nearly enough.

There is one more crucial aspect. We should never loose sight of the knowing that the Integral map itself arises out of absolute space as a manifestation of that space. It is the form arising from emptiness, God delighting in God. Thankfully, Integral Theory acknowledges the emptiness from which it arises. From an absolute view, there is nothing wrong; reality is beautiful as it is. From a relative view, we suffer and rejoice. Without awareness of the absolute, serving in a relative world will eat us alive, as there is no emptiness into which we can release suffering. Without one foot in the relative, we grow immune to the painful cry and shocking beauty arising before us.  I have never been able to commit fully to the absolute, feeling myself also the bride of the relative, torn between these two loves, needing both, belonging fully to neither. When I lose sight of suffering, I need a good dose of form to humble me. When I am burned out and paralyzed by the pain I have witnessed, I must take time to return to Divine emptiness.

I had a dream recently that allowed me to touch the ever-present, absolute freedom in Daryl, and it has quieted some of the distress I’ve felt in the face of his suffering: I dream that Daryl is running toward me in an open field. It is late afternoon in the soft sun of early September. The grass is waist high, bleached amber from the sun’s patient attention. He is not wearing his baseball cap or shirt. His hair is dark brown, as it was when I first met him. His eyes are unclouded and free, and his body moves as though uncaged, almost as if preparing for flight. I hear the shuffling of the grass, like a friendly whisper, and the rhythm of his breath. He passes me, and I turn and watch him run off as his back ripples and his arms flail—completely unburdened.

I awake in my bed in the stillness of the deep night. Wherever he is, I release him into the empty darkness.

Endnotes