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Thursday, January 1, 2015

Hiding in Plain Sight - A Path of Mental Illness

Hiding in Plain Sight

A Path of Mental Illness

This Blog entry has been perhaps the most difficult piece to write among the catalog of posts I've published. It has emerged from a recent personal experience that prompted reflection on the plight of those people challenged by mental health issues. Furthermore, this experience caused me to examine the opportunities of people afflicted with mental health difficulties to navigate the ebb and flow of society. Additionally, this Blog seeks to explain why our school district has long recognized the value of actively addressing mental health concerns as an integral element supporting instructional success, and maintains an investment in the staff trained in delivering services to those in need. We have a full-time social worker, a full-time school psychologist, and a full-time guidance counselor for our preK-12 community of 344 learners.


She was born in Colorado three months premature, at a time (1959) when few births in that condition emerged alive, and discarded in a plastic bag that was discovered soon thereafter in a dumpster. She was adopted within days of her recovery by a loving and accommodating couple who was fully aware of her beginning and steadfastly committed to her future.

She died in Texas fifty-five years later (last month), alone, of natural causes in the bath tub of her home, and was discovered by police called by property maintenance staff to check on her whereabouts.  She had been dead for approximately a month without anyone aware of her status.

In between these two auspicious book-ends of a tragic spectrum, in what in retrospect must have been a life shadowed by sorrow and understandably burdened by bitterness, she existed on the edges. She was not cognitively challenged enough to qualify for institutional support and mental health assistance, nor was she fully capable of appropriately sustaining herself as an adult in a complex society operating at a speed and direction beyond her orientation.

Her family moved to Maine when she was six years old. As a child she experienced, and benefited from, a nurturing home. Her father’s successful medical practice provided an income that accommodated her needs and wants and allowed her mother, a former educator, to remain at home and offer support in her development. Her parents were aware of her needs and sensitive and responsive to her challenges. Her brother and sister, each adopted from separate biological parents in the Denver area, displayed as much care and consideration as they could render as they progressed from child to adolescent to adult.

Federal legislation promoting special education originated in 1975, when she was sixteen years old and already in high school. Prior to the introduction of that intervention schools typically did not differentiate instructional practices or environments attendant to children identified with cognitive deficiencies or social, emotional, or psychological issues other than those with pronounced and obvious disabilities. Mental health issues eluded the reach and grasp of public schools at that time.  And too many of those with the greatest needs were institutionalized.  Nor were there specialized schools available as they are today to address the unique needs of learners challenged beyond the capacity of public schools. As such, with an IQ that fell in the mildly retarded range, and developmentally delayed social skills, she existed within the cracks between regular educational programming and institutionalized/specialized schooling. She received private tutoring funded by her parents to supplement her education at school and the help her mother provided with her schoolwork at home. She was tacitly promoted from grade to grade until “graduation” marked by what is frequently referred to as a “local diploma.”

Her interpersonal communication skills were lacking so her social experience at school was limited. She suffered from being ostracized by her peers to the point she was rendered invisible at school and infrequently invited to birthday parties and other activities common among children. She was physically awkward so any of the athletic groups many kids were involved in were out of reach for her. She was often left out or the last picked for activities. These obstacles led her to retreat to her bedroom as a refuge where she engaged with life through prolonged indulgences with her music system and television. She began insulating herself from a world she found intimidating.

Her parents attempted to expose her to as many cultural and learning opportunities as possible, with regular vacations throughout the country, some extending overseas to London and Rome, and interesting events at museums and concerts. Her parents devoted themselves to filling in the gaps, educationally and socially, between her abilities and her needs and interests.  They were always aware of her shortcomings and the expectations of functional members of society. Their goal was to create a safety net to catch her for the inevitable falls.

Three years after completing high school, she moved with her family to Texas, where her father continued his practice at a leisurely pace of semi-retirement. Her sister, who had moved to the same city in Texas and lived there for seven years, eventually moved to New York with her family. Her brother, who had been living in Colorado since the early 1990’s, was married and had cultivated roots in Denver. The three siblings would interact during the holidays and special occasions such as weddings and anniversaries that brought them back to Texas.

A paramount concern of her parents was her life as an adult. This was a particular concern given the dispersion of their other children to Colorado and New York, and the fact they were in their late thirties and early forties when they adopted her and realized she would outlive them both. She lacked the social acumen necessary to successfully maintain a job. As a result they established a trust that would manage her financial requirements and ensure her of a home and support for medical needs and living expenses.  Her father suddenly passed away in 2003 and her mother followed in death in 2004 after suffering with Alzheimer’s disease. Prior to their deaths her parents were comforted by her marriage in 1997 and a subsequent partnership with a man they hoped would bring her companionship and support and assuage some of their fears. Unfortunately, her husband died in 2006, making it three years out of four in which she had experienced devastating personal grief.

Those tragic losses precipitated a resolute and conscious choice on her part to escape the harsh realities of life. She systematically excluded those who could provide assistance and help with direction. This complicated any efforts to attend to her needs. She was determined to withdraw from her remaining family and society and live as a recluse within in a city of 200,000 people. Not only did she stop attending church, consequently discarding the help of those who ministered to her and supported her in a variety of groups like chorus, but she insisted that the church erase any evidence of her membership. She did not have a job so there were no relationships to maintain in the workplace.  She sequestered herself in her home just like she had in her bedroom as an adolescent in a self imposed exile. She regularly changed her phone number and refused to answer entreaties by family members delivered by phone call, mail, or a knock on her front door.  Hence, the lengthy period of time that elapsed between her death and the discovery of her body.

The funeral director delivered the service at her gravesite. He had known her when she first started attending the church where he was a member. He experienced a friendly relationship with her when they both participated in a singles group at church years ago.  He and others in the group were accommodating to her because as he stated, “she had the heart and mind of a child.” He shared that he became concerned for her when she disappeared from the church.

During the service, attended only by her two siblings and their spouses, and four representatives of the bank that managed her trust, the funeral director volunteered that he hadn’t seen her in years until she showed up at his funeral agency about a year ago with plans for her own funeral. She informed him that she was a widow and he responded by saying he hadn’t even known she was married. She had intimated her interests regarding a future funeral. He noted that she frequently came in to place both informational and unusual items in her “file” that she insisted he maintain for her involving the funeral. She was adamant that there be no obituary in the newspaper or program at the funeral. She stressed that nobody would be invited to the service except for the funeral director and representatives of an obscure bureaucratic agency. Nobody could ascertain or even guess at any relationship between her and the agency. Even more startling was her request to fund a five course meal at an upscale restaurant, complete with open bar (she never drank alcohol) for the tiny group she had invited. This fantasy was just one of many that she constructed to rearrange reality and make life more amenable in the final eight years of her life.

The funeral director appeared to be the lone person that she maintained even a semblance of a relationship with, at arm’s length and on her terms. He described her with the term “child-like” at least three times during the service. He explained that in her last couple of years she was a far different person than the one he had known at church years before. He begged our understanding and offered that he perceived her as extremely bitter and manifesting thoughts and behaviors approaching paranoia. She would sometimes visit his office with food stains on her clothes. She visited a local food pantry for assistance, yet upon her death she left over $100,000 in the bank and a home without a mortgage. She had evolved into a person of darkness. His words were acknowledged by the siblings and in-laws of the departed since they were all well acquainted with her challenges. And the bank representatives, dealing primarily in numbers and objectivity, were not inclined to really know the scope of the person at the receiving end of the money they managed on her behalf.

It was a very sad and lonely end for an individual who had started life discarded in a plastic bag in a dumpster. It was a life that exposed our nation’s lack of investment in the mental health issues and the human infrastructure necessary for a free, democratic, civilized society. A statistical analysis of national appropriations to mental health issues would call our commitment to all members of our country into question. There must be supportive programs and interventions developed across the country to help those battling varied forms of mental illness.

I chose to title this Blog Hiding in Plain Sight because I feel that people afflicted with mental health issues do not actually hide per se, but rather they are obscured by the benign neglect of a society that elects to look the other way and not address this critical need with the same commitment expended on other social and civil issues. Many of us look but we may not see. In retrospect, perhaps she didn’t hide, maybe she grew tired of people not finding her and then opted to recoil from society and become reclusive.

We need to discover the people and their problems. It reminds me of when my daughter was a toddler and we would play the game “hide and seek.” Once, I found her hiding in plain view with her eyes covered. She believed that if she couldn’t see the person looking for her then they likewise couldn’t see her. That’s not an effective approach to ministering to the needs of those suffering with mental health issues.

How many reports do we have to read about instances such as the one on Adam Lanza (the young man who killed 26 people at Sandy Hook Elementary School in Newtown, Connecticut - before we accept responsibility as a society to properly and systematically attend to the needs of the mentally ill? This report cites the failure of institutions to act and work in concert to craft appropriate and responsive programs and safeguards.

I may be guilty myself of not understanding, or worse, not seeking to understand. The subject of this Blog was my sister-in-law. Also, I am the son of a mother of seven who attempted suicide  when her children were young.
The aversion we have to confront those who are so different selectively insulates us from their needs and undermines any opportunity to learn how to comprehend, respond and support those wrestling with mental health matters. It is a fear that leaves the rights of those suffering from mental health issues behind those who have championed civil rights regarding gender, race, and sexual orientation. In fact, there has been recent news coverage of people debating in courtrooms over the legal rights of primates. All of this before we lift the collective veil of discomfort and awkwardness in order to commit to, and generate,  a coordinated effort to defend the rights of, and support the needs of, humans confined by their emotional and psychological demons.

From the standpoint of a school district leader I am concerned that many public schools have reacted to decreased financial aid and budget shortfalls by reducing staff that are not directly linked to the curriculum and state assessments. Staff cuts in social workers, school psychologists and guidance counselors may sever critical support systems for children who experience emotional, social, and psychological problems that overwhelm or impair their ability to focus on school achievement. Abraham Maslow's research on the Hierarchy of Needs contends that the need for achievement is more likely to be met after one has already experienced satisfying levels of prerequisite needs for health, friendship and acceptance. We must maintain that perspective and priority.

I will close with a link to an article in The Atlantic magazine on mental health disorders in America and how we compare to other industrialized nations (for a context on this issue).

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