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Life Inside

I Escaped My Manic Demons, but My Clients Usually Can’t

A social worker struggles to keep the mentally ill poor out of jail.

This article was published in collaboration with Vice.

I met Raheem in an arraignments shift at the Bronx Criminal Court in New York, where I was slated to serve as his social worker.

Raheem had been arrested for stealing lice shampoo from a pharmacy and then getting into a scuffle with the security guard who caught him. As we talked, he fidgeted and scratched at his body while explaining that a lice plague was ravaging the world and only he knew the secret cure. He added that he actually had enough money to buy the shampoo, but couldn’t let the store employees know about his plan, so he had tried to sneak out without paying.

At the time, Raheem was on parole, stemming from his record of over 30 arrests, almost all of them minor misdemeanor charges related to his unmanaged schizophrenia. The new arrest meant he would be sent to prison for a year.

The outcome of Raheem’s case was hard for me to swallow — and not just because I was part of his defense team. Like Raheem, I too had once shoplifted from a pharmacy while in the grips of a manic episode. For some reason that had felt completely compelling at the time, I needed to stock up on over 20 bottles of nail polish without anyone knowing about it.

As a well-dressed white woman, however, nobody suspected a thing and I had simply walked out of the Chapel Hill, N.C., store without notice. The episode ended in a psychiatric hospitalization, through which I received the treatment I needed to get my symptoms under control.

Even as someone who advocates every day for people with mental health diagnoses, and whose work involves dismantling the stigma that surrounds them, it is still hard for me to disclose my own struggle.

I was diagnosed with bipolar disorder the year I graduated from college. It happened after my first full-blown manic episode, in which I sped on a highway at over 100 miles an hour after buying a $3,000 engagement ring on a whim, planning to surprise my then-boyfriend halfway across the world.

Needless to say, this plan did not come to fruition, and my spontaneity, risk-taking, and impulsivity soon morphed into terrifying psychosis. I was suddenly convinced that my reality was just a big stage and everyone was acting out a script, and I was hospitalized and prescribed anti-psychotics and mood stabilizers.

About four years after my first episode, I pursued a master’s degree in social work with the intention of becoming an advocate for those like me. In a mental health policy class, I remember debating the use of physical restraints, and arguing vehemently against the practice. My classmates did not know that I myself had been strapped to ER beds and restrained in seclusion rooms.

But it was in that same class that I learned about the deinstitutionalization and subsequent over-incarceration of people with mental illnesses, and began to slowly comprehend my privilege as a white woman whose circumstances had allowed her to lead a productive and fulfilling life in between episodes.

Now that I am a social worker at the Bronx Defenders, I’ve met many people like Raheem: men and women of color struggling with mental illness while trying to survive in the South Bronx, one of the poorest districts in America. Many end up ensnared in the criminal justice and immigration systems instead of getting the health care they need.

And I have met many more clients whose experiences are eerily similar to mine, even if their outcomes could not have been more different.

Not too long ago, I had to call a man to inform him that his brother, Jose, my client, had been arrested in a psychiatric hospital for allegedly assaulting a nurse. I heard him weep on the other end of the phone — and I remembered the time that, in the throes of my own psychosis, amid the chaos of a hallway in the ER, I bit a nurse because I thought she was trying to kill me with laser beams.

I was not arrested. Instead, I was admitted to the psychiatric ward and walked out, restored to my sane self, about two weeks later.

I’ll never forget Jacob either: a green-card holder from South America whom we represented through an immigration public defense program funded by New York City.

Jacob had been working as a medical professional when he first began experiencing symptoms of schizophrenia. His illness caused him to lose his job, and he fell into homelessness and substance abuse in an effort to self-medicate. He was in and out of hospitals and ended up being arrested as the result of an incident in which he found himself responding to powerful command hallucinations. His convictions landed him in immigration detention, where he continued to deteriorate and even attempted suicide.

Despite our effort to explain his symptoms and need for treatment, an immigration judge denied his application for relief. Jacob was put on a charter plane back to a country he hadn’t been to in decades, where he no longer has any family or access to meaningful treatment. I never heard from him again.

It is in moments like these that I feel survivor's guilt most acutely. I have struggled to live with my diagnosis, but how can I reconcile the stark contrast between my experience and those of Raheem, Jose, Jacob, and so many others? Every time I visit my psychiatrist in her Park Avenue office, I feel a pang of guilt accompanied by overwhelming gratitude. Gratitude that I have access to quality care, and gratitude that I respond well to treatment.

My personal experience has been both a blessing and a curse. It has made me more compassionate and patient in working with clients experiencing mental health symptoms, but it also challenges me with painful reminders of past experiences that continue to be shrouded in shame and a feeling of unearned privilege.

So I’ve learned that to be the best possible social worker for the community I serve, I must understand that vicarious trauma is real — that if I don’t try to understand how my own experiences affect my interactions with clients and vice versa, I am doing them a disservice. In the social work profession, we are often in a position of power over our clients, and to some extent, we separate them fully from ourselves.

But I think we should all recognize that many of us share much more in common with our clients than we would readily admit. It is time for people like me to say: I, too, am one of them, but I have been permitted to survive. Survival should not be a luxury.

Kristen Anderson is a social worker at The Bronx Defenders, a public defense office serving low-income communities in New York City.

The names of Kristen Anderson’s clients are pseudonyms, to protect their privacy.