When mental-health counselor Jean Kramer stepped inside Ted's Santa Monica apartment, the place looked as though it hadn't been cleaned in weeks. Ted's sleeping mat lay unmade in one corner; dirty clothes were strewn across the unswept floor. Such indolence was characteristic of chronic schizophrenics like Ted, Kramer knew. But she also knew that was no excuse.
"Which would you like to do first: Straighten the apartment or do the laundry?" Kramer asked.
Ted waited awhile before answering. "Awww, I don't want to do laundry today. Let's go the beach instead."
"I know it's not fun, but everyone has to do their laundry," Kramer said. "Who wants to walk around in smelly clothes?"
"All right," Ted said reluctantly. "But . . . I don't have any change for the machines."
"I do," Kramer shot back.
Outmaneuvered, the 25-year-old mental patient began to stuff his soiled clothes into a laundry sack.
Ted's behavior was typical of schizophrenics, the counselor said later. "So often, they'll sit around in clothes that smell bad or don't even match, and they'll wait for someone else to take care of it for them," Kramer said. "Instead of letting Ted avoid responsibility by behaving like a sick person, we've tried to communicate the idea that normal, healthy people don't rely on others that way. They take responsibility for themselves."
Based in Santa Monica
For 15 people enrolled in (Re-)Socialization Skills Inc., a private, Santa Monica-based pilot program for the chronically mentally ill, that simple message seems to be coming across. Founded in 1979 by Bart Ellis, a licensed clinical social worker, (Re-)Socialization Skills has pursued a "mainstreaming" approach to psychiatric therapy by taking patients out of tax-supported institutions and placing them in their own apartments. With the help of counselors (Ellis calls them "special friends") who are available on a one-to-one basis, the patients (or clients) learn how to cook, shop, clean house, balance a checkbook, take a driver's test and, ultimately, look for a job.
(Re-)Socialization Skills has worked with about 60 clients, their problems ranging from adolescent adjustment difficulties to learning disorders.
One client is Richard, 37, whose developmental disabilities have left him with the emotional age of a pre-adolescent. Before the program, Richard was not able to live on his own or work. After three years in Ellis' program, he is living on his own and working part time.
After years of delusion and dependence, those in Ellis' program are learning to face reality. Like Ted, about a third of them suffer from chronic schizophrenia, a mental illness marked by disordered thinking patterns, hallucinations and bizarre behavior. While the illness generally is considered to be incurable, schizophrenics often can quell their symptoms with major tranquilizers. Believing themselves well enough to stop taking the drugs, many then become trapped in a hopeless "revolving door," bounced from brief periods in the street to a state mental hospital to a minimal board-and-care facility; in time, the cycle begins again.
"The medical establishment thinks little can be done for schizophrenics outside of medication and institutionalization, so there are few efforts to integrate them into the larger community," said Ellis, 46. "We think a great deal can be done, but different approaches are needed. The entire system needs major surgery. Long-term patients have spent 15 to 20 years learning how to be good mental patients. Because psychiatrists, parents and friends treat them like they're made of Dresden china, that's the way they act. Their craziness--the voices they hear--attract attention, so there's incentive for the crazy behavior to continue.
"Science shows that chronic schizophrenics probably have a biochemical imbalance, but there's also very much a learned, manipulative component to the illness that people don't realize," Ellis said. "Most of the clients we work with prefer to remain babies, for instance; they're allergic to work. With mainstreaming, we say to the client, 'Wait a minute. You're not an invalid. You're not helpless. And we don't want to hear about your voices. What did you do today? You cooked an egg and washed your hair? Good for you! You're getting stronger every day.' "
Some Don't Improve
Because of the nature of the illness, however, not all in Ellis' program get stronger. Such was the case with Randy, a quiet, Los Angeles-born college student who first "snapped" on Thanksgiving Day, 1980, after overindulging in marijuana and alcohol.
"Randy was chanting, 'I'm the devil' and talking crazy about President Reagan and the Russians," his sister said. "When he ripped the turkey apart and threw Mom across the room, we drove him to the hospital."