The Art of American Mental Health Care

A wildfire rages on the Kansas plains. Flames lick at the darkened sky; thick smoke coats the boy’s hair and kisses the mother’s cheek with a dusting of ash. The lithe bodies of women sway as children congregate at their feet. These women move with precision, a delicate precision with each step. They know how to dance through fire. She’s desperate for their knowledge.

She’s carried her child through this hellscape, his body burned. His skin now shades of red and pink, glistens with a thin coating of plasma. She needs these women to teach her child how to heal his singed remains, to hear the rhythm in the burning, to frolic en flambé. A woman pirouettes with a fire whirl; the children near her follow suit. 

This field is littered with the charred remnants of children who couldn’t get close enough to these instructors or arrived too late to learn. Their tiny fingers disintegrate under the soles of my shoes. So many lives lost, and no one available to teach them. She holds the near-lifeless body of her own child closer. Throngs of children clamber toward the instructors. Occasionally, she’ll see an instructor pulled under, trampled by children pleading, screaming to be extinguished. The woman will fall; the children crowd, and like water dropped into a heated pan, she sizzles and evaporates. 

The mother pushes through unbearable heat. If only her child could touch the hem of their garment, if she could just get him close enough, perhaps he could learn to be fueled instead of burned by the blaze. 

——

A jaunty piano melody flows from her cell phone speaker. She suspects it’s meant to be uplifting, but the intermittent static is a stinging ember in her ear. She’s been on hold for forty-three minutes and fifty-eight seconds. Occasionally, she looks up to see how much higher the number has gotten. She’s cut thirty-six quilt blocks from fat-quarters of fabric. Soft ten by ten-inch squares sit neatly stacked. The black flannel leaves sooty-tufts stuck to her carpet. The rotary cutter rips through the fabric, dividing what was whole, so that it can be more beautifully reassembled. This quilt is for her friend; he’s going to hate it. But in this moment, the rolling of the blade across soft coal-colored fabric, the squaring of corners, the measuring-measuring-measuring is reprieve from that damn piano playing from her phone. 

She doesn’t know how many hours she’s spent on hold this year, how many wrong offices she’s finally gotten a hold of. Her inbox is a void – emails she sent to which she will never get a reply. Headlines remind her there is a mental health crisis in the United States, the statistics show the rising number of teen suicides. No nurses warned her when they placed her vernix-coated newborn in her arms that this child may be a data point that breaks her. They made sure she knew the football hold, that her child could latch, that she could swaddle in ways that would comfort him. If she could wrap this man-child in a blanket, hold him close, and soothe his hurting, she’d rock him for hours, his gangly limbs touching the floor with each lilt forward. She yearns to be the warmth and calm she once was. 

Now, her son sleeps upstairs, his box fan drowning out any sound. His soul is an inferno that cannot be quelled. He’s burning from the inside out. To touch him is to sear oneself. Yet when he wakes, she’ll sit by him, holding the heat as closely as he’ll let her. For now, she drives pins through sandwiched squares of fabric. Each accidental finger prick feels right and good. Straight pins know how to meet her in her scorching grief. 

“Hello?”

Somehow, she missed the moment the static piano cacophony gave way to human voice. She slides the safety over the circular blade of the rotary cutter she must keep hidden to prevent her son from driving the blade into his own flesh. She rushes to turn off the speakerphone – this topic feels too intimate to discuss where anyone could hear. No one in her house would be surprised by her words, but each call feels like a confession of her failure.

“Hi. I’m calling on behalf of my child. His therapist recommended we see a psychiatrist, and your doctor came highly recommended. Would it be possible for us to schedule an appointment with him?”

“I’m sorry. We don’t handle our doctor’s scheduling. They do that at the Lee’s Summit office. Would you like me to connect you to them?”

“That’d be great. Thank you,” she says. But it doesn’t feel great. She’s living in a state of emergency. Her child wants to be dead and finding support for her kid feels like playing a game, but no one has told her the rules. A tear sears her cheek. It’s anger. Irritation. It needs to be brought under control before the Lee’s Summit receptionist picks up the phone. She gruffly wipes it from her face. Fuck that tear and fuck this system. The phone rings several times before rolling into voicemail. She leaves a message with her name and number; She pours out her deepest fears to a recording system. She’s bare, vulnerable with a pile of combustible embers asleep in the room above her – “my child wants to kill himself, and I could really use some help. Please call me back when you get a chance.” 

She crosses her legs, unsheathes her blade and resumes cutting squares. It is something she can do. She can roll the sharp wheel, cutting fabric with exactness and when she’s sewn it together, she will have given lifeless fabric purpose. 

—–

FADE IN: 

INT. DOLBY THEATER – DAY

That’s how the script she’s reading opens. In this room with twenty-foot ceilings, drenched in fiery oranges of natural light, she finds herself wishing she could fade out. Her kid is doing homework on his iPad. For the first nine-years of his life she was wildly regimented about screen time. She wanted him to have enough exposure to pop-culture to be able to identify with his peers. She wanted him to have time to be bored, to create. The American Pediatrics Society says no more than an hour in front screens. She trusted them to help her raise a healthy child. It seems pointless now, so much of education has been digitized. She’s taken her twelve-year-old out of school, because after four months of trying to get him scheduled with a psychiatrist, they finally have an intake opportunity.  

Despite its brightness and apparent cleanliness, the putrid breath of mental illness fills this room. Though they crossed the expansive parking lot in below freezing temperatures, there is a rotund woman in tight blue athletic shorts sitting beside them. She’s picking at her cuticles, blood running down her fingers. Her thick leg hair shines a pointed light on the mother’s intrinsic understanding of femininity. She feels she doesn’t care that she hasn’t shaved her legs, but she can’t stop glancing at the tangled mats upon her shins. In the hour they’ve been waiting in this room, the man snoring in the corner has awakened himself at least three times with a particularly disrupted inhale. A woman in a tight leather jacket, with buoyant carrot-colored ringlets of hair, talks animatedly with two friends about her spending. She just can’t stop, and the mother wonders if mania results in bankruptcy in other countries. 

That’s all of them: the bleeder, the snorer, the spender, and her kid who wants to off himself. If they make it through this suicidal devastation, she wonders if one these patients are harbingers of her child’s future. 

She reads the same line of the script over and over. Her mind is so easily distracted. People enter the building, rifle through the trash can and leave. Doctors step into the waiting room. Each time she holds her breath in disbelief. Have they finally found a shepherd who can guide them through this turmoil? The doctors look above the heads of those waiting, they disappear down hallways, listen to the whispers of nurses. They vanish as quickly as they came. She watches a doctor retreat to his secret lair. She returns to her reading. The script is titled The Uncanny Valley. She tries to assess imagery of nearly human actors but the discomfort the writer is seeking is unplumbable, as this mother is surrounded by the rawest of humanity. She’s in a room filled with melting souls.  It is uncanny, so real it is unbelievable. 

Her kid is finally taken back for intake assessment two hours after they arrived – no appointments, walk-ins only. You must adequately show your desperation before you can be seen. Perhaps they’ve finally sent up the right offerings, their sacrifices deemed sufficient. Perhaps the psychiatry gods have found the aroma of her son’s smoldering soul pleasing. She hopes, as she skims pages of dialogue. 

In a back room, she and her husband sit side by side as the financial associate enters their insurance information into a form that they would have filled out online if they could. He verifies their address twice. Both she and her husband confirm. Her husband is rapid firing text messages to coworkers, trying to keep up with work while saving his kid from peril. She looks back to the script trying to formulate constructive feedback- conceptually it is fantastic, but the transitions feel clunky. Maybe they aren’t. It is difficult to focus. She keeps thinking about her son, wondering what he’s telling the intake nurse. The manic woman is pouring her life story out to the financial associate helping her. Flames fly from her mouth, but it is clear that the financial associate is so accustomed to these fires, he’s become resistant.  The sound of key clacks stops.  The mother’s eyes meet the associates helping them, and she knows immediately to brace for disappointment. 

“Our organization is ninety percent funded by the state of Missouri. We can’t take Kansas patients,” he says.  It reminds her of the time she found an injured newborn rabbit in her garden. She’d called the wildlife rescue seven-minutes from her house. They’d deliver a monotone apology. They couldn’t take animals from Kansas. Her husband drove fifty-five minutes south of their house to a rescue in the state of Kansas. Bunnies have notoriously low survival rates. Her husband is the kind of person who will drive two hours for her on the off chance that it might mean salvation for a rodent. It seems they can’t be helped here because they live four blocks on the wrong side of the state line. 

They spend an hour with the intake nurse. She sends emails on their behalf, recognizing how dire their situation is. The mother cries, she can’t not. For a moment she’d breathed what had felt like crisp air, no suffocating smoke filling her lungs. For a second, she’d believed her son might learn the choreography of those surviving the tumult. Instead, he sits in the corner, defeated. There is still no help to be found. If love was enough to hold him up, he’d float. Instead, they’re engulfed in despair. After three hours in this oppressively spacious building, they leave with only more emptiness, the flames even higher than before. The nurse, despite her best efforts, cannot help them. It’s a systemic problem – too many patients, not enough care providers.

—–

After eight months of calling and emailing, after more hours on hold, and speaking to not quite the right person, they manage to set up an appointment. The psychiatrist is booked until December, in ten-weeks perhaps her kid will find reprieve. The kid’s lost four pounds in a month, and the pediatrician is scared for his well-being. She begs the parents to keep his psych-appointment, as if they’d give up what they’d worked so hard to get. Her son purges in the bathroom. The mother’s sure there is something she should be doing, but she doesn’t know what. Pigment spreads across a sheet of paper, her wet brush bringing life to an inanimate page. Her heart breaks at her son’s hurting, but there is little she can do to stop him. This new method of starvation is slower. He’s dying but perhaps at a speed that allows his death to be redirected. She’ll hold him later if he lets her, listen to his pain. But for now, she makes haphazard black watercolor circles as the toilet flushes down the hall. 

—–

There are still two weeks until his appointment. The mother receives a call from the school social worker. She’s panicked; this kid is suicidal. The social worker’s fear splashes up against the mother. There is no help she can offer. The social worker’s never navigated the terror of opening her child’s bedroom door, not knowing if Jackson Pollock-style splatters of his flesh and blood may be sprayed across the wall. She’s never envisioned the innermost parts of her child dripping down childhood drawings and pictures of happier moments. The mother has no energy to soothe this well-meaning woman.  She considers how ridiculous it might sound if she suggested the social worker try making something. She knows she’d sound insensitive. She also knows she can’t make her child sleep or eat – that she and her son can walk in the afternoons to ensure he’s getting enough exercise and vitamin D, but that even the sunshine can’t temper his burning. Her son has taken all the right steps, still, he burns. He’s taken wrong steps, he burns more. The social worker wants to know he’ll be ok. The mother can’t tell her it will. 

—–

The appointment comes and goes. There are two more appointments. Medications are tried; they work but not well-enough. Dosages are increased, decreasing the fire but it still rages. Somedays the mother feels that her son might survive. She’ll notice a twitch in his foot. It may be a reflex or perhaps he is beginning to feel the pulse of life again. On an evening in February, the son tells his father that he is unsafe to be alone, that he’s sure he’ll kill himself tonight. The mother and father are grateful for his honesty. They are exhausted by this reality. The mother sits with her son in silence; there’s no changing his mind. The father calls five in-patient facilities. After spending a cumulative sixty-seven minutes on hold, they learn there are zero beds available. The parents do what must be done, taking turns on fire watch. One sleeps while the other keeps vigil. In the pre-dawn hours of the morning, the mother outlines a tragedy while her son sleeps. The fear and pain are carefully contained behind predictable Roman numerals. No matter how trying the sequence, these are characters she can save, a luxury of control she lacks in her daily living.  

—–

There is a wildfire burning across the plains of Kansas. Blinding smoke billows as she carries her son through the field. His shallow breaths are enough to keep her marching through the flames. Women dance to the sounds of a jaunty piano enveloped in static blaring through a cell phone speaker. The remaining children claw and climb, begging to be taught to dance, while the bodies of their counterparts lay strewn across the baren sward. She holds his body close to her, their burned flesh fusing together. She prays from the within heart of this wild furnace, someone teach us to dance.