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Policy Made Me Involved: We Need a Better Public Health System

The views expressed are those of the author and are not necessarily those of Scientific American.


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This post is part of a collaborative narrative series composed of my writing and Chris Arnade’s photos exploring issues of addiction, poverty, prostitution and urban anthropology in Hunts Point, Bronx. For more on the series, look here.

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In the beginning, I said that I was a documentary writer, chronicling stories of addiction in one of the poorest communities in the United States. Strictly situationally based to tell a story, someone else’s story. I’ve been near-obsessed with removing myself from the narrative, an observer but no more. I haven’t, and still don’t, believe in adding myself, an unnecessary figure in an already complicated community’s tale.

Now, though, I wonder. Michael is sitting next to me on my couch as I type, awaiting transition to rehab. A 37-year old transsexual heroin addict who has lived homeless in the Bronx for years.

He was released from a seven-day detox facility on Staten Island yesterday morning, not anticipating a gap before rehab intake on Monday. A full 48 hours of freedom. Michael, like many, has no place to go, no family or friends to take him in. Though treated with suboxone in detox, Michael now has no drugs in his system, prescription or otherwise. His body is a nest of aches, even the smallest movement labored. The last time he detoxed, over 10 years ago, he was in jail and given methadone. Yesterday, he was poised to return homeless to the Bronx, chemically naked for the first time in decades.

Michael clean: Staten Island
Michael clean: Staten Island. Courtesy of Chris Arnade.

When we neared Hunts Point, the place he’s called home for years, he began speaking of needles, just one hit of crack to say goodbye. Just one. No more heroin. Just crack. Just a needle in the skin one more time. He was babbling, barely coherent, tearful.

Jarred, we left the neighborhood, the clothes he came to fetch and any notion of his staying there the weekend. To remain clean, Michael wanted and needed to leave. He wanted out but didn’t know where to go. He set up camp at my house, a place without the allure of prescription medication, a different neighborhood where the location of drugs was unknown. And so he’s on my couch. I can’t write this, what I hope to be the story of Michael’s recovery, without including myself.

Policy has made me imbedded because of the few, if any, options the people I cover have, those homeless on the streets of a major city, a city seemingly ill-equipped to cogently deal with conditions of mental health for the disadvantaged. Michael is an adult who wants to get clean but has no place to go. Or, at the least, is unaware of where he could go and lacking the resources — like a phone, a computer, or stable friends or family — necessary to find out.

Over time, I’ve understood: this is the story. We — Michael, Chris and I — are the story. The bad policy and methodology of getting clean without aid, a near impossibility. The beginning of a documentary project that spilled into something akin to social work. My shame, journalistically, of being involved this way. My transition from journalist to writer/advocate/friend/ally.

I’ve spent the last year immersing myself in Hunts Point and have yet to meet anyone on the streets who has begun successful addiction recovery. There’s been no story of independent success, no phoenix rising from the depths of poverty, incarceration and consistent drug use.

Readers sometimes ask, “where are the good stories?” The truth is, there are very few. “Better” is gauged in fits and spurts, in the few days after jail release, or after a stint in rehab. “Better” lasts a few days if someone’s lucky.

There are gaps in the system hindering those who want to make a change, gaps that fuel arrest, rearrest, periods between treatment, continual homelessness. Resources are pebbles in the dark.

I never meant to be involved, but out of compulsory humanity, I’ve had to be.

Michael clean: Astoria
Michael clean: Astoria. Courtesy of Chris Arnade.

Now, it’s early Sunday morning. The night was rocky, with both Michael and I scarcely sleeping. Michael periodically begging for methadone or benzodiazepines, spinning occasional romantic sentences about suicide. My half-hearted humor back. “Stop it, Michael, I like my rug and you too much.”

What about a pill, just a little something. It hurts. Is it supposed to hurt? My helpless google attempts at answers: “what to do between detox and rehab nyc.” My tries at coping with his depression, listing what being clean will do. My inability to promise him a sound future or a hopeful trajectory from rehab to a stable life.

In my head, I can at least say that he’s not on the streets, back to what would have been immediate drug use in Hunts Point. That his efforts in detox and his dreams of a new life weren’t wasted. That at least one person might, against the odds, escape the neighborhood.

There is no better judgment here, no staying objective and distanced while retaining compassion. I’ve never wanted to save anyone, only to record. But in a population in such desperate want of a helping hand, only to find one lacking, I can’t stay in a box seat.

Public health policymakers, please take note.

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More Hunts Point Addiction Writing
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Cassie Rodenberg About the Author: I write on culture, poverty, addiction, and mental illness: I explore things we like to ignore. I also teach public school in New York City's South Bronx. Follow on Twitter @cassierodenberg.

The views expressed are those of the author and are not necessarily those of Scientific American.





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  1. 1. shaun.shelly 11:49 am 02/24/2013

    Hey Cassie, I am an addiction specialist working in Cape Town South Africa in the non-profit sector in a gang infested sub-economic community with much meth and heroine use (though currently not much injecting). I first came across the work you and Chris do in an article where you said “No, I’m not afraid, not in the least. I leave my answer at that. I ask in return: if you carry the disrespect of fear for an area or group of people, how can you expect not to be treated aggressively in kind?” This impressed me in its truth and I have since used it with all my staff.

    Chris’s work, although it documents life on the other side of the world, reminds me of the value of what we do daily. I wish more clinicians would view his work even if a minute a day on facebook, and read your commentaries. It would keep them much more real. I am about to write a piece about it for my webpage and put it in my monthly newsletter.

    It is indeed impossible not to get involved and become part of the narrative. In our out-patient facility we battle not to cross boundaries, but we do, simply because there are some amongst us who have no support structure. We are all they have.

    As for Michael, why she was not put on a high dose Suboxone maintenance therapy, at least temporarily, I don’t know – it seems crazy that there is so little science in a first world treatment setting.

    My thoughts and prayers are with you all, and I know that when I visit New York, it will not be the normal tourist venues I visit, but Hunt’s Point.

    Shalom

    Link to this
  2. 2. ChristiCole 3:58 pm 02/24/2013

    Cassie I have been reading about your and Chris’ work for several weeks. I don’t know how you could meet these lost souls and not care deeply. Thank you from all of us who follow your posts here and Chris’ on FB.

    Michael, Honey you hang in there and stay strong. We are the same age and darling I very much want for you to see this through to see 38 and beyond. You have many MANY people who are pulling for you, more than you know. Unfortunately we cannot be there to help you out as your angel Cassie has but know that there are literally hundreds of arms holding you tight from around this big ol’ world. Much love and respect beautiful <3

    Link to this
  3. 3. phg1960 5:57 pm 02/24/2013

    Having no experience in this area, I can’t say we need a better health care system. But it certainly sounds like we need a smarter one.

    Best of luck to Micheal. You can do it.

    Link to this
  4. 4. Tim May 6:52 pm 03/3/2013

    We have a “health care system” that is paid-for by non-drug-using, non-alcoholic working Americans. These working Americans support the various needle exchanges, HIV clinics, rehab centers, methadone issuances, and many other taxpayer-funded programs for the various drug users, streetwalkers, derelict drunks, and crack whores.

    What people need to do is to make the right choices. Early on.

    Those who don’t cannot possibly be helped by a “better” (= even more subsidized) health care system. As you said:

    “I’ve spent the last year immersing myself in Hunts Point and have yet to meet anyone on the streets who has begun successful addiction recovery. There’s been no story of independent success, no phoenix rising from the depths of poverty, incarceration and consistent drug use.”

    One would expect that if addiction could be solved externally through a health care system, that at least _some_ of the people you’ve encountered could’ve been cured of their addictions.

    (BTW, the situation in my part of California is basically what you describe for Hunts Point. We have numerous free clinics, needle exchanges, drop-in centers, subsidized rehab, free rehab, etc. And yet the “recidivism” rate is nearly 100%. The addict wants to smoke and dream his life away….)

    There is no simple answer to what is basically the result of a bad set of choices a person makes.

    Link to this
  5. 5. aidel 5:10 pm 03/8/2013

    You know, Cassie, your posts really do help. Those of us who are still clinging to a ‘normal’ life, who occasionally slide. Those of us who go to 12 step meetings, white knuckles…. To look at your blog, and all the poor souls who have sunk so low, and to say, “that shape am I potentially,” well, it helps.

    Link to this
  6. 6. aidel 5:12 pm 03/8/2013

    What do you say to those who claim that addiction is not a brain disease?

    Link to this

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