Tuesday morning at precisely 9 a.m., my secretary informs me that my 9 o’clock appointment has just canceled (for the second time this month). I remind myself that I need to call some insurance companies to authorize more sessions, and that I’m behind on my case notes. I should use the free hour to catch up, though the mere thought makes me tired. It also occurs to me that I need to lose 10 pounds, minimum. Then, a welcome distraction: a phone call from Dave, the manager of the crisis-intervention unit for the city of Dallas.
“Ken, we’ll have an opening soon on our crisis team,” he began. “I’ll be looking for somebody who knows both community and disaster mental health–you know, somebody who can juggle a lot of balls. I figured you might know someone.”
“I’ll keep an eye out,” I said.
After we hung up, I started in on my case notes. But I couldn’t concentrate. The job Dave mentioned kept floating before my eyes. He’d called me, I knew, because I was pretty familiar with the world of crisis intervention. Several years back, I’d trained as a trauma specialist, and I currently worked with a group of therapists and chaplains who volunteered at disaster sites in the U.S. and abroad. I found the work energizing and rewarding.
Still, my crisis work thus far had been occasional–bursts of intense, electric activity punctuating an otherwise quiet life. I wondered: What would it be like to do it all the time? I imagined myself racing back and forth each day to street corners and apartment buildings and public places all over Dallas where somebody, suddenly, could no longer cope. Physically, I’m a pretty big guy–6 foot 6 inches, 250 pounds–so the idea of working solo in inner-city neighborhoods didn’t overly concern me. In fact, it sounded pretty interesting.
My mind reeled back to the excitement of playing basketball for my college team–dribbling down the court in a close game, my heart pounding, prepared to roll with the unexpected and ready to improvise. There was something about being in the moment and getting the chance, now or never, to make a difference, that made me feel totally alive. This job, I thought, sounded like a good, tough game of basketball. Maybe it was for me.
Abruptly, I came back to earth. I was 49 years old. I had a well-established private therapy practice, one my dad had started and invited me to join 20 years ago. My clients were mostly like me–white, middle-class, not too disturbed. I could choose my clients. I had control over my time. I knew the territory and felt comfortable in it.
Nonetheless, a week later, I found myself sitting in Dave’s office. “I might be interested in the job myself,” I told him, and asked for more details. But as Dave began to describe the work, I found myself listening less closely to the job description than to something in his voice, something I recognized right away.
Dave was a clinical social worker with 20 years of city crisis work under his belt. Yet, as he talked about it, he sounded a lot like my old college basketball coach, Brooks Dozier. During time-outs in the locker room, Coach had a way of pumping us up with his own enthusiasm, making us itch to get back out on the court and make something happen. When Dave leaned forward in his chair and said with real passion, “There’s still so much to be done,” I felt that old locker-room sense of “Yeah, let’s go!”
In my therapy office, I was finding passion harder and harder to come by. Just a few weeks earlier, I’d wrapped up a particularly productive session with a couple. Both partners had finally begun to own up to their part in their struggles, and toward the end of the session, the man had reached for his wife’s hand. Earlier in my career, such a moment would have given me a month’s worth of energy. Now it just felt like business as usual. Anybody could have walked them through that, I thought. And, then: Why am I doing this?
The truth was, I craved more action in my work. I wanted more basketball moments.
A Rocky Start
After my meeting with Dave, I thought things over long and hard. For me, this leap was on the level of a marriage proposal, or starting a family. If I went for this job, I’d be plunging into a drastically different work environment, with unfamiliar clientele, longer and more erratic hours, and a very steep learning curve. In deep middle age, was I ready for this? I found myself thinking of my dad. After 20 years as a pharmaceutical salesman, he’d taken his own plunge, going back to school to pursue a second master’s degree–in psychology–and opening up the counseling center at which I now worked. “It’s a big world out there, Ken,” he often told me. “There’s always more to go after.”
I called Dave and told him I wanted to formally apply. I went for an interview. I got the job.
Two weeks later, I showed up at City Hall for my first day of work. At the cheerfully chaotic crisis intervention office, Dave greeted me, introduced me around, and then informed me that I’d be the sole mental health caseworker for the city of Dallas. As I listened, stunned, he told me I’d be responsible for receiving, reviewing, and responding to all police department mental health referrals. I was up for a challenge, but this was wild. “Budget issues,” Dave explained. I tried to cover my anxiety with a can-do nod.
In short order, I was dispatched to visit Wanda, an elderly woman who lived alone in a low-income neighborhood at the edge of town. Her next-door neighbors, who were trying to sell their home, had complained to the police that Wanda was scaring off potential buyers with her menagerie of pets. The neighbors claimed she was “crazy.” As I climbed the steps of her tiny, frame house and knocked on the door, I realized that I had no clue how this encounter would go. That was just fine with me.
But when Wanda cracked open her door, the odor hit me like a runaway freight train. Struggling to hide my disgust, I introduced myself, and then asked if we might chat for a moment. I noticed that she looked pale and dangerously thin. “We can talk out here,” she said in a dry, whispery voice, stepping outside onto the stoop and closing the front door behind her.
Stench or not, I knew I had to get inside Wanda’s house to get a handle on her situation. Attempting to establish myself as a trustworthy person, I made what I thought was friendly small talk, asking Wanda about her house, the neighborhood, her family. This went nowhere. Desperate for some way to connect, I finally said, “Tell me about your pets.”
Her eyes lit up. She began to talk of her cats, dogs, and birds as if they were her children, regaling me with tales of their various achievements and adorable habits. It went on for some time. Standing with Wanda on her front stoop, I thought, So, this is crisis intervention? Discussing the fine points of feline personality types? ? Finally, I made my big pitch. “Could I meet some of your pets?” It was the magic password: she opened the door and waved me in.
I wasn’t sure I could make it into the house without a Level 3 gas mask. I looked around quickly, taking in stacks of newspapers at least three feet high. I counted 36 cats, 10 birds, and 6 dogs. So, Wanda was a woman who hoarded animals and newspapers. I’d read about such disorders, but I’d never seen it in my private practice.
Breathing through my mouth, I asked whether I could help her with any services she might need–Meals on Wheels, county health services, help getting in touch with family members. But Wanda continued to stonewall me. “I’m fine,” was her refrain.
By the time I left, I felt I’d failed everyone–the neighbors who’d complained, the city who’d hired me to intervene, and, especially, Wanda herself. I wondered how the unsanitary conditions resulting from her compulsive collecting were affecting her health, and whether she was spending more of her Social Security check on pet food than for her own meals. Was there something more I could have done?
But I beat back that worry with a long-held belief of mine: People choose the lives they have. I’d always been a kind of pull-yourself-up-by-your-bootstraps kind of guy, believing that those who needed help but refused it just needed a few more hard knocks in the “grad school of life” before they were ready to grab hold of their lives. It was their choice.
As I continued to respond to calls over the next few weeks, I had several more “Wanda” experiences. I’d knock on people’s doors, hoping to be of some use, and usually emerge feeling overwhelmed and impotent. My clients’ problems were immense: I was meeting people with paranoid schizophrenia, bipolar disease, severe depression, panic disorder, substance abuse. Most had multiple medical problems; some had histories of violence. A few seemed glad for my company, although almost none wanted my help.
I felt frustrated, baffled. Why were my clients so resistant? I was working very hard, calling on these folks again and again, offering any number of services to help them out. In the process, I was giving my clients plenty of support and positive regard–to no apparent avail.
This was what puzzled me most. While I was no paragon, most of the time I felt I was able to listen attentively to my clients and respond to their grim stories of hardship with real compassion. Responding that way had been the cornerstone of my work for 20 years; I believed it to be the very foundation of therapeutic change. Yet, my new clients weren’t buying it.
I wanted challenge, but I was discovering that I harbored a hidden assumption about challenge–that I’d always be equal to it. Over the years in my therapy practice, I’d acquired a good bit of confidence in my ability to help people. But in that previous life, I’d my desk to hide behind, degrees on the wall to reinforce to me how smart I was, and a secretary to make calls and run interference for me. Even more important, my clients came to see me because they wanted my help. Usually, they were referred by a trusted doctor, friend, or pastor.
In my new life, I was showing up unannounced at people’s doors. I was now the man in the joke that goes, “I’m from the government and I’m here to help.” My new, inner-city clients didn’t know me, hadn’t asked me for assistance, and certainly weren’t impressed with my credentials, training, or publications. All I had to give them was myself. Much of the time, it seemed like a paltry offering.
It was in this state of escalating self-doubt that I got called out to pay a visit to Mr. Ham. It was a sweltering morning in July, the kind of day in Dallas when nobody wants to be without electricity. But according to the police report, Mr. Ham had none. He was also overweight, severely diabetic, and apparently depressed. When I arrived at the crumbling, abandoned house where he lived, he answered the door in raggedy shorts and an undershirt, huffing and sweating. On a small table, I saw crumpled packages of corn chips and some empty Coke bottles.
At first, I was heartened by Mr. Ham’s willingness to accept my help. He agreed to let me make arrangements to get his electricity turned on and a window air conditioner installed. I got him signed up for food stamps, and then for disability benefits. I visited his dilapidated house frequently, often just to chat and find out how he was doing. He admitted that he was lonely, especially since the recent death of his wife. Since then, he’d lived on a pretty steady diet of junk food, even though he had serious diabetes. “I’m not doin’ so good,” he confessed.
I acknowledged what a hard time he was having. Then I suggested that we go together to the county hospital, where he could get help for his diabetes and perhaps for his depression, too. He went pale. “No way!” he yelled. “They’re mean to me there!”
Cut the melodrama, I thought. I’d just about had it with the poor-me, victim mentality that seemed to be the standard response of my city clients. They expected others to treat them poorly, and therefore refused to even try to get help. With all the patience I could muster, I tried to persuade Mr. Ham of the need for treatment, especially for his diabetes. But he was having none of it. When I returned the following week, I saw an open wound on his foot that was oozing pus; I grew nauseated looking at it. “We’re going to the ER,” I told him firmly. “Now.” Mr. Ham sighed and nodded.
When we arrived, a sharp-faced man who was the nurse on duty cursorily examined Mr. Ham’s foot. He looked up, pursing his lips. “Are you diabetic?” he demanded. The question sounded like an accusation. When Mr. Ham nodded, the nurse raised one eyebrow. “What have you had to eat or drink today?” Cringing, Mr. Ham mumbled something about a soft drink. The nurse now looked at him with undisguised contempt. “Don’t you know how toxic that is for you?” he spat out. He shook his head in disgust. “You know what?” he said. “When you behave like that, you just make my job harder.”
I’ll admit that I was naive, but I’d assumed that a nurse in an ER of a public hospital would try to be helpful–or at least minimally polite. After all, the nurses here were treating the most helpless people in the city, those who had no choice but to use the ER. I felt outrage rise in me. Mr. Ham was a good man, and he badly needed help. Where did this nurse get off treating him like some kind of annoying bug?!
Then, with a start, I thought: You’re going down the same road. True, I hadn’t yet sunk to the level of Nurse Ratchet. I tried my best to treat my clients with respect, and I genuinely cared about them. But the truth was, I was quick to judge those who didn’t readily get their acts together. As Mr. Ham and I sat side by side in the ER for the next several hours, awaiting a doctor, I thought about my unspoken attitudes toward my clients–my impatience with their “melodramas,” my conviction that those who refused assistance simply hadn’t yet “chosen” to get well.
I also thought, with a stab of guilt, of how crashingly bored I was. It seemed preposterous that the city was paying me to hang around waiting rooms with people. Where was the action, the chance to make the play that counted? Was this–sprawling in a metal chair reading outdated magazines with a depressed client by my side–what my job was all about?
I soldiered on. One evening, after a long day of frustrating visits, I came home to a ringing phone. It was Dave. “I need you to meet me downtown,” he said briskly. “A man has just been run over and killed in front of the homeless resource center.” When I arrived on the scene, I waded through a mass of police cars, flashing lights, microphones, and cameras until I spotted a small group of disheveled-looking folks talking quietly with one another. I gathered that they were homeless people, perhaps friends of Harry, the man who’d been killed. Perhaps some of them had seen it happen.
I approached them, introduced myself, and asked what they’d seen. A few spoke, haltingly, about the horrific sight of the SUV charging down the street toward Harry. But most people just stood silently, looking haunted. I hung out with them for a while, listening for clues, saying little. But I was hatching an idea.
The following evening I stood in front of about 20 people at the homeless resource center. That morning, I’d gotten Dave’s okay to lead an impromptu meeting for anyone who’d been upset by the violent death the night before. Having conducted countless debriefings in the wake of disasters, I was pretty skilled at engaging traumatized people and helping them process their grief. For a change, I was feeling confident.
“Ladies and gentlemen, thanks for meeting with us,” I began. “This is an opportunity for you to express what you’re thinking and feeling about the tragedy of last night. This isn’t an investigation,” I assured them. “Whatever you say here will be held in complete confidence.” I waited for the expected outpouring of shock and grief.
Instead, an African American man with a missing front tooth stepped out of the crowd. “Why doesn’t the city take better care of us?” he yelled. “It’s the same ole shit from you guys from the city,” sneered another man, whose raggedy cutoffs exposed dark bruises on his legs. There was an angry murmur of assent. I looked out and saw a sea of faces, faces hardened by both weather and animosity.
I was stunned, unprepared. It was a basketball moment, but one in which my team was behind by 20 points in the third quarter, and I had to find some way to pull myself together and get back into the game. All I had was myself, my court sense, and my intuition about what to do next.
“I know that there’s a lot of anger about what happened,” I ventured. “That’s totally understandable.” Twenty faces stared back at me. The silence was icy. “Look,” I said, realizing that this was my last shot. “If you’re pissed off, or scared to death, or anything else, I’d really like to hear about it. Whatever it is, let it rip.”
At this, a middle-aged woman in a tattered Army jacket spoke up. “Name’s Marie,” she said. “I want to know, if this can happen right here in front of the resource center, where are we safe?”
“Yeah! Tell ‘im!” rumbled a voice in the back. I felt shoved off balance. My working assumption had been that homeless people chose to be out on the streets–after all, the city was full of shelters. “Let us sleep at the resource center, where at least there’s people to look out for us,” Marie cried out. “Them shelters are dangerous!” Then a man yelled, “Doesn’t matter what he tell us, you can’t trust the city! They tell you one thing, then they change things up on you.”
For the next 45 minutes, people vented their rage and frustration. I tried my best to absorb it. They told me what it was like to live in a state of constant uncertainty, with no idea where they’d lay their heads at night, or in what kind of weather. Some talked about how they’d landed on the streets of Dallas to begin with–many had been laid off from unskilled jobs, or were mentally ill, disabled, or addicted to drugs and alcohol. Many were terrified of the random violence on the streets. Nearly all expressed their doubt about the city’s commitment to meet their most basic needs for shelter and safety.
I thought once again about my long-held belief that people created their own lives; that everyone had the basic wherewithal to choose well for themselves, and if they didn’t, their difficulties were “their problem.” But listening to the homeless folks that night, I saw a glimmer of another reality, just as I had with Mr. Ham. Perhaps the institutions that were charged with helping people weren’t nearly as responsive, and responsible, as I’d assumed.
The more I thought about it, the more holes I saw in the safety net. It was no secret, for example, that most homeless citizens suffered substance abuse and/or mental illnesses. Yet neither the city nor the state legislature provided enough funding for state-of-the-art treatment and medications. For the few homeless folks who did have decent meds, there were no effective services to help them stay on their regimens. In my own department, we lacked something absolutely critical to delivering good services–a computer database. Here we were, a major U.S. city operating in the 21st century, yet to keep track of clients we still relied on caseworkers’ notes that were stuffed into manila folders that were, in turn, stuffed into file cabinets. How many citizens got lost in that particular shuffle? Could there be legitimate reasons why so many people distrusted the government guy, knocking at their door with offers of “help?”
Getting into the Game
As I start my second year on this job, my entire worldview continues to shift. Overall, I’m still a pretty conservative-leaning guy, but this work has made me deeply question some of my convictions. Until recently, I honestly believed that everybody had the same opportunities that I had, more or less. If you didn’t get what you wanted, then you just didn’t want it badly enough. Now that I’ve met the Wandas and Mr. Hams and Maries of this city, I can see that a middle-class upbringing–mine or anybody else’s–offers huge advantages. To some, this may seem staggeringly obvious, but it wasn’t obvious to me. It isn’t easy to start over with some basic assumptions about life in middle age.
When I tell friends about my work, some of them ask me if I’m ready to return to the calmer waters of private practice. I’ll be honest: I’ve thought about it. But I’m not going to bail out, not anytime soon. A core value I was raised on, and still believe, is that each of us has the capacity make a difference, wherever we happen to find ourselves. What’s shifted, though, is my understanding of how I can best make a contribution.
Imagining that I can swoop down on my own, Indiana Jones-style, to help some of our poorest and sickest citizens turn their lives around is a fantasy I’m slowly laying to rest. Instead, I’m now taking steps–smaller and quieter ones than I’d ever imagined–to nudge our city to become more accountable and trustworthy to its most invisible residents.
The project I’m most passionate about is one I never thought in a thousand years would grab me by the collar: I want to establish a client database for the crisis intervention unit of Dallas. It’s a big, complicated undertaking. Making my case will require a lot of work, a lot of documentation, a lot of patience. But I’m up for it!
While I marshal support for this larger goal, I’m still doing my day job–knocking on strangers’ doors to offer what I can. Occasionally people allow me help them; more often, they don’t. At times, I still fight frustration and impatience. But I view the work a bit differently now. With every personal connection I make, I know I’m panning for gold. For there may come a time when I’ll be able to stand before to the powers-that-be and say: “This is Mr. Ham’s world. This is Marie’s daily reality. This is why we need change.” I can offer more than a row of statistics. I can paint a vivid, and I hope unforgettable, picture of the individuals who struggle for survival in our city.
This is definitely not the rough-and-ready, action hero role I’d initially envisioned for myself in this job. But I’m pumped about it. I find myself waking up at night thinking of ways to alter our city systems to truly support people. What if every homeless person in Dallas could be guaranteed a safe place to sleep at night? To me, that’s a vision worth going for.
In its own strange way, it feels like standing at the free-throw line, with time expired and two shots to win the game. I think of the movie The Replacements, with Gene Hackman as the coach and Keanu Reeves as an unseasoned player. It’s the moment when Hackman says to Reeves, “Winners want the ball.”
I think part of me will always be a 19-year-old kid at the end of a big game, lit up with adrenalin and hungry to make the play. But there’s another guy by his side now, a slower and slightly more humble 50-year-old, who’s trying to better understand a world he once thought he had a lock on. With the game on the line, we both want the ball. Together, we’ll get it done.
Ken Sharp, MS, LPC, LMFT, is the mental health caseworker for the City of Dallas Crisis Intervention Unit. He has a small private practice and teaches at the graduate school of counseling at Dallas Baptist University.