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Another article has been written about one of my clients. These are people who fill me with such love...I am honored to be a part of their lives.
Breaking the Cycle
It's expensive and time-consuming, but a court can help cure the hard-core homeless problem in San Francisco
By Eliza Strickland
Published: August 8, 2007
Steve Winters' single room in the Tenderloin's Ambassador Hotel is a dismal scene. The bare mattress shoved against the wall is a dirty gray, a heap of clothes inhabits one corner, and the bathroom is a little too gross to describe. But Winters brags about his room. "It's got a refrigerator," he says proudly. "I feel like Jeffrey Dahmer with that refrigerator."
Winters suffers from paranoid schizophrenia. Although he's now on medication, he still has the delusions and obsessions that have been his companions since he was an adolescent. Conversations start normally, but veer abruptly off course — suddenly he's reviewing the Zodiac Killer's string of grisly murders, or he's ranting about a racist Georgia politician who was arrested for several church bombings. His illness — and its lack of treatment — has defined his life for most of his 53 years.
For about 20 of those years, Winters lived homeless in San Francisco, a shambling, unmedicated wreck who cycled through the city jail for a succession of petty crimes. The courts had placed on him what is known as a "stay away" order from a street corner in the Inner Sunset where he routinely harassed shopkeepers and their customers.
In one year, he was evaluated by jail psychiatric workers 18 times, and each time he was released back out onto the street instead of being sent to a treatment program. He didn't slip through the cracks — he didn't want to get better, and no one could force him to.
Winters was living a life punctuated by incarceration. He says he has been confined to mental hospitals in North Carolina, Georgia, and Louisiana — and they weren't so bad, he says; they were better than jail. He's known penitentiaries in North Carolina and Georgia, and has become very familiar with the San Francisco jail since he started visiting it in the late 1980s. Toward the end of his drifter days, the locked doors stopped bothering him. "When you're young, jail seems worse than it does when you get older," he says, rocking back and forth.
For those 20 years on the city's streets, Winters was the type of hard-core homeless guy who gave San Francisco politicians heartburn, and made tax-paying citizens feel simultaneously guilty and resentful. He was part of a troubling problem that everyone wishes would go away.
Now, although he still looks like a street-dweller with his long, greasy gray hair and grungy sweatshirts, he's a success story. He gets his shot of medication every two weeks, and lives a stable life under the roof of the Ambassador Hotel. An examination of his case shows exactly what it takes to get one troubled homeless person off the street. It shows that there are solutions to San Francisco's homeless problem — but they're expensive and time-consuming, and it's an open question as to whether citizens are willing to pay the bill.
Winters went through the Behavioral Health Court, a program that takes mentally ill defendants off the path to prison, and hooks them up with mental health care. In the unusual courtroom, the defendants come to court every few weeks to report on their progress, and a judge tries to keep them on the high road through a combination of praise, counseling, and stern warnings. It worked for Winters. Since he "graduated" from the program three years ago, he hasn't been arrested a single time, and he hasn't returned to the mental ward at San Francisco General Hospital.
He got into court because he finally committed a crime that had serious repercussions — he was charged with attempting to derail a train, a felony. Initially he was let out on probation, but when he continued to get arrested, the district attorney's office decided to throw the book at him and send him to state prison. That's when the staff at the Behavioral Health Court found him, and invited him to join the program. Winters was told that if he participated, he would likely avoid his prison term entirely, and his probation could be reduced. That was enough incentive to sign up.
But some advocates for the mentally ill worry about the mental health courts that are popping up all over the nation. The National Mental Health Association published a report in 2004 discussing the possibility that mental health courts are forcing patients to accept treatments — and medications — that they wouldn't accept under other circumstances. The report noted that many of the courts impose "treatment compliance" as a condition of release from jail, and failure to comply can result in sanctions such as incarceration. "The qualified right of a person with mental illness accused of a crime to refuse a particular treatment, including a particular medication, should be protected," the report concluded.
However, Winters' case seems to show that sometimes, a little coercion is just what the doctor ordered. It's hard to get a paranoid person like Winters into treatment, notes his caseworker, Kyong Yi, because he often won't trust people who offer help, and gets nervous when he's told to take pills. "That's what's great about behavioral health court," says Yi. "Using that legal leverage, they could get him in the door where he wouldn't go otherwise."
It was a Thursday afternoon in June, and a pretty typical day at the Behavioral Health Court — which meant that only the newcomers were surprised when one of the defendants took out his trumpet and began to play.
He was a middle-aged man, with his head shaved smooth and his shirt tucked in neatly. He came before the judge holding a small black instrument case. The defense lawyer said later that he had started saving for the trumpet soon after getting released from jail.
Judge Mary Morgan leaned forward from the bench. "So, do we get a treat?" she asked.
"Yes, your honor," replied the man. He brought the trumpet to his lips, and launched into a breathy rendition of "Over the Rainbow." He flubbed a few notes in the first verse, but added trills as he gained confidence. For a few minutes, the dozens of impatient defendants waiting their turns stopped talking and fidgeting in the wooden folding chairs. The judge, a kindly woman with curly gray hair and glasses, watched with a smile. The song seemed an apt choice for a roomful of people looking for a place where they won't get into any trouble.
Standing beside the defendant was Jennifer Johnson, a dynamic and overworked public defender who keeps her 100-plus mentally ill clients in line. The cases she handles at the Behavioral Health Court run the gamut. "Low-level theft, some assault or family violence, drug cases — we have a smattering of everything," she says. "People who are symptomatic get involved in all sorts of situations that get them in trouble." Most of her clients are charged with felonies, and would face state prison if they dropped out of the program. Because of objections from the district attorney, the court doesn't take defendants charged with extremely violent crimes — "no rape or murder or mayhem," as one staff member put it.
Johnson doesn't use words like "coerce" or "leverage," because she's well aware that advocacy groups are concerned that patients' rights are diminished in these courts. But watching the court in action, there's no other way to put it: The court, which has been operating for five years, takes the people who are most in need of mental health care, and uses the threat of jail time to get them into treatment. While participation in the court is entirely voluntary, most defendants agree to sign up when they're told that it means the charges against them will be dismissed or reduced. To stay in court, each defendant has to comply with the treatment plan his caseworker draws up, which often includes medication. That's what got Winters to start taking the antipsychotic medication he'd been avoiding for decades.
Once a defendant has agreed to take part in the court, it's largely up to the case manager to keep him coming back. Steve Winters remembers his first case manager fondly, and cracks into a broad grin when he's mentioned. "He was a slave driver, he was!" he says happily. The success of each troubled client is largely dependent on whether or not they trust their case manager, and believe him when he says that a better life is possible. Winters' first case manager helped him get a subsidized room in the Ambassador Hotel, and went with him to buy a TV.
The final element at the Behavioral Health Court is Judge Morgan, who sets a tone of maternal authority — she is firm but benevolent, and unfailingly courteous. She praises a man who has faithfully attended his Alcoholics Anonymous meetings and calls for a round of applause, and she tells a defendant who is feeling blue that he is a "valuable person." When an ashamed woman talks about a recent drug relapse, Morgan doesn't yell at her, much less send her back to jail. Instead, she gives her encouragement: "Everybody can fall down," the judge says, "it's only a few people who can pick themselves back up."
After a court session earlier in the year, Morgan explained to visitors why she thought the court worked for deeply troubled people who had resisted treatment for years or decades. "When they come to this court, they're held accountable for what they've been doing by people who really want to see them succeed," Morgan said. "Most of these folks, they're used to being kicked around. When they come in here and everybody applauds, it may be the first time in their life they've gotten that kind of approval."
Everyone hopes that the Behavioral Health Court will save the city money over the long run, but it's not a simple equation. When people agree to be in the program, they're held in jail for weeks or months while they wait for a bed to open up in a treatment program. There's also the expense of the intensive case management, provided by a San Francisco General Hospital outpatient program, which keeps defendants stable over the following years.
A new study by researchers from UCSF's Langley Porter Psychiatric Hospital took the first step in proving the court's efficacy. Researchers compared participants in the Behavioral Health Court with other mentally ill adults who had been booked in jail around the same time. When they compared recidivism rates, they found that 18 months after leaving the court, graduates were 40 percent less likely to have been charged with a new offense, and 54 percent less likely to have been charged with a violent crime.
Jo Robinson, director of Jail Psychiatric Services, sums up the argument for the court: "It's labor-intensive, and expensive — but it's what works." Some Sacramento legislators have caught on; earlier this year state Sen. Darrell Steinberg introduced a bill to encourage the creation of mental health courts throughout the state.
However, when dealing with such troubled clients, smooth and steady recoveries are rare. Less than 15 minutes after the trumpet serenade on that June afternoon, the emotional atmosphere of the court took a dip. A tiny, angular woman in a long tan coat came to stand before the judge with a Spanish interpreter by her side. She was jumpy and agitated. "I don't know if I'm well or not," the woman said right away. "My body is going crazy."
"Did you take all your medicine this afternoon?" asked the judge in her measured tone.
"I've taken all my medicine, but my body is dislocated," the woman said through the puzzled interpreter. "My nose is in my head, and my ears are in my mouth."
The room quieted again. The judge calmly asked the woman's caseworker to approach the bench, but the woman was already frustrated. She wheeled around and strode out of the room, making angry, dismissive noises through her teeth. A uniformed deputy and the woman's case manager walked swiftly after her. It was a reminder of how close many defendants still are to the edge.
Court carried on, but a few minutes later the case manager was back with the woman. Judge Morgan gave the woman some sympathy — "I know it must be very upsetting when it feels like your body is disorganized or out of place," she said, and gave the woman her instructions.
"If you don't go see your psychiatrist tomorrow, it's going to be very hard for you to stay in Behavioral Health Court," said Morgan.
"What happens if I don't?" said the woman.
"Back to criminal court," said Morgan grimly.
Winters' story begins in Winston-Salem, N.C., where he was raised by a hard-drinking stepfather and a hardworking mother, he says.
He often tells the story of what happened to his useless right eye, which has a milky white film covering the blue iris. When he was 10 years old, he got shot in the eye with a BB gun, he says. "That BB didn't feel too good, but it didn't blind me," Winters says. The damage was done by the handkerchief soaked in rubbing alcohol that his stepfather told him to press against the injured eye.
"It was that rubbing alcohol," Winters says. "I said, 'It's burning, it's burning!' Daddy said, 'Keep it on a little longer! We're going to sue them!'" Winters says the family did sue, and got $11,000 in a settlement. "My stepdaddy, he got about $3,500 of that money for his expenses," he says.
Winters quit school in the ninth grade, and got a job at McDonald's, where he worked for almost three years. Winters thought about learning a vocational trade like brick-making, "but it just didn't work out as well as I hoped," he says. Instead, he starting getting into trouble with the law in North Carolina, most significantly when youthful urges caused him to break into a boarding house, intending to visit two girls who were staying there. He says he didn't get very far; still, the cops called it burglary with intent to rape and he ended up in the state penitentiary for a couple of years.
It's impossible to get Winters to give a linear account of his life — he doesn't think that way — but the stories he tells can be pieced together into a loose narrative. He lived in Atlanta when he was a young man, living in cheap hotels and working as a dishwasher or as a temporary laborer. He went to live in New Orleans, but got hauled back to North Carolina by a probation officer. He wound up in a mental hospital in North Carolina for a spell, and again in Atlanta when a diversion program sent him to the mental hospital instead of the state penitentiary.
He tried living in New York City for a few months, he says, but it was too hard.
"It's hard to make a buck in N.Y.C.," he says. "Hustling gays — that's a demoralizing job. It's hard to turn a trick in N.Y. I guess you have to look like Richard Gere." Winters says he isn't gay, but that never mattered when he needed a bit of quick cash.
His next move was a better fit, he says. Back in the temporary labor pool in Atlanta, he met a man called Hippie Bill, from San Francisco. "He said the best thing I could do was live in San Francisco," Winters says. "He said the police are more liberal." So more than 20 years ago, Winters and two friends piled into a cheap car and drove west.
He does remember what happened on his second day in the city, when he picked up a trick in Civic Center Plaza. "He said, 'Ever do any fist-fucking?'" Winters remembers. "I said, 'I don't think I can do that.' He said he'd give me $25. Then, when he finished, he couldn't find his wallet!"
That was Winters' welcome to his new home, where he'd stay for the next 20 years. He got his monthly Social Security check delivered to the post office — Winters is considered both mentally and physically disabled, on account of his bad eye and a bad leg from getting hit by a car in Atlanta. He became the typical San Francisco street guy, occasionally getting a room in the Tenderloin for a few days, but mostly sleeping in Golden Gate Park or at shelters, he says. "Lot of times I'd blow my money on girls and weed," he says.
The police incident reports tell Winters' tale from there on, with a steady drumbeat of arrests. (Police records from before 1990 were purged, so Winters' rap sheet runs from 1990 to 2003.) Some of the crimes were as petty as it gets — like a 1991 arrest for breaking into an Alcoholics Anonymous meeting hall and stealing $5. Others have an edge of violence to them, like another arrest that same year for lighting matches in a Tenderloin building and dropping them on the floor.
By 1996, he had adopted the Inner Sunset as his neighborhood, and hung out at Ninth Avenue and Irving Street to sell copies of Street Sheet, the newspapers printed by the Coalition on Homelessness. Over the next eight years, he proceeded to thoroughly wear out his welcome. Police reports show that he harassed passersby, and for a while in 1999 he made a habit of slapping people in the back of the head (he was arrested for battery). By 2001, merchants were complaining that someone was routinely tipping over trash cans on the sidewalk; when the police staked out the corner, they saw Winters methodically roll each can to the doorway of a store before dumping it.
Winters was arrested for public nuisance in that instance, but was out of jail again probably within 12 hours. The trouble continued — store owners came to work to find their windows coated in cooking oil, and neighbors complained of public defecation and Winters' "erratic behavior and threatening manner." A judge issued the stay-away order to keep Winters from troubling the merchants at Ninth and Irving, but in March 2003, he was arrested at that corner on two subsequent days.
Winters downplays the constant trouble he was in, either out of embarrassment or because he sincerely doesn't remember; his case worker notes that he has very little insight into his mental illness and its effects. "I guess I wasn't the best neighbor in the Sunset; they had their problems with me," says Winters. "I guess they got tired of a bum, basically."
So what happened to Winters after each of those arrests? According to Jo Robinson, the director of Jail Psychiatric Services, he likely received a psychiatric evaluation almost every time he was brought in. Certainly in the last few years of Winters' time as a vagrant, the jail psychiatrists got very familiar with him. According to Winters' case manager, he was evaluated in jail 18 times between April 2002 and March 2003.
But Winters' petty crimes kept him in jail for a couple of days at most. And, like many others who cycle endlessly through the Hall of Justice, he appeared to prefer an unmedicated life on the street to anything the psychiatrists were offering. "We try to get them into services, but a lot of them don't want services," says Robinson. "We'll talk to them each time we see them. We'll ask them, "How about this time? Are you ready?'"
Robinson says that 11 percent of the jail population has a serious mental illness like schizophrenia or bipolar disorder, and almost 25 percent of the population is on some psychotropic medication (which includes commonly prescribed drugs like antidepressants). According to a spokeswoman for the sheriff's department, the San Francisco jail is the biggest provider of mental health services in the city.
The three psychiatric units are as therapeutic as the staff can make them. The inmates can hang out in "socialization areas" during the day, playing checkers or chess at picnic tables. They can attend individual and group therapy sessions, or try art therapy or yoga. They even have periodic celebrations for the inmates — a party in June featured puppet shows and karaoke.
While Robinson makes the inmates sound like kids at a day camp, she says the image that the outside world has of her clients is quite different. "I still think there's a stigma attached to mentally ill people who come through the jail," says Robinson. She believes they're no different than mentally ill people who come to treatment through the hospital, or through private doctors. "They're the same people — it just depends on what door they come in," she says. "There's this idea that they're all horribly violent. But it's due to their mental illness that they've committed some crime."
The crime that eventually got Winters into court and into treatment was most likely the result of a paranoid fantasy, but Winters doesn't remember what it was. "They said I tried to wreck the Muni train, but they were exaggerating a little bit," Winters says. "I guess I threw a steel rod pretty much right in front of it. I don't know why I did that," he says, with a genuinely puzzled air.
According to the incident report, on April 18, 2000, Winters wedged a metal pole in the Muni tracks at 14th Avenue and Judah Street. A Muni worker saw the pole and pulled it out before a train came, but as soon as he put it down, Winters snatched it up and put it back on the tracks. The Muni worker had to take the pole out again and guard it until the police came, as Winters kept making grabs for it.
Winters says he waited in jail a long time, and was told that he might get a sentence of up to 25 years for the felony charge of train wrecking. Instead, he got five years of probation, according to Johnson, the public defender. But he went straight back to his usual corner of Ninth and Irving, where his petty crimes began to be counted as probation violations.
By March 2003 those violations had added up and Winters was being held in custody — but that's when the Behavioral Health Court intervened. The program was new, and Winters was one of the first people to sign up. "Without Behavioral Health Court, Steven would have wound up in state prison," says Johnson. The state prisons are already crowded with mentally ill prisoners, and last year a federal judge found that the state violated the constitutional rights of these prisoners by providing inadequate care.
Instead, Winters made it through the program in about a year, and his probation was terminated early when he "graduated." Three years after that graduation, Winters still goes to see his current case manager, Kyong Yi, every Wednesday. They meet at Yi's office, and walk together to Winters' room at the Ambassador Hotel, where she assigns him cleaning tasks. Sometimes she goes shopping with him for necessities like garbage bags and cleaning supplies. "My job is to support him in building a life for himself that he enjoys," Yi says. There is no loftier goal than complete autonomy: "I can't imagine Steve not being a client here," Yi says. "I think the transition for him would be disastrous."
Winters lives off his "government check," as he calls it. Until he got his room at the Ambassador Hotel, the check was $900 a month; it went down to $770 a month because he now has cooking facilities in his building — namely, a communal microwave. Winters doesn't complain, though, and seems proud that he can make his own meals. "I use that microwave to warm my hot dogs up every night," he says. "I been living on hot dogs entirely, about four, five, six hot dogs a day — $1.29 a pack, eight in a pack."
Yi has Winters' rent payment deducted automatically from his check so that he won't forget to pay it. From what's left over, he gets $42 each Monday and Friday, a lot of which he spends on good weed from the medical marijuana clubs, bought secondhand. He gets an extra $10 when he takes his biweekly shot of medicine — an important inducement, because Winters doesn't like medicine. "Risperdal — they started me on that stuff at jail, but I was spitting out those pills," he says. Yi says the switch to a supervised shot contributed greatly to Winters' stability, though he won't admit it. "I don't know what the Risperdal's for," he says, "they just figure I need it. Nerves, I guess."
At Yi's office, Winters gets to call home to his 74-year-old mother in North Carolina. "My momma tells me, take your medicine, Stevie, be good!" he says. And he is being good. Last Halloween, he showed the Tenderloin that he has civic spirit. "I got one of those $5.99 bags of M&Ms, gave 'em to the trick-or-treaters going down Eddy Street." After 20 years as a San Francisco outsider, he's not just a law-abiding citizen, he's a good neighbor.
3/23/07
Yesterday my client killed himslef by leaping out of his window. I don't have the specifics, but over the past two years he has confided in me about his substance use, his sexuality, and his fear of AIDS. Suicidal ideation never came up in our discussions. I feel that this death was not premeditated suicide, rather drug induced in some way. In addition, in the past few weeks he showed severe deterioration.
My heart goes out to those people who witnessed the fall, who discovered the mangeld body on the sidewalk. Suffering has ended for this person, but the cruel image will remain in the minds of those people who found him dead.
I've held the suicide issue close for most of my life, and I advocate not only for suicide prevention, but also for more discourse surrounding suicidal thoughts and feelings. Normalizing suicidal thoughts, I believe, will allow a freedom of discussion currently veiled in shame, fear, and guilt.
I have struggled with suicidal issues for years now. There are so many levels to it, it's one of the most difficult realms of human suffering to describe. What is so counterintuitive is that it is not always about overwhelming problems...theres a love in it, or maybe a joy.
I advocate for suicide prevention in the ways suicide is often used as an escape from seemingly insurmountable problems. Coping strategies, cognitive-behavioral training, and even medication can be solutions.
Sometimes, though, it goes deeper. What happens when you realize that you no longer want to kill yourself only because you are on meds? Or you don't want to kill yourself only because you go through cognitive readjustment?
By changing thoughts, you can change emotions, and by changing emotion, your outlook on life can change. This brings up the transience of life, that everything we think is real can be changed by meds, meditation, therapy, etc.
Thats the point I'm at...trying to find something that is real, unchangable. What does opinion matter if your emotions can be changed?
If you walk through a maze cluttered with suffering humans, you may see people emaciated from hunger, people suffering direst poverty, as well as tears, blood, or protruding ribs. If you keep walking, though, strolling upon a room with a playground may surpise you. A smiling little girl kicking her legs as she swings back and forth may suffer just as much as the people conveying those hellish images.
What qualifies suffering? Is empirically explaining suffering possible, or can the explanation only exist subjectively for the sufferer? Somewhere in that maze, a row of doors must exist, symbolizing the order underneath the suffering; maybe each door is labeled "thought," "emotion," and "experience."
In my work, I have seen suffering redrawing the boundaries of kin networks. Suffering often draws people together,and sometimes it estranges people from their community depending on the sufferer's experience. Disease, for example, often draws people together. Not always though; diease may estrange people from their community.
Illness and disease often bring people together, but sometimes the shame of the illness may make someone shirk from participating in their personal network.
One case, as an example of illness bringing people together, involves someone suffering with breast cancer, who, on hearing the news, made an attempt to establish a bond with her estranged sister. Her sister offered emotional support and now they speak of one another fondly with sincerity. Previous frustrations and conflict between the sisters are ignored, but not forgotten.
Conversely, a man diagnosed with HIV refused to admit this to his network , becoming more withdrawn and introverted.
Different responses to diagnosis of disease may say something about the individual, or maybe the response resulted from the social framework of the two diseases. I wonder if social acceptance of breast cancer outweighs that of HIV. Personally, it makes sense to me that acceptance of breast cancer is greater than that of HIV.
I'm sure there are a thousand or more facets of explanation encompassing response to disease, but it's interesting to see how social ties can be strengthened or weakened depending on the disease, its perception, and its social framework.
A homeless beauty and the beast, heroin
A slave to her addiction, young woman squanders her family and her potential
Kevin Fagan, Chronicle Staff Writer
Saturday, March 25, 2006
Rhonda Bye had a lot going for her -- brains, beauty, feisty strength.
Heroin and crack crushed it all.
The narcotics ruined her looks and attention span, snuffing out her potential both as a young clothing model for Nordstrom and as a computer whiz who could fix office network problems. Three years ago, a slave to her heroin addiction, Bye landed on San Francisco's streets as a homeless panhandler.
Still, she refused to give up, fighting her way through a frustrating maze of city social services to get into housing and drug rehabilitation. She shook off her addiction, and in the last couple months she had been talking about retraining to work with computers again.
But it was too late. Drug abuse and the ravages of street life had damaged her kidneys so badly that, in mid-February, doctors told her she would need dialysis for the rest of her life.
She missed her treatments three times in a row and went into a coma three weeks ago.
On Wednesday, she died. She was 39.
Bye leaves behind two sons and a daughter -- and a lifetime that her family hopes will be an example, in the harshest way possible, of how drugs and homelessness can destroy a person.
"She is an Exhibit A on what heroin and crack does to someone who is unbelievably beautiful, has the sweetest personality in the world, and is even smart," said Bye's brother, Robert Davis of Everett, Wash. "She could have done so much in life, so much. But drugs. ... It was drugs."
Bye lies in the San Francisco General Hospital morgue, the destination of all such indigents who die alone in the city from the ravages of drug abuse. But members of her family, many of whom haven't seen her in years, aren't focusing on that image. They choose to remember her in the days before everything went bad.
"She had such a great smile, back when she had teeth, and such a cute giggle," said her mother-in-law, Kay Vestre of Kent, Wash., who is raising Bye's three children and is a manager for the local child protective services office. "Back before she did drugs, they hired her at my workplace to work on the computer system, and oh, my, was she good. She became a trainer for other technicians."
But that -- like most of the promising things in Bye's life -- was before heroin seized her.
Bye was raised in Washington state, by a single mother who struggled on welfare or low-paying jobs for much of her childhood, her brother said, "but she always had the strength and brains to try to make something of herself."
Throughout middle school, she attended Bellevue Modeling Academy and walked the runway showing off clothes for Nordstrom. She pulled A's and B's in school, he said, "and by high school she was probably the most popular, cutest girl in class."
Then she met David Bye, whom as recently as this winter she called "the love of my life and the most interesting guy I ever met." By 17, she had dropped out of high school, and they were married, their first child on the way.
"The two of them just started doing cocaine a bit, and very slowly over the next bunch of years they lost what they had," Davis said. Jobs came and went, but about six years ago heroin had gripped them both, and they wound up on and off the streets. Vestre got custody of their three children -- and three years ago, things exploded out of control.
David Bye shot a man to death in Seattle in a fight over insurance money, and the couple fled toward Mexico. San Francisco police found them huddled in an alleyway, arrested David Bye and extradited him to Washington. His wife was left on the street -- and there she stayed.
Over the next year, she became a fixture at the Duboce Street off-ramp from Highway 101, the smiling, gentle woman with the ever-ready sign pleading for "just a little help." With her husband out of the picture for the first time since she was 17 -- he was convicted last year of second-degree murder and is serving 32 years in prison -- she was truly on her own for the first time in her life.
"This is not how I wanted to end up," she said one rainy day in 2004 as she begged in traffic. "I want to set a better example for my kids. All I need is a little more of a chance."
That chance came that year, when city Human Services Director Trent Rhorer struck up a conversation with her as she visited with a Chronicle reporter and photographer. He summoned an outreach worker, who signed her up for housing and rehab appointments.
It proved to be the one spark she needed. Bye followed up her many appointments diligently, and nearly three months later, she had a room in the Elm residential hotel and was firmly on methadone treatment to kick heroin.
"Rhonda struck me as someone who genuinely recognized her plight and really wanted to live a better life," Rhorer said. "She was no dummy. But sometimes the toll of drugs is just too much, and it catches up with you.
"What this tells me is that we have to work even harder to get the chronically homeless inside before this kind of damage sets in so deeply."
Her family hoped that she would learn so much from her street ordeals that she could become a counselor someday. Bye herself held that ambition.
"I know how the whole thing works now," she said one day last month in her hotel room, going over brochures of computer training classes. "Man, I could actually help people avoid the crap I've had to live through. Wouldn't that just be great?"
In addition to her husband, brother and mother-in-law, Bye is survived by two sons, David Bye Jr. and Chad Bye, and one daughter, Crystal Bye, all of Kent, Wash.; three other brothers, Billy Davis of San Diego and Sol and Cyrus Davis, both of Washington state; mother and stepfather, Phyllis and Ben Jones of Colorado; and her father, Bill Davis of Washington state.
Bye's family intends to have her cremated and her ashes flown to Washington state to her children.
February 07
This was such a heart-wrenching experience, to have my client brutally murdered. Jill had several write-ups in the chronicle this year about her murder. The poor thing...even after the police were informed of the person who robbed her, she was still dragged off and burned alive by her assailant later that same day.
It seems obvious that someone may shirk from their community if they are involved in some way with a murder. What may not be so obvious is the claim of ownership by the network of friends, family, or service providers on the person who was murdered.
Kubler-Ross writes that much of grief is selfish. When one mourns, many times it is a sadness for the loss of the surviver's relationship with the dead. With tragic death, the shock seems to cause a community to become evern more entwined and self-affected. People often bring up the tragedy as if it happened to them, more so than the loss of kin to disease or natural causes.
Homeless woman's horrible death
She was doused with gas and set on fire after she told police who had robbed her -- 2 women held
Jaxon Van Derbeken, Heather Knight, Chronicle Staff Writers
Thursday, February 15, 2007
In a crime prosecutors say showed "exceptional depravity," two San Francisco women stand accused of dousing a longtime homeless woman with gasoline and burning her alive in an apparent witness retaliation slaying.
Mia Sagote, 30, and Leslie Siliga, 29, are believed to have selected the victim, Leslie "Jill" May, 49, after May told police on the day of her death that she had been robbed by Sagote on the street in the Tenderloin the day before.
"The victim was kidnapped off the street and taken to Candlestick Park, doused with gasoline and set on fire," said Assistant District Attorney George Butterworth. He said the crime was especially heinous and showed "exceptional depravity."
Authorities say May was first accosted in the Tenderloin the morning of Jan. 11 by Sagote, who was angry that May's boyfriend owed her $150 on a loan. When May said she had no money, Sagote allegedly slammed May to a wall, then threw her to the ground and punched her face, police said.
Later that morning, Sagote pulled May behind a trash container and stripped the victim of her clothing and cash, leaving her naked behind a garbage bin, authorities say. The incident was witnessed, according to police.
May went to authorities the next day and reported the crime. Authorities believe that at least one of the women involved had learned, apparently by word on the street, of May's police report naming Sagote. That afternoon, May was back in the Tenderloin when she was approached by two women, forced into the backseat of a car, and driven to the stadium parking lot at Candlestick Point and set on fire, authorities said.
Sagote, who was arrested on Jan. 23, is charged separately in the robbery of May on Jan. 11. Siliga was arrested Tuesday and appeared in court Wednesday and pleaded not guilty. Both women are charged with murder and murder in commission of a kidnapping, which could lead to life in prison without parole.
Both remain in custody and are scheduled to return to court on Feb. 22.
May had been a longtime homeless woman and crack addict who stayed in the Tenderloin. She was one of the hardcore homeless who had been identified for outreach help under Mayor Gavin Newsom's effort to move the chronically homeless off the street and into housing and social service programs.
May told her story to The Chronicle in 2004. She said her mother was a drunk, and when May was 12, she found her mother dead on the kitchen floor from alcohol poisoning.
The girl was then raised in Pocatello, Idaho, by her father, but she ran away, she said, after he raped and impregnated her at age 16.
After a miscarriage, she became a prostitute and came to the Bay Area in 1976. She and Ricky Smith -- a onetime pimp known as "Slick Rick" who had 24 prostitutes working for him -- shared a life on and off the streets. They had three children together.
Back then, May was a stunner dubbed "Legs" who attracted business from men of all professions and income levels, according to people who knew her.
"She had legs like Tina Turner, you know?" Smith said on a recent afternoon.
"Jill was a classy hooker," agreed her longtime friend Anne Griffin. "She had that personality. She had that look. She was the glamorous girl -- she looked like she stepped out of a magazine."
In the 1990s, May and Smith struggled with parenthood and keeping a roof over their heads, eventually turning over their children to Smith's brother to raise.
The couple repeatedly had been arrested for drugs and prostitution but never entered into court-ordered rehabilitation programs. They ended up living on two blocks of the Tenderloin on Jones Street, between Geary and Ellis streets.
Addicted to heroin and crack, May lost her teeth and so much weight she was practically skin and bones. Her once-famous legs grew infected from dirty syringes, and she couldn't walk anymore so much as shuffle.
In 2004, May told a Chronicle reporter, "Just one day before I die, I'm going to see the Statue of Liberty. I'm going to get on a Greyhound bus, see the country. Go to school, get a job. I want to do normal things."
Last fall, with the assistance of the city, the couple finally got permanent housing, but May still spent her days out on Jones Street using drugs. The city outreach team leader said May was singled out for efforts on a regular basis.
"It's horrible. It's a tragedy," said Fire Department paramedic Capt. Niels Tangherlini, who heads a city outreach team working with San Francisco's hard-core homeless population. "It's really sad -- we feel like we invested our heart and soul in her situation. We felt her situation was finally improving. Then the street can reach and grab some people.
"It was wrong -- for all she had been through, it felt very wrong," Tangherlini said.
Friends recently held a memorial for May, remembering her as someone who cared about her fellow downtrodden of the Tenderloin.
"Oh man, I miss Jill," Smith said. "She used to get on my nerves. I loved her, though. Jill had a one-track mind. She never had enough drugs. I worried about her all the time. Now I can rest, man."
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How to help
City outreach workers who tried to get Leslie "Jill" May into housing have set up a fund to help pay for her burial. For information, e-mail Ben Amyes at benjamin.amyes@sfgov.org.
E-mail Jaxon Van Derbeken at jvanderbeken@sfchronicle.com.
This article appeared on page A - 1 of the San Francisco Chronicle
Perception of the homeless results from a structure of the human mind to classify the world into binary opposites. When people hear the word ‘homeless,” connotations of disabled, surly, dirty undesirables come to mind. The media sensationalizes the homeless image by reporting psychiatric statistics, ignoring contrary statistics describing the vast majority of homeless who do not suffer from mental disability, consisting of people affected by economic recession and cuts in federal programs. The perpetuation of the negative image of the homeless leads to a reifying of the homeless, as we place them into a group of people characterized as “them” as opposed to “us.” In a public opinion Internet survey, the homeless were characterized negatively, or received attributes that prove the us-them phenomenon. These perceptions, magnified by media and government, place the homeless at risk for violence, as we see in the popularity of a series of videos ("Bumfights"), which records assaults of homeless people for public entertainment.
The results from the Internet poll and the ideas written by newsmagazines give credence to the view of the “homeless” as outsiders to the society. Nobody mentions that thousands of people suffering homelessness look the same, act the same, and experience the same issues as those who do not suffer any mental disability or are not considered undesirable. In my work, many clients have experienced homelessness not because of disability, rather of the inability to get a job. Many of them, as minorities, have grown up in poverty, without access to a proper education, living in a neighborhood in which the foremost responsibility is simply survival. Without education, they do not attract employers, and sometimes become depressed and hopeless, inhibiting their faith in pursuing jobs and creating a vicious cycle.
My mother, as another example, raised four children as a single mother. Her first husband put a shotgun to her head, leaving her with a bullet in her brain and a a seizure disorder. She had two more children with my father, who abused drugs heavily and ended up in prison as she raised her children. Without education, she worked in fast food trying to pay rent and support her children, but she would lose her job after a seizure. She was not considered disabled enough to receive federal assistance because she could work temporarily. Living check-to-check on her minimal salary, we often could not afford high rents, and we often found ourselves sleeping in shelters, churches, or on the street. MOst of the food we got was from dumpster diving behind "Ralphs."
In order to make sense of tragedy, in order for us to maintain some structure in our own lives, we create a subconscious classification system that orders people into groups, into a binary-opposites system. Too difficult to comprehend that a tragedy like homelessness could happen to ourselves, we cognitively place those suffering homelessness into a different arena - an arena that entails mental disability, lack of insight, and poor decisions. Because of this placement, we feel free to delight in images of their suffering through websites like "Bumfights."
Many people place a biological restriction on their concept of family, so restrictive that staple participants active in a person’s life may not be accepted as family. This biologizing ignores the relationships developed by many people with the invisible influences in their life. Notions of kin encompass deceased relatives, but the deployment of the term does not take into account active relationships with the deceased, or relationships with non-living, non-human entities. One's spirit guides should be accepted as family because of the blood relationship as well as the reciprocal obligations of exchange that takes place. There are meanings tied to blood that , expands the notion of family from a biological unit to a greater social construct. Blood is a vehicle through which social relations depend, such as the shedding of blood during initiation ceremonies or the transfer of blood from parent to child. The use of blood is often central to developing a relationship with the invisible. Blood is used in ritual as a vehicle through which possession occurs or alms are offered. Just as blood is used to explain the notion of family with the living, I concede the same principles apply to the notion of kin with the invisible.
The realm of the invisible manifests itself as family by principles of reciprocity, also. Just as kin has reciprocating obligation, a person must offer some sacrifice to the invisible to have a request granted. The type of sacrifice ranges; animal, food, money, or time. This gift increases the strength of the entity, and the repayment relates directly to the sacrifice offered. . Other similarities include time differences in exchange (exchange is not always simultaneous) and market value does not determine the value of the goods exchanged, rather the stakes of the sacrifice determine the power of the outcome.
This system of exchange also directly influences a person’s other relationships, when, for example, a person may make a commitment of sexual loyalty to an entity for at least one night a week.
It is important to convey the importance and the emotion of these relationships. I continue to discover how the invisible manifests itself, the principles of reciprocity, the systems required to fulfill the relationship and its development, and also the difficulty in acceptance of having the relationship.
Practice derives from theory, and current practices within the realm of healthcare rest on the foundations laid over a century ago. Within this history, racism has influenced healthcare practice sometimes overtly, sometimes translucently, but always embedded deeply into the very structures that define our communities and our society. Not always blatant and sometimes requiring a detached view of oneself and of reality in order to see it, racism has the power to define decision, to cost lives, and to skew equality. This essay provides several examples from very different historical periods to describe how racism informs healthcare. The first example describes the way in which eugenics and the development of biomedicine converged at the Pan-Pacific International Exposition in the early 20th century. The second example is the infamous Tuskegee experiment, a 40-year long research project beginning in 1932, recording the devastating effects of syphilis on the black body, and examples from my work will be included as well, such as the varying treatment by the community for people of different skin tones.
The definition of healthcare, as used in this essay, exists outside of the hospital, in the scope of a multidisciplinary collaboration of several fields. In this essay, healthcare encompasses meeting the basic needs of people as well as meeting needs of biological, body health. The tasks of providing housing, food, clothing, medication, and the general care of an under-served population falls under the auspice of healthcare. Healthcare includes work inside of the hospitals, but also involves community care for those who cannot provide for themselves. It involves outpatient services for those who are mentally stable, as well as services for those who are not.
Examples used here result from working with diverse communities in the healthcare field for five years, from providing counseling and treatment services for people being tested or treated for HIV, to providing sex education to those exchanging needles within the needle exchange program, to providing services to mentally ill offenders. Currently, my work is with mentally ill offenders, who, as a result of a serious psychiatric disability, have found themselves locked and confined within the criminal justice system. These people run the gamut of age, race, background, and class (prior to the onset of their disability). My specific job entails meeting someone after their release from jail or prison. While they were confined, they would have been set up with the psychiatric services offered within the jail, and I am provided with their diagnosis, what medications have worked and what have not, their offense, and other pertinent details. At this point, they are homeless, without money, and usually undermedicated.
My team immediately follows up with their income source, usually Social Security Disability to get their income flowing. We get them set up in a residential hotel or board and care and identify what they may require to get themselves back to a functional, safe place in the community. Their backgrounds are not uniform, and the clients we serve do not all fit within the expectations and assumptions of the public. A large number of them had successful lives before the onset of their disability. Among them are former models (that some of the public would recognize seeing in former magazines), stars of various films, wealthy business owners, and people with Ph.D. credentials. Some are white, some black, some Asian, some Latin, some Native-American, some older, some younger, but they all suffer a severe disability that has caused their lives to result to poverty, homelessness, drug abuse, and an inability to care for themselves. All of them, after experiencing their first psychotic episode, lost their families, homes, jobs, and won’t be able to take full control of their lives again.
If I asked a group of people to come up with a visual image of a homeless, mentally disabled person (which I have done in the past for articles regarding the reification of the homeless), the answers would differ to a degree, but more or less the consensus would be that of an dirty male, 30s-40s, with a substance abuse issue. Not surprisingly, I have found that the image of the homeless person differs in San Francisco more than in cities with a smaller homeless population, since SF has had an incredibly high rate of visible homeless (the homeless sleeping out on the streets).
The point is that there is an objectification and reification that occurs between the classes, between religions, between the sexes, between the races, etc, in which assumptions and judgments are made, based on seriously lacking evidence that is void of substance or reason. These assumptions, I would argue, aren’t taken from the air, they are not thought up as independent thoughts isolated within a vacuum of subjective experience, rather, assumptions are informed by experience, informed by pedagogy, informed by the structural factors that may be invisibly doctoring our relationships with others. This is where diversity meets its dark follower, racism.
Trauma has been afflicted upon unknowing and knowing people, trauma that may have been lurking underneath the surface, or trauma that was acute, raw, that many were aware of at that time. Martin-Baro, when he was alive, speaks of violence and its influence on three entities: the perpetrator of the violence, the person afflicted by the violence, and the witnesses to the violence. Granted, his discussion primarily involved violence in the context of war (Baro, 151-167), but the same dissonance appears within our society, masked by structural factors. One example is government funding for education channeled into institutions of the wealthy, like public school in affluent neighborhoods. Another example of this structural violence involves prescribed racism, as we see have seen in the discordant allocation of powerful positions occupied by the white elite.
The Pan-Pacific International Exposition (PPIE)
At the turn of the century, social anxieties were born from the Spanish American war, immigration, urbanization, technology, suffrage, and technological innovation devastating human lives. In the midst of this upheaval, in the midst of brutal European warfare, the U.S. was victoriously celebrating the opening of the Panama Canal by unfolding the Pan-Pacific International Exposition in San Francisco. The world’s fair brought heterogeneous experts of many fields together to share and display their work – in fact, over 19 million people passed through the doors of the PPIE. (Stern, 28).
What occurred was a blending of ideas and hypotheses, forming new theories, which has informed healthcare since that time. In this particular historical moment, a transition was occurring from Lamarckian ideas of inheritance of acquired traits and environmental factors of disease causation ( some of the founding ideas for eugenicists) to a more biologized and less malleable view of disease, involving infections resulting from microbes. Not too say it was such a simple equation as that or to say that the world’s healthcare system resulted from this single event in history, but there is evidence that the two fields merged at the PPIE, as exemplified by the racialized visual displays at the PPIE and the ongoing work performed by the attending experts. In addition, immediately following they PPIE, fecal samples were required of Chinese immigrants at Angel Island and a 20-year quarantine occurred against Mexico to ward off typhus fever. (Stern, 48). The result of this blending was a medical movement incorporating these theories into a system that views the biology of man with an idea that environment and heredity are among the causative agents of disease. This is not a radical notion – aren’t Hawaiians obese because they are built that way? Don’t Native Americans drink alcohol because alcoholism is in their genes? Aren’t Blacks notorious for spreading multiple diseases, like Syphilis and AIDS? Aren’t Mexicans alcoholics because they are born that way, lazy because of the arid environment they live in? Aren’t Italians and Irish prone to alcoholism also? Connections between disease and race flourish, but these representations don’t result from independent thought. They are ideas handed down from generation to generation, learned from peers, seen in the media, etc. They are the result of information provided to the public by our experts, who founded their work on previous theories developed by experts of the past.
The 19 million lay people exposed to notions of disease as being racially defined have handed down their experience through the generations. It is important to note, however, that this was not that long ago. Only recently has attention been brought to the racism infiltrating ideas about disease. Cultural memory exists within individuals, and ideas influence work which creates theories that are continued to be built upon. Even if theories are defeated, there remains a shadow of the idea that oftentimes dominates a particular area of study, or even an area of geography. As an example, we see today the debate of Creationism, and its dominance in certain parts of the U.S. Thus, the legacy of eugenics remains. When was the last time you have seen an evolutionary scale of man beginning with a light ape and ending with a black man? No – illustrations of the evolution of man still end with a light-skinned European, illustrating the peak of evolutionary growth.
The Tuskegee Experiment
Yet another example of racism within healthcare is the Tuskegee experiment, a record of the progression of syphilis in black men, directed by the U.S Public Health Service for over 40 years beginning in the 1930s. The researchers followed a group of Alabama based African-American volunteers in their secondary and tertiary stages of syphilis, recording the progression of the disease while withholding available treatment, resulting in the death of many of the volunteers. After the death of the men, the researchers would autopsy the bodies in order to describe the racial aspect of the disease. As recorded, the disease was thought by the researchers to cause severe neurological disorders in whites, but the affect of the disease on the black body would primarily cause cardiovascular problems as a result of the “smaller, more primitive” brain of the black man.
Compensation for the experiment included rewards focusing on an impoverished life of the black man: free burial, draft exemption, twenty-five dollars, and a certificate of completion, all the while withholding the effective treatment of penicillin. The resulting civil rights case brought to public attention the extensive human medical experimentation that occurred. But even within the review panel challenging the experiment, racism was prevalent. The panelists were chosen with specific backgrounds, both racially and professionally, and it was discovered that there was a purposeful rejection of one of the more important advocates for the victimized group: an historian, an expert of identifying, analyzing, and interpreting pertinent documents relating race to the study. Because of this, documents were withheld and tapes were burned, and race was not brought into question at the trial. But the study is not the worst or only example of the black body as a target for experimentation– in other studies, blacks were exposed to biological hazards, injected with infections agents, and tested risky products, among other atrocities. (Washington, 157-185).
Medicalization of the races occurs frequently, as we have seen in the case of several different racial and ethnic groups. Within my work, I see my patients challenging racism frequently. This occurs both within my work environment as well as outside of it, in the community. For example, I work with a variety of clients, differences revolving around their gender, the color of their skin, their appearance, etc. It is much easier to provide for clients who have a lighter complexion (they are not necessarily Caucasian, but there is an obvious discrepancy between treatment of people based on the shade of their skin.) For example, one of the elements of getting people stable is finding them housing. To find a lighter-skinned client housing in a residential hotel has been a simple matter, relative to the effort it takes to keep a darker-skinned client housed. The lighter client is accepted more readily by housing providers, even if their pervious crimes have been much more serious than a darker patient seeking housing in the same hotel. In fact, clients have been rejected housing by overt statements, like “I don’t like the way he looks.”
The same holds true in putting credit on a person’s account at a participating restaurant or at a convenience store. The client generally brings a check made out to the store or restaurant, and the manager provides them with a credit to be able to purchase cooked food or groceries. Most of the time, with a darker-complected client, I will have to go with the client for the provider to accept the check. Not so with the lighter client – generally, his check would be taken. These are simply examples of the deep-seated assumptions permeating our culture about people in regard to the color of their skin.
In another example within my workplace, a client was in the initial process of screening. In this situation, he was being seen by a psychiatrist outside of the jail, outside of San Francisco. Upon reading the description of the male and his diagnosis of disability in the referral the psychiatrist provided, it was written that he had a “disheveled appearance,” wearing several layers of clothing nontraditionally, his speech was erratic, and his hair was unkempt and dirty. This description was used to support the diagnosis of schizophrenia, the diagnosis du jour. When meeting the client, living in San Francisco, we were more keen to differing cultural styles and realized that what the psychiatrist was describing was the hip-hop style of dress and being. The client was young, had several baggy jeans on, spoke in thick, modern ebonics, and his dirty, unkempt hair was dreadlocks! Although the client did suffer from a disability, the supporting evidence that suggested particular treatment was primarily uninformed, culturally insensitive, and racist.
Racism manifests in many ways in this society, probably in every society. It has an impact within healthcare, an impact that has traumatized many people. We can see by going back a century how experts can get together, share experience and research, and formulate new hypothesis based on the work of others. The PPIE was an example of how belief in heredity and environmental disease causation converged with the burgeoning biomedical movement, creating racist notions of disease. Ideas formulated here may have led to ideas that disease affects only certain racial types, and the global subordination of the darker skinned allowed for the brutal experimentation of the black body.
Today, we see racism flourish in many aspects of our society, within the power dynamics of the workplace, within immigration, even in providing for the basic needs of someone. We see it in HIV research – that money is allocated to proving that AIDS came from somewhere external; “probably Africa” the authorities began to say almost immediately. We recently saw money funneled into research proving the way the black man’s organ absorbs and spreads HIV more readily that the white man’s. We see it everywhere, even within our own perception and experience.
RFERENCES CITED:
Stern, Alexandra. Eugenic Nation. University of California Press: Berkeley 2005.
Washington, Harriet. Medical Apartheid, Doubleday: NewYork 2006.
Martin-Baro, Ignacio. Writings for a Liberation Psychology. Harvard University Press: Cambridge, 1994.
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