"Things is getting bad," Shanelle said, as soon as she had sat herself down in the chair. It is a typical office chair with arms on wheels and sometimes she gets stuck in it when she attempts to rise too quickly. I always pretend not to notice as her body collapses back down into the seat and try not to watch her hands grip onto the chair's sides on her next try as she uses her heft to her advantage, her arms as fulcrums.
"How?" I asked.
"Moms. She's so crazy. There ain't no unnication in that house. Always calling people B's and whores and talking about peoples is following her."
Shanelle is mildly retarded. She wears a dark, curly wig that sits sideways on her head despite her constant tugs as she talks, except in summer months when she replaces it with a crocheted skull cap pulled low. I have no idea what is or isn't behind that hat or wig, but I know she blames moms for whatever it is because she be telling me so. Sometimes I find myself unnicating like she does for hours after she's left.
"Following her how?
"Oh, they're following her and watching her."
"That makes me a little worried."
"Nobody's following her." She says this suspiciously, watching me closely, thinking, Is this one crazy, too?, it seems.
"I know. I mean, that she's thinking that, though, makes me worry about what's going on mentally."
"Oh, she's mentally ill, that's what she is. Messed up in the head, mentally ill like. I think it's that instan the nurses be giving her. I think that's messing up her head." She means insulin when she says this, and it's funny how you can know what people mean not by what they say but how they say it, and it doesn't make a difference that she can't pronounce or doesn't know the name, we both know what she means and that's all that really matters, so I call it "instan" when I talk to her about it, too.
"What do the nurses say about the people following her?"
"Oh, them nurses don't do nothing. They see how she is, too, how she's always doing burble abuse. She's worser than a husband. You know that? Worser than a husband."
And I find myself nodding, yes, I understand, gosh, it's gotta be getting pretty bad if it's worser than a husband.
"Talking about how she's gonna get an attorney and find out what we're talking about."
"You know, everything you tell me is confidential—unless it's about hurting yourself or someone else." I tell her this every week, at least twice most times. "What's in that chart?" She'll ask. "I'm taking that chart home." Until I remind her that if she does, moms will probably find it and she agrees that, yes, it probably is safer here but I better lock it up and I say don't worry, I always do, even though the drawer where I keep them does not really lock at all and I feel bad for lying.
"I know. I told her, go ahead, hire an attorney. It's like domestic violence. Always yelling at Shanae saying she's smoking crack and always be sucking dick. I said that's a 18-year-old minor. What you doin' talking to an 18-year-old minor like that? I'm telling you things is getting worse."
"How is Shanae?" Shanae is her daughter and she lives with Shanelle and moms, too.
"Shanae ain't smoking no crack. If she was, her skin would be real dark like and she'd be skinny." She is observant in her blunt, not unkind way, like most retarded people are, I've found. And children. I am constantly surprised by their capabilities. Probably because we always just expect so little of them. "I told moms, I told her, that child ain't on no crack. She is feeling sadly though."
"Her boyfriend got sent to that Rikers."
"Yeah. I went to see him, I was like, what you getting messed up with that armed robbery for?"
"You went to see him?"
"Yeah. I told him he's my son now. I'm going to call him my son and he said when he gets out he's gonna marry Shanae."
"Would you want Shanae to marry him?"
"He's a nice boy."
"Armed robbery is a serious charge, though."
"I told him no more of that. That's what I told my son. I'm going to go see him again tomorrow. That's a long bus ride to Riker's. You ever been?"
"To Rikers? No. I haven't".
"That's a long ride. You got to take the train all the way from Coney Island to Queens Plaza I think it is. Then you get on a bus. There's a lot of people on that bus. Then you get there and you gots to wait in line and be searched. They wouldn't let Shanae in, even after all that travelin' time."
"She had that scarf on her head. They wouldn't let her in with that scarf and she wouldn't take it off."
"Why wouldn't she take it off?"
"I think she likes that scarf. "
"So you went in alone?"
"Yeah. They's lots of cuties there."
"Yeah. Lots of cuties. I said, my goodness, look at all the cuties. Some is all beat-up-looking, though, like they got beat up. I said to my son, You better not be getting beat up in here. That's some big place, Rikers. Like a college. Like a big college. What happened to you last week, anyhow? How come you wasn't here?"
She gets so upset when I'm out that I try not to be on her days. And if I know I will be I tell her weeks in advance. I say, Shanelle, remember, Christmas is in five weeks and is on a Tuesday so we won't be able to see each other that week and she'll say OK, and I'll remind her again a week later and she'll say OK again but the week before she'll still get upset, even with all that advance warning. There wasn't any warning this time, though. At least none I could give to her.
"I wasn't feeling well," I responded, because I didn't know what else to say.
"What you been eating?"
"I don't think it was anything I ate."
"Pork. You been eating too much pork." And she says it with such authority that I wish I could agree with her, even though I haven't eaten any pork at all, and even if I had it wouldn't have caused this.
"All that Wendy's and Macdonald's you been eating."
"You're getting fat."
And that's when I knew I would finally write you.
I got a new client today who spent twenty-five years at Clinton Correctional Facility. I rarely get long-sentence-servers like that. Mostly, I just get people who have spent time in Rikers, or just a few years, small bids, upstate. Upstate is what we call prison here. So many of my children (did you know I see kids, too?) say, "My daddy's upstate," and you know right away they don't mean on a farm in Binghamton. You probably know that, though. You probably know a lot, don't you? More than I do.
I wanted to ask if he knew you. I'd like to ask if you know him. But either question is off-limits, against the rules. One violates the patient-therapist relationship. The other violates confidentiality.
Just as his length of incarceration is different, so, kind of, is his story. The first few sessions I have to gather information for a psychosocial assessment. This is how they pretty much all go:
X is a single, (insert 20-30) year old, heterosexual black/Latino male/female. He/She was born in Brooklyn, product of an unplanned pregnancy. His/Her mother was (insert 13-17) years old at time of birth. Patient's development was WNL (within normal limits). He/She was raised by his grandmother and multiple siblings in a two bedroom apartment in the (insert project name) Houses. His/Her mother left the family when patient was a toddler and was last known to be living in a neighborhood crack house. Patient's father is unknown.
Patient's grandmother had her leg amputated at age 40 due to diabetes and raised the children on a combination of her disability payments, food stamps and whatever her daughter would leave her during her few and far between sojourns home. A modern-day prodigal child. X was left back in the first grade and was eventually placed in special education classes due to behavioral problems. X was briefly removed from his/her home at the age of 8 following allegations of sexual abuse by a maternal uncle. While a physical exam was inconclusive, X was placed in foster care until Grandma agreed to make Uncle leave the home. X was reported to be hypersexual at a young age and was found in the school bathroom at age ten engaging in oral sex. When X was returned home, Grandma reported increasing behavioral problems and stated to child welfare workers that: "I just don't know what to do with that boy/girl."
X had his/her first child at 16. (If x is a girl, her grandma got custody. If x is a boy, his baby's mama's mother did). X reports beginning to use alcohol and marijuana at age 13 and had his/her first arrest for criminal mischief at age 15. X was placed on probation and returned to grandma's custody. X's second arrest was at age 16 for possession and intent to sell marijuana. X spent 3 months in Rikers Island and was mandated to 6 months of out-patient drug and alcohol treatment. At age 17, X began using crack cocaine and had his/her second child. As X's addiction worsened, Grandma kicked him/her out. At age 18, X was arrested for (insert assault and battery if female/assault with a deadly weapon if male) and served 3 years "upstate." At 24, X was arrested again for (insert prostitution if female/sale of narcotics if male) and was mandated by the Alcohol Treatment Court to 12-18 months of inpatient alcohol and drug treatment. Patient was referred to out-patient mental health clinic due to poor coping skills, anger management deficiencies, parenting skills needs and possible depression.
Axis 1: Major Depressive Disorder 296.33 R/O Cyclothymia Crack Cocaine Addiction in Remission
Axis 11: R/O Antisocial Personality Disorder
Axis 111: Asthma, HTN
Axis 1V: Severe—periods of homelessness, childhood sexual abuse, parental abandonment, poor support
Axis V: GAF = 50
GAF means global axis on functioning, I think. But everyone just refers to it as GAF, so I'm not really sure. Anyway, there is a range of scores and mostly I see people who are between 50 and 70 because if you are below 50 you are probably too fucked up for my services and if you are above 70 you probably aren't fucked up enough to be of use to me. I'm the one who assigns the number, though, so I guess it's kind of arbitrary and mostly I just want something that can show some progress at the end. If I can take you from a 55 to a 65, then that's good.
Anyway, Clinton (the patient) is a little different. He's white, for one. And he graduated high school. And grew up with two parents. But he's probably the biggest narcissist I've treated. And, quite frankly, the biggest asshole. I'll give him some time, though. Most of my patients are kind of assholes at first.
It takes a while for them to drop their guard, their suspicions, their fear.
Anne Yackee was raised in Pennsylvania and moved to New York City at age 18 to attend college. She is a graduate of New York University and of Hunter College, and currently works as a psychotherapist at an out-patient mental health clinic. Unnication is her first novel.