SoCiaL PhOBiA anXiEty dISoRdeR and Homelessness!

Rasheed comes storming into my office, slams the door, plonks himself down in the chair in front of me and starts furiously ranting….

“Jeremy; You better do something!”

“I’m as mad as hell; if you don’t do something, I’m gonna snap, yeah man, I’m gonna hurt that boy, you better do something Jeremy, before I hurt him!”

“You know me man! I’m old enough to be his daddy, he better not yell at me like I’m his kid. I ain’t his kid! You know what I’m saying? I’m bi-polar, I’m schizophrenic, I’m both of them: what’s that called?”

“Schizoaffective disorder”

“Yeah! That’s it; the doctor says it causes me to snap. That’s why they give me meds. Let me show you all the meds I gotta take everyday!”

Rasheed reaches into one of his bulging pockets, and pulls out a paper-bag fill of medication. He starts showing me his prozac, seroquel, risperdal and some other prescribed psychotropic drugs.

“You see what I’m saying Jeremy, you better do something or I’m gonna snap!”

I calm Rasheed down, by trying to use as many peace-making techniques as possible. We discuss how he cannot change how this twenty-something year old man treats him, but that he’s responsible for how he reacts. We discuss how it may be harder for someone with a schizoaffective disorder to react peacefully, but hurting someone is wrong and could result in being barred from the shelter, or even worse, imprisonment. We look together at the insults Jesus took, and how he didn’t call a legion of angels to destroy those who had arrogantly harassed him. Rasheed mellowed out and temporary peace was achieved.

Now, the reality is, variations of this scenario frequently happen around or in my office! People charging up to see me about their depression, schizophrenia, bi-polar disorder or PTSD. Like Rasheed, they frequently end up placing a host of prescribed psychotropic drugs on my desk, packaged in brown paper bags. Most of these men and women are very open to meeting and discussing their issues with mental health outreach workers.Together, we try to tackle the obstacles they are facing.

But there’s something that silently enslaves many homeless folk. It’s often ignored and forgotten, leaving too many people quietly depressed, grieving and suffering. It called Social Phobia Anxiety Disorder or Social Anxiety Disorder (SAD)!

Michael’s roommates bugged me all morning. Each one of the guys came complaining about the previous night’s drunken episode. He had stumbled into the room and threw up all over the floor; then he fell asleep, leaving the room with a rancid stench and covered with watery vomit. His empty bottle of rum lay next to his outstretched motionless hand. The roommates could not tolerate this smelly health hazard, so they mopped up and sanitized his disgusting mess, as the disheveled Michael lay comatose.

They were furious, so one-by-one, they started ranting. Some just wanted me to kick him out of the shelter, while others felt sorry for him. Michael was only in his late 40’s and had already had a stroke that had left him partly paralyzed. He was unable to work, and had been waiting a long time for his disability benefits to finally kick in. I heard about how he lay in bed all day, kept himself isolated, wasn’t motivated, hardly ate, didn’t shower enough and had irregular drunken incidents.

The truth is; all the complaints were legitimate. He barely left the comfort of his bed and novels, except to smoke cigarettes and use the bathroom. He seemed to live off a diet of Red Bulls and Pepsis, which were often lined up by his bed. The times he ventured outside were to go to appointments or stores, and that is when he consumed alcohol. The overcrowded CCO cafeteria and the extremely social “smoke rooms” overwhelmed him. Michael was a sickly rack of bones. He had a couple homeless buddies, who did a lot of running around for him and possibly purchased alcohol for him.

I knew Michael had committed a number of offenses (a few times) to be thrown out. He sat in my office sweating. He was petrified. He was consumed by the prospect of having to sleep outside or in another shelter. He had been living with us for quite a while and never caused any trouble, except for these occasional incidents of quiet drunkenness. At the time of this particular incident, he was also moments away from finally receiving his disability income (SSDI).

In my office, we discuss some sad elements of his life; the stroke that ended his working life and left him homeless, the depression that rocked his daily existence and his addiction to alcohol and pain pills. We work out an appropriate discipline; he was able to stay, but he had to be moved to another location, but only if he met a number of mandatory requirements that would help him with all his physical and mental health issues.

That day, I told Michael I thought he had Social Anxiety Disorder. He had never heard of it and immediately denied it. He nervously shuffled in his chair, desperately wanting to escape our conversation. Yet, the evidence was undeniable; he never initiated conversations, nervously spoke with a quivering voice, avoided eye contact, steered clear of large areas full of people and stayed isolated as much as he could. AA meetings, waiting in lines and making phone calls terrified him. His health drastically suffered because of these things; he simply didn’t eat because of an overabundance of boisterous people in our cafeteria, he overindulged in energy drinks and alcohol to try and gain an ounce of confidence and smoked too many cigarettes to settle his overtly anxious nerves.

I am not a psychiatrist, but have studied SAD, and believe I struggle with it myself. Here is a link to my own self diagnosis.

This is the reality: Michael’s story is depressing! He is a realistic picture of what many homeless people struggling with social anxiety go through daily. The truth is, homeless shelters and the homeless community simultaneously terrify, challenge and satisfy the SAD individual. Being homeless means; they live in, and can’t escape, a world where they have to make contact with other human beings. Due to their circumstances, they are forced to deal with their fears, which is something we all, as human beings, need to do.

When someone, like Michael, transitions into their own apartment or SRO, relief is realized, because they no longer feel all eyes are watching and judging their every move. They feel they can now, just simply, “be themselves”. Yet ironically, it is not necessarily the best thing, as they are then left isolated and alone, with no way to challenge all those haunting and daunting fears!

All this leads me to say, the homeless environment can actually be better for an SAD individual than the isolating reality of a subsidized apartment. This also leads me to say: this reality challenges my whole premise and way of helping and case-working people. A SAD homeless person needs housing that offers an all important network of care and community around them, so they don’t simply “fade to black!”

Well, Michael finally got his disability check (SSDI) and successfully moved into his own apartment. He received a little of that all-important continued community when he moved. He moved just a few blocks from the shelter, and a couple of his homeless buddies would frequently visit him in his apartment. We encouraged him to come around and eat an occasional meal in our cafeteria. He also moved into subsidized housing that provided continued case-management and check-ups. Sadly, Michael died a few short months after transitioning into his own place.

A few years ago, I bumped into Derrick. He had stayed at CCO before and was consumed by worry. He is an impeccably dressed African American in his mid fifties. I ignite a conversation and he tells me his story: he is homeless again and is sleeping under some bush a little up north. He didn’t beg for help, he just had this lost look in his eyes because he was unemployed, without any cash and was sleeping under Chicago’s smoggy stars. He groaned, with a slow depressive monotone, about his plight and his doomed future. Derrick told me how his life was a picture of misery and how he was always judged by the people who surrounded him.

I gave Derrick a spot to stay at Cornerstone. He was convinced his roommates were judging and looking down on him. Yet, the reality was, people only had very good things to say about him, as he was extremely tidy, respectful of others and quietly went about taking care of business.

Knowing Derrick’s social phobias and his very depressive anxious demeanor, I set up appointments for him. I got a very reliable local outreach worker to meet with him in CCO. Every week when he came, he was usually bombarded with a long line of very vocal mentally ill folk waiting to utilize his services and most of them did not worry about sharing their struggles with an audience. I knew Derrick felt differently and would not get the help unless there was just the 3 of us chatting.

This meeting ended up being extremely profitable and beneficial for Derrick. It was the thing that kick started him getting the psychological help he needed, a vitally good support network, employment and, eventually, his own apartment. If it wasn’t for a couple of people gently nudging him in the right direction and respecting his Social Anxiety Disorder, Derrick would quite possibly still be wallowing in his own grief and homelessness.

A couple days ago, as I was wandering down Wilson Ave, Derrick rushed up on me and profusely thanked me and CCO. He told me to shake his hand because I was looking at a Cornerstone success story, Derrick is still housed in the same apartment, has that all-important supportive network around him, started receiving SSDI and is actually enjoying his quiet life: I told him how thankful I was to see how he is doing and we parted ways!

Feliciano had been staying in Epworth for quite a while. He would quietly stand in lines, get his tickets and lie on his bed at night. He never caused a problem. In fact, most people didn’t even know his name, who he was and that he even stayed in our shelter. Feliciano is close to 60, so when a spot opened on the 4^th floor where we allow some of the older guys to stay, we selected him to move into the open bed. These beds give older and disabled men an opportunity to get more of the rest their bodies actually need.

Because of the general chaos of my life at Cornerstone, combined with the over-abundance of extroverts invading my space, I rarely got to communicate with Feliciano. He never came down to my office and when I would do room checks, he would be sleeping. His blanket or a t-shirt would be covering most of his face. He had quietly zoned out.

A couple of months ago, one of his room-mates came up to me and loudly complained about him just outside their door, stating the obvious, “all he does is sleep! I’m out there working my butt off, trying to find employment every single day, and all he does is sleep, sleep, sleep! He doesn’t even shower! He needs to do something! It isn’t fair.” I had been planning to talk to Feliciano, so I went into their room and set up an appointment for the next day.

Feliciano had heard my whole conversation with his room-mate, so within an hour, he hurried down to my office in a panicked state. He was absolutely convinced I was going to throw him out, so I had to reiterate again and again that he was in no danger of being tossed into the snow and I asked him to “not to let his nosy neighbor live rent-free in his head.” I probed into his personal life and he nervously told me how he was being constantly judged and analyzed by everyone that surrounded him. He shared about his many recent tragedies that left him unemployed, family-less and homeless.

It took quite a while, but I was able to calm down this quiet man riddled with phobias. Our little meeting ended up being extremely profitable. Not only did we extinguish many fears, we established a few attainable goals and now they are getting met. Feliciano is still homeless, but is regularly meeting with a couple of very compassionate and patient outreach workers who are helping him with his social anxiety disorder, chronic depression and PTSD. They are also assisting him get an income and ultimately transition from homelessness into housing.

(update: 8/22/13) Feliciano has now been housed in a very supportive housing program for a few months. He is doing well, healthy and enjoying his life. He continually thanks CCO for all the love and support we have been able to give him over the years.

When I look at these three men, I see guys controlled by crippling fear and paranoia; a fear that captures many homeless folk and which often goes unnoticed; it is an unrealistic illogical fear of the people who surround them, fear that is governed by thoughts that they are being constantly judged and analyzed. They fear daily that they can never reach “the standard” and they are letting everyone down. I know, because I myself, struggle daily with social anxiety disorder and have written about it here!

Mike, Derrick and Feliciano are from three different races and had very different backgrounds. They all dealt with their Social Anxiety in different ways; Mike fell into addiction, while the other two are both drug and alcohol free. Derrick was very active and sought answers, while Feliciano tried to escape and sleep. SAD is a silent killer which isolates and captures it prey. Cities are full of socially anxious individuals barely talking to another living soul. Yet, with strange irony, homelessness helps illuminate the problem, by actually making the Socially Anxious individual face their fears.

Those of us working and living in this field of social work, (along with many other fields like the Church), need to keep our eyes and ears open. Our doors may be already wide open, but a socially anxious person will never wander in and lay their burdens upon us. We need to be constantly looking and analyzing, so we can make the advances and lend a compassionate hand.

Some of my efforts have been futile. I’ve missed, and sadly ignored (or dismissed), many opportunities to help a SAD person. Some of my efforts have bore fruit, and I am thankful that God has been able, and will continue to use me, in the lives of wonderfully quiet folk like Michael, Derrick and Feliciano.

Jesus could have ignored the bleeding woman, but he stopped in the midst of the hustle and bustle, and said, “Who touched me?” She wanted to vanish, but Jesus wanted her to receive complete healing. He took the time, drew her out of the crowd and let her (and the impatient mob) know that she was a precious, important, wonderful and beautiful woman, that had as much right to him as the extroverted masses that squashed up against him. His eyes saw beyond the rowdy desperation and the pompous arrogance that constantly sought his attention, by seeing a silent voiceless sufferer and he met her humble needs.

We must do likewise…..