🎧You Find a Place | Chapter 27

Sarah Fay

Nov 10, 2023

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How can we expect people to recover from psychiatric disorders—especially those who’ve been struggling for decades—without giving them a safe, supportive environment to do it in? When it comes to regaining mental health, where we live determines if we heal. The four dimensions of recovery as outlined by the Substance Abuse and Mental Health Services Administration (SAMHSA) are health, purpose, community, and home. Home is the big one. It sits prominently on psychologist Abraham Maslow’s list of basic human needs—home, income, food, safety, and companionship.

Place and recovery: it’s so obvious, yet we’ve done little to create environments for people with mental illness, so they can heal. As the psychologist and mental health innovator Patricia Deegan, who fully healed from schizophrenia, says, “Stop asking what’s wrong with people with mental disorders and instead ask, ‘How do we create hope-filled, humanized environments in which people can grow and fulfill their human potential?’”

In a meta-analysis of the scientific literature on environment and mental health, researchers analyzed the importance of each aspect of our surroundings. “Hominess” has been found to decrease patients’ physical and emotional pain. Unsurprisingly, views of nature, gardens, and indoor plants can increase positive emotions and lessen negative ones. Natural lighting encourages healing and increases positive thoughts. Ambient chaotic noise, like that found in hospitals, creates stress. A space free of distractions (i.e., phones off, focus time on) contributes to productivity and calmness. Feeling safe and having privacy matter. Color affects mood though the internet is a hotbed of conflicting information on just which colors create which effect.

But the most significant factor is if you have a view. Greenery is best but even being able to see a concrete sidewalk with people on it or a dirt road on which a car might pass is crucial to mental health and healing.

Place. A view onto something. A physical view: the physical equivalent of having a future.

I’ve been living in a tiny studio apartment that looks out onto a brick wall. Now that I’ve advanced far enough along in my recovery to be able to advocate for and do things for myself, I determine to move. The apartments are either too expensive or dilapidated; there’s no in-between.

One apartment seems promising though the photos were all taken at night, making the rooms seem small and a little dismal, which may be why it’s available. A friend of the owner shows me the apartment. It’s late dusk. The moment we enter, I’m home. It’s palatial in comparison to my brick-wall studio: 720 square feet. The open floor plan makes me want to run through it. (I don’t.) The kitchen has all new appliances. They gleam. There’s a dishwasher—something I’ve never had. The rest of the main room has space for a small kitchen table and chairs, a sofa, and my desk. The bedroom area is sectioned off.

Then I see it: the balcony. I walk toward it. It’s brittlely cold out, so I don’t open the sliding glass door. In the distance is the skyline in full view. No brick wall. The city lights flicker and dance—mostly because I’m not wearing my glasses but still, they dance.

The other best part: It’s quiet. Not a sound from the surrounding apartments like in my studio. No bass thumping through floorboards.

I make an appointment to see it again the next day. Most of my family comes with me. The agent shows us in. I follow my mother, stepmother, and father around the apartment, trying to gauge their expressions. It takes everything in me not to convince them how great the apartment is. The four of us stand at the sliding glass door. The winter sky is flawlessly blue. The skyline stands strong. I can see the lake—pewter blue and still—the same lake I once thought of drowning myself in.

My stepmother says it first: “This is a great place.” My father nods. My mother smiles.

My illness took a toll on them. It led to periods of caretaking and strain, tension and distance. Having them here is almost as important as having found a place to live.

My mother helps me move in. For five years, I lived with her in her apartment. We turned the room she used as a study/office/den into a makeshift bedroom. One year became two, then three, then four. Five years of her as my caretaker—dealing with my moods and anxieties and compulsions and depressions, going to the emergency room with me, being on suicide watch. Too much to ask, especially of someone without the emotional support family members and caregivers need and deserve.

She unpacks the dishes and takes them out of the newspaper. I shelve books and set up my computer.

After an hour, she surveys the main room and says, “You look like you’re in good shape. I don’t think you need me anymore.”

She means that afternoon, but the words—in all their meaning—make my stomach do a little flip with what must be excitement or pride. It’s true. I don’t need her the way I once did.

We walk to the door and hug. For the first time, we hug each other equally.

My new couch is against the wall, just where it should be. In the bedroom, my bed is made. My desk is set up for me to write tomorrow morning.

At dawn, I wake and rush to the balcony and stand at the sliding glass door. Fog has rolled in off the lake. I’m high enough up—the twenty-sixth floor—so that I’m above it. There’s only blue sky and fog below.

I get my phone and take a picture. Every morning for the next year I’ll do the same, photographing pink sunrises; white, puffy cumulus clouds; orange sunsets; heavy clouds of pewter grey and the faintest blue. One late afternoon, I’ll capture a whole rainbow, end to end.

The history of how we’ve treated and housed those with mental illnesses is inexcusable, particularly the nineteenth-century asylum system; but there have been examples of the degree to which environment plays a role in recovery. Although the word asylum may bring to mind images of half-clothed, raving “lunatics” chained to walls, it means sanctuary. Many early asylums were intended to function as retreats. As Yale researcher Larry Davidson and his colleagues have shown, they boasted astounding recovery rates. Between 1813 and 1843, retreats reported recovery rates between 70 and 90 percent for those patients who’d been admitted within the first year of experiencing a psychiatric crisis. (Let that sink in.) Overall, the recovery rate was between 45 and 65 percent. (Though some scholars contend that these percentages are too high, in the 1950s, Davidson cites studies that have confirmed these numbers.) In 1881, one public asylum, Massachusetts’ Worcester Asylum for the Insane, surveyed over a thousand patients who’d been discharged and found that 58 percent had not experienced mental illness again.

Several asylum superintendents—later called alienists and then psychiatrists—claimed that under the right conditions, the insane could recover their sanity. (Mental illnesses fell into two categories: insanity and idiocy though the terms were often used interchangeably.) This was a bold claim. Patients typically included the most severe cases of mental illness, alcoholics, the elderly suffering from senility, and syphilitics. Enthusiasts like mental health advocate Dorothea Dix, politician Horace Mann, and the heads of the Ohio State Asylum and the McLean Asylum in Boston insisted that mental illness was entirely curable through moral and humane treatment.

The “cure” for mental illness had everything to do with where the patients were housed. The architect, physician, and mental-health advocate Thomas Story Kirkbride designed asylums that offered patients fresh air, beauty, privacy, and comfort. The center structures of his buildings proudly faced out, and the wings let in fresh air and natural light. They housed museums, libraries, and workshops. Patients had their own rooms, which had twelve-foot ceilings. They sometimes tended the lush grounds themselves. Mental hospitals, Kirkbride said, should impress the patients and inspire faith in the psychiatric profession.

Retreats offered patients idyllic environments in which to heal. But these retreats were private and very expensive. They housed twenty-five or thirty-five patients and didn’t extend care to the majority of those in need.

By the final decades of the nineteenth century, the number of public asylums increased, as did the number of patients crowded into them. Some, which once housed less than fifty patients, had over two thousand patients. Living conditions were revolting and inhumane.

Hospitalization is still the primary treatment option for those in psychiatric crisis, but the question as to whether people should be removed from their everyday lives to receive care is hotly debated. Davidson and others argue that removing patients from the community—whether to a retreat, an asylum, or an inpatient psych ward—doesn’t help the patient recover. (The question of whether inpatient programs are or are not useful in psychiatric crises and emergencies depends on which activists and scholars you consult.) He refers to the influential sociologist Erving Goffman, who wrote in 1961 that hospitalizing a patient was akin to saving someone who can’t swim and is drowning in a lake, teaching the person to ride a bicycle, and putting the person back in the lake.

Although the issue of inpatient versus outpatient treatment often concerns those with serious mental illness, recent studies confirm that environment greatly impacts everyone’s mental health. Psychology professor Anthony Mancini discusses the critical role of “the external environment in facilitating the internal conditions of recovery” today. It can’t be brought about by will. He writes, “[I]t must be facilitated by factors external to the person. Unfortunately, these facilitative conditions are typically in scarce supply for people with serious mental illness, in large measure because such illness puts them at risk of being in environments that are suboptimal for healthy functioning.”

The morning after I move in, I go for a walk, passing the building just north of mine. It’s run down. Small windows look out onto the street, but the windows on either side of the building look out onto brick walls.

Outside the building stand a group of mostly men, not together, each on their own, all smoking. One mutters to himself. They stare dazedly at the cars passing.

I recognize them, not personally but as people with mental illnesses. Maybe it’s a stereotype. Maybe I see myself in them.

At first, my stomach lurches. I don’t want to be close to it, don’t want to be reminded of how I was before my recovery—as if it’s contagious.

Then comes a shift. Even with healing and a view, I’m one of them and always will be. Oddly, my chest swells with a sense of connection.

The small plaque on the side of the building that reads Clayton House confirms my first impression. A Google search on my phone tells me it’s a transition home for people with serious mental illness.

When I come back, they’re gone. The only difference between them and me is privilege and opportunity: healthcare, eventually finding a good psychiatrist, family support, healthy food, medications with low-side-effect profiles, no co-occurring addictions, and a life filled with purpose in the form of writing and teaching. I had what was needed to heal; they and so many others do not.