Mental illness does not respect class, race or income. About 35 million Americans, rich and poor, suffer crippling depression. One percent of the world's population is afflicted with schizophrenia. All kinds of people, at some time, need psychiatric help.
In Washington, which is among the world leaders in psychiatrists and psychologists per capita, that help is abundantly available to those who are well heeled or well insured. Unfortunately, like all first-rate medical care, it is not always available to the poor, who often have the greatest need.
"The fact that we have such atrocious service for the poor here is not surprising," says Gail Marker, who has studied care at the District of Columbia's two public mental health clinics as an investigator with the Mental Health Law Project. "The private psychiatrists here don't want to work with poor people because they are not paid enough, because clients are not good at verbal therapy. The clients sometimes have hygiene problems. They sometimes do unpleasant things in the office."
The stories that follow are about local people, many of them poor and extremely ill, who are receiving psychotherapy in Washington. They are outpatients at the D.C. Institute of Mental Hygiene, a clinic that is an oddity in Washington's mental health establishment because it provides the poor with a brand of care normally reserved for the middle and upper classes.
Dr. Harold I. Eist, who runs the D.C. Institute, permitted this look behind the closed doors of psychiatry because he says most Americans have a vague and distorted understanding of mental illness.
The patients whose lives and illnesses are described, all of whom have been given pseudonyms, volunteered their cooperation because they say they are getting better and they are proud of themselves.