Nowhere to Hide

There’s nowhere to hide on vacation. At every turn, we’re sharing a car with friends; a hotel wall with strangers; a cathedral with tourists. Always, in some way, on display.

That’s why I’m holding in the scream. It’s lodged between my lungs and my heart. I’ve felt it since before our plane took off, a jagged stone pushing upward. I’m tempted to open my mouth in the Gothic cathedral, where there’s a chapel with incredible acoustics—even whispers reverberate off the walls. I say it out loud: Wouldn’t it be cool to scream in here? My partner and her friend side-eye me. Don’t you dare, my partner says. I choke it back down.

While the scream is stuck in my chest, my consciousness has taken off. I can feel it hovering just above my scalp. We’re road-tripping through the countryside in Wales, but when we get out of the car, I don’t really care to see the sights. I lie in the grass, willing my spirit to come back down to earth.

We go to a park—there’s a “sensory trail” you’re supposed to walk barefoot. I peel off my purple tights and hand my shoes to my partner. I put my headphones in and blast “The Kintsugi Kid” by Fall Out Boy. I run along the grass and wood chips, I skip, I pause and wait for my partner to catch up. I run off again. The trail ends in a creek. I wade in. It’s cold. I feel my soul slip back into my body, briefly.

Every night, when I experience the closest thing to privacy—a hotel room with two shared walls—I loosen my grip on composure. I lie on the floor and sob. I stand in a cold shower, trying to snap myself out of whatever this is. I sleep only a few hours. In the morning, I prepare myself to keep a white-knuckled grip on normalcy.

I keep one headphone in at all times. Music drowns out the noise from within and without. I’m constantly writing in the notes app on my phone—letters to people I haven’t spoken to in years. The letters start coherently, but as sentences build on sentences build on sentences, I lose the thread. My jumbled thoughts stay confined between my ears. No one has to know.

But then I begin remembering horrible things I’ve forgotten. The friends we’re traveling with—they’re not who I thought they were. Their eyes darken, their expressions twist beyond recognition, revealing the monsters on the inside. I hear them whisper things to me when their mouths are closed. Back in the hotel room, I tell my partner, They’re trying to kill us.

Soon after, everything goes black. When my memory kicks back in, I’m on the floor again. My partner is in front of me, desperate. She’s pleading with me. I can see it in her face. But I can’t hear her. I’m punching the floor with my fists.

In the darkness, the jagged stone in my throat dislodged. The scream drowns out everything else. The scream exits the hotel room, and I follow it out, down the hallway, down the stairs.

Outside, the scream subsides momentarily. I run down the street. I don’t know where I’m going, but my movements are premeditated. I’ve never been here, but I’ve done this before. There’s a script, and I’m following it.

Eventually, I’m told by an unseen force to turn back around. I head back toward the hotel. When I see the lawn outside, something switches on inside my brain, and my voice comes hurtling back out of my mouth. I don’t even realize I’m in public anymore. Tourists continue their dinners on the hotel’s pub patio.

The scream attracts the police—they’re arriving now. Several approach me. They’re wearing yellow vests. They form a half circle around me and back me into a fence.

They’re actors, I think. But I can’t figure out the script anymore. I’m trapped. I don’t understand what they’re saying. My heart creeps up the back of my throat.

I try to run again, toward the line of police. I shove one of them.

Suddenly, many hands are on my body. They’re twisting me. They’re pushing me down. My arms are pinned behind my back, and I feel as if six people are piled on top of me. There’s an elbow in my back. My body is in the grass, but I’m not in my body.

Then I’m in handcuffs. There’s no chain in the middle of my wrists, just a solid metal bar. They put me in the back of their van, and I sit on the floor. I see my shoes on the other side of the glass partition. I squirm, trying to find a comfortable position. I can’t find one.

I’m no longer in public, but I’m also not in private. I’m awoken in the middle of the night by a key in the lock of my room’s door. I’m startled, but the sedatives anchor me to my bed. The door opens to reveal a figure, backlit by the fluorescents in the hallway. Darkened by the contrast, he resembles one of the shadow people. But when he asks if I’m okay, I recognize his voice. Just a nurse, just checking up on me. There’s nowhere to hide here.

In the daylight, I sit on the tile floor across from the front doors. They’re locked. I know, because I’ve pulled and pulled and pulled on the handles. I’ve lost access to the outside. Right now, I can accept that. Later, I will try again.

I don’t usually know what time it is. But today, I know my partner will be here at 2:30 p.m. for a thirty-minute visit. When she arrives, a nurse leads me into the visitation room. There’s a small couch with a big stain in the middle. The room is stuffy and smells vaguely of puke. I wonder if that’s what the stain on the couch is.

We sit on the floor. We talk, but my speech is disorganized. The antipsychotics haven’t kicked in yet.

They tried to slam my spirit back into my body.

Why are you making me stay here?

They’re force-feeding me drugs.

There’s a man without a soul here.

My partner has been told not to contradict me. To speak calmly, in short sentences. She’s exhausted—she has to walk here from the hotel—but I don’t know that. I just know that she comes here every day, and it’s the only thing I look forward to.
I hold her hand and I’m temporarily tethered to the present.

More than any medication, the presence of the one person I still trust helps keep me afloat as reality turns to liquid around me. She is enough of a life raft to help me return to lucidity after two and a half weeks of inpatient care.

I’m discharged with the diagnosis of “brief psychotic episode.” A week later, a psychiatrist will amend the diagnosis to bipolar I.

In the aftermath of my psychotic episode and new diagnosis, I upped the frequency of meetings with my therapist, started seeing a psychiatrist, and tried new medications. None of those treatment options has changed the way I feel about being arrested.

Panic rises in my chest when I hear sirens or see an armed guard checking receipts at Fred Meyer. Whenever someone with handcuffs on their belt comes across my vision, I feel myself tugged back to the lawn outside the hotel, pressed into the ground, immobilized.

No matter how diligently I swallow my pills or how many hours I spend in therapy, there’s a part of me that feels unsafe. My brain poses some kind of risk to me at all times, and I could be punished for it.

Police enforcement helps calm bystanders’ fear of people with uncontrolled mental illness. That fear is a response rooted in a lack of understanding about what’s actually happening when someone is in crisis. Stigma paints a picture of someone dangerously out of control—not someone deeply terrified and desperate for help. It’s traumatizing to be forced to the ground and restrained in handcuffs when you genuinely have no idea what’s happening around you.

There are some alternatives to police enforcement, like Portland Street Response and Project Respond in Portland, and CAHOOTS in Eugene, which bring mental health professionals, social workers, and peer support specialists to the scenes of mental health crises. These programs differ from police response in that the professionals are unarmed and able to stay with someone over a longer period of time to help de-escalate the situation. They can get down on the ground to someone’s level and help them return to equilibrium without the threat of force.

Chelsea Swift is a crisis worker and medic with CAHOOTS. She spoke to the power dynamic that inherently exists between the average person and a police officer. “As long as an officer is standing there with weapons and handcuffs that I can see and the ability to make decisions for me, they could say all the greatest de-escalation language in the world, and there’s still going to be a wall up between us,” she said.

These mobile-response programs are designed to be trauma-informed and are led by individuals trained in de-escalation. They have the resources to get people help, and they don’t penalize people for their behavior during a mental health crisis.

“Our hope is to actually facilitate connection to the resource they might need to help them feel whole again,” Portland Street Response program manager Lielah Leighton said. “And so we work a lot with our partners on the crisis care continuum, whether it’s a hygiene facility, a day center, a shelter, a clinic, or another mobile responder. It’s really important to show that there is a net—we can support you. And here are other partners to help us with that as well.”

And yet, these programs are chronically underfunded and understaffed. I see community challenges to this type of work—because of how mental illness itself is stigmatized, and also how it intersects with other highly stigmatized communities, like the unhoused and those experiencing substance use issues. Decades of excluding people with these experiences from the community has led us to the present situation, where a crisis occurs daily on the streets.

Duke Reiss is a peer support specialist for Blanchet House, a homeless shelter and residential program located in Old Town. He sees people in crisis on the street regularly. Sometimes, he said, housed people he knows tell him, “‘I don’t act like that outside.’ And I’m like, ‘Well, you have a room to go act like that in. They don’t. This is the room. The outside is the room.’”

These public crises are often met with judgment on the part of the average bystander.

“I think there’s a real empathy problem,” said Rocky Hostetler Lippy, a longtime Portland psychiatrist and mental health activist. As someone trained in both psychiatry and psychological first aid, sometimes she’ll try to work with people experiencing crisis on the street. “When trying to respond, I’ve had [bystanders] yelling at me to stop,” she said.

As long as people in crisis are perceived as threatening and dangerous, we cannot design a response that’s compassionate. The first step to addressing the mental health crisis is humanizing those who experience mental illness in ways that are disruptive. I did not lose my personhood in psychosis, and yet I often see people in crisis dismissed as nuisances.

Hostetler Lippy and others in the mental health space note that the stigma around mental illnesses like bipolar disorder and schizophrenia is rooted in a lack of education. People don’t know what those conditions look like in real life, nor how prevalent symptoms like psychosis are. According to the National Alliance on Mental Illness, 3 percent of adults in the US have been diagnosed with bipolar disorder—that’s around one million individuals.

Mental health crises are not unique to those with serious mental illness diagnoses, either. Any person is just one stressful life event away from struggling with their mental health.

“Crises don’t occur in a vacuum,” Leighton said. “It’s really important to understand that inside all of us, we are capable of crisis. It’s not like there’s a class of human that experiences crisis.”

Leighton notes that it’s important to know the signals of an impending mental health episode before one happens to you or a loved one. Extreme changes in sleep, appetite, and social interaction can all be signs of something else happening in the brain. Being able to identify an impending crisis and head it off can make the difference between someone getting help and someone ending up on the street, screaming.

I’ve thought about that a lot since my psychotic episode. I was experiencing all the warning signs for at least two weeks before that day on the lawn at the hotel—I wasn’t sleeping well, I was eating less, I was fixated on weird things, I was having strange interactions with the people around me. Had my partner and my friends known what to look for, my experience might have been less traumatic. I could’ve checked myself in to the hospital, instead of being forcibly taken there by police.

Even though they weren’t able to prevent the episode, the people around me supported me during it and in the aftermath. I’m only stable enough to be reflecting on my experience for a magazine because of community support.

My friend Tay Turbyne just graduated with their master’s degree in social work. They were one of my main sources of support during and immediately after my manic and psychotic episode. Throughout their education, they’ve spent a lot of time interacting with individuals in crisis, particularly in homeless shelters. They’ve told me it’s significantly more difficult to de-escalate a person in high crisis if that person doesn’t know you.

“It’s dependent on the relationship,” they said. “Just like with any other type of crisis. You’ll feel more comfortable talking to somebody who you already have an established relationship with, rather than somebody who’s a stranger trying to calm you down.”

Seeing someone you love in crisis is difficult, though.

“I was scared,” Turbyne told me, about interacting with me during my episode. “I wasn’t scared that you were going to harm me. But it was disruptive in the way that it wasn’t the normal way of us interacting. It’s scary to see somebody be so entirely different from how you know them.”

That’s why it’s important to prepare in advance of a crisis. Both Turbyne and Leighton spoke about the importance of safety planning in advance of anything happening. A safety plan is a document that lays out a plan in case a crisis occurs—whether that be a mental health crisis, a medical emergency, or some other kind of disruption to one’s life.

“I really like having crisis plans in place that you talk about with your loved one in advance. And I think this becomes more accessible and more approachable when we realize that all of us are capable of crisis,” Leighton said. “Coming up with that plan when the person is in basic equilibrium goes a really long way.”

A safety plan answers questions like: Who are you comfortable with me calling? If this [emergency situation] is going on, do you want to go somewhere? Where? What are the places you don’t want to go? And in what circumstances?

Of course, this strategy assumes that people have a community to fall back on. I’m extremely privileged to have the relationships that I do. My partner visited me every day in the hospital and took leave from her job to support me afterward. My friend Turbyne already had de-escalation training under their belt. Even though I felt disconnected from reality, I was never really alone.

“We’re not meant to do things alone. That’s not how we are as a species,” Turbyne said. “I don’t know what keeps us going other than human relationships, you know?”

But not everyone has a partner or a friend who won’t let go of their hand when the lights go out.

My perspective on seeing people in crisis has changed radically since experiencing psychosis myself. When I hear screaming on the street, it’s a familiar sound. I know what it means—it’s an expression of terror. I have never been so afraid in my life as I was that night on the grass. There were real things to be afraid of, like the cops surrounding me, but my mind was also inventing things to fear. There was nowhere to escape to. Screaming felt like the only way to express the turmoil inside my brain. Isn’t that what we’re taught when we’re young—that when you need help, you should call out for it?

I want everyone who calls for help to receive it in a trauma-informed manner. I want to see us build stronger relationships with our loved ones, especially when things get hard. I want us to care about people we don’t know, too. I want us to be informed enough to know we can call 911 and ask for Portland Street Response or Project Respond, instead of jumping straight to police intervention. I want to live in a world where people can access care before they reach peak crisis.

I will live with bipolar I disorder for the rest of my life. The potential energy for another crisis lives in the folds of my brain matter. I will never feel fully safe in my community without radical changes to how we approach public crises. For my sake, and for the sake of those who share this experience, I hope we can move away from carceral approaches and toward communal approaches to healing each other. Losing your mind should not mean losing your humanity—or your community.

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