My husband and I adopted our son, Abraham, as a toddler, believing we could provide him with a good life. Abi, as we called him, was a bright, curious kid who blossomed into a kind and popular teenager, a star student who won a scholarship to the University of Michigan. In his last year of high school, though, he began acting in ways we could not understand.
Abi tore family photographs from the walls and burned them in what he called a “death ritual.” He announced that he was a prophet of God. He stole our cars. Two of our other children were living at home, and all of us woke up every day terrified to find out what had happened in our home overnight. Abi was diagnosed with schizophrenia, but as is often the case, he was unable to perceive that he was ill. Nothing — not psychiatric care, not even police intervention — could convince him he needed help. Then he turned 18. He became an adult in the eyes of the state, and that was the end of our influence.
Now, three years later, Abi drifts from parking garages to homeless shelters, panhandling on sidewalks for a few coins. He won’t come home; he won’t even stop by for food or medicine.
Every few months, he acts out more than usual and he is hospitalized. Doctors administer enough medication to briefly calm him, then label him “stable” and “not a harm to self or others” and discharge him back to the streets, where he is exposed to harsh winter nights without any support — sometimes even without shoes or a jacket.
This is not anonymous urban homelessness. It is local and relational, playing out in full view of his childhood friends, former teachers and soccer coaches. They don’t know how to help him any more than we do.
At one especially dark moment of despair, I found myself wishing he had cancer instead.
I know that sounds crazy, and of course it is. As a psychotherapist, I sit with families every day whose children face illness, pain and death. I lost my beautiful 7-year-old niece to a brain-stem tumor. I understand the weight of a cancer diagnosis and I wouldn’t actually wish it on anyone, certainly not my own child. But I have seen how people respond to cancer: with urgency, empathy and effort. When someone has cancer, there are people to turn to, people who really try to help. When the daughter of a woman I know finished treatment, the hospital staff gathered to watch as she rang a bell they keep on hand for such occasions, and everyone erupted into applause.
There is no bell for mentally ill individuals marking their survival through another brutal season of homelessness, wandering the streets untreated, unsheltered and utterly vulnerable.
Since Jan. 1, 2024, Abi has been in hospital emergency rooms at least 20 times. Sometimes we hear about it in time to steel our hearts and go see him. We know that he will have been medicated, and might even be lucid, but we also know that he will soon be discharged — with prescriptions he cannot fill, appointments he cannot organize and instructions he cannot follow — and we will lose him again. At our last visit in November he expressed his confusion: “It’s a conundrum,” he said, the sweet, innocent kid we once knew shining briefly through the disease. “I don’t know where to go, I don’t have a way to get to the pharmacy, I don’t even have a wallet.”
When I questioned the latest social worker assigned to deal with us about his unsafe discharge plan, I was met with a dismissive shrug: “Ma’am, I know how you feel, but there is nothing we can do.”
“You know how I feel?” I shouted, despite bracing myself for this by now predictable interaction. “Do you have a mentally ill, homeless son sleeping in parking lots, who cannot keep himself alive because no one will intervene unless he is actively violent or dying?”
HIPAA rules add a cruel paradox. Doctors ignore us, despite our pleas that the illness makes it impossible for our son to manage his own care. Hospital administrators ignore our urgent emails and calls requesting longer-term treatment. All in the name of protecting Abi’s privacy.
The court in our leafy, upper-middle-class suburb notes offenses such as defiant trespassing or lewdness, and issues summonses that come and go, unheeded. We recently begged for police officers to intervene with Abi, or even to arrest him. A lieutenant responded, “Please forward any further inquiries, communications, etc. through the township attorney’s office.” I’m familiar with bureaucratic stonewalling, but that is a failure of basic humanity.
Some angels do emerge, typically those with the least power. Immigrant shop owners offer our son food or clothing. They often express dismay that this country treats mental illness so poorly. They tell me to send him back to Ethiopia, where we adopted him, because he’ll get better support there.
The irony is unbearable. We adopted our son believing America would keep him safe. Instead, our systems repeatedly release him into danger because technically, on paper, he has rights: rights that do not earn him care, rights that do not protect him, rights that prevent professionals from intervening. As one psychiatrist put it bluntly, my son may “die with his rights on.”
We do not need to return to the large, abusive psychiatric asylums of the past, but the law has swung so far toward individual autonomy that the concept of “do no harm” has all but vanished. If someone is so severely ill that he clearly cannot care for himself, it should be possible for him to be committed. And once committed, it should be possible for him to get actual care, rather than being pushed back out the door by an insurance system that rewards brief stabilization over comprehensive long-term treatment. Being left to die on the street is not freedom.
More than anything else I have ever wanted, I want to stop this revolving door. I want schizophrenia to be treated with the same urgency, seriousness and continuity as any other life-threatening illness.
I want physicians who are determined, and empowered, to pursue real care. I want social workers who engage beyond scripts. I want police officers who don’t shrug. I want judges who understand the futility of issuing summonses to someone who cannot organize his life. Finally, I want hospital discharge plans that lift people up instead of merely pushing them out.
I want my son’s life to be treated as though it is worth saving.
Madeline Till is a psychotherapist.
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