Friends May Be the Best Medicine

“They give you sodium pentothal. I remember that they strap you down, so when you come to, you don’t fall off the table.”

That’s Nathaniel Anthony Ayers talking about shock therapy, which he had at the Woodruff Psychiatric Hospital in Cleveland some time after his first psychotic break several decades ago.

We were talking in his new apartment on skid row in downtown Los Angeles, where he was supposed to be giving me a cello lesson. But Nathaniel was in a chatty mood, reflecting on a life of great ambition and greater disappointment. I reached for a pen instead of a bow, and over the next 2 1/2 hours, he revealed aspects of his life he had never talked about before.

“I guess they don’t like quitters,” Nathaniel said. “I’d quit Juilliard, so they gave me shock therapy.”

I interrupted him. You didn’t quit Juilliard, I said. You had a nervous breakdown before completing your final year and ended up in a mental hospital.

Nathaniel had been living on the streets of downtown Los Angeles for years when I saw him playing a two-string violin in Pershing Square. In the year since I got to know him, he has never said more than a few words about his schizophrenia or the treatment he received many years ago. The man is seriously ill and I’m no doctor, so, as usual, I had no idea where we were headed as we began exploring the mysteries of his mind.

But I wondered if this was yet another step on his road to some form of recovery and a more honest assessment of his illness. He’s been sleeping in his apartment more and more, growing comfortable with the idea of running water and warm blankets. He’s been talking about working toward a recital with his cello teacher. And now he seemed to be frankly assessing his mental state.

I decided to plunge in. Sometimes, I told him, he seems to talk to people who aren’t there.

“Do I do that?” he asked with a look of dread. “That’s socially embarrassing when someone talks to himself rather than relate to a friend and participate in his surroundings.”

It sounded like something he’d heard years ago in therapy.

“I don’t know if I hear voices or not,” Nathaniel said after giving it more consideration. “I don’t know if what I’m hearing is abnormal. I think there’s an incredible amount of subconscious energy. It emits itself through the brain and into your nervous system.”

I’m told that Nathaniel has been closely observing fellow clients at Lamp -- the skid row center he visits -- as they act up. He appears to be recognizing his own behavior in theirs, according to Stuart Robinson, one of the agency’s directors, who said Nathaniel has been offering words of encouragement to his fellow travelers.

Since the topic was on the table, I asked Nathaniel -- as delicately as possible -- to describe the breakdown that landed him in a hospital years ago.

“I could not understand what was going on in New York,” he said.

Meaning what?

“I couldn’t understand what the constant attack from people was all about.”

What attack?

“A person smoking a cigarette in front of you.”

As we spoke, he pointed disgustedly to cigarette burns in the carpet, and after compulsively cleaning a window with a squirt bottle of 409, he scrubbed his hands at the bathroom sink. Then he checked the toilet and flushed it for the second time in five minutes.

“Then I had the pressure of my lessons,” he said of his days at Juilliard. “I was all alone, no family around, none of my people there.”

Your people?

“The black people.”

All of which must have made his worsening mental state more devastating and his recovery more daunting. Once his illness kicked in, Nathaniel said, he was prone to fistfights and all manner of abusive behavior, and he recalled the efforts of therapists to rein him in.

“They helped me understand I don’t want to behave in a violent way. I don’t need to be out of control.”

He’d left me an opening here, I thought. Maybe intentionally, maybe not. The few times it had come up in the past, Nathaniel had told me he wasn’t interested in doctors or therapy ever again. No way. But his mood sure sounded different now, so I asked if he would consider it.

“I will support any psychiatrist who will support me,” he said firmly, telling me that one particular doctor in Cleveland helped straighten him out for a while.

“My mind would not strive to be the best citizen I could be; my mind could not strive to do what’s best for Nathaniel. You have no idea what’s going on with God, country, yourself. Your relationship with your family erodes, you have no friends, no human desire. You get into fights.”

That sounds like a long time ago, I told him, reminding him of all his progress. Nathaniel nodded and said he’d like to make his own contribution to “the psychiatric environment.” I asked if he was saying he’d like to one day be a therapist, which isn’t as crazy as it sounds. Lots of mental health advocates are former clients.

“I’d want to be a music therapist,” Nathaniel answered, saying he’d prescribe music as medicine for the mind and soul. “The real reason for music is to create something to help you understand yourself.”

When I later spoke to Dr. Mark Ragins, a psychiatrist who has been one of my sounding boards for Nathaniel’s developments over the last year, he said the latest news is all good. He said that sometimes when people come indoors after living on the streets, it can take the edge off and make them less resistant to help. That could be what’s happening with Nathaniel. It’s the kind of story, he noted, that validates the plan to spend Prop. 63 money on housing and outreach for people who are mentally ill.

I asked if maybe Nathaniel was one of the lucky ones who seem to rebound from schizophrenia in middle age. He might be in the long run, Ragins said, but that type of recovery occurs over a much longer stretch. Instead, he said, he thought Nathaniel’s new friendships -- with me, Stuart Robinson at Lamp and others -- have driven his recovery.

“Relationship is primary,” Ragins said. It doesn’t have to be more than once a week, and it doesn’t have to be someone with an advanced degree in therapy. “It is possible to cause seemingly biochemical changes through human emotional involvement. You literally have changed his chemicals by being his friend.”

I wasn’t alone on this, but his point is an important one. Mentally ill people often wear out the patience of friends and family. Unless someone else comes along to take up the slack, they can become completely untethered.

Nathaniel has a long way to go, Ragins reminded me. Acknowledging your mental illness is frightening, he said, and so is coming to grips with the lost years. It takes tremendous courage to get through the day, let alone design a new world for yourself -- a world of new possibilities also presents new risks.

Don’t push him into therapy right away, Ragins suggested. He advised me to remind Nathaniel of the discrepancy between the life he envisions and the hurdles that stand in the way, and gently guide him toward therapy or whatever else might help.

Just before we left his apartment, Nathaniel said it was many months ago that he first considered coming in off the streets.

“When you gave me the Beethoven sonatas,” he said, “it gave me the idea of living in a house for the sole purpose of having a piano and learning something from the Beethoven statue” in Pershing Square. “The Beethoven statue encourages me to carry on with the most difficult challenges of my life.

“Professionalism, courtesy and respect. I read that on a police car door.”

He never disappoints.

As I began to leave, Nathaniel called me back and gave me a long, firm handshake. He held me in his glance and sealed something there, too.

My smile followed his, and neither of us needed to say a thing.