Songs from the Black Chair

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An ode to the residents of the Bellevue Men's Shelter

A thousand men each year sit in the black chair next to my desk. I am a mental health worker at the Bellevue Men's Shelter. These men are between 18 and 80 years old, usually black or Hispanic, usually with a psychiatric problem and a substance abuse history (crack, heroin, and alcohol), often with a forensic history (usually released from prison that day), and quite often with a major medical illness.

At some point during the interview with these men, I get around to these questions: "Are you hearing voices? Have you ever seen things that other people didn't see? Have you ever tried to hurt yourself?" A few times a month I hear responses like, "I thought about jumping in front of the subway," or "I can't tell you whether I'm going to hurt myself or not." Or I am shown wrists that have recently been cut, or bellies and limbs and necks with long scars. At that point, I calmly tell my clients in the black chair that I think they need to go to the hospital in order to be safe. Almost always they agree without complaint.

THE STAFF AND I are instructed to classify the men we see into one or more of the following official categories of disability or distress, as promulgated by New York City's mental health department:

SPMI [severely and persistently mentally ill]
MICA [mentally ill chemical abuser]
Axis II [personality disordered]
Medical
Forensic [released from jail or prison]
Over 60 Years Old
Mentally Retarded/Developmentally Disabled
Immigration
Physically Disabled
Vocational
Domestic

It's a nice list of nice bureaucratic categories, but it means nothing, really. I've created my own list. These, I've learned in my two years of sitting next to the black chair, are the far more descriptive and pertinent categories:

The travelers and wanderers
Guided by voices
Vietnam vets
Waylaid tourists, usually recently robbed
Criminals
"No English" and no papers
Various persons destroyed by alcohol, crack, heroin, or some other substance
Alzheimer's patients and other victims of senility
Manic in America
People who choose to live underground and in darkness
The truly weird, for whom we can find no category that fits

But all this I keep to myself. I sit at the computer and duly check off the city's official list.

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