Once there were two women who were both named Katy. They lived in different apartments a mile from one another and never met, though their stories are similar. Each worked as a waitress, loved her independence, and owned a cat. They liked to read and tended their little gardens on the balconies of their separate apartments. They were both well liked by their neighbors and appeared neat and friendly to all who knew them.

The most striking similarity, however, was yet to come. A sinister disease began to manifest itself in both of their lives. It started when they began to make mistakes at work, and eventually lost their jobs. Some days they were fine, but there were times when the things they imagined seemed more real than the world around them. It frightened them and they worried that they were losing their minds. They were. They were often disorientated and important things were overlooked, like bathing. They sometimes forgot to feed their cats or clean the litter boxes, and their little gardens died of neglect.

They had difficulty sleeping and were occasionally seen wandering the neighborhood after midnight. Other times they sat for long periods in their apartments and stared at the walls. Neither could concentrate enough to read, anymore. They forgot to fix meals or eat, even when food was brought to them. Their families worried and suggested they shouldn’t be living alone; but both women resisted help, and imagined that those who tried were conspiring against them. Still, when it became obvious to everyone that they could no longer care for themselves, each Katy went to live with family. It didn’t work out for either of them. The Katys became more stubborn and irritable, and very impulsive. Occasionally they struck out violently at those who cared the most for them. No one could handle them anymore. Their families took them to see doctors, where each was diagnosed with a severe mental illness and treatment was started.

This is where their stories take very different turns. One Katy was moved to a nursing home where she is today. A full-time staff makes sure that she is cared for. She is treated with dignity even when her mind is far away and her actions inappropriate. Medicaid began to pay for her needs when her own meager funds were depleted. When she tries to leave the home, as she often does, a nurse gently guides her back to her room or the solarium where other patients gather to pass the time. It is understood that Katy no longer knows what is best for her, and no one questions her need to be cared for in a restricted and safe environment. There are activities, programs, nourishing meals and snacks. Someone combs her hair, does her nails, and makes sure she takes her medications. There are conferences where her caregivers compare notes and plan her treatment. Katy is not free -- but she is safe, and she is cared for.

Our second Katy was hospitalized immediately, where her treatment began. She was prescribed medications and after three weeks she was released from the hospital though she was far from rational or capable of caring for herself. Her family protested, saying it was too early. After she took her pills for a while, though, she got better. Katy thought more clearly and functioned on a limited level.

The side effects were troublesome, however, and she began to wonder if she needed the medication. When she went without them for a couple days, she felt more alert and so Katy decided to throw them away. Her family tried to reason with her, but Katy would not accept that she was ill. Conflicts arose that became worse as her symptoms reemerged. She began to hallucinate and sank deeper into her delusions. Her family tried to get her into a group home, but there were none available for someone not taking their medications. When she became unmanageable they called the crisis center to have her readmitted to the hospital.

They were told that, since Katy was not suicidal or threatening anyone, she could not be committed against her will. She has a right to do as she will, they said, as long as she is not hurting anyone else. When her family reasoned that she could not take care of herself, they were told that, since she had food and shelter, no matter who provides it, she was not in danger. Katy’s family tried again to make her take her medications, but it was no use. The pressures of the situation finally erupted in a family argument and Katy left, convinced that they were her enemies.

She had no where to go but the streets and that is where she is today. Though Social Security sends modest disability checks, Katy can’t gather the wit to find an apartment, so she sleeps at a shelter at night and eats her meals at a downtown mission. She drinks to deal with the hallucinations and lives in fear that alcohol will be taken away from her. Her family doesn’t know where she is most of the time, and when they do make contact, their intentions are suspect. Katy is alone, haunted by the voices she hears and held captive by her delusions.

She is afraid of the streets, but more afraid to go home. There is no staff to care for her – no activities and programs, no one to see that her hair is combed and certainly no one to make sure she takes her medications. No caregiver conferences comparing notes and planning treatment. The vagrants on the street are Katy’s companions. There is no dignity in the way she lives, and no respect afforded her. Katy’s inappropriate words and actions are met with judgmental stares or a turned head, and no one wants to get close to her unwashed body. No nurse gently guides her back to safety. She has the right to be crazy.

Both Katys have a severe brain disorders and neither understands the nature of her illness or its implications. They both deserve to be cared for in a restricted and safe facility by people who understand their illness and who treat them with dignity. The only difference is in society’s perception. The first Katy is 67 and has Alzheimer’s disease. We associate Alzheimer’s with the vulnerability of age and so we appreciate the fragile nature of her disability and provide for her with our tax dollars.

Our second Katy is 31 and suffers from schizophrenia. She is no less vulnerable and her suffering is a national disgrace. She is being discarded by a society that is offended by the pitiful human wreckage that we allow to waste away before our eyes.