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Welcome to the mentally ill on Elm Street

Central Manor – the worst is when people check out

“All I want to do is stay in bed and hide and burn incense.’’ - Image by Craig Carlson
“All I want to do is stay in bed and hide and burn incense.’’

Last March 16, Marshall could no longer tolerate sharing a dingy nine-by-eleven-foot room with someone who talked nonstop about the CIA and who woke him intermittently during the night searching for bullet holes. “Living with screwballs is driving me nuts,” he told the assistant manager of Central Manor. “If I don’t get my own room, either he’ll kill me or I’ll kill him,”'he warned. “I can’t stand it another minute!"

In 1979 Paul was cast in the title role in the UCSD production of Agamemnon.

Before he left with his few personal belongings, Marshall demanded his medications. As the assistant manager gave him 110 fifty-milligram tablets of the antidepressant imipramine and thirty-six five-milligram tablets of Ativan, a mild tranquilizer, he recorded the amounts in Central Manor’s daily log.

Central Manor owner George Latham was arrested for soliciting a former employee to murder his daughter-in-law.

From the corner of Fourth and Elm streets, Marshall began walking south toward the Greyhound Bus Station. But he didn’t have the price of a bus ticket. He had lost track of his two children and three former wives. Even if he did have the money, where would he go?

After the front door is locked at 11:00 p.m., they enter through a back door left open by some of the residents.

At the Burger King at Fourth and C, he bought a Coke to wash down all the pills. Next, he called the licensing department of the state’s department of social services to complain about the quality of food at Central Manor and about broken locks on three of the bathroom doors. Then he called one of the therapists at the Downtown Mental Health Center on Sixth Avenue. “I just swallowed 146 pills,” he announced, and he hung up. I could hide in the bushes around the Civic Center and I could die there quietly, he figured.

The dosage hardly seemed to affect him. Before walking to the Civic Center, Marshall stopped at a cocktail lounge near the courthouse. He remembers ordering a Scotch and soda and feeling woozy when he lit a cigarette. When he woke up in Mercy Hospital connected to several tubes, he heard someone say he was "damn lucky to be alive.” Marshall didn’t think so. Ten days later, he was back on Elm Street eating from trash bins and sleeping on the floor of somebody's room in Central Manor, until management discovered his presence. Then Marshall was reinstated in one of the largest of San Diego County’s resident homes for ambulatory, mentally disordered adults.

Marshall’s history of suicide attempts began fifteen years ago with an overdose of sleeping pills. Last summer, when he slit his wrists with a razor, his blood clotted. When police heard him moaning in a Pacific Beach alley, he calmly told them he was bleeding to death. They took him to CMH (County Mental Health Hospital) in Hillcrest, the county-run acute care facility for mental patients.

Ask Marshall how he got to Central Manor, and he’ll say it was via Norfolk, Virginia, where he was born nearly fifty years ago. “My mentally unbalanced grandmother raised me,” he says. “She dressed me all in white and kept me indoors, away from other children because they had germs.” When he started school, Marshall was terrified of the children. Probably because he hadn’t built an immunity to germs, he was chronically ill and often stayed home. Although he managed to learn the alphabet, he fell far behind in reading. “To inspire me, my family beat me with a razor strap,” he says. “In front of the whole class, my mother told the teacher not to send any homework home because it wasn’t her job to teach me. From the third grade on, I spent most of my time helping the janitor paint,” he remembers. “And I never learned to read ” When he was fourteen, he dropped out altogether. Despite his limited formal education, Marshall was, and is, remarkably well-informed. “I learned a lot by watching educational television and news programs,” he says. “Edward R. Murrow was my hero.” He also learned magic, and he mastered enough tricks to perform at PTA functions. Eventually, the lounge acts he created provided a third of his income, he says. The rest came from driving a cab. “The State of Virginia gave me the written test orally,” he claims. But competing in a literate world exhausted him. “Every time I logged an address, I had to get out of the cab and painstakingly copy each letter of the street name,” he recalls. “Filling out forms was another nightmare.” After eighteen years of driving cabs and performing magic, the daily struggle to fake it became increasingly frustrating. His anger swelled to a fury that drove away his wives. When the stress became unbearable, he sought help. Tests revealed that his intelligence was above average; in abstract thinking, Marshall says he scored genius level.

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Three years ago, Marshall severed his ties with Norfolk. He sold his house, his car, and his magic equipment, and he made his way west to Santa Monica, where he overdosed on pills again. He wound up in a Salvation Army building mopping floors and sorting clothing in exchange for room, board, and unsolicited salvation. There he discovered the Laubach Literacy Program, and three years ago, he began learning to read. As soon as his potential was recognized, the former cabbie was put on the Salvation Army payroll. “I was a desk man, essentially the assistant manager. I had the power to kick peopie out,” Marshall laughs, “and I was illiterate.”

But the unrelenting proselytizing in that environment soon became intolerable. From his salary, he managed to save $300, and in June of 1986, he took a bus to San Diego. As his funds expired, his despair increased. He lived on the streets, slept in doorways, and sought help from crisis centers and from CMH. On cool nights, he lived in a gulley in Hillcrest in a big cardboard box that he lined with plastic. “I kept warm with a blanket I stole off a truck,” he says. He took cold showers at the beach and warm showers in missions, where he ate twice a week. Other times he ate from trash cans. When he sold his plasma to the San Diego Plasma Center on F Street, he had enough cash to wash his two sets of clothing and to buy tobacco and marijuana.

Marshall has been to both clinics and hospitals. “Once when I went to CMH, I asked them to put me to sleep permanently. I didn’t have the balls to do it myself, and I was sick of shrinks, sick of living in the streets, and sick of scumhole clinics,” he says. Although his depression was evident, psychiatric evaluations determined him to be only temporarily unable to work. That meant he was ineligible for SSI (Supplemental Social Security Income) of $632 per month, but he was entitled to general relief, a county program that would pay $225 per month, even if he stayed on the streets. If he lived in a resident home, the county would pay the facility directly for his board and care, and he’d get a separate fifteen-dollar monthly check for pocket money. His medication would be provided by CMH.

So last November, Marshall got one of the fifty-five beds in Central Manor, one of the few of the county’s one hundred residence homes (also known as board and cares) that take mental patients on general relief. Marshall liked the central location. He knew that physical exercise helps counter depression, so he walked to the downtown YMCA and swam a mile a day, six days a week, paying the fees from the twenty dollars or so he got each week for selling his plasma. He motivated Paul, another Central Manor resident, to go with him and work out with weights. And he resumed studying the Laubach Literacy Program at the Episcopal Church on the next block. For six hours each week, he was tutored by Evelyn Allen, a volunteer. “Marshall was very eager to learn. He was making great progress and moved up several levels,” says Allen. “He especially loved reading mysteries with a real plot.”

She was the first person Marshall called when he returned to Central Manor after his suicide attempt last March. He told her it was impossible for him to study in a small room with someone who seldom bathes and who keeps him awake all night. “If I had my own room. I’d be able to concentrate,” he explained. Allen agreed to subsidize the payments. From a small state pension and from her own social security check, the eighty-one-year-old childless widow began giving Marshall forty-seven dollars a month so that he could have a private room. Although he still hasn't returned to the reading program, Allen has taken Marshall to Sea World and the Wild Animal Park. When they went to the Space Theater in Balboa Park, they included Paul, whom Marshall's considers his closest friend. Last Mother's Day, at Marshall’s behest, Paul composed a Mother’s Day poem that the pair sent to Allen.

Paul and Marshall are an odd combination. Some of Paul’s poetry and prose have been published in literary journals. (His name has been changed in this story.) He owns thousands of books, for which he’s been paying hefty public storage charges since 1979. He has lived in San Diego for most of his forty-two years, graduated from the University of San Diego, and received a master’s degree in English Literature from the University of California at Santa Barbara. In 1976 he taught writing at the University of San Diego. Later he became a teaching assistant in UCSD's drama department, where he’d been studying for another master’s degree in fine arts. He won critical acclaim on many local stages including the Old Globe, Cassius Carter, and the Coronado Playhouse. In 1979 Paul was cast in the title role in the UCSD production of Agamemnon. The script foreshadows Orestes killing his mother. It had such a powerful effect on Paul that it triggered a mental breakdown. (His first breakdown occurred seven years earlier in Pakistan, where he had been studying Arabic, called himself Omar, and was planning to become a Moslem.) “During a rehearsal, I was taken to Mercy Hospital. I had to drop out of the play,” Paul remembers. After his release from Mercy’s psychiatric unit, he stayed with his mother in her Pacific Beach home, where he killed her in order to spare her from the nuclear holocaust, which he sensed was imminent.

The five years of treatment he received in Patton State Mental Hospital near San Bernardino was paid for from the trust fund set up from the proceeds of his mother’s estate. Anguished over his crime, he often contemplated suicide. “But I figured I'd muff it and they’d keep me in there longer,” Paul says, “so I never tried.” Three years ago, he was transferred to the psychiatric security unit at the downtown county jail, then paroled to Central Manor. When he first arrived, he wrote:

  • In Central Manor, near Balboa Park, one lives a fitful life from day to day. commingling with the derelicts who stay in the lobby, on the porch, in rooms dark with stains of shattered sensibilities.

This excerpt refers to street people who wander in and out of Central Manor, especially at night. After the front door is locked at 11:00 p.m., they enter through a back door left open by some of the residents. They create disturbances by knocking on doors late at night. Sometimes they sleep in the laundry room. “When they’re caught, they get thrown out,” Paul says. “But they come back. People on the street know about this place.”

Paul and another man who sells newspapers at the Padres’ games are the only two residents who hold outside jobs. In the evenings, Paul takes the bus to North Park, where he sells subscriptions to the San Diego Union and the Tribune by telephone. Although his probation is open-ended, Paul will most likely be permitted to live on his own when he works full time; he has applied to the community colleges for a teaching credential. Last spring illegal drugs showed up in a routine urine test ordered for him by the probation department, and Paul spent the month of May in jail. “One night Marshall and I got high together,” he shrugs.

Marshall is always high. So he says. “All I want to do is stay in bed and hide and burn incense.’’ he yawns. Since Central Manor is only two blocks from the park, marijuana is easy to come by. But Marshall doesn’t have to leave the building, he says, to get illegal drugs. Before his last suicide attempt, one of the janitors fronted him, he alleges, with an eighty-dollar ounce of marijuana, which Marshall split into fourteen dime bags. “The profit supported my habit for a while,” he says. “Sometimes I sold a joint at a time for a dollar apiece.” On weekends and late at night, a janitor is the sole employee on the premises. In addition to cleaning the building, scrubbing floors, sinks and bathtubs, laundering bed linens, and answering the phone, he is responsible for fifty-five mental patients and for dispensing and denying their medications. He makes $3.80 per hour. No pharmacology background is required, nor is a high school diploma. According to an official in the state licensing department, anyone who’s been fingerprinted is qualified to hand out medication. And the patients have the right to refuse it. Since there is no Nurse Ratchet on duty, Marshall sometimes takes the cup of pills into his room to store in his top drawer. “No one watches to see if I swallow them,” he says, “and I'm suicidal.” One of the janitors, whose last job was in construction. has been enrolled in a drug-abuse program. “I used to sell codeine on the streets,” he tells a Central Manor resident who wants codeine for a toothache.

Besides dope, cigarettes are in big demand at Central Manor. “Gotta cigarette?” is a common refrain heard in the small lobby, on the front steps, and outside on the street. If the answer is no, the borrower requests “shorts” — the short end when there’s only a couple of drags left. Some offer to buy a single cigarette for a dime. “Everything’s negotiable here,” Paul says. For nine dollars, he recently bought two weeks left of a monthly bus pass from one of the residents.

The ratio of men to women at Central Manor is about six to one. Sex is for sale on the premises, either for cash or dope. “I pay two dollars,” smiles Paul, who says the “urge is active and the price is right.” A mother of three who has traded sexual favors for a single joint says she’s available outside the building, too. “When I go into cars,” she explains in an enchanting, mellifluous voice, “I get ten dollars.” Some of the residents at the New Palace Hotel next door also pay her. “In prisons, people know the consequences of their actions," Marshall figures, “but here, half these people don't understand that they can get AIDS and spread it.”

Daily mail call at 10:00 a.m. is a big event at Central Manor. “Everyone is waiting for a check,” Paul explains. Also important are the Friday-morning house meetings, which are usually run by Marco Flores, the administrator. Flores has no degree in social work or in psychology, no degree at all, in fact. But he has taken a few business administration classes at National University, which help him order supplies and keep the books. Marshall says the main topic at house meetings is housecleaning. “Behavior is discussed, too,” says Flores, who explains that residents who stay in bed all day are reprimanded. Those who attend the meetings are rewarded with candy bars.

“We used to give out cigarettes,” Flores admits, “until another board and care was sued by the family of someone who developed lung cancer.” For years, room inspections have been made twice weekly by two of the residents. “They check to see if beds are made and if towels are missing,” explains Flores. “They get paid seven dollars a week.” When some of the residents perform work therapy, they are paid by the job. Dishwashing pays about two dollars a shift, and serving meals pays a dollar. “It’s easy to avoid paying minimum wage by calling it work therapy,” Paul says.

Built in 1928 by the Knights of Columbus, the Elm Street building was a meeting hall until 1939, when the Bank of America foreclosed. After local businessman George Latham bought the building from the bank, he remodeled it and operated a fifty-bed hospital called the Fourth Avenue Hospital. “Later it was called the Balboa Hospital,” explains Latham, who owned several other small private hospitals as well as the Hitching Post Motels. Ten years ago, when the Latham family applied for a board and care license. Central Manor was set up as a family corporation with a board of directors — Latham, his wife, son, and grandson.

The following year, patriarch George Latham was arrested for soliciting a former employee to murder his daughter-in-law. Before the bail hearing was set, the San Diego Union reported that in 1920, Latham had been convicted by a North Dakota court of being an accessory to murder. However, San Diego Superior Court records indicate only that Latham admitted to a drunk arrest about seventy-five years ago; he would have been eleven years old. On Valentine’s Day of 1979, Latham pleaded guilty to the murder solicitation charge. Judge Earl Gilliam fined him $5000, sentenced him to three years' probation, and ordered Latham to undergo psychiatric and/or psychological therapy. Although he will be eighty-seven years old in December, Latham still attends monthly board meetings and turns up on Saturdays for lunch. He is also seen several times a week walking around the premises with a plunger. “I'm the plumbing inspector, too,” he says cordially.

Although state licensing files show no record of Latham's past, they do show complaints about soiled carpets, short supplies, and inoperable emergency buttons. But state social workers who make frequent periodic unannounced visits report that many of the complaints made by Central Manor's residents are unsubstantiated. They overlook the dimly lit and poorly ventilated rooms — inside rooms share an air shaft in lieu of windows. And they ignore the malingering odors of stale urine, vomit, and smoke.

Contrary to common belief, board and care homes are not halfway houses. They are set up for mental patients who take their medications regularly, who remain stable, and who can function without being in a hospital. But the residents need structure until they can live independently. Half never make that transition, according to Flores. He predicts that some of the residents will be living in Central Manor forever. “But they don't cause the trouble that ‘high-functioning’ residents like Marshall do," Flores notes.

“That’s because some of the others are kept in chemical straitjackets and they're zombies," Marshall argues. “This place is a warehouse," he continues, “and we’re the inventory." Paul says that some of the people he met at Patton were better able to function than some of the Central Manor population.

Sally has been in what mental patients call the “mental health system" for thirty-three of her forty-nine years; she has spent the past decade in Central Manor. She seldom leaves her room except when she goes to the liquor store on Fifth and Elm to buy a Coke. She refuses medication and lotions for the scabies that covers her body. Like Sally, many of the building’s residents never get beyond Elm Street, never beyond the liquor store. Some have come to Central Manor from San Diego’s streets, alleys, and doorways. Others come from jails, prisons, hospitals, and other board and cares. When John was arrested several months ago for shoplifting, he was too drunk, he says, to remember the details. “The judge OR’d me and sent me to Central Manor. I'll be forty-two soon. I've been in and out of board and cares and jails and hospitals since 1972, when my head problems started. Probably because I did some acid. My folks are fed up. They want me to get a job,” he explains. John continually borrows cigarettes and money and stays up most of the night. When he gathers enough cash to buy a bottle of liquor, he creates disturbances and the other residents complain. His goal, he says, is to get a private room. “So I can sneak girls in at night," he smiles.

The first indication of Ted’s schizophrenic paranoia appeared when he was nine years old. He never finished high school, and he’s spent more than half his forty-three years in psychiatric units at Mercy, CMH, Clairemont Hospital, and in local resident homes. He has been living in Central Manor on and off since 1980. “I feel more comfortable with mental patients than with regular people,*' Ted says. He doesn’t go on outings or on buses because he is also agoraphobic. He spends most of his time alone listening to his Walkman, smoking cigarettes, and drinking coffee. Every day Ted goes to bed after he receives his 5:00 p.m. medication. “I don't like to eat,” he explains, so he skips dinner.

He usually rises at 1:00 a.m. and drinks coffee and smokes cigarettes until five the next afternoon.

Ted's sister is also a mental patient. They grew up in La Jolla. Despite Ted's general fears, he says he feels safe living in Central Manor. There are things that bother him, though. “Con games go on all the time,” he says. “Everyone's trying to con me out of money and cigarettes. They promise to pay me back, but they never do. And the toilets are always getting jammed,” he adds. “Some people throw three rolls of toilet paper down the toilet.” Ted figures that the residents who deliberately urinate and defecate on the floor right next to the toilets are expressing their anger against authority. “Once someone lit his sheets on fire. Another time someone came down the stairs naked,” he continues. “Everything that happens in a mental hospital happens here.”

What disturbs Ted most is that sometimes residents simply wander off and disappear. “I never see them again. I never know what happened to them. But the worst is when people check out,” he explains. “Two years ago, my best friend jumped off the Laurel Street bridge. It was Christmas week. He was depressed because he didn't get along with his parents. His mother wanted him to wash the dishes.” That same week, one of the female residents jumped off the same bridge. Last year, one of Central Manor's most deeply disturbed residents hanged himself in the closet of his room.

“I've always fallen in love with the wrong men,” explains Monica, a thirty-one-year-old former data processor who was in the navy, stationed in London when her trouble began. (Monica is not her real name.) “The last time, it was Prince Andrew,” she continues. “Scotland Yard investigated me because I was sending him letters. I guess they were pretty bizarre.” As a result of the investigation, Monica was discharged from the Navy three and a half years ago. Since she left the VA hospital, she has been living in San Diego board and care facilities. She takes buses and handles her own money. Her income is much higher than any other Central Manor resident, and the VA and SSI checks come directly to her. Money is a big issue with Monica. Because she refused to pay rent, she was evicted from Mora Manor, a board and care in Spring Valley. Since May, she has not paid rent for her private room in Central Manor. She has ignored eviction notices.

Since I’ve been here, my medication has increased. I’ve turned into an animal. I do things I never thought I’d be doing,” Marshall says on a recent midsummer night. “Like selling dope to mental patients. Like eating meat with my fingers because there aren’t any knives here. I feel dehumanized. My incentive to swim and learn to read is gone. It’s become an effort for me to walk downtown to sell my plasma. But I have to so I can buy cigarettes and toothpaste. They’re supposed to supply toothpaste here, but they’re always out of it. Sometimes I walk downtown for nothing. When my blood pressure gets too high from tension, they don’t let me donate,” he says.

He is sitting on the front steps, smoking. Some of the men are leaning against the side of the building. One man is lying on a tiny patch of grass in front. Silhouetted against a smoky charcoal purplish sky, the full moon peers beyond a motionless palm tree. In the bright moonlight, the uncovered windows glare, making the stark white building look as hollow as a stage set. Marshall watches the taxis pass. “I’ll take the one on the left,” yells a man in a painter’s cap as the men watch a group of young women walk by. “I’ll take them all,” brags another resident in army fatigues. “Gotta cigarette?” John asks. “Got a quarter?” asks Sally.

“Hey, Jesse, why do you always carry that water jug?” Marshall asks a man whose plastic water bottle has become a trademark because he is never seen without it. The answer comes slowly from the forty-five-year-old Berkeley graduate who seldom says anything. “Maybe,” he pauses to stroke his graying beard, “Jesse wonders why everyone doesn’t carry a water jug.”

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“All I want to do is stay in bed and hide and burn incense.’’ - Image by Craig Carlson
“All I want to do is stay in bed and hide and burn incense.’’

Last March 16, Marshall could no longer tolerate sharing a dingy nine-by-eleven-foot room with someone who talked nonstop about the CIA and who woke him intermittently during the night searching for bullet holes. “Living with screwballs is driving me nuts,” he told the assistant manager of Central Manor. “If I don’t get my own room, either he’ll kill me or I’ll kill him,”'he warned. “I can’t stand it another minute!"

In 1979 Paul was cast in the title role in the UCSD production of Agamemnon.

Before he left with his few personal belongings, Marshall demanded his medications. As the assistant manager gave him 110 fifty-milligram tablets of the antidepressant imipramine and thirty-six five-milligram tablets of Ativan, a mild tranquilizer, he recorded the amounts in Central Manor’s daily log.

Central Manor owner George Latham was arrested for soliciting a former employee to murder his daughter-in-law.

From the corner of Fourth and Elm streets, Marshall began walking south toward the Greyhound Bus Station. But he didn’t have the price of a bus ticket. He had lost track of his two children and three former wives. Even if he did have the money, where would he go?

After the front door is locked at 11:00 p.m., they enter through a back door left open by some of the residents.

At the Burger King at Fourth and C, he bought a Coke to wash down all the pills. Next, he called the licensing department of the state’s department of social services to complain about the quality of food at Central Manor and about broken locks on three of the bathroom doors. Then he called one of the therapists at the Downtown Mental Health Center on Sixth Avenue. “I just swallowed 146 pills,” he announced, and he hung up. I could hide in the bushes around the Civic Center and I could die there quietly, he figured.

The dosage hardly seemed to affect him. Before walking to the Civic Center, Marshall stopped at a cocktail lounge near the courthouse. He remembers ordering a Scotch and soda and feeling woozy when he lit a cigarette. When he woke up in Mercy Hospital connected to several tubes, he heard someone say he was "damn lucky to be alive.” Marshall didn’t think so. Ten days later, he was back on Elm Street eating from trash bins and sleeping on the floor of somebody's room in Central Manor, until management discovered his presence. Then Marshall was reinstated in one of the largest of San Diego County’s resident homes for ambulatory, mentally disordered adults.

Marshall’s history of suicide attempts began fifteen years ago with an overdose of sleeping pills. Last summer, when he slit his wrists with a razor, his blood clotted. When police heard him moaning in a Pacific Beach alley, he calmly told them he was bleeding to death. They took him to CMH (County Mental Health Hospital) in Hillcrest, the county-run acute care facility for mental patients.

Ask Marshall how he got to Central Manor, and he’ll say it was via Norfolk, Virginia, where he was born nearly fifty years ago. “My mentally unbalanced grandmother raised me,” he says. “She dressed me all in white and kept me indoors, away from other children because they had germs.” When he started school, Marshall was terrified of the children. Probably because he hadn’t built an immunity to germs, he was chronically ill and often stayed home. Although he managed to learn the alphabet, he fell far behind in reading. “To inspire me, my family beat me with a razor strap,” he says. “In front of the whole class, my mother told the teacher not to send any homework home because it wasn’t her job to teach me. From the third grade on, I spent most of my time helping the janitor paint,” he remembers. “And I never learned to read ” When he was fourteen, he dropped out altogether. Despite his limited formal education, Marshall was, and is, remarkably well-informed. “I learned a lot by watching educational television and news programs,” he says. “Edward R. Murrow was my hero.” He also learned magic, and he mastered enough tricks to perform at PTA functions. Eventually, the lounge acts he created provided a third of his income, he says. The rest came from driving a cab. “The State of Virginia gave me the written test orally,” he claims. But competing in a literate world exhausted him. “Every time I logged an address, I had to get out of the cab and painstakingly copy each letter of the street name,” he recalls. “Filling out forms was another nightmare.” After eighteen years of driving cabs and performing magic, the daily struggle to fake it became increasingly frustrating. His anger swelled to a fury that drove away his wives. When the stress became unbearable, he sought help. Tests revealed that his intelligence was above average; in abstract thinking, Marshall says he scored genius level.

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Three years ago, Marshall severed his ties with Norfolk. He sold his house, his car, and his magic equipment, and he made his way west to Santa Monica, where he overdosed on pills again. He wound up in a Salvation Army building mopping floors and sorting clothing in exchange for room, board, and unsolicited salvation. There he discovered the Laubach Literacy Program, and three years ago, he began learning to read. As soon as his potential was recognized, the former cabbie was put on the Salvation Army payroll. “I was a desk man, essentially the assistant manager. I had the power to kick peopie out,” Marshall laughs, “and I was illiterate.”

But the unrelenting proselytizing in that environment soon became intolerable. From his salary, he managed to save $300, and in June of 1986, he took a bus to San Diego. As his funds expired, his despair increased. He lived on the streets, slept in doorways, and sought help from crisis centers and from CMH. On cool nights, he lived in a gulley in Hillcrest in a big cardboard box that he lined with plastic. “I kept warm with a blanket I stole off a truck,” he says. He took cold showers at the beach and warm showers in missions, where he ate twice a week. Other times he ate from trash cans. When he sold his plasma to the San Diego Plasma Center on F Street, he had enough cash to wash his two sets of clothing and to buy tobacco and marijuana.

Marshall has been to both clinics and hospitals. “Once when I went to CMH, I asked them to put me to sleep permanently. I didn’t have the balls to do it myself, and I was sick of shrinks, sick of living in the streets, and sick of scumhole clinics,” he says. Although his depression was evident, psychiatric evaluations determined him to be only temporarily unable to work. That meant he was ineligible for SSI (Supplemental Social Security Income) of $632 per month, but he was entitled to general relief, a county program that would pay $225 per month, even if he stayed on the streets. If he lived in a resident home, the county would pay the facility directly for his board and care, and he’d get a separate fifteen-dollar monthly check for pocket money. His medication would be provided by CMH.

So last November, Marshall got one of the fifty-five beds in Central Manor, one of the few of the county’s one hundred residence homes (also known as board and cares) that take mental patients on general relief. Marshall liked the central location. He knew that physical exercise helps counter depression, so he walked to the downtown YMCA and swam a mile a day, six days a week, paying the fees from the twenty dollars or so he got each week for selling his plasma. He motivated Paul, another Central Manor resident, to go with him and work out with weights. And he resumed studying the Laubach Literacy Program at the Episcopal Church on the next block. For six hours each week, he was tutored by Evelyn Allen, a volunteer. “Marshall was very eager to learn. He was making great progress and moved up several levels,” says Allen. “He especially loved reading mysteries with a real plot.”

She was the first person Marshall called when he returned to Central Manor after his suicide attempt last March. He told her it was impossible for him to study in a small room with someone who seldom bathes and who keeps him awake all night. “If I had my own room. I’d be able to concentrate,” he explained. Allen agreed to subsidize the payments. From a small state pension and from her own social security check, the eighty-one-year-old childless widow began giving Marshall forty-seven dollars a month so that he could have a private room. Although he still hasn't returned to the reading program, Allen has taken Marshall to Sea World and the Wild Animal Park. When they went to the Space Theater in Balboa Park, they included Paul, whom Marshall's considers his closest friend. Last Mother's Day, at Marshall’s behest, Paul composed a Mother’s Day poem that the pair sent to Allen.

Paul and Marshall are an odd combination. Some of Paul’s poetry and prose have been published in literary journals. (His name has been changed in this story.) He owns thousands of books, for which he’s been paying hefty public storage charges since 1979. He has lived in San Diego for most of his forty-two years, graduated from the University of San Diego, and received a master’s degree in English Literature from the University of California at Santa Barbara. In 1976 he taught writing at the University of San Diego. Later he became a teaching assistant in UCSD's drama department, where he’d been studying for another master’s degree in fine arts. He won critical acclaim on many local stages including the Old Globe, Cassius Carter, and the Coronado Playhouse. In 1979 Paul was cast in the title role in the UCSD production of Agamemnon. The script foreshadows Orestes killing his mother. It had such a powerful effect on Paul that it triggered a mental breakdown. (His first breakdown occurred seven years earlier in Pakistan, where he had been studying Arabic, called himself Omar, and was planning to become a Moslem.) “During a rehearsal, I was taken to Mercy Hospital. I had to drop out of the play,” Paul remembers. After his release from Mercy’s psychiatric unit, he stayed with his mother in her Pacific Beach home, where he killed her in order to spare her from the nuclear holocaust, which he sensed was imminent.

The five years of treatment he received in Patton State Mental Hospital near San Bernardino was paid for from the trust fund set up from the proceeds of his mother’s estate. Anguished over his crime, he often contemplated suicide. “But I figured I'd muff it and they’d keep me in there longer,” Paul says, “so I never tried.” Three years ago, he was transferred to the psychiatric security unit at the downtown county jail, then paroled to Central Manor. When he first arrived, he wrote:

  • In Central Manor, near Balboa Park, one lives a fitful life from day to day. commingling with the derelicts who stay in the lobby, on the porch, in rooms dark with stains of shattered sensibilities.

This excerpt refers to street people who wander in and out of Central Manor, especially at night. After the front door is locked at 11:00 p.m., they enter through a back door left open by some of the residents. They create disturbances by knocking on doors late at night. Sometimes they sleep in the laundry room. “When they’re caught, they get thrown out,” Paul says. “But they come back. People on the street know about this place.”

Paul and another man who sells newspapers at the Padres’ games are the only two residents who hold outside jobs. In the evenings, Paul takes the bus to North Park, where he sells subscriptions to the San Diego Union and the Tribune by telephone. Although his probation is open-ended, Paul will most likely be permitted to live on his own when he works full time; he has applied to the community colleges for a teaching credential. Last spring illegal drugs showed up in a routine urine test ordered for him by the probation department, and Paul spent the month of May in jail. “One night Marshall and I got high together,” he shrugs.

Marshall is always high. So he says. “All I want to do is stay in bed and hide and burn incense.’’ he yawns. Since Central Manor is only two blocks from the park, marijuana is easy to come by. But Marshall doesn’t have to leave the building, he says, to get illegal drugs. Before his last suicide attempt, one of the janitors fronted him, he alleges, with an eighty-dollar ounce of marijuana, which Marshall split into fourteen dime bags. “The profit supported my habit for a while,” he says. “Sometimes I sold a joint at a time for a dollar apiece.” On weekends and late at night, a janitor is the sole employee on the premises. In addition to cleaning the building, scrubbing floors, sinks and bathtubs, laundering bed linens, and answering the phone, he is responsible for fifty-five mental patients and for dispensing and denying their medications. He makes $3.80 per hour. No pharmacology background is required, nor is a high school diploma. According to an official in the state licensing department, anyone who’s been fingerprinted is qualified to hand out medication. And the patients have the right to refuse it. Since there is no Nurse Ratchet on duty, Marshall sometimes takes the cup of pills into his room to store in his top drawer. “No one watches to see if I swallow them,” he says, “and I'm suicidal.” One of the janitors, whose last job was in construction. has been enrolled in a drug-abuse program. “I used to sell codeine on the streets,” he tells a Central Manor resident who wants codeine for a toothache.

Besides dope, cigarettes are in big demand at Central Manor. “Gotta cigarette?” is a common refrain heard in the small lobby, on the front steps, and outside on the street. If the answer is no, the borrower requests “shorts” — the short end when there’s only a couple of drags left. Some offer to buy a single cigarette for a dime. “Everything’s negotiable here,” Paul says. For nine dollars, he recently bought two weeks left of a monthly bus pass from one of the residents.

The ratio of men to women at Central Manor is about six to one. Sex is for sale on the premises, either for cash or dope. “I pay two dollars,” smiles Paul, who says the “urge is active and the price is right.” A mother of three who has traded sexual favors for a single joint says she’s available outside the building, too. “When I go into cars,” she explains in an enchanting, mellifluous voice, “I get ten dollars.” Some of the residents at the New Palace Hotel next door also pay her. “In prisons, people know the consequences of their actions," Marshall figures, “but here, half these people don't understand that they can get AIDS and spread it.”

Daily mail call at 10:00 a.m. is a big event at Central Manor. “Everyone is waiting for a check,” Paul explains. Also important are the Friday-morning house meetings, which are usually run by Marco Flores, the administrator. Flores has no degree in social work or in psychology, no degree at all, in fact. But he has taken a few business administration classes at National University, which help him order supplies and keep the books. Marshall says the main topic at house meetings is housecleaning. “Behavior is discussed, too,” says Flores, who explains that residents who stay in bed all day are reprimanded. Those who attend the meetings are rewarded with candy bars.

“We used to give out cigarettes,” Flores admits, “until another board and care was sued by the family of someone who developed lung cancer.” For years, room inspections have been made twice weekly by two of the residents. “They check to see if beds are made and if towels are missing,” explains Flores. “They get paid seven dollars a week.” When some of the residents perform work therapy, they are paid by the job. Dishwashing pays about two dollars a shift, and serving meals pays a dollar. “It’s easy to avoid paying minimum wage by calling it work therapy,” Paul says.

Built in 1928 by the Knights of Columbus, the Elm Street building was a meeting hall until 1939, when the Bank of America foreclosed. After local businessman George Latham bought the building from the bank, he remodeled it and operated a fifty-bed hospital called the Fourth Avenue Hospital. “Later it was called the Balboa Hospital,” explains Latham, who owned several other small private hospitals as well as the Hitching Post Motels. Ten years ago, when the Latham family applied for a board and care license. Central Manor was set up as a family corporation with a board of directors — Latham, his wife, son, and grandson.

The following year, patriarch George Latham was arrested for soliciting a former employee to murder his daughter-in-law. Before the bail hearing was set, the San Diego Union reported that in 1920, Latham had been convicted by a North Dakota court of being an accessory to murder. However, San Diego Superior Court records indicate only that Latham admitted to a drunk arrest about seventy-five years ago; he would have been eleven years old. On Valentine’s Day of 1979, Latham pleaded guilty to the murder solicitation charge. Judge Earl Gilliam fined him $5000, sentenced him to three years' probation, and ordered Latham to undergo psychiatric and/or psychological therapy. Although he will be eighty-seven years old in December, Latham still attends monthly board meetings and turns up on Saturdays for lunch. He is also seen several times a week walking around the premises with a plunger. “I'm the plumbing inspector, too,” he says cordially.

Although state licensing files show no record of Latham's past, they do show complaints about soiled carpets, short supplies, and inoperable emergency buttons. But state social workers who make frequent periodic unannounced visits report that many of the complaints made by Central Manor's residents are unsubstantiated. They overlook the dimly lit and poorly ventilated rooms — inside rooms share an air shaft in lieu of windows. And they ignore the malingering odors of stale urine, vomit, and smoke.

Contrary to common belief, board and care homes are not halfway houses. They are set up for mental patients who take their medications regularly, who remain stable, and who can function without being in a hospital. But the residents need structure until they can live independently. Half never make that transition, according to Flores. He predicts that some of the residents will be living in Central Manor forever. “But they don't cause the trouble that ‘high-functioning’ residents like Marshall do," Flores notes.

“That’s because some of the others are kept in chemical straitjackets and they're zombies," Marshall argues. “This place is a warehouse," he continues, “and we’re the inventory." Paul says that some of the people he met at Patton were better able to function than some of the Central Manor population.

Sally has been in what mental patients call the “mental health system" for thirty-three of her forty-nine years; she has spent the past decade in Central Manor. She seldom leaves her room except when she goes to the liquor store on Fifth and Elm to buy a Coke. She refuses medication and lotions for the scabies that covers her body. Like Sally, many of the building’s residents never get beyond Elm Street, never beyond the liquor store. Some have come to Central Manor from San Diego’s streets, alleys, and doorways. Others come from jails, prisons, hospitals, and other board and cares. When John was arrested several months ago for shoplifting, he was too drunk, he says, to remember the details. “The judge OR’d me and sent me to Central Manor. I'll be forty-two soon. I've been in and out of board and cares and jails and hospitals since 1972, when my head problems started. Probably because I did some acid. My folks are fed up. They want me to get a job,” he explains. John continually borrows cigarettes and money and stays up most of the night. When he gathers enough cash to buy a bottle of liquor, he creates disturbances and the other residents complain. His goal, he says, is to get a private room. “So I can sneak girls in at night," he smiles.

The first indication of Ted’s schizophrenic paranoia appeared when he was nine years old. He never finished high school, and he’s spent more than half his forty-three years in psychiatric units at Mercy, CMH, Clairemont Hospital, and in local resident homes. He has been living in Central Manor on and off since 1980. “I feel more comfortable with mental patients than with regular people,*' Ted says. He doesn’t go on outings or on buses because he is also agoraphobic. He spends most of his time alone listening to his Walkman, smoking cigarettes, and drinking coffee. Every day Ted goes to bed after he receives his 5:00 p.m. medication. “I don't like to eat,” he explains, so he skips dinner.

He usually rises at 1:00 a.m. and drinks coffee and smokes cigarettes until five the next afternoon.

Ted's sister is also a mental patient. They grew up in La Jolla. Despite Ted's general fears, he says he feels safe living in Central Manor. There are things that bother him, though. “Con games go on all the time,” he says. “Everyone's trying to con me out of money and cigarettes. They promise to pay me back, but they never do. And the toilets are always getting jammed,” he adds. “Some people throw three rolls of toilet paper down the toilet.” Ted figures that the residents who deliberately urinate and defecate on the floor right next to the toilets are expressing their anger against authority. “Once someone lit his sheets on fire. Another time someone came down the stairs naked,” he continues. “Everything that happens in a mental hospital happens here.”

What disturbs Ted most is that sometimes residents simply wander off and disappear. “I never see them again. I never know what happened to them. But the worst is when people check out,” he explains. “Two years ago, my best friend jumped off the Laurel Street bridge. It was Christmas week. He was depressed because he didn't get along with his parents. His mother wanted him to wash the dishes.” That same week, one of the female residents jumped off the same bridge. Last year, one of Central Manor's most deeply disturbed residents hanged himself in the closet of his room.

“I've always fallen in love with the wrong men,” explains Monica, a thirty-one-year-old former data processor who was in the navy, stationed in London when her trouble began. (Monica is not her real name.) “The last time, it was Prince Andrew,” she continues. “Scotland Yard investigated me because I was sending him letters. I guess they were pretty bizarre.” As a result of the investigation, Monica was discharged from the Navy three and a half years ago. Since she left the VA hospital, she has been living in San Diego board and care facilities. She takes buses and handles her own money. Her income is much higher than any other Central Manor resident, and the VA and SSI checks come directly to her. Money is a big issue with Monica. Because she refused to pay rent, she was evicted from Mora Manor, a board and care in Spring Valley. Since May, she has not paid rent for her private room in Central Manor. She has ignored eviction notices.

Since I’ve been here, my medication has increased. I’ve turned into an animal. I do things I never thought I’d be doing,” Marshall says on a recent midsummer night. “Like selling dope to mental patients. Like eating meat with my fingers because there aren’t any knives here. I feel dehumanized. My incentive to swim and learn to read is gone. It’s become an effort for me to walk downtown to sell my plasma. But I have to so I can buy cigarettes and toothpaste. They’re supposed to supply toothpaste here, but they’re always out of it. Sometimes I walk downtown for nothing. When my blood pressure gets too high from tension, they don’t let me donate,” he says.

He is sitting on the front steps, smoking. Some of the men are leaning against the side of the building. One man is lying on a tiny patch of grass in front. Silhouetted against a smoky charcoal purplish sky, the full moon peers beyond a motionless palm tree. In the bright moonlight, the uncovered windows glare, making the stark white building look as hollow as a stage set. Marshall watches the taxis pass. “I’ll take the one on the left,” yells a man in a painter’s cap as the men watch a group of young women walk by. “I’ll take them all,” brags another resident in army fatigues. “Gotta cigarette?” John asks. “Got a quarter?” asks Sally.

“Hey, Jesse, why do you always carry that water jug?” Marshall asks a man whose plastic water bottle has become a trademark because he is never seen without it. The answer comes slowly from the forty-five-year-old Berkeley graduate who seldom says anything. “Maybe,” he pauses to stroke his graying beard, “Jesse wonders why everyone doesn’t carry a water jug.”

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