Vicious Circle of Hope, Despair

I got the message while I was out of town. The owner of Little Pedro’s said Nathaniel had flipped out while playing cello at the downtown Los Angeles club, launching into a belligerent tirade in front of his audience.

Fortunately, Nathaniel Anthony Ayers had calmed down before the situation got ugly and continued his concert on the sidewalk outside. But this well-meaning effort to treat him with dignity and respect, offering a job that might nudge him toward recovery, lasted only three performances and served as a reminder of how ill he is.

I was disappointed but not surprised. The man I met early this year is still a citizen of the streets, occasionally seeming as rational as you or I, at other times lost to the relentless cruelty of schizophrenia.

By at least one standard, the Juilliard-trained musician has taken a great stride. Almost every day, he pushes the shopping cart that contains his two violins and a cello to Lamp, a skid row agency whose mission is to gradually coax the mentally ill in off the streets. I had introduced him to Lamp months ago, but Nathaniel had no interest at first.

Patricia Lopez, the director, sees great promise in Nathaniel’s visits for meals and a shower. It takes some clients years to get that comfortable. Nathaniel insists on earning his keep by mopping and sweeping the floors, although he isn’t always a model citizen.

The 54-year-old Cleveland native sometimes argues profanely with other clients. He had to be separated not long ago from a woman he insulted. He uses a stone to doodle names and images on the courtyard sidewalk. He upsets blacks and whites alike with racial slurs, then is just as quick to offer impromptu concerts, sometimes making beautiful music and at other times struggling to remember a favorite Tchaikovsky or Haydn piece.

The quickest way to set him off is to offer housing or therapy. Nathaniel has been known to blow up or just stomp away.

“He insists very strongly that he doesn’t want what he calls mental health involvement, because he insists there’s nothing wrong with him,” says Vera Prchal, a Lamp psychiatrist. “These are probably side effects from being forced into treatment before, and it’s not unusual. Most of us wouldn’t want to be told we’re crazy -- that our brains don’t work.”

And so we wait, a strategy that seems both logical and insane. Nathaniel has to decide in his own time that he wants help, the pros keep telling me. And I keep wondering how a disturbed man can be expected to make a rational decision. It’s a small window into the maddening, vicious circle of eternal hope and despair every family of a mentally ill person endures.

Nathaniel has an understanding champion in Anthony Hamilton, a homeless advocate who walked into Lamp one day and asked, “Whose violin and cello?”

“I went to the New York High School for Music and Art,” says Hamilton, 44, a classically trained trumpet player who hasn’t picked up the instrument in years. “I lost my mind in 1985,” Hamilton tells me, “and there are things I used to be really good at that I can no longer do.”

I asked, naturally, what he meant about losing his mind.

“I just lost my mind, just like that. I was working in PR in New York, and my thing was colors. I’d see certain colors, and they meant something to me -- mostly things that were spiritually negative.”

He hoped it would pass. But his untreated delusions only got worse. In time, he developed a fixation on sidewalks and insisted on sleeping on the street. His horrified parents tried to help, but 20 years ago, Hamilton fled New York for Los Angeles, where he wandered in a daze until someone referred him to Lamp.

A diagnosis of schizophrenia followed, and Hamilton spent five years on skid row. Lamp founder Molly Lowery helped rescue him, he said, and now he tries to rescue others.

“I’m very struck with Nathaniel,” he said, partly because they’re both African American and artistic. Hamilton just went to the Basquiat exhibit at MOCA. The artist’s colorful, eccentric street art reminded him of Nathaniel’s pavement scrawling and of the way Nathaniel adorns his shopping cart with palm fronds, hubcaps and other trinkets.

“I see a lot of myself in Nathaniel,” says Hamilton, whose illness is controlled with medication that’s much more effective, and has fewer side effects, than what he and Nathaniel were both treated with years ago. “But one difference between us is that I knew something was wrong with me. Right now, Nathaniel doesn’t have any insight into how sick he is. I think he could do well on medication, but you can’t push them.”

Sometimes, though, I want to do just that. I want to indulge my impatience, ignore the experts, and push.

Skid row teems with human misery, and the summer air reeks of urine, scorched asphalt and rotting trash. Men and women are sprawled on sidewalks. They scream at ghosts. They stumble and rant and threaten each other’s lives.

Outside the door of Lamp, on a recent visit, a man lay in the street as if he’d just toppled out of his wheelchair. Was he drunk, sick, dead? I saw amputees, drunks, predators, drug dealers and the hopelessly psychotic, the lot of them thrown together and hanging on by a thread in a city and state without enough treatment centers, beds or concern.

Each night, Nathaniel lies down and sleeps on a sidewalk here, protected only by a hubcap he calls his shield and his trusty Beethoven stick.

Patience, say the experts, and surely they know best.

But is patience the humane approach, or the one that might one day cost Nathaniel and others their lives? I worry about him being attacked for the instruments I helped him get. I would testify, as Nathaniel’s friend, that he is a danger to himself, that he and thousands of others need at least a temporary commitment in the hope of saving them.

Yes, I know the horrific history of involuntary confinement, but I wonder why an enlightened society can’t agree on a humane way to rescue wives and husbands and sons and daughters who now sleep in gutters not far from the glittering skyline.

I think more and more about the advice of one psychiatrist who, while he agrees that patience is important, told me there may come a time when someone has to push.

I see Nathaniel’s days slip away, lost forever. I flinch when the phone rings at night, wondering if something has happened to him.

I imagine telling him he can do much better than this, and that his resistance to help makes no sense. I’d like to tell him that the medicine is different now from when he was diagnosed 30 years ago, and that treatment could help him enjoy his one passion -- music -- without the hassles and dangers of the streets.

But I’m afraid of driving him away. And besides, how do you speak rationally to an irrational man?

Reach the columnist at steve.lopez@latimes.com and read previous columns at www.latimes.com/lopez.