A few miles from the hipster sprawl of modern Brooklyn is the 200-year-old Kings County Hospital, in East Flatbush, home to the psych facility the late rapper Ol' Dirty Bastard memorialized in "Brooklyn Zoo" ("In the G Building takin' all types of medicine"). The gothic, infamous "G" was closed in 2009, and Kings County's Behavioral Health Center, where I volunteer as a resident artist, now inhabits the airy new R Building, heralding a reset for the public institution. After years of neglect and the much-publicized 2008 death of Jamaican immigrant Esmin Green, who was found convulsing on the floor of the waiting room, CNN referred to the hospital as a "symbol of a health-care system that seems to have failed horribly." The tragedy, though, spurred a sea change in patient care that resulted in the U.S. Department of Justice, after years of oversight, recently calling Kings County a "model acute care psychiatric facility."
I can attest to what is happening there. The mere existence of my position — artist-in-residence — speaks to the hospital's attempt to move toward transparency and creativity while serving one of the poorest, most ethnically diverse, and most trauma-affected populations in New York City. I work as a shrink elsewhere, but at Kings my work is not clinical; my photographic work is about hearing and telling the stories of the remarkable patients who have opened up to me, about humanizing them and trying to capture the complexity and contradictions of their lives, which a DSM diagnosis can never really do.
I met Nathaniel, the subject of these pictures, in February, after he was briefly hospitalized for acute depression, PTSD, and suicidal ideation. If you had met him at the Nuyorican Poets Cafe or at Lane Bryant, where he was on track to be a visuals manager, you would never have guessed what this creative, stylish, witty, and driven 21-year-old had already lived through.
We connected while I was embedded in the Partial Hospitalization Program (PHP), a six-week day program that seeks to provide a transition from inpatient to outside life. And I've gotten to know a number of young adults in PHP who find themselves not just between intake and discharge but between whatever trauma or chemical imbalance landed them there and the utterly normal post-adolescent striving to define who they are, what they're into, and what they aspire to become. Nathaniel was one of the patients who invited me into their lives. I've photographed him and others in their homes and with their families. I've also shot them at shelters they once lived in, while recording music, and on the streets where they grew up. For some of these kids, the arc seems daunting — recurring hospitalizations, worsening symptoms, the side effects of medication, hearing voices, family or societal nightmares. For others, transformation seems possible. Their promise has only been interrupted. It could be realized, if their condition is, in a word, tweaked.
This was the case with Nathaniel.
Nathaniel was born Angelica, the name his mom still calls him four years after he started to transition with testosterone therapy. (With his permission, I will refer to his pre-transition years as Angelica's.) Angelica was born when her mom was twenty years old and homeless. Her mom already had a boy, four-year-old Justin, whose dad had left the family after the baby had become blind from a retinal disorder. Angelica's dad moved out after her parents broke up. They split because her father disclosed he was only sixteen when Angelica was born, and he has remained mostly estranged over the years.
Angelica's mom had been raised on the street, in abandoned buildings and homeless shelters, by Puerto Rican heroin-addicted, homeless parents and by occasional foster-care families. Angelica's maternal grandmother died of AIDS, and her maternal grandfather suffers from schizophrenia. Angelica's mom became a runaway in the eighth grade to escape the violence and sexual abuse at home; she began to live on the street and in shelters such as the Covenant House, where Nathaniel would later stay twice as a teenager.
Nathaniel remembers his earliest years as Angelica only as "clips," but they were spent in shelters and briefly and traumatically in foster care as well as some time as a toddler with her maternal grandparents, who both sold drugs. This stay ended when, during a drug bust, Angelica's grandmother, who had heroin strapped to her body, used the child as a shield against the cops. As a three-year-old, Angelica was molested by a young babysitter. When her mother discovered this, she dropped out of college to be with her kids. But she found herself in violent relationships, often with men who sold drugs. There was also rage and violence within the family, once resulting in a broken jaw that required the young Angelica to have surgery.
Angelica's mom eventually extracted herself from these relationships, and the family ended up in the shelter system for years before finally being able to rent a floor in a house in Jamaica, Queens, and then living in a family friend's home in the projects. Angelica's mom worked long hours as a tax preparer to try to stabilize the family, and Angelica remembers a childhood full of self-supervision.
When Angelica was around eight, she started, at her mother's urging, to act and model as well as compete in beauty pageants. Her family's first real home (and the home they still have), in Woodside, Queens, was purchased largely with money she earned as a young girl in Chuck E. Cheese's and DSW ads. But the persona of Angelica proved problematic, since "my mom wanted me to be like this little doll thing … to live out the dreams that she couldn't," while Angelica was spending most of her time with boys, doing "crazy shit" on the streets of Woodside and becoming precociously sexual. In eighth grade, one boy broke up with her because, he said, "It feels like I'm dating a boy." When she tried to dress more feminine, it felt "like I was wearing paint on my body."
Angelica first hooked up with a girl at twelve. But when Angelica's mom walked in on them together one day, she "freaked out." Having grown up Christian, amid the belief that homosexuality is a sin, Angelica partially internalized her mom's reaction and felt that, in fact, her behavior was an "abomination" that would lead to hell. Her relationship with her mom deteriorated fast; she once told her child, "walk in front of me, because I don't want you staring at my ass."
"That broke me," recalled Nathaniel. "It destroyed me; it molded every terrible feeling afterward." Angelica was sent to churches and therapists in an attempt to convert her, and she "had no idea what to do. I thought I was a monster. I thought I was disgusting. I thought I was an animal." Her conflict — both internal and with her mom — led to years of alternately intensely acting on and repressing her sexuality. At one point, she was sent to a religious school where she had to sign a contract to not be openly gay. "We were arguing a lot; she was putting her hands on me. There was a lot of mental, physical, emotional abuse going on. I was broken all the time. I hated myself, I hated who I was, I hated that I couldn't change. I tried to change so bad. And it did a lot of damage to me. Mentally, I was depressed, I was sad all the time, I — started burning myself. I didn't want to be alive. I felt like my mom didn't want me. Like I was damaged." But "there was no way I was gonna hide who I was. I was terrified, but I wasn't gonna hide it."
Yet this conviction was fragile, and there were periods when she would try to be straight and attend church a lot. Then Angelica met a girl at a church group who became her first real girlfriend and who would remain so for years. Her mom was enraged and pulled her out of the school, where she was thriving in academics, visual art, and basketball. Angelica then ran away from home for a while, and eventually this led to her living in a teen shelter for the first time. She would try to return home, but intense conflicts caused her to run away yet again — this time to the Covenant House (where her mom had herself lived as a homeless teen).
She received housing in Brooklyn through the Ali Forney Center, a nonprofit with a mission to "protect LGBTQ youths from the harms of homelessness," but it was so far from school that she felt things falling apart, and "one thing I wanted to make sure of was that I would not fail school, because it was the only thing I had left." So, again, she moved home and tried to "live for God and live for my mom and date boys." When she graduated high school, she had a boyfriend and planned to go to college. She made it through one week of college before saying "Fuck this," and within days, she was back at Covenant House and dating her girlfriend again.
Having aged out of child shelters, Angelica moved into the Chelsea Foyer, a supportive-housing program for at-risk youth in Manhattan, and it was there that she was introduced to the possibility of transitioning. "Since I could remember, I always felt like a little boy … it never felt right living as a girl, but I didn't know any other way." Her girlfriend, who strongly identified as a lesbian, struggled with the prospect of Angelica's becoming a male. But after deciding that "I can't live like this anymore, I wrote her a letter explaining how I feel like I'm someone else trapped in this body and that other person just wants to come out." It was then that Angelica began to go through testosterone and psychotherapy at the HEAT program (Health and Education Alternatives for Teens) and took the name of Angel and then eventually Nathaniel.
Nathaniel began to work in visuals at Cole Haan and Lane Bryant and moved into his own apartment for the first time. But then he "crashed" and had his first bad depressive episode, where he "couldn't get out of bed. I wanted to die, and I moved back in with my mom." This was brief. After a fight with her that turned physical, Nathaniel moved out, but he soon fell apart emotionally again, this time struggling with depression and panic attacks. When he and his girlfriend suddenly broke up after years together, he became suicidal, and that's when he was admitted to Kings County.
His time at Kings County was brief, but he described it as life-saving. For the first five nights, Nathaniel fell asleep clutching a picture of himself and his girlfriend in Boston together, "holding on to the memory of us." He had long written poetry, but in the hospital he started writing about his life and how he had gotten to this point. He started taking medication and attending group and individual therapy, and it helped. The hospital also gave Nathaniel the space to rethink his future. While he was enmeshed with work in fashion and retail, he began to think about his desire to get a degree in biology at a two-year college (because he was always afraid to take his SATs). He envisioned working as a zookeeper and in animal shelters, with the dream of opening an animal or wolf sanctuary (his spirit animal) somewhere rural, as well as advocating for and counseling LGBTQ kids.
Since Nathaniel left Kings County, we have spoken and shown photographs together, and his honesty and ability to connect to people can be remarkable. At one event, a woman who runs an arts nonprofit asked if he would please be an "ambassador for being human" and then invited him to do a reading elsewhere, and he was later interviewed and shared his story on a Brooklyn public radio station. His mental health is still fragile, and he recently has identified with being bipolar. His mom still calls him Angelica. Their home is plastered with pictures of sacred family memories, but nearly all with Nathaniel as a young, pageant-ready girl. He has recently moved out of the house and is living in a basement apartment with his new girlfriend, Anichela, who is Haitian-Italian and also bipolar. They work together at a pet salon — jobs they landed with the help of Nathaniel's mom through a job-placement program.
Nathaniel's narrative, going back generations, is a pendulum of instability and trauma on the one hand and survival, self-reliance, attachment, and redefinition on the other. His charismatic older brother, Justin, has no usable vision but is a courier in Manhattan and just graduated from college. His mom, after all the trauma and poverty she's lived through, has raised a family alone, works tirelessly, and runs a food pantry for the homeless. And Nathaniel, with all his talent and ambition, is living his truth and transition at any cost.
Just the other day at Kings, I was reminded how precarious this all can be when a 21-year-old woman whom I had gotten to know and had photographed at PHP earlier in the year was back in inpatient after an acute manic episode. She had returned to college, was preparing to be on the basketball team, and seemed stable on meds for bipolar disorder. Historically, she had excelled at school, played multiple instruments, played basketball, and had trophies throughout her room, which was otherwise a mess. While she, too, may get better — as recovery is not without relapse — this was her fourth hospitalization, and she was severely manic, even delusional, in this recent episode, which may have been drug induced. Yet this is exactly why working with this age group is so vital and compelling. It is a cusp in the narrative where any number of variables, choices, and risk factors can tilt the course of the illness and of their futures.
All of our lives carry uncertainty, but these lives are more uncertain than most. The causes of their symptoms beyond genetics make a familiar list poem: raised amid poverty, broken homes, multigenerational histories of trauma and loss, sexual violence, substance use, and complex immigration issues. But that's just the beginning of who they are and what they will become. Some will ride on the carousel of what psychiatric care in America is right now — multiple short-term hospitalizations, reliance on medication over therapy, absurdly strict limits on reimbursement for treatment. But some will look back at their stays in a psychiatric hospital and see it as the time when they found perspective and clarity and be able to say, as Nathaniel did, that "PHP saved my life."
Charlie Gross is a photographer and psychotherapist based in Brooklyn. Find him on Instagram: @charliegrosss.
Read a letter Nathaniel wrote to his mother here.