Witnessing Without Power

What it means to see and still be unable to help

Photo by Brendan Beale on Unsplash

I recently traveled to Baltimore for the annual Association of Writers and Writing Programs conference, a huge event that always an immersion in language, craft, and community. I expected to spend my days moving between hotel ballrooms and lecture halls, listening to panels on pedagogy and creative structures. And I did. But what I didn’t expect—what I couldn’t quite prepare myself for—was how persistently the city outside those rooms would press in, demanding a different kind of attention.

I’d been to Baltimore once before, but this time, the city revealed itself in fragments between conference sessions: on early morning walks in the chill, in the quiet hours after evening readings, in the spaces just beyond the polished interiors where writers gathered. I encountered a striking number of unhoused individuals, more than I’d anticipated. They weren’t invisible, though it quickly became clear how easily people learn to look past them. They occupied sidewalks, bus stops, doorways—spaces of waiting. Some asked for help. Others simply existed in a kind of exhausted stillness.

But one moment in particular stayed with me, refusing to fade into the blur of travel memories. On my final night, I stopped inside a fast-food restaurant for something quick to eat. Inside, it was crowded and chaotic, but after a few moments, the atmosphere shifted almost immediately when a young woman entered. She was visibly unwell. Her distress was palpable in the way she moved and spoke. Her words tumbled out loudly and disjointedly, as if she were arguing with someone no one else could see. Her clothes were soiled, her hair matted, and there was a deep, persistent cough that seemed to rack her entire body. Several customers pulled up shirts or cupped napkins over their noses and mouths.

People around her reacted in familiar ways: discomfort, avoidance, irritation. Some stared, others deliberately looked away. Staff members tried to manage the situation, but it escalated quickly. Within minutes, the police were called. Watching her be led out—still shouting, still coughing, still clearly not understanding what was happening to her—was deeply unsettling. I felt my own body tense with a mix of fear, helplessness, and a kind of aching recognition. Despite everything I have learned about mental health, all the language and frameworks I carry, I was confronted with how little any of it could actually do for her in that moment. It was a painful reminder that knowledge does not always translate into intervention, that understanding does not equal the power to help.

But what struck me most was not just her behavior, but the unmistakable obviousness she didn’t recognize her own condition. I was witnessing anosognosia—the neurological phenomenon in which a person is unable to perceive their own illness—in action, in real time. The young woman wasn’t consciously choosing chaos, she was living inside it, without the ability to step outside and see it clearly. And without that awareness, the pathways to help like medication, therapy, housing become incredibly difficult to access or sustain. It becomes a closed loop: illness preventing treatment, and lack of treatment deepening illness.

Photo by Ev on Unsplash

When I returned home, I became very sick with influenza. The cough was relentless, exhausting, and isolating. There is a particular vulnerability that comes with illness—the way your body becomes unfamiliar, unreliable. As I lay there, feverish and drained, I found myself thinking about that young woman again and again. I had a bed, medication, the knowledge that my illness was temporary and treatable, and also in the privacy of my own home. She’d had none of those assurances.

And I’m still thinking about how on a larger scale, it underscored the vast difference between temporary sickness and chronic, untreated mental illness compounded by homelessness. What does a cough mean when you have no place to rest? What does hunger feel like when it’s constant, not just an inconvenience between meals? What happens when your mind itself is working against you, distorting reality and preventing you from seeking help? The intersections of serious mental illness, anosognosia, and homelessness are lived realities, visible in moments like the one I witnessed and I wish more people were aware of and understood.

The conference itself was full of conversations about storytelling—whose stories are told, whose voices are heard, what it means to bear witness. But outside those rooms, I was reminded that some of the most urgent narratives are unfolding in plain sight, but to a misunderstanding audience.

I left Baltimore carrying more than notes from panels or ideas for future writing. I left with an image I can’t shake, and questions that feel heavier than answers:

What does it mean to see someone clearly, even for a moment? What responsibility comes with that seeing? And how do we begin to imagine systems of care that meet people where they are—not after crisis, but before it?