I left my hotel and headed down Fremont Street toward Las Vegas Boulevard. Fremont throbbed with loud, drunk revelers carrying supersized beers and giant cocktails brimming over from clear plastic containers shaped like footballs.

The celebrants were waiting for the next lightshow, a pulsating, pounding, eardrum-piercing music experience shown on the hour throughout the evening—showcased on the world’s largest video screen, an arched canopy that stretches along three casino-studded city blocks. Nowhere but Vegas can you find this sort of mega-extravaganza of flashing, glittering sights and sounds. Think MTV on steroids. Think Lake Mead and the Hoover Dam and the Mojave Desert of lightshows.

During my walk down Fremont Street, I encountered two men in wheelchairs, each man missing a leg, as evidenced by the raw, mottled stumps that protruded from their chairs. My guess is they were in their late forties, maybe early fifties, though they could have just as easily been hovering around 60. They both wore green army fatigue jackets made of heavy cotton ripstop, worn and faded and tattered at the edges. The jackets hung loosely around the men’s sloped shoulders and folded into their bent legs and stubs.

Fremont Street in Las Vegas

One said something to me as I passed, his words so mumbled and shredded and hoarse, I had no idea what he meant or even what language he was using, but the wild glare in his eyes suggested it was best not to ask him to repeat himself. Or step too near to where he had parked his chair.

The other said nothing. He sat motionless, his clothes scruffier than the first’s, his hands so greasy and soiled, they appeared not have been washed in months. He stared at his boot with slitted eyes. I saw no perceptible movement his body or even a twitch in his face, as though lost in a reality so distant that returning seemed no longer possible.

I headed south on Las Vegas Boulevard until I reached a 7-Eleven. I waited in a short line at the counter while holding a pack of gum. The woman in front of me—30, perhaps, with scraggly brown hair and a scarecrow sagging face—tapped her foot, bounced from leg to leg, picked at the candy bars on the shelf in front of her, stopped, looked around, then started her movements over again. She finally grabbed a Snickers and dropped it on the counter next to her giant can of Foster’s. Her eyes darted nervously while she clicked her nails against the can. When it came time for her to pay, she dropped a five on the counter, along with a handful of coins, and mumbled, “Keep the change,” her voice shaky and throaty, like that of a tweaking frog.

She ran out of the store and across the parking lot.

If such events were rare, they would perhaps garner more attention from the press and the public. As it is, the streets are full of people falling through the cracks. I came across more of the same in Sacramento last week. When I was standing in Capitol Park, next to the California State Capitol and amid several homeless crashed out on park benches, a man with a dark beard and Medusa-like hairdo raced past me and shouted, “I’m getting me a Bud. I’m getting me a Bud.”

After he sped away, I slipped into the restroom to pee. Perhaps it was the suggestion of beer so early in the morning. Perhaps it was the pot of tea I drank earlier.

At the sink, a man who looked surprisingly like the Budweiser sprinter, was standing at the sink, mixing a Tang-like concoction in a Tupperware container while clutching under his arm a mini-box of Cheerios. He stared and stirred and mumbled into the container. I believe he spoke in anticipation of his orange-ladden cereal.

That happened the day after I arrived from San Francisco, a city chock full of folks who wonder the streets and talk to themselves and struggle to make sense of a world that by no measure can be judged as anything even close to sane.

At one point during my stay there, I was riding a bus down Mission Street. We stopped at a traffic light at an intersection like hundreds of other intersections in that town—full of people and trash and brick and concrete and shouting and glass. I noticed a young man leaning against an ancient building worn and tagged and ready to fall. He banged his head against the wall and pulled at his hair with a ferocious grip, as though trying to rip off his scalp. A look of anguish had settled on his face, a look that ran so deeply nothing could touch whatever terror he held inside.

Later that day I ran into a drunk guy up near Castro, about 50 maybe, give or take a decade or two. Between staggering steps and gasps for breath, he belted out an offer to sell his wife for 25¢. A mere quarter, he said, so he could get some beer. Obviously he meant more beer. And at such prices, who could blame him?

I’m in Palm Springs now. Yesterday a windstorm raged through here with gusts reaching 90 MPH. Sand blew. Trees fell. Tiles flew off roofs. Some hit my van, in fact, leaving a reddish scar many inches long.

Shortly before the winds began, a slight, bent-over man stormed down the sidewalk across the street from me. He screamed with a thick Mexican accent at the cars passing by. He yelled at them to go away, get off his street, leave him alone. He huffed and puffed, until the wind picked up and blew him down the sidewalk.

Later that evening, after the gusts had somewhat subsided, I was strolling past the Jack in the Box on South Palm Canyon Drive. A young man sauntered out of the building, holding a carton of curly fries and a Coke. He said hello and offered to share his weed with me. He spoke in a rambling, slurred, nasally, pothead sort of voice. I’m not sure he even really saw me. I declined and moved on.

This morning I was driving my tile-scarred van through Palm Springs—again traveling down South Palm Canyon Drive—after hiking part way up the mountain that overlooks the valley. A man wandered into the street, all the time staring at the asphalt several feet before him. A breeze fluttered through his long, thin, unnaturally yellow hair. He reminded me of a burnt-out, one-hit wonder from the ’60s, a man unaware of the traffic about to run him down, a man unaware of the fact that he was in the street at all—the way he weaved back and forth with an unerring stoner’s gate, glancing up for only a moment, as though to assure himself that his place in this world had been secured.

I can’t say whether he was high or drunk or tweaked or whatever. I can’t say whether addiction or substance abuse or mental illness was even a factor. The same is true for all the folks I encountered. Something is going on, though—with them and a hell of a lot of other people out there.

According to the Substance Abuse and Mental Health Services Administration, nearly 20% of US adults—over 45 million people—suffer some form of mental illness, with close to 9 million of them dealing with substance abuse issues. Then there are the homeless, 3.5 million in any given year, at least 20% of whom suffer from severe mental illness. In fact, the US Conference of Mayors considers mental illness the third largest cause of homelessness for single adults.

Given the state of our economy and our growing trend toward undercutting public safety nets—a trend with roots in Ronald Reagan but one that found an easy home with Bill Clinton and the George Bushes—we’re not likely to see the number of homeless and mentally ill and addicts diminish any time soon. In fact, I suspect the problem will grow much worse before the politicians and political pundits and the populace who put them in power take these problems seriously.

But if there’s one thing we’re good at in this country, it’s pretending that problems don’t exist, or if we do acknowledge their existence, we figure out a way to blame the victims for causing them in the first place. Perhaps if all the disenfranchised souls were to form a corporation—a friggin’ multinational conglomerate the size of Wal-Mart—they’d at long last have a voice in government. In fact, they’d probably receive more handouts than all the oil and tobacco companies out there.

She stands at five-feet-four, minus a couple inches for her perpetual stoop. When she walks, she never lifts her feet off the floor. It’s more a sleep-walker’s shuffle—a mix between indifference and the result of a stout, squat body that no longer wants to move.

The café where Grace works—and perhaps owns and has done so for her century-long career—is a nostalgic gateway to Hollywood’s golden era. In addition to the years of grease and grime, the walls are covered with movie star posters that range from Mae West to James Dean.

My favorite is a large silver screen version of The Last Supper, with Marilyn Monroe in the center, Humphrey Bogart to her left, and Clark Gable to her right. Also at the table are Elvis, Cary Grant, Marlon Brandy, and several other Hollywood dignitaries from days gone by.

Though it’s only a few minutes past noon, I’m the only customer. I open the menu and try to read through the grease and food stains. That’s when Grace shows up, her pen and pad poised to take my order. She stares at the space across the table as she waits for me to decide. Old rock-and-roll music pours from the crackling speakers—currently an Elvis song, though nothing I recognize.

Grace dyes her hair a bright red-orange. Judging by the thick gray roots, it’s been a while since her last treatment. She has a bulbous nose that hooks down toward meaty jowls and sagging lips, giving her face a squashed look, as though years of gravity have caused it to cave in on itself.

She has a look about her of a person not fully in this world, an old woman biding her time, only partially aware that she’s still alive. It’s the look of someone who has watched too much television, someone whose eyes have been permanently glazed over by sitcoms, reality shows, and mouthwash commercials.

If she were of a different generation, I would suspect too many hours in front of a computer.

I close the menu and order eggs and hash browns and coffee. She writes down my order. I feel as though I participate in an ancient ritual.

Grace shuffles over to the counter and calls my order to the two Hispanic cooks. She speaks in a stilted, halting voice, as though she’s never fully learned how to use her vocal chords, as though she came from a place of cloistered silence and was dropped here on Mission Street.

When a few other customers trickle in, she smiles, greets some by name, takes their orders. None of them talk on cell phones or send text messages or work at computers or listen to iPods. I can’t remember the last time I was someplace where I could say that.

In between customers, Grace sits at the counter and stares at the stainless steel walls and the shelf full of hamburger buns and loaves of white bread. Occasionally, she squeezes behind the counter to take a customer’s money—cash only, rung up on a manual register unable to match today’s prices.

Grace lives in a world locked in ’50s memorabilia, free from the Internet and hand-held electronic devices—a holdout against progress and the gentrifying forces that squeeze in around her. Grace lives in a world of diminishing returns, a world that leaves her little space in which to retreat.

In some ways, Grace might be considered one of San Francisco’s more fortunate. She has plenty of food, a place to spend her days, and in all likelihood, a home of some sorts—though for all I know, it could be a back room in the restaurant.

Many in San Francisco are not so lucky. Any visitor to the city can quickly discern the severity of the problems associated with homelessness, substance abuse, and mental illness.

Last night, as I waited for a bus on the corner of Eighteenth and Castro, I watched one man get into a debate with a garbage can, two men curl up on a blanket next to the curb, another two men yell drunken insults at a third man across the street, and still another man so bent and twisted and inhibited in speech that he could not formulate the words or gestures necessary to beg for money.

Anywhere you go in the city—outside the wealthier neighborhoods—you’ll find a wide range of drunks, tweakers, junkies, panhandlers, mentally ill, and homeless people so disabled they can barely move. Any night you find the disheartened, the discarded, the walking wounded. This is the San Francisco not mentioned in the brochures.

According to the San Francisco Homeless Services Coalition, about 35,000 people are homeless in the Bay Area at any given time. Of these, 62% live on the streets during the night. In fact, San Francisco proper has the highest rate of homelessness of any U.S. city.

Yet San Francisco is by no means alone. About 800,000 people in the U.S. do not have a place to live—and as many as 20% of them have fulltime jobs.

There’s more. According to the Substance Abuse and Mental Health Services Administration, 20-25% of the U.S. homeless population suffers from some form of severe mental illness, yet only 6% of the general population suffer the same fate. In fact, mental illness is considered one of the top causes of homelessness for single adults.

Yet the U.S. spends only $2 billion a year on federal programs aimed at helping the homeless. Compare that to the $700 billion spent on defense. (That’s according to the Washington Post. Some estimates put our defense spending a lot higher.)

As I sit in the Mission Street café—trying to eat a slice of toast so saturated in margarine I can barely get through half—I gaze toward the display near the front window, a wide shelf covered in fake cellophane grass, the kind you find in Easter baskets. On top of the grass are hundreds of plastic animals and plastic flowers and plastic houses.

While studying a rather sick looking frog, I notice a woman out on the sidewalk, slouched against the building, so tweaked out she can barely stand. She appears to be in her mid-sixties. She wears a blonde wig. She wears lipstick the color of bing cherries. She wears false eyelashes so long her eyes seem entangled in spider webs.

She smiles at several men who walk by, perhaps attempting to turn one last trick. But they don’t acknowledge her. I don’t think they even see her. Many talk on cell phones. Many are plugged into earphones. Many are texting as they walk.

Many look as equally lost.

We are a culture of damaged and displaced and dismissed souls. But as long as we have our iPhones and Facebook pages and HD televisions, as long as we let ourselves be endlessly entertained and distracted and misled, we don’t have to look at those we leave behind. We don’t have to be accountable, feel responsible, take action.

I push my plate aside and sip what remains of the coffee. Grace comes by and drops off my bill. She says that I should jot down my name and phone number on the back of the check. She says I could win a $25 gift certificate. Then she smiles and returns to the counter.

When I pay my bill, Grace punches the sale into her ancient register. It rings and the drawer pops open and she counts out my change like a little girl playing bank teller.

I did not write my name and number on the back of the check. And Grace never says a word. She smiles and returns to her seat at the counter.