Are most homeless people "mentally ill"? Who benefits by

Tom Boland (wgcp@earthlink.net)
Sun, 7 Feb 1999 01:10:12 -0800 (PST)


Policy makers and journalists repeatedly state that many people are
homeless because they are "mentally ill".  Do you agree or disagree?  Why
or why not?

Who stands to gain by portraying homeless people as "mentally ill"?  Who
stands to lose?

Does the widespread perception that homeless people are "mentally ill" help
those so-labeled get more of what they need?  Does it help homeless people
in general, that is, as a group or class?

What's your evidence for your answers?  How do you know it's reliable?

Those questions were easy.  Now for the tough question:

For those who might disagree with you about whether many homeless people
are "mentally ill", how might you persuade them to your view?

See related article below:

FWD  February 7, 1999 (New York Times)

SEEING A LINK BETWEEN DEPRESSION AND HOMELESSNESS

By Lynette Holloway

It was spring when J. Geraldine Jackson first began
to feel the world closing in on her. It seemed as if
she were living in a cave inside her mind. She slept
countless hours and lost her job. Her heart raced.
Sometimes her left leg went numb. Her favorite
television show, "The Equalizer," a dark drama about
crime in Manhattan, no longer held its allure. Noise --
especially laughter -- made her want to fight.

It was a little smart talk from her sister that finally
set her off. She pummeled her sister with her fists,
grabbed a pocketbook and a change of clothes, and fled
the housing project in the Bronx where she lived with
her mother. She landed in a homeless shelter.

"I had to go," Ms. Jackson, 39, recalled. "I was really
beginning to lose it. I had lost it."

That day last May marked the final phase of her journey
into homelessness, which, she can now see, had begun
more than a decade ago. It took the doctors at the
homeless shelter a few weeks to give her problem a name:
manic-depression.

As mental health experts learn more about mood
disorders, it is becoming clear that depression and
manic-depression, with its wild mood swings, are a
significant cause of homelessness. Homeless shelters
have long been filled with schizophrenics, people whose
hallucinations and delusions force them out of jobs and
homes and relationships. But the link between depression
and homelessness is only now becoming clear.

Much attention has been focused on depression and
manic-depression in recent years as a number of
prominent -- and well-off -- people have offered public
accounts of their battles with the diseases.

In "An Unquiet Mind: A Memoir of Moods and Madness
(Vintage Books, 1995), Dr. Kay Redfield Jamison, a
psychiatrist, gave a moving portrait of her own battle
with manic-depression.

Mike Wallace of "60 Minutes" did a segment on the
program with Art Buchwald in which they discussed their
struggles with depression. William Styron's memoir of
his struggle with a deep depression, "Darkness Visible,"
became a best seller a few years ago.

But they all had safety nets, and they were brought
back, some from the brink of suicide, by expensive
treatments and dutiful families.

"I was able to get the best medical care possible," said
Dr. Jamison, a professor of psychiatry at the Johns
Hopkins School of Medicine. Whenever she sees a homeless
person, she thinks, "There but for the grace of God go
I," she said.

For Ms. Jackson and others like her, there is no such
safety net. It is unclear how many others are in similar
situations, but Dr. Ronald R. Fieve, a pioneer in the
use of lithium to treat depression and manic-depression,
said aggressive efforts to identify homeless people with
the disorders could significantly reduce the population
of homeless shelters.

"These people are in a state of chronic illness that is
treatable," said Dr. Fieve, who has recruited homeless
patients at shelters for clinical studies of mood
disorders.

Aa a rule, doctors say, manic-depression like Ms.
Jackson's, also known as bipolar disorder, responds to
mood stabilizers like lithium, Depakote and Tegretol,
but diagnosing the disease can be a formidable task
because it can appear, in its later stages, like
schizophrenia. During the highs, manic-depressives can
become delusional, like schizophrenics.

Because schizophrenia's symptoms are easier to diagnose,
emergency room doctors and shelter operators are much
more likely to classify someone as schizophrenic than
manic-depressive.

During the low points for manic-depressives, extreme
fatigue is common.

"There is no desire to get going on anything, which
means they become burdens if they are living with
anybody," Dr. Fieve said. "They are not able to earn any
money. If you work, you've probably lost your job
because of excessive absenteeism and poor performance.
If you are poor, this is where homelessness sets in.
Your family can't deal with you. So, you're out on the
streets."

Ms. Jackson turned to cocaine in an attempt to quiet her
demons. It only made things worse, she said. And when
the doctors did sort out her problems, she said, they
had difficulty treating her manic-depression because of
her drug addiction.

Even with the appropriate diagnosis and medication, the
complexities of manic-depression are such that patients
live in denial. Sometimes they stop taking their
medicine when they start to feel better, leaving them
open to more intense episodes.

On this point, and many others, Ms. Jackson's is a case
study in how manic-depressives can drift into
homelessness and, if their problem is recognized,
reclaim their lives.

The reclamation does not occur overnight, but comes in
fits and starts as Ms. Jackson's metamorphosis shows.
Though it takes years for some people to get the disease
under control, it took her less than a year. She was
supervised closely by doctors who were experienced in
helping homeless manic-depressives.

Ms. Jackson allowed a reporter to follow her on the
journey, which lasted about eight months, the length of
her stay at a homeless shelter for mentally ill women in
lower Manhattan. She permitted doctors and social
workers to discuss her case with the reporter because
she wanted her story to help others.

The first meeting with Ms. Jackson occurred last June,
after her third week at the shelter. Angry and
suspicious, she believed she had been misdiagnosed. She
wore a billowy denim dress and tried to hide behind huge
sunglasses and a sun hat.

She spoke in fragments, but she made two things clear.
She wanted a home for herself and her 13-year-old son,
Timothy, who is living with her father during her
recovery. And she was sick, she said, but not in the
head. She had heart palpitations, a headache and a sharp
pain that charged up and down her left leg.

During several meetings in June, the signs of depression
lingered. The headaches, palpitations and leg pain
persisted. Once styling spray from her short curly hair
dripped into her eyes and slid down the sides of her
face. She didn't notice. A hallmark of depression is the
loss of concern about one's appearance.

But by July, the transformation was dramatic. The
headaches, heart palpitations and leg pain had
disappeared. Depression can sometimes cause unexplained
pain, said Dr. David E. Nardacci, who had first
prescribed a combination of mood stabilizers,
antidepressants and sleeping pills for her. Later, she
was stabilized on a new combination of mood elevators
and antidepressants, including Wellbutrin and Tegretol,
and taken off the sleeping pills.

No longer irritable, she was talkative and energetic. A
toothless smile had replaced the vacant stares and the
darting glances. She wore her short curly hair pinned
back.

She even chatted with a security guard at the front desk
of the shelter and joked with other residents as she
left for an outing. Over a dinner of steamy pasta at a
trendy downtown restaurant, she talked about
reconnecting with her family and living drug free.

And she ruminated about how manic-depression can ruin a
person's life.

"I can't believe I didn't think I had this," she said of
manic-depression. "It's so obvious to me now."

She was ready, she thought, to go back to work. But her
counselors urged her to take one day at a time. She had
been fired in March 1997 from her clerical job at an
insurance office because of excessive absenteeism, a
symptom of her disease. She talked about wanting to
repair her credit, which was ruined years ago by wild
spending sprees during manic phases.

"I'm glad I made this move," she said of her entry into
the shelter system. "If I had done it sooner, things
wouldn't be so bad now. I would have been able to save
my job. I would have had my own house. I could have been
in school. I could have had a car and credit cards. I
would have been able to save a lot of things."

Feeling better than she had in 20 years, Ms. Jackson
left the shelter last month and moved into assisted
housing on the Lower East Side. She signed up to live
there for two years, she said, but she plans to be out
in about seven months. She wants to become an addictions
counselor.

Because new symptoms of anxiety and depression had
flared up a few months ago, Dr. Nardacci added lithium
to Ms. Jackson's daily dose of medications. The pills
are in part responsible for a 30-pound weight gain, but
Ms. Jackson was unfazed.

Dressed in a yellow turtleneck and tweed pants, her hair
swept up into a beehive, Ms. Jackson was happy yet
apprehensive about leaving the shelter.

Her next stop, Los Vecinos on Pitt Street, is geared
toward mentally ill people with substance abuse problems
and offers counseling and psychiatric treatment, among
other things.

The services at Los Vecinos are much like those offered
at the shelter, but Ms. Jackson has her own room instead
of a cubicle.

She shares a common space with two other women.

"I wake up to whatever the plan is for that day," she
said. "I have no baggage from the day before. I can deal
with things. That's a big plus. It is so awesome that I
can deal with things that used to grip me for days."

END FORWARD

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