Despite my early interests in specializing, I strongly believe that there are several fields I want to develop as my core competencies that will contribute to my skill as a specialist. If I choose to be a Pulmonary and Critical Care physician, cardiology, nephrology, and infectious diseases are obvious complements. An additional field I want to develop a strong foundation in is psychiatry, the current subject of my coursework (known to medical students as “Behavioral Science”). As a medicine physician (as opposed to a surgeon) working with adult patients, I will become very familiar with depression (common in the elderly), delirium (from electrolyte imbalances secondary to many common medical conditions), and dementia (e.g. from Alzheimers, hypertension, etc.). As a student of medicine in New Orleans (and hopefully in my future residency program and work settings), I am also going to become very familiar with another population: the homeless.
I, like many others, have not always been particularly sympathetic to the homeless, but this is largely a product of inexcusable ignorance. This is partly a result of my background as an immigrant: many immigrants hold to productivity and hard work as core principles of their existence and pathways to better lives. The struggle is the cost we pay for success and happiness; failure to thrive is the greatest disgrace and loss of honor. When we see others not working, we sometimes assume that they do so willingly and to their own deserved detriment. This view is, at best, misguided. According to one of my psychologist instructors, approximately one half of all homeless people are suffering from a mental illness and became homeless as a result of their mental illness. Of this 50%, most of them have schizophrenia, a disorder that is poorly understood by the general public. Schizophrenia is not multiple personality disorder. Instead, it is characterized by periods of time when they suffer from hallucinations (false sensory perceptions, especially auditory or voices), delusions (false beliefs not held by others), and other symptoms such as social withdrawal and disordered behavior (odd speech patterns and content, poor grooming, etc.). One problem that frequently occurs with schizophrenics is the downward drift: their difficulty in functioning in social and work situations causes them to slide into problematic living situations (e.g. losing jobs, relationships, housing, support structures, etc.). Unfortunately, illicit drug use is common, particularly since sometimes drugs like cocaine and alcohol are the only effective methods of quieting terrifying hallucinations or are needed to complement medications (which may not reduce 100% of schizophrenic symptoms). For some, homelessness is actually a preferable option to living in a house: the isolation of homelessness is sometimes more amenable to the ways they perceive interactions and the world around them, and our normative ideas of living are very difficult for them to adapt to. However, this life is a difficult one: “knowing which fast food restaurants one can sleep in and knowing how long they’ll allow it, staying awake at night because that’s when bad things happen.”
Does knowing that half of homeless people suffer from a disabling mental illness make one more sympathetic or interested in helping them? For me, yes. Our society likes to cast blame on others, and I believe that it is never right to blame someone for the adverse effects of the disease they suffer. The disabling aspects of schizophrenia impair the ability of these individuals to lead normal lives in the absence of consistent, conscientious, and proactive care. In the absence of family support or societal acceptance and aid, who else can lend these people a hand and show some understanding?
Recently, a homeless schizophrenic killed a young female police officer in New Orleans, resulting in a media frenzy and a flurry of pointed fingers. As all sides try to cover any potential liability on their parts, the news has portrayed the man as one who has “taken advantage” of the hospital system. Several psychiatrists I have spoken to instead contend that this tragedy is a failure of the mental health system, which has been struggling to revive itself after Hurricane Katrina. Notably, there are only about 40 psychiatric beds in New Orleans, as the DePaul psychiatric hospital in uptown New Orleans has not been reopened, partly as a result of the discouragement of locals in the neighborhood.
Today, we had a man with bipolar disorder and a woman with schizoaffective disorder speak with us about their diseases, their experiences with physicians, and their struggles to stabilize their lives and help others in distress. One of the patients (who works to help others with mental illnesses) said, “This is nothing to be ashamed of. This is something that can happen to anybody. We need people to listen to us and realize that we’re just like anyone else who needs help.”