Chapter One
In 1988, almost by accident, I began working with homeless people suffering from mental illness in New York City. This was meant to be a short term vocation, a year at most. But for the next fourteen years, I worked with the homeless mentally ill in Manhattan in a variety of settings–first on the streets, then in shelters, then in supportive residential programs. All of my clients suffered from, as the psychiatric textbooks put it, “severe and persistent mental illness.” That is, they were diagnosed with various forms of schizophrenia, extreme mood complications such as bipolar disorder and major depression, and a range of personality disorders. Most of my clients had been or were addicted to some combination or other of alcohol, heroin, crack, cocaine, benzodiazepines, and PCP. A very large percentage had chronic physical ailments like diabetes, HIV, and hepatitis. Despite the rather remarkable burden of their collective afflictions, my clients were also of ...
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