The Bipolar Paper Truck
Special acknowledgements to Dr. Dana Clark, Vianna Quach, Chelsea Godfrey, Jonathan Lall, Norman Zheng, Lexxie Hutson, and Thomas Gebert for their efforts to transcribe and digitally archive this written work.
Part I: Editor’s Comments (written by Nick Peoples)
The words below have followed a circuitous route to their immortalization on this blog. The Bipolar Paper Truck, which appears in its full form below, originated as an unpublished essay written by a Houston man – known to us only by his pen name of “Homeless-TDW” – who passed away nearly 15 years ago. He gifted the only copy of this essay to Dr. Dana Clark, his physician at the time. In early 2022, as my writing about the intersections of homelessness and public health was lifting off, it then found its way into my possession. I found his missive to be brutal, humorous, and insightful (in particular, some of his critiques of medicine rang uncomfortably true). But I also found his essay fascinating for an entirely different reason.
In graduate school, I studied under a couple of prominent medical anthropologists who introduced me to ethnography. Described satirically by Clifford Geertz as “deep hanging out,” ethnography is a unique social science methodology where the researcher attempts to learn about a culture or community from the inside-out. There is a soft requirement of spending a minimum of two years within the community and more formal requirements of taking copious fieldnotes and conducting interviews in the local language. This eventually culminates in an “ethnography,” a book or manuscript that reflects both the hard-won insights into human culture and the author’s lived experience. What stood out to me about The Bipolar Paper Truck is that it – though inadvertently – followed the format of many professional ethnographies. This felt significant.
I thought an academic anthropology audience, given that they are professional ethnographers, might appreciate this firsthand account of lived experience. So, I worked with a close friend of mine (who did train in anthropology at The University of Chicago) to craft a short introduction. We argued that works like The Bipolar Paper Truck are deserving of publication in a scholarly journal because, though the author was not a formally trained “academic expert,” his lived experience comprised its own (and significant) form of expertise on homelessness. We further argued that such a firsthand account should be considered at least as important as those of the professionals who study these problems from a distance:
It is common coin to hear the humanitarian world speak of “amplifying the voices of marginalized communities,” or to employ the well-worn refrain, “being a voice for the voiceless.” In practice, these catchphrases often become realized as speaking for and about marginalized communities (Oti and Ncayiyana, 2021), betraying a naïve paternalism that too often characterizes unreflective activism [footnotes 1, 2] … Therefore, most public writings on social justice historically come from the “researcher” or the “activist,” and not the “vulnerable person” or the “subject”…To honor the lives and stories of the people we serve at HOMES Clinic, like “Homeless BP-TDW,” we are now responsible to share this engaging firsthand account with a broader readership. In doing so, we hope to “amplify his voice” in the purest sense: with dignity, respect, and without alteration.
Disappointingly, our colleagues in academia disagreed. More interested in the views of a 27-year-old with an ivory tower education (one that did not include living on the streets, it should be added), they responded:
We would like to consider a piece by you and maybe your co-author written about your reflections of what it means to come across this writing. Did it change your perspective on patient lives in any way? How does it impact your learning as a medical student? You could include several short excerpts from the pages to demonstrate how you read the pages and the way that your thinking might be impacted or changed by reading first person narratives and stories from patients about their lives outside of the healthcare system. A piece that reflects your perspective would be useful and interesting to our readers. We have many readers who are also medical providers and/or work as researchers within and beside healthcare systems and medical providers. Your insights might be informative for practice in those ways. [emphasis added]
We responded, perhaps a bit defensively, that:
We provided our reflection of what it means to come across this kind of writing in our introductory comments. We argued that the author’s words are important and valuable on their own, and do not need to be “filtered” by someone with a PhD or MD in order to be worthy of presentation to an academic community. True, his writing does not meet the academic standard of a professional ethnography (which is why we did not submit it as one). But in that same vein, even the most rigorous and stylistically brilliant ethnographer could not write about the struggles of housing insecurity and mental illness with the kind of firsthand account of lived experience presented here.
We believe this work will inform practice by serving as a scholarly retort to trendy but unreflective catchphrases such as, “being a voice for the voiceless,” which imply the need for a self-appointed spokesperson. This work counters that there is no such thing as a voiceless person or demographic. People experiencing homelessness are routinely the subject of derision, condescension, and humiliation. They are placed into stereotypes such as “stupid,” “worthless,” and “lazy.” This piece, and its introduction, would inform practice by buttressing the view that vulnerable groups have a voice, that they have a message, and that they are capable of much more than the rarefied circles of medicine or academia oftentimes give them credit for. The work asks us to engage in self-reflection with respect to how we view, talk about, and write about vulnerable peoples.
Long story short, the journal declined to move forward with publication. Undeterred in our belief that this work still merits a broader audience, however, we have opted to share it here on Word on the Street. Included below is the full submission, a letter-for-letter transcription without any alteration to the original source material.
[1] During a lecture series I was fortunate to witness at Yale University in 2018, a Ugandan activist put it bluntly: “There is no such thing as a voiceless person.”
[2] Physician-anthropologist Seth Holmes, in his study of migrant farm workers, writes: “I have been…shocked how often conferences on migration include no migrants, even though they are presumably experts on the topic” (Holmes 2013).
image originally published by The Houston Chronicle
The Bipolar Paper Truck written by “Homeless BP-TDW”
If you live in the Houston area you have probably seen one of the many mid-sized “bobtail” Houston Chronicle trucks scooting about the early morning streets just before dawn. These familiar gray trucks look like giant beetles with their big square, wasp-like windshields and their short, squatty cargo boxes that look similar to the bugs’ backside. As you drive up close to one of these trucks you can see they are loaded down with the morning Houston Chronicle newspaper salesmen who will be dropped off at various street corners to sell the morning paper. When one of these “beetle” looking trucks stops at one of its locations, you will usually see a worn, ragged looking man jump out of the back of the truck with a huge stack of newspapers.
Before the early morning traffic gets going, he will strategically stack the papers in a high visibility area on his “every day corner.” For the next four to ten hours, he will walk endless miles in and out of heavy traffic, carefully watching the traffic lights and running to his customers, who are gulping hot coffee and frantically waving a dollar or two from a cautious, small opening in the driver’s side window.
Selling newspapers can be a grueling task, dodging heavy traffic, enduring extremely hot or cold weather. Forever fighting a blistering, frustrating when that blows sports sections, food sections and coupons all over the countryside. Not an easy way to scratch out a very meager living.
Recently, I had the misfortune, or perhaps the fortune, to experience working in one of the Houston Chronicle trucks. I spent several days selling newspapers and getting to know and understand many of these hard nosed, often misunderstood street sales people.
I had lost my job and was completely broke. I was forced to move to a homeless shelter for single men; “The Star of Hope.” I was like a fat old house cat that had been thrown to the tough, hard streets. I was devastated from fear and anxiety in my new, hostile environment. However, I knew one thing was certain, I had to make some money, some walking around cash to keep up my appearance and buy bus fare to keep myself mobile while looking for a new job. Aimlessly walking around in the homeless shelter, I couldn’t stop thinking back over the the past few years. My job performance was down and my rather large, successful family was no longer speaking to me, and I truly did not understand why.
I was certain, however, I had been drinking far too much over the past few years and I felt I was growing more distant from friends and associates. I didn’t think anyone notices a change in me, for the most part, I felt “okay.” I was in good physical shape, I felt I still had value and was confident I would be successful again. Nevertheless, I knew something was wrong inside me and it seemed to be getting worse.
I had long, expensive visits with many doctors, of all specializations, and was bombarded with many diagnoses, theories, and wild guesses as to my problem. But it seemed not anyone could identify what was wrong. I did know, however, when under any level of stress I would become very anxious, neutralized and unable to concentrate. I became defensive and felt separated from the world. However, without stress I felt like my normal self. It was like I had a sleeping monster in me, and stress of any kind would wake him, and leave me in a state of malfunction. I found that a couple shots of alcohol with calm this growing monster and when he was asleep I would feel optimistic again, spirited and motivated, ready to conquer the world!
Yet, there I was, standing on a wet sidewalk outside the home of shelter, at three in the morning, waiting to jump on a newspaper truck with a bunch of other homeless man. Hoping to be picked up and dropped off at dawn the sell some newspapers and make about ten bucks.
This was painful. I felt alone. “This is not me,“ I thought, I wanted to run. The monster was stirring in my stomach and I felt nauseous. About three-thrity in the morning two gray “beetle looking“ trucks came rattling up the wet street. My anxiety started to consume me. The trucks slowly came to a halt a few feet away, their red and yellow lights flashing. I just stood there not knowing what to do. Suddenly, all of the other homeless men routinely boarded one of the trucks and it crawled off into the night. Like a little kid, I just stood there staring at my feet and rolled a rock around with my foot.
The remaining truck slowly crawled toward me. I looked up to see the driver’s side window sliding down and a Mexican man with a thick, heavy, mustache stuck his head out of the window. “Hey senor, you want to sell some ‘peppers’; get ‘een?” I hesitated, then walked along the dark side of the truck until I could feel the cold wet bumper on the back of the truck. I got a foot in and two shaky steps later, THUD! I was on my hands and knees on the floor of the dimly lit paper truck.
Embarrassed at my clumsy entrance, I quickly flipped over in a cross-legged position. Somewhat shaken and short of breath, I slowly looked around and grew stiff with acute mortification! It looked as if I had falled into a Malaysian funeral ceremony during a multiple wake service, somewhere in the dark jungles of Malaysia! In the dim light of the lumbering truckI could see about ten men, who looked recently embalmed, lying in prone positions on heaps of white newspapers.
They were painfully thin, their skin reptile-like, hands and faces weather beaten, wrinkledand dried out from far too much alcohol and exposure to wind, sun, heat and cold. Not one of them seemed to notice me. I pushed a few stacks of papers to one side and the “paper men” slowly came alive and sat up. They pulled at their shirt pockets for cigarettes. I was amazed to see everyone of them smoked. They drew in great clouds of smoke, lighting one off another. From the light of the burning embers I could study each man’s face. Their eyes were lonely, without any expression of hope. They sat stoop shouldered looking detached from the world. I was slightly amused to see a lot of them had an astonishing resemblance to Willie Nelson. The truck was thick with smoke, I could barely breathe. Trying to get more comfortable, I uncrossed my legs and slid my wet tennis shoes off across the floor and it sounded like I “broke wind!” They all broke into a toothless laughter, and I laughed too, but I thought it was strange that nine out of the ten men were toothless! I would guess the average age of these guys was only forty years old.
Bang! Suddenly we hit a deep pothole and the paper truck bounced and swerved. Everyone was tossed around, slamming into each other. Tempers flared, instantly a fight broke out, but it was quickly settled. There was chaos and loud shouts of vulgar profanity. For a few long minutes everyone was tense, angry eyes threatened every man. A few miles down the road I was still uncomfortable, as aimless obscenities were exchanged. The chain smoking continued, it was like a dense fog. I sat as still as possible hoping to go unnoticed. I studied everyone for a while, it was amazing to me how short fused, argumentative and ill tempered these men were. Strangely, it seemed to be a common characteristic among them, almost biological.
The smoke from the strong, unfiltered, cigarettes was so thick it became very difficult to breathe. Suddenly a feeling of impending doom washed over me. A choking panic attack gripped the muscles in my neck and chest. I covered my face with my hands. How long would I have to live this way? What had reduced me to this level? What happened to me? I was brought up in a good home by successful parents in one of the finest neighborhoods in Houston. I went to a great high school and a wonderful university on an athletic scholarship and enjoyed great success in the investment business. I had a fine home, a beautiful wife and children, and enjoyed a great social life. What had gone so wrong in my life? How could I end up on the newspaper truck with a bunch of broken down men who seemingly know only how to curse, drink booze, chain smoke, and go out early in the morning to sell newspapers earning just enough money to support their self destructing habits? What had reduced me to this point? What had reduced these men to this point? I had to find out.
The paper truck made four or five stops to let the men jump off with their stacks of newspapers to sell at their "regular corners". The truck driver, the Mexican man with the thick, heavy mustache, climbed out of the paper truck and walked to the back. He pointed at me and said, "Senor, you are next to get out." Hysterically, I pointed at myself, "Me?" "Si senor, you can sell mucho 'peppers' at thees corner! " Now, a little more optimistic I quickly jumped out of the paper truck with a heavy stack of papers. It was a beautiful Sunday morning, the sun was rising in blazing pink with a clear, pastel blue background. A tiny smile crossed my face, I was actually doing something positive. However, as I looked around the area, my heart sank and my legs began to shake. The corner where I was to stand and sell my newspapers was on Westheimer, just west of the Galleria and a couple of blocks from my old neighborhood during my high school and college days! Now all of my high school and college buddies will drive by in their big shiny cars with their beautiful families pointing and laughing. I can see their cell phones lighting up now! They will have more gossip at the company water cooler on Monday morning then they've had in twenty years. GREAT!
I wanted to crawl back into the truck. The morning was getting brighter, the traffic was getting heavier, and there on the comer I stood, meekly holding a newspaper in front of me, tears streaming down my face and feeling like a fool in full living color. I sold my first newspaper to a nice old man in a gray Cadillac. He had a friendly smile and thanked me for being there instead of under a bridge. After dropping a small tip in my pocket, I made a solemn vow to find out what had gone so wrong in my life.
Several days pass and I am actually enjoying some success in the street corner newspaper sales. However, more importantly I am becoming better friends with the highly sensitive, very private, paper men on the truck. I was cautiously trying to become a trusted friend in order to ask some personal questions with hopes of finding what caused such a downward spiral in their lives and whether any of it applies to the tailspin in my life?
The paper men had great reservations about speaking out about any deep-seeded problems. Not only were these guys irritable and short fused, but they harbored countless frustrations from the absence of any family love or support most of their lives. It was obvious this neglect caused much bitterness and even though they were beginning to trust me, I could see smoldering resentments toward anyone who pried into their past. They felt talking about it was useless, no one had ever understood them and never would.
After a day of selling papers, we would usually stop at a convenience store for a quick beer, coke or chips. One of the men on the paper truck had a severe stuttering problem which irritated the store clerk. In order to avoid a confrontation he would usually stay on the truck. He was a nice man of about thirty five years and normally kept to himself. When we made our routine beer stop, I bought him some chips and a coke. He thanked me and to my surprise, in spite of his stuttering problem, he enjoyed talking to anyone that would listen. BINGO! He was willing to tell me his life story, and if it took a week, I was willing to listen!
After two days of painstaking conversation and long tearful pauses, I came to know and understand his painful story and his long fall to the paper truck. Early morning, three days later, we boarded the paper truck. I could tell my friend had been drinking most of the night. He sat on the floor next to me, pulling his knees to his chest. He sat very still and blankly stared straight ahead without a word spoken. He turned up a half pint of vodka and softly swallowed, never looking at me. In a soft drawl he began to speak with barely a stuttered word. All of the men sat silent and stared at the floor. I hung on every word.
"My momma, my daddy, my wife and my kids all left me cause I couldn 't keep a job no more. They all thought I was nothin' but a sorry drunk. " He thought for a moment, "Before I had this other problem they say I got, I worked at the same job for eleven years. Done good too. They made me a supervisor and I took care of my wife and them kids. I had a good home, nice truck and everything. It's just, no matter how hard I try, I just can't hold a job no more."
Everyone on the truck was silent, all eyes were frozen on me as if the deep, dark, secret I had been searching for was about to surface. He turned up the half pint of vodka to wet his dry lips.
"Sometimes I get angry, sometimes I can't sit still, I can 't think like I used to and a lot of the time I just feel lazy. " He took a deep breath and went on. "The doctors say I got this mental thing. It is somethin' called bipolar disorder, it makes me feel real uncomfortable all the time. "
He set the empty bottle down. "I can feel pretty good when I drink a few beers or a pint of vodka, kinda like I used to before I came down with this bipolar curse. "
The paper truck lumbered and rattled down the road, but the men were quiet. A young man with long blond hair nervously looked at me. "I am bipolar too, just found out a year or two ago." One by one, as if it were time for confession, nine of the ten men told me, at one time or another, they had been diagnosed with bipolar disorder. As if they had been reminded of something horrible, the men were solemn and serious.
Suddenly, a tall, slim black man stood up and smiled. He shouted "I'M NOT BIPOLAR, BUI' I AM CRAZY!” Again a roar of toothless laughter.
Nine of the ten men on the paper truck were bipolar, obviously this was not a coincidence. I interviewed several more men on the paper truck and it didn't take long for me to understand that this mental disorder is very serious, underrated, misunderstood and often misdiagnosed.
Some of the men said they had been abused as a child, both mentally and physically and lived a lifetime without love or support of any kind. This abuse greatly enhances bipolar dysfunctions. Some of the men believed they became bipolar dysfunctional early in life and some said it surfaced much later as an adult. They all agreed that alcohol and drugs actually helped them cope with the mood swings as well as other symptoms such as; anger, quick temper, aggravation, depression and inability to concentrate or sleep. They were emphatic about the perils of alcohol and drug use. However, they felt the use of alcohol was the enabler that allowed them to somewhat function and get them through each day. The men claim it dulls the dysfunctional characteristics of bipolar disorder.
I was suffering from many of the same symptoms as the men on the paper truck. I thought for a moment, I too, felt that the use of alcohol would make me feel somewhat better and more functional. Soon, I made an appointment with a good psychiatrist and it did not take long to determine I was suffering from bipolar disorder.
I started taking the prescribed medication as soon as possible and relayed the medication information to the men on the paper truck in order to see a physician and get themselves on the proper prescribed medication. To replace the use of of alcohol as a medication. The doctors informed me that bipolar disorder is usually hereditary and may lay dormant for many years and will surface or become active for a number of reasons: one's natural biological system, personality, and many doctors believe chronic stress plays a primary role as to when or if the bipolar monster becomes active.
Looking back, my bipolar disorder became consuming about ten years ago. I was under enormous stress at that time of my life and I believe that is when the bipolar monster in me woke up! I slowly became more and more dysfunctional and consumed more and more alcohol to function and feel like my normal self. I now know this combination (bipolar disorder and alcohol) caused me to lose everything, almost my life.
Now, with new confidence, more information and cautious optimism, I set out to do a bipolar investigation on a larger scale. I headed back to the Star of Hope men's shelter where approximately two hundred homeless men reside every day. I took a survey of one hundred men and I was shocked to learn that seventy two out of the one hundred men I interviewed had been diagnosed With bipolar disorder! The remaining twenty eight men did not know or would not respond. The seventy two homeless men had been diagnosed at various county clinics and hospitals in and around Harris County.
Incredible, I thought, homelessness could be caused mainly from bipolar disorder; and this mental illness can be successfully treated with the proper treatment of medication and psychiatric care. Perhaps forty to fifty percent of homeless people could get off the streets and from under bridges and perhaps live a somewhat normal productive lifestyle.
At this point, for the most part, my information comes from the victims of this illness. In simple English, from a "hands on", non professional perspective, and of course, my own experience with this mental disorder.
I jumped on a Metro bus with my notes and information and headed for some of the Harris County clinics and hospitals to share my information with the good doctors of those facilities. The psychiatrist were more than willing to speak with me concerning the information I had gathered. However, their general consensus and concerns for the homeless people with bipolar disorder was; "the patients or victims of bipolar disorder either refused to take their medication or ineffectively take it for a short period of time". This was frustrating news as well as puzzling.
I returned to the Star of Hope men's shelter and asked some of the homeless victims of bipolar disorder, "Why do you refuse to take your medication?" The first man I asked was a huge black man, perhaps six foot seven, three hundred pounds. His hair was loosely woven in long gray and black braids that hung below his shoulders. He was blind in his left eye. The lighter skin around his eye socket suggested he sometimes wears a patch over the scabby, empty socket. With his one eye he studied my face for a long time, my eyes burned from the thick, haze of smoke, but I didn't blink or move a muscle. The huge man spoke in a deep, clear, voice with a heavy Jamaican accent.
"Mon, the streets of any large city are extremely dangerous places to live. For example Mon, in New York City the average life span for a homeless mon is only four years. A frightening statistic. The bipolar medication makes a mon extremely slow and lethargic, and when your home is the streets; a most violent and dangerous place, the very last thing a mon wants to be is lethargic, sleepy". "Easy prey for those who lurk in the dark shadows and alleyways". His one eye widened and froze on mine, then he smiled. "If the medication makes you fall asleep on the sidewalks and you don't move along as Police say, HA! You are handcuffed and dragged like a dog to his Police car, no good Mon, I don't take the medication."
Somehow, at least for that moment, he made sense to me. I was writing everything down as fast as I could, when I looked up, he was lumbering his way through the heavy crowds of the Homeless.
I interviewed many other homeless, bipolar victims and their response was very much the same. I hit a snag, so I telephoned one of the doctors that I previously interviewed and he said, “These are indeed some of the side effects of the medication and I certainly sympathize with these people. However, after four to six weeks of taking the medication the chemicals in the brain should start to level out and the patient should adjust and move on with business as usual.”
During my research of bipolar disorder, I realized just how unknown and misunderstood that mental disorder is by the general public. For confirmation I took my study to the working man on the streets of downtown Houston. I stood on the sidewalk in front of City Hall. The first man I walked up to was a burly, husky, older gentleman, with a large red face and white hair. He wore a khaki uniform and was a long time employee of the telephone company. I pulled out my notepad, gave a comforting smile and asked him this question, “Sir, what do you know about people that are bipolar?” He stopped, looked away and thought for a moment. He put his hands on his hips and cocked his head sideways and looked at me like a big bird.
“Shoot bou, I have been in the telephone business for a long time and I know quite a bit about bipolar.” He had my attention and I carefully listened. Rubbing his chin, deep in thought he said, “You see son, as I recall, these were them housewives back in the fifties and early sixties.” Now I was puzzled. He went on, “Yeah son, these young housewives back then couldn’t be satisfied with just one phone, no, they had to have one in the living room and one in the kitchen. Some kind of a fad I guess, probably come off the ‘I Love Lucy’ show or something. Now son, this causes a giant headache amongst us telephone men cause back in them days we had to put up two telephone poles in their yards for this kind of hook-up, and that was called bipolar, yes sir, that’s where all this bipolar business got started.”
In disbelief I smiled weakly trying desperately to hide my hysteria. He crossed his arms and remained serious. I hurried away. I interviewed a few more people and was disappointed at most answers and attitudes. I decided to interview one more person and then move elsewhere. I noticed a well dressed lady walking toward me so I gave her a friendly smile and stopped her for a question or two. She was very friendly, had a beautiful smile and neatly cut crown of flaming red hair. Proudly, she informed me that she sold ladies perfume and make-up at one of Houston’s most famous and expensive department stores. Enthusiastically, I smiled back at her and asked, “ma’am, do you know anyone that is bipolar?” Her eyes widened, she suddenly got excited and pulled at my arm. “Why sugar, yes I do!” She was smiling like the winner of a county fair beauty pageant. She sang out:
“As a mater of fact I do! I have this cousin that was with the National Weather Service, something to do with those big balloons, and my goodness, they made him travel all the way to the north pole. And I guess they got mixed up, cause they turned around and sent him to the south pole! Now a days, he is always braggin’ to me that he is bipolar!”
She giggled and pulled at my arm again. I put my notepad back in my pocket and waved at an oncoming trolley car. The trolley cars of Houston ride as rough as a boat over a jetty. While going back to the Star of Hope mission it became obvious to me how people with bipolar disorder have been completely misunderstood and disdainfully misjudged. Their failure and shortcomings have been blamed on alcohol, drug abuse, laziness or stupidity. Unlike any other illness, bipolar disorder takes the victim away from those who love him, leaving the victim angry, unresponsive, withdrawn and hopeless.
Attention Deficit Learning Disorder (ADLD) and Attention Deficit Hyperactivity Disorder (ADHD) are often thought to be early warning signs in children of the bipolar illness. They share the same symptoms and can be devastating to children and young adults. Children’s limited communication skills and natural moodiness can confuse a proper diagnosis.
However, for years many children have silently suffered from early stages of bipolar and ADLD and ADHD. They have been harshly disciplined by their teachers and unjustly spanked and shamed by their parents for poor grades, lack of attention and daydreaming in the classroom. How unfair, it’s not their fault. This denial, ignorance and prideful neglect of these early warning signs and unwarranted discipline promotes catastrophic insecurities in children as well as low self-esteem and enhances a host of other problems. That’s sad.
At this stage of my bipolar research expedition, I’m running very low on cola money, I’m down to fifteen cents. In order to finance any further study I had to return to the newspaper business and get with my friends on the paper truck.
It was good to see these guys again and in spite of their bipolar disorder I have come to realize these guys still had purpose in life, they desperately wanted to contribute something positive to society. Many of them at one time or another enjoyed some degree of success. Many served in the military, some had good jobs, most finished high school and some went to college. They had pretty wives and beautiful children, they enjoyed family outings, sports, church and a meaningful life. Somewhere the bipolar monster woke up and surfaced in their lives, slowly crippling them, taking away so much of their natural functions and behaviors.
I have some to understand that the bipolar illness is destructive to the body as well. Bipolar mental illness is a “manic depression disorder,” the men on the paper truck were toothless. Most of the men at the Star of Hope men’s shelter who suffer from bipolar disorder had poor teeth, no teeth or wore dentures at an early age. In the “manic stage” the sufferer is very hyper, anxious and aggressive. He usually goes without sleep for days. The “manic stage” causes the body to use extraordinary amounts of calcium, as well as other valuable vitamins and minerals. The results are poor teeth and bones at a very early age. It is not necessarily due to poor dental care or hygiene.
Once again, a negative assumption by family members who have very little or no understanding of bipolar disorder. Too often family members are content to believe the problem is irresponsibility, alcohol or drugs. Doctors have known for years that the use of cocaine can create symptoms and moods that resemble the “manic stage” of bipolar disorder. I have seen many cocaine users at the Star of Hope men’s shelter and most of them have poor teeth or no teeth, even at an early age.
A proper diagnosis at an early age along with regular dental care and large doses of calcium and other vitamins and minerals will promote an attractive smile and sound teeth and bones to the bipolar sufferer.
After long hours of research and many interviews with bipolar victims I have come to several conclusions. Bipolar disorder must be more aggressively addressed by physicians and the psychiatric society, especially in areas of clinical psychopharmacology. Parents must be more educated and aware of the signs and symptoms of bipolar disorder. Especially concerning young family members. A loved one in your family may be struggling silently with the bipolar monster at this moment. The mood and behavior can be so bizarre that they are far removed from the moods of healthy people.
The classic characteristics and symptoms can be recognized if you are aware of bipolar disorder dysfunctions and behaviors. You should be especially concerned if any family member; aunts, uncles, grandparents etc… have been diagnosed with bipolar - manic depression mental illness.
Bipolar, manic depression, causes mild to severe mood swings and what triggers an episode is not necessarily what causes the disease. An accumulation of life stresses, especially if they interfere with sleep, may be to blame.
In the “manic stage” the victim may be very hyper, extremely anxious, have excessive energy, a rapid, hard to understand, speech. Delusions can include grandiose beliefs, thinking he has special skills or talents. The manic stage may last for days or weeks and decrease sleep is a compounding feature.
A suffer in the “depressive stage,” can be irritable, experience diminished interest in any pleasurable activity, a loss of energy, a feeling of impending doom or hopelessness and inability to concentrate.
The bipolar illness causes many dysfunctions in a sufferer's daily life. These can be as follows: makes poor decisions, can’t finish any project once started, poor management of finances, feelings of detachment and repeated trouble at school or at work.
Many bipolar sufferers go through life undiagnosed or perhaps misdiagnosed. As the victim goes into adulthood and life‘s daily stressors begin to waken the monster, there may be a helpless decline in the quality of the victim's life. This will lead to failed marriages, broken homes in families, lost jobs, alcoholism, drug abuse and a mismanaged life in general.
In my research of bipolar disorder I have come to realize, that for whatever reason, bipolar disorder is on the rise. I truly believe this alarming increase in bipolar sufferers is due to the stressful world we live in. However, it really doesn’t matter if it is caused by genetics, stress, pollution, cell phones, or toilet seats. It is debilitating and it will ruin one’s life. The symptoms must be recognized early and properly diagnosed. The families of a bipolar victim must give him support, love and undying understanding, with the proper physician’s care and medication he or she can look forward to a normal, fulfilling, prosperous and happy life.
As for me I am happy to say I’m doing a lot better! I’m putting my life back together and my friends on the bipolar paper truck had a lot to do with that. I would like to thank the Houston Chronicle newspaper for providing these men, and many others like them, a chance to work on their “street corners” selling newspapers and keeping their sense of self-respect. With the hope of someday working back in the main stream.
I would also like to thank the Star of Hope men’s shelter. These are such good people and they provide a quality, clean, Christian home for those who suddenly look up and don’t have one. There are two doctors in particular I worked with, they know who they are, and their contribution was so helpful. Thank you.
- Homeless BP-TDW
Ethics Statement
While we know it is in line with the author’s wishes that this work be shared widely, in keeping with ethical standard for posthumous publication, we additionally requested and received permission to share this work from his next-of-kin.
Disclosures
Nicholas Peoples is a medical student at Baylor College of Medicine and Executive Director of Clinic Operations at HOMES Clinic, a program of Healthcare for the Homeless-Houston. Dana Clark, M.D., is a faculty physician at Baylor College of Medicine and a physician at Healthcare for the Homeless-Houston.
References
Holmes, Seth M. "Fresh fruit, broken bodies." In Fresh Fruit, Broken Bodies. University of California Press, 2013.
Oti, Samuel Oji, and Jabulani Ncayiyana. "Decolonising global health: where are the Southern voices?." BMJ Global Health 6, no. 7 (2021): e006576.
