Friday, February 24, 2006
Memory tricks
I remember one time when I was a resident in neurosurgery at the University of Michigan, and I was called to provide a consultation on a gentleman in his mid 40's who was destitute and diagnosed with a mental disorder. When I examined him, it became clear that he had no memory whatsoever. He could not even remember me when I said "hello" and then returned five minutes later. He had no short-term memory and had absolutely no long-term memory either. In short, he had no past, present or future.

He was complaining of headaches though, so we ordered an MRI scan of his brain. What we found blew us away. He had a large benign brain tumor sitting in the front of his brain, squarely pressing on the structures responsible for memory. Sure enough, when we took it out, he rapidly started to recollect everything. He had once been an engineer, but had developed a personality problem that got him fired. In retrospect, that personality problem was probably the first sign of the brain tumor. He then turned to alcohol as a salve, which eventually led to him becoming homeless and destitute. Once the tumor was removed, it was as if the last eight years of his life had never happened. I have never forgotten that gentleman and his remarkable story.

Tonight, we tell the story of Doug Bruce. One day, he suddenly "woke up" on a subway. He got on the subway as Doug Bruce, but by the time the train had stopped, he was no longer that man. He had forgotten everything, including his name, where he came from, his family. He didn't even know why he was on the train. It turns out Doug may have had a cyst in his brain that ruptured, causing instant and complete memory loss. As a neurosurgeon, I can tell you that it can happen.

But it got me wondering: How many people out there who are homeless and dismissed as mentally ill might in fact have a very treatable brain problem? And how could we ever figure that out?
Posted By Dr. Sanjay Gupta, CNN Medical Correspondent: 6:58 PM ET
It makes you wonder what kind of health care he received while he was still working...he apparently didn't see a decent doctor when the troubles at work began. Perhaps the employer should've recommended a medical checkup? Good grief, but it always seems like the weirdest things happen when preventive care - or at least early care for a problem - doesn't take place for whatever reason. This man got too far out there before he ended up, years later, being referred to you somehow/someway/by somebody. The root of it all began at the office. Maybe therein lies a potential solution?...
Posted By Anonymous Dana I., Lawrenceville, NJ : 7:24 PM ET
We cant unless we MRI everyone who is homeless and dismissed as mentally ill. And you know thats not going to happen because the United States would rather fund a billion dollar war rather than help its own people(please check Katrina blogs) and you'll see what I'm saying. Why is the government so eager to fight wars overseas but won't fight wars here at home?
Posted By Anonymous Jeff, Fresno,Ca : 7:25 PM ET
My husband (then 46) experienced a severe anoxic brain injury after cardiac arrest. I am a nurse and am still stunned by the almost 100% recovery he made in a short time (18 months) so there is little about brain "events" that could surprise me.
There is so much about the brain that we still need to learn........
Posted By Anonymous Pat, Onalaska, WI : 7:31 PM ET
That is the most fascinating thing I have heard on the cooper blog. I really hope you pursue this further.
My question is, how long can someone live for with a tumor or other disorder in their brain? Would all the various brain disorders that cause this phenomenon have severe physical repercussions within a few years?
If so, it would seem that they would find medical attention sooner or later. If not, this could be a major contributing factor to homelessness.
Posted By Anonymous Lawson cas, Normal, IL : 7:39 PM ET
My brother, God rest his soul, went through the same thing. He had a tumor on the brain when he was 16 years old. He had lots of problems as an adult, became alcoholic, etc. He finally sobered up in his thirty's. About 8-10 years later, he started to act strange and everyone thought he had gone back to drinking. I took him to a doctor and they found another tumor on his brain. He only lived 2-3 weeks after that.

Helen Salisbury (also known as granniebags)
Oceanside California
Posted By Anonymous Anonymous : 7:42 PM ET
Wow that is truly interesting. I don't understand how the problem was not diagnosed much earlier before the gentleman became totally broke and homeless.
Posted By Anonymous Kyle, Toronto Canada. : 7:46 PM ET
I doubt that most of the homeless population has some sort of problem along this way due to the fact that a large majority of them have put them selves in the position by abusing drugs and alcohol. I do think however, that once sober and after treatment they can be at a much more normal state of mind.
Posted By Anonymous Esteban, Dallas TX : 7:49 PM ET
Hi Dr. Gupta:

Thank you for your insight into these special brain tumors. One aspect of the obesity problem in the US that is not covered is that vascular dementia can cause memory loss when the there are Trans Ischemic Attacks (TIA) or small stroke from elevated blood pressure or block carotid arteries or even fatty deposits building up in the brain from elevated cholesterol.

While recent studies have indicated that a low fat diet may not lead to cancer, there is increasing evidence that high fat diets lead to other health aspects that may affect memory in the brain.

Certainly we have see patients who have blocked carotids and give of the appearance of memory loss or even an Alzheimer like condition which all came from elevated cholesterol. That is why drugs that reduce cholesterol are so interesting because of the secondary benefit to the reducing blockage in other areas.

Also diabetes can play a role in vascular insufficiency to the brain.
Posted By Anonymous Sue, UCSD School of Medicine, La Jolla, CA : 7:50 PM ET
Perhaps further study should be done on the mental faculties of homeless individuals. I can't imagine that many of the homeless people are simmilar to Doug Bruce. His problem was a physical obstruction in his brain. From the many of the homeless people I have seen, I would think that they were either a victim of poor luck or had psychological problem like bipolar disorder or schizophrenia which arise not as a result of physical trauma. I imagine most of these psychological conditions and bad luck conditions are treatable. A better question to ask is, "what is our responsibility as members of society to actually go out an seek all of these people for treatment?" They may not know that there are resouces to help them... if any. Also, those that need it may refuse treatment, so how does one know if they are psychologically impiared or expressing free will. It is would be such a complicated process that it may not be worth the effort... which goes back to the question, are we responsible for them?
Posted By Anonymous Tom, Bronx, NY : 7:55 PM ET
Dr. Gupta,
Even when unwell people go to a doctor early on with a condition, they are commonly misled. Even though my mother had almost none of the risk, factors that point to vascular dementia, and no CVA's found in the MRI's and CT's she was diagnosed with vascular dementia. Almost 2 years later, her new PCP arranged a PETscan and it points solidly to Alzheimer's. There isn't much difference and wouldn't have changed her treatment since she was so far along before any of the tests were done, but it points out how narrow-mindedly doctors diagnose, even failing to address obvious clues. I do believe that many tragically ill patients, especially the mentally ill, are one diagnostic test short of an accurate, successfully treatable diagnosis. Thank you for making a similar point.
Thank you,
Emily L Dye
Posted By Anonymous Emily L. Dye, Farmington Hills, MI : 7:56 PM ET
Wow, incredible story. I have a cousin who was just like any normal kid. However starting at the age of 6, and over the course of about 13 years, he had gradually worsening headaches. Medications, changes in physical/mental/eat habbits, and therapy all had little effect. Doctors finally decided to do x-rays on his head and found a grapefruit sized benign tumor. It was located just below the brain at the rear of his skull. Once removed, he never had the debilitating headaches again and the void just filled in with no noticeable side effects. His mom never asks him not to play video games anymore, as it turns out they really weren't the cause of his pain.
Posted By Anonymous Brent Knutson, Minneapolis, MN : 8:06 PM ET
"But it got me wondering: How many people out there who are homeless and dismissed as mentally ill might in fact have a very treatable brain problem? And how could we ever figure that out?"

Sanjay, your questions evoke several emotions. One is sympathy. How afwul it must be to suddenly lose it all and not even know it. Another is admiration. You're a noble bunch, you doctors -using your medical background to help us humanize and empathize with a group of people usually discraded as human garbage. Yet another is fear. Imagine if a significant number of homeless people actually did have the kind of brain damage you describe - it's within the realm of possibility. Imagine if we never noticed. What would that say about us, as a society?
Posted By Anonymous Josh, New York, NY : 2:15 AM ET
It is amazing to read stories like this. It really makes one think about how many undiscovered disorders and illnesses really exist in this world especialy in such an uncharted vessel like the brain. Furthermore, it is intersting to think about how it has impacted the lives of those inflicted in a way in which we cannot understand. It is a scary idea and really makes a person think twice before passing judgement on the homeless and disadvantaged. Hopefully with the continued effort of science and medicine, more horrible conditions like these can continue to be unmasked.
Posted By Anonymous Nick Schimmer, Kansas City, Mo. : 2:45 AM ET
Hello Dr. Gupta ,

My Dad recently had a severe aneurysm and since then I have begun to learn a little bit about the delicate thing that is the brain. You have a great point when you ask how many are out there living like this now. Well the answer is probably millions worldwide. As far as finding a way to detect it, well that is a whole other matter as you know. I think you neurosurgeons are saviors and you personally should go back into practice rather than wasting your time with all of these reporters. Though I must say it is refreshing to see that CNN has a medical correspondent such as yourself who knows what he is talking about.
Posted By Anonymous Seth W. Steinlauf, Sacramento, CA : 3:15 AM ET
The article makes the assumption that compassion is an ordering principle of our society. The medical establishment spends more on lawsuits than on helping those who could use their help. Life and death decisions are made every day with little or no thought to the bigger question: Am I my brother's keeper.
Posted By Anonymous Garrett Osborne, Marina Del Rey CA : 3:39 AM ET
Dr. Gupta:
We can figure it out by having an MRI of the brain being part of the workup for any significant "psychosis". Problem is, as always, who will pay for it.
Luis Rivera, MD
Emergency Medicine
Posted By Anonymous Luis Rivera, MD Melbourne, Florida : 4:06 AM ET
A friend of Doug's made a documentary about him last year that I was fortunate enough to see an early screening of. It's a fascinating story, but as Doug had already retired in his 30s and (at least as far as the documentary showed) had no desire to discover much of his missing past, it made it difficult for me to feel sorry for the man. I'm sure there are others out there suffering from memory loss not as fortunate financially or with friends and family who care as much.
Posted By Anonymous Chris, Minneapolis MN : 4:09 AM ET
Dr. Gupta, with all due respect what homeless are you talking about, did not know we had poor people in this great country of ours. Our government does not acknowledge this problem, they are always sending money elsewhere(out of the country) gee, what an eye opener! We all (Americans) have mostly treatable problems, just cannot afford to get medical care and cannot afford medical insurance. Sorry, I for one, cannot just see the mentally ill as going untreated.

Actually, there are thousands of homeless/mentally ill/poor people/people without insurance, etc. just trying to survive in this great country of ours, but, alas...who wants to hear about it????? Sad, but unfortunately true! Guess that is why I find it hard to comment on just one segment of the population when healthcare is so lacking in all areas. I am sure you as a Doctor must be well aware of the healthcare situation in this country. The lack of healthcare insurance in this country knows no bounds, nor will it in the future.
Posted By Anonymous Moe, Liverpool, NY : 5:03 AM ET
My goodness...this is certainly one of those stories that puts life into persepctive. It is often true that many of the homeless and destitute people we encounter from day to day were, at one time, extraordinary individuals. What we must remember is that we never know what someone's situation is and how they came to be in the situation that they are in.
Posted By Anonymous Ambrose Sayles, Washington, D.C. : 5:28 AM ET
Yes, after reading the last paragraph, I comment by quoting this from the Torah: "What is hateful to you - do not do to your neighbor". I keep quotes on bits of paper near my computer, so my eyes can read them every now and then and the above quote is just to the right of me.
As a Christian when I encounter homeles s people I am taking with that I am encountering Christ.
Posted By Anonymous Elaine DeFelix, Clearwter, Fl : 5:30 AM ET
I read this article and it made me think of how many times I've been stopped at a light and passed judgement on someone who was asking for money and look fit to work. Thanks for bringing back my sense of reality that not everything is as it seems. We should quit judging people by their outer selves and look deep within first before we pass judgement.
Posted By Anonymous John, Tampa, FL : 5:43 AM ET
Thank you for this article. It is a frightening example of the fragility of what we think of as our lives, our very "selves".

But back to hard reality: who will pay for the necessary tests (MRI, etc.) for these helpless people who may have been wrongfully diagnosed as having mental health problems, while in fact this may be a physical probelem.

Reminds me of how Schizophrenia was once viewed as a purely mental problem arising from childhood trauma. Now we know that in many cases this is a chemical imbalanace that can be remedied through medication.

Dr. Gupta, will you be able to perhaps start a fund that can help many homeless people regain their lives?
Posted By Anonymous Ramesh, East Windsor, NJ : 5:46 AM ET
Could you forsee a time when a brain scan is a normal part of one's annual physical? I'm sure it's terribly expensive now, and some techniques are unhealthy if done regularly I'm told... but considering the consequences that one little tumor or cyst rupture can have on a person (or society for that matter), it seems like watching out for these types of brain problems should be of considerably high importance.
Posted By Anonymous Benjamin Sullivan, Boston, MA : 5:53 AM ET
Dr. Gupta, That might be a very good thing for society to look into. Perhaps we would start by asking aid workers at shelters for some "most promising" cases and work from that small sample?
Posted By Anonymous Paul Nale, Gilbert, Pennsylvania : 5:56 AM ET
That's an amazing story! I might suggest to the Doctor, that he come up with a questionaire and pass them out at Homeless Shelters, and local Churches that help the needy. That would be a start, and hopefully restore alot of lifes that have fallen victim to this type of problem.

I think he will uncover one of the main reasons behind Homelessness.
Posted By Anonymous Steve P. , Lewisville, TX. : 6:11 AM ET
Dear Dr. Gupta: Your perspective is very interesting. I saw the documentary about Doug Bruce last night, and while my friends and I were very moved by it, we kept talking about how different the story would have been if Doug Bruce had been a poor man. When he was finally identified, the life he returned to was a very fortunate one--a beautiful apartment, a load of money in the bank, and opportunities afforded because of the support system of family and friends he had that was also aided by their own class. What if he hadn't had the money to fly to visit his family again? What if he didn't have the money to pay rent, or couldn't keep his job? The doctors say cases of total amnesia like this are rare, but I wonder if there aren't five or ten homeless people in New York who are actually suffering the same problem.
Posted By Anonymous Devon, Brooklyn, NY : 7:43 AM ET
Perhaps you could seek a grant that would permit a mobile MRI program that could tour major cities, offering free MRI's to the indigent.
If you find patients with such tumors, perhaps you could then design a study in which they receive surgery, then post-operative outcomes could be studied.
They do the mobile mammograms-
why not MRI?
Posted By Anonymous Betsy, Birmingham AL : 7:46 AM ET
I feel that anyone who is dismissed as mentally ill should be given a through MRI to see if in fact there is a tumor or cyst before they are dismissed as mentally ill. A lot of people who have been determined to be mentally ill do in fact lose their careers, families, and become homeless. It has to be something going on with their brains because anyone in their right mind would not allow the afore mentioned issues to occur.
Posted By Anonymous C. Hollins, Baton Rouge LA : 7:57 AM ET
Doug's story was told on NPR yesterday; apparently a friend has made a film of Doug's experience. It's a fascinating and provocative story, as is your question. I believe that as a society we need to disseminate the idea that most if not all "mental" problems are indeed organic in nature. If this idea takes hold, perhaps more people will get the help they need, instead of being dismissed as crazy, alcoholic or paranoid.
Posted By Anonymous Susan E. Lakeville MA : 8:02 AM ET
The answer to your wondering is simple:very few, as there has been large numbers of autopsies done on deceased homeless without the notice of any such tendency. Therefore, the answer to your second question is just as straight forward: we do not need to!
Posted By Anonymous Ronald M. Burkhart, M.D., Kilauea, HI : 8:12 AM ET
This reminds me of the movie "Memento", starring Guy Pearce as a unfortunate bloke suffering from a trauma-induced condition that makes him unable to form new memories ever since he got his brain injured. It's stories like these that make us pause and wonder about things we take so much for granted - like memory and everything that is built on top of it, such as relationships, expectations and faith.
Posted By Anonymous Eisen, Singapore, Singapore : 8:20 AM ET
For an interesting book on the subject of brain tumors causing incredible behaviour see New York City neurologist Oliver Sack's "The Man Who Thought His Wife Was A Hat".
Posted By Anonymous ron mattimore, west seneca, ny : 8:27 AM ET
Dr. Gupta: I'm a Neuro ICU nurse and I've often wondered the same thing. Many homeless are certainly schizophrenic or have other mental illnesses but if a stoke or tumor can cause memory loss, then how many are wondering around with this type of thing???
Posted By Anonymous Liz Sparks, RN, McLean VA : 8:28 AM ET
I also had a benign cyst wrapped around optic nerve. After 3 surgeries, 90% has been removed; but scar tissue prevented spinal fluid from circulating and I had to have a shunt put in to prevent the pressure causing an implosion. My symtoms initially were the feeling I was walking on eggs; then was tested w/halter monitor and similar for a cardiac condition. It wasn't till I was in London talking on the phone to relatives, when I woke up and had a mild case of memory loss which I recovered from, but lost about an hour of my life and this repeated itself as "absence seizures" until the shunt was implanted in 1993. After 12 years the shunt is still doing its job, but it has caused scar tissue in my abdomen whiich Reglan seems to have overcome.
Posted By Anonymous Ken ,Johnson city, Tennessee : 8:33 AM ET
While studying psychology and working at a church in a low-income area, I was able to experience first-hand what Dr. Gupta is suggesting. Many of the people who we served in the area were homeless or lived in low-income housing.

While working I studied how cities will sometimes use the "bus system" to "take care" of thier homeless. The system involves a one-way bus ticket to a city far enough away that they won't find thier way back easily.

From experience and study, I agree, many times people who are homeless might have a treatable problem. It might be brain-related, but brain-related or not, there is a chance that whatever the problem is, it might be treatable. But instead of ordering a brain scan, many officials order a one-way ticket instead.
Posted By Anonymous Justin Harms, Dubuque, Iowa : 8:41 AM ET
I have to agree that this is an remarkable story. There are so many people out there that we don't want to deal with, both ones we know...and ones we don't know. Reading that this could be the problem is amazing.

But Dr. Gupta is right, the big quiestion is, how would you find this out? Just amazing...
Posted By Anonymous Karen, Mount Pleasant, NC : 8:42 AM ET
So, as Americans, are we to start paying for MRI's and other forms of brain scans for homeless, destitute people? With everything that is going on in the country right now, don't you think that this should be one of our last priorities?
Posted By Anonymous Dennis, St. Louis Missouri : 8:47 AM ET
Although most patients suffering the sudden onset of amnesia like Mr. Bruce are suffering from a psychiatric disorder, I too have seen a case of an elderly father of a physician with a meningioma, the most common benign brain tumor, whose memory and general function improved after surgery. His tumor was not so strategically placed as in Dr. Gupta's patient, but there was a bit of brain swelling around the tumor. It almost seemed as if the tumor was exuding some type of toxin that had effects we could not measure, beyond the mechanical ones, so surprising was his return toward mental clarity after the operation.
Posted By Anonymous Harry S. Morehead Jr., MD, Phoenix AZ : 8:48 AM ET
The human body is such a mysterious thing. So much goes on inside and most are unaware. Couple that with the stigmas of mental illness, and some would rather just not know. Seems to me that a complete overhaul of our medical system is needed and not just from the cost perspective that gets some attention today. Similar to the Red Dress campaign, but even stronger. Educating individuals, young and old, HR departments and the entire medical profession. Help remove the stigmas and provide more basic levels of education to everyone so they better understand and are not afraid that they are just nuts.
Posted By Anonymous Lynn Cole - Brockport, NY : 8:56 AM ET
I totally agree. When i was a fourth yr med student my neuro/psych professor had described something very similar. He was called upon to examine a patient who was a top brass officer in law enforcement. He was brought for psychiatric evaluation after he performed voluntary micturition (urination) on the sacred altar inside a temple after he was done praying. His family and co-workers attested to his good behavior at home and at work but they also said he would at times lose his temper and flare up. A CAT scan revealed a glioma (a tumor that grows from the cells that support your brain cells) in his frontal lobe (front of the brain)!! It was promptly removed and he returned to work and was never caught urinating in wrong places or throwing temper tamtrums again!! And another story is that of a doctor who lost his ability to speak (also called broca's aphasia) every now and then. He was found to have a subdural hematoma from a mild trauma that he suffered about 8 yrs before his present symptoms started. He was hit by an apple on his left forehead. Interesting huh!

PS- So now we know how and why Issac newton turned out to be such a genius! (the apple!!) ;)
Posted By Anonymous Dr. Anil Neelakantan, Buffalo, New York, U : 8:59 AM ET
Dr Gupta raises a very morally deep question - how should a country deal with its homeless. Some could very well be treated by any number of different medications or psychological help. But how much in the way of resources would that take?

The only way that this would be possible is if a country - it would have to be at a country-wide level to be truly effective - takes the moral and financial responsibility to at least ensure that the homeless and destitute are reviewed for correctable ailments. That assumes in turn a method of being proactive with this approach, rather than waiting for people who may be desperately ill to show up for last-minute treatment, with the subsequently much higher monetary commitment to attempting to make them better.

None of what I'm suggesting negates the inherent need for each person to be responsible for their own life and not simply sponge off the state. But if people are supposed to be responsible to the state, so should the state be responsible for its people. There may be many genuine cases of people suffering who can be helped back to life in society, and that could be reviewed by a simple screening process in each homeless shelter.

But the bigger question then becomes, where does the commitment by the state stop, and the commitment by the individual begin? There are lots and lots of people in this country and around the world in similarly high-income countries who don't even accept a basic level of responsibility for their income, their health and their own happiness. There have been many studies to show that the burden on countries for healthcare would be significantly reduced if the individuals would take more care of themselves and not just expect 'the system' to take care of them after the fact - something that would be almost impossible to enact without a fundamental change of culture. It's already being proven that an ageing population will create a huge financial drain on the major economies - healthcare as a whole has to be reviewed and the model changed outright.

But I think that there is a good starting point - simple initial screening for the homeless, which would at least provide stable numbers to justify a bigger commmitment to their care; but also a more fundamental acceptance of personal health and welfare.
Posted By Anonymous Greg, Marietta GA : 8:59 AM ET
I would submit that a majority of the problems that plague America's homeless are "very treatable." We need only get serious about allocating the resources, both financial and human, to start treating them on a large scale. I think this story does an excellent job of bringing to light the reality that not all homeless people are "bums," many just have treatable problems that they either can't recognize themselves or can't solve themselves.
Posted By Anonymous Meredith, Washington D.C. : 9:03 AM ET
Wow that is powerful and has now changed my perspective on the homeless. Whereas I had compassion before, it really has opened my eyes to the fact they may be otherwise ill.
Posted By Anonymous Kelly, Peterborough, Canada : 9:05 AM ET
Very interesting question Sanjay. If an investigation were done I am sure that we would be shocked at the results.
Posted By Anonymous Bev, Farmington Ar. : 9:10 AM ET
Dr. Gupta,

I believe as the great "America" we are in this world, we need to take care of our own. We need a visionary to lead us, to inspire others across our land. We, however, cannot be scattered around the world fighting battles for others and leave our citizens to fend for themselves in times of hardship as the men you wrote about here.

United we stand, divided we fall in all areas that make America so great. Lets not forget the citizens who make up this wonderful country.

I was intrigued by the story you wrote about these men. They need time and someone interested in the problems they have and not to be forgotten or swept aside. Thank you for the reminder.

Posted By Anonymous Sandy Hamilton, TX : 9:13 AM ET
My father had a highly malignant brain tumor which we later discovered was responsible for the personality changes which prevented him from keeping his job and, moreover, functioning. These personality changes existed for a few years before anyone thought to check for this. It's important to recognize warning signs.
Posted By Anonymous Jared Barron of Birmingham, Alabama : 9:18 AM ET
Unfortunately, people aren't willing to care about finding an unlucky group of people within a population they have no "moral" tolerance for, although you will always have people who agonize over the situation but never enough to actually change it. They make the same judgement call when it comes to the death penalty, it isn't worth saving an innocent person if you can punish the guilty.
Posted By Anonymous Debra, Santa Clara, CA : 9:21 AM ET
Since I'm not a medical professional, this might not be a feasible response.

Perhaps the answer would be to get a manufacturer of MRI equipment (or the goverment, or another appropriate entity) to underwrite a study on the homeless or mentally ill in partnership with a major hospital and several homeless shelters in a major US city.

Fortunately, progress in reducing human suffering relies on both finding the right answers AND asking the right questions. Dr. Gupta has accomplished the latter. Hopefully, this post will attract more qualified responses.
Posted By Anonymous Jarrod Broussard, New Orleans, LA : 9:26 AM ET
As someone who has recently begun to learn a lot more about America's (Boston's) homeless, the simple answer to your question (" could we ever figure that out?") is to "care enough to find out."

I am running this year's Boston Marathon as a fundraiser for the Pine Street Inn in Boston, and as our running team has been learning more and more about the backgrounds of some of the Inn's guests, it became readily apparent to me that many of our fellow, homeless citizens are decorated war heroes, struggling mothers, impoverished elderly, victims of making a single bad choice in their lives, those fighting illness (both mental and physical), etc. -- they are more in need of compassion and help then criticism or rejection.

I am hopeful that reminders like your feature about Doug Bruce as well as the heroic, ongoing good works of America's shelters, social workers, and volunteers (including those in the medical and legal professions) can overcome this country's predominent urge to ignore, criticize and fear the homeless. Unlike many of our other political and social ills (which happen to make for sexier news features), homelessness is one that could actually be "figured out" and treated.
Posted By Anonymous Paul Joseph, Natick, MA : 9:27 AM ET
Dr. Gupta,

If people knew how many of the homeless were just suffering from brain damage or disease it would shock them.

I had severe depression several years ago and money, family and insurance kept me functioning until I went into remission. I would have wound up like the engineer with the tumor; on the street and indistinguishable from a garden variety drunken bum.

You did your residency at Michigan? Go Blue, Doc. I'm class of '99 and '01. Nice to see CNN getting the top quality personnel.
Posted By Anonymous James, Simsbury CT : 9:28 AM ET
I find your statements about mental illness to be quite compelling. I am not a doctor of medicine, but I am a Professor of Behavioral Finance, so this leads me to respect the profound impact that psychology has on nearly every aspect of our reality. The difficult thing about a brain problem is that it is not visible to the naked eye. We think that people with mental illness are simply normal people who have chosen to behave in an illogical way. Were mental handicaps more readily visible (like a broken leg), it would lead us to have a greater understanding of the individual's problem. An interesting analogy to this issue is abortion (I am neither pro-choice or pro-life, I just enjoy watching both sides fight one another). If a child is in the womb, we have little problem killing the fetus. But once the child exits the womb, then killing it becomes one of the most heinous crimes a person can commit. I sometimes wonder: if we were able to see the child in the womb, would our abortion laws be the same? Again, I say this being neither pro-choice or pro-life. The doctor's statements are a strong reminder of the impact that our mind plays on the reality in which we live. Without our minds, there is no reality....everything we are and for which we live would cease to exist. A very humbling thought indeed.
Posted By Anonymous Dr. Boyce Watkins, Syracuse, NY. : 9:32 AM ET
my cousin is currently "idiotized" after ungoing several surgeries to remove a cancerous tumor from his brain. but, right before this tumor was discovered, he lost his entire financial empire through unwise, erratic decison making.
we too have wondered if the tumor may have had to do with this.
as to the homeless- we must come up with an inexpensive way to give them exams!! wouldn't that be nice? and some crazy people too, while we're at it!
Posted By Anonymous amanda livoti, santo domingo, dominican republic : 9:41 AM ET
Posted By Anonymous JASON, ATLANTA, GA. : 9:43 AM ET
The homeless in america are extremely misunderstood, as many of them have invisible physical or mental barriers that need attention and care. ?Just we assume "innocent" until proven "guilty", we need to assume "legitamately needy" before we assume "working the system".
Posted By Anonymous M. S. , Hamden, CT : 9:45 AM ET
Dr. Gupta poses an excellent question. Homeless people in particular are not hard to find - a random sample from that populaton could be examined, provided one could obtain informed onsen, which may be dificult. We already know that many of them have a history of mental problems or alcoholism. I know of no study in this group involving brian imaging.
Posted By Anonymous Peter Kaufmann, Annandale VA : 9:50 AM ET
Wow. If this could be the case it would not be difficult to find the rest of the homeless and subject them to the brain scan. But happens if many of them suffer the same problem? Will the government fork the bill to help them, or let them return to their dark hole?
Posted By Anonymous Don, Arlington, Texas : 9:52 AM ET
Dr. Gupta, we treat our homeless citizens terribly. We chase them out of our parks, off of our benches, out of our weatherproof malls, hoping they will move on to someone else's town. During times of inclement weather, we may open a shelter for the night, announce it on our local news (as if the homeless are watching tv), and expect our homeless to find their own way to the shelter. (I too would rather huddle in an alley than trek ten miles in the cold rain to shelter in an unfamiliar area.) Furthermore, my county (Palm Beach) has more shelters and rescue leagues for homeless animals than homeless people. If you are a homeless dog in my town, there is a very good chance we will either (a) try to find where you belong because we know someone is missing you, (b) invite you in to our home, (c) call animal rescue to transport you to an animal shelter where you will be bathed, housed, fed, and examined by a doctor, or (d) at the very least we will let you spend the night in our yard and give you food and water. Unknown mental illness of the homeless certainly may play a big part, not only in the initial cause of human homelessness, but also in our reluctance to assist or even acknowledge them. We must not forget that the homeless are human beings, sons and daughters, often parents themselves. And they deserve respect and care.
Posted By Anonymous E. Thomason, Delray Beach, FL : 9:54 AM ET
My own family thought I was crazy and for seven years no one took seriously the syptoms of headache and disorientation I was complaining of. I told many doctors that I knew something was wrong. I feel I was ignored mostly because I am poor. I've seen the difference in the emergency room between having insurance and having medicaid. If you have medicaid, they give you an aspirin and send you home.I am now 100% disabled (at 55) due to incompetent health care and
this horror story continues, but the real message here is; if someone you know well begins to exhibit strange behaviors and their personality starts changing..make sure they get an MRI first to rule out physiological problems, then look into psychiatry if there is no sign of abnormality in the brain. It's so easy to say a person is mentally ill and drug them beyond recognition. Had a bright ear, nose and throat doctor by the name of Dr. Mowry not done his homework and discovered the tumor in my head, I'd be dead now. One more thought - remember when brain tumors were rare? I live in a small community and I know of six other people who have had the same kind tumor!
Posted By Anonymous Susan, Trumansburg NY : 9:58 AM ET
To me, your story and resultant question make an excellent argument for social medicine (at least some minimal mental health, or brain scan testing). The cost benefit of "saving" an individual like Doug Bruce through early testing would far outweigh the cost of that sort of poor soul on the homeless/jobless/mentally ill rolls of our society. I'm speaking here about far more than monetary costs, but the social and emotional cost to the individual, their family, friends and our society at large. There is a quote about the measure of a society being how it treats the least of its members (sorry I don't recall who said it). My question is, who among us has not thought at one time or another that they were losing their mind? Come on, be honest! Even if just for a fleeting moment, and with the pressures, challenges and sadnesses of the current world upon us? The consequences of stress on brain chemistry is well-documented (nevermind the consequences of a brain incident, like a tumor) and could conceivably send any one of us over the edge of sanity at any moment. It is my belief that, for many of us, just one more "stressor" could be the straw that breaks the camel's back," so to speak. It could happen to any one of us. I would vote for legislation for this type of testing and I would support any political candidate who would push for this kind of potential saving grace. Every functional, mentally healthy individual can be an asset to our society. It is possible that one of those who fell over the edge might have been the very one who could have figured out the answer to your question, "How many people out there who are homeless and dismissed as mentally ill might in fact have a very treatable brain problem?" I have never posted to a blog before, but this one really got my attention because I think the line between sanity and insanity is a fine one and none among us is immune.
Posted By Anonymous Ginny, Palm Coast, FL : 10:05 AM ET
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