Dear Dan,

I watched the movie The Soloist about Steve Lopez's relationship with Nathaniel Ayers, the inspirational homeless musician in L.A.

I'm wondering if you can share your insights on the authenticity of the movie, especially regarding the relationship between Ayers and Lopez and the mental illness symptoms of the homeless people depicted in the film.

I'm a theology teacher in a Catholic high school and in my senior classes, we study homelessness - the realities, causes and consequences. I'm thinking that this movie may be useful. I look forward to any insights you can offer me.

- Suzie Eyler
Dear Suzie,

As you may know, schizophrenia is one of the most disabling of all of the psychiatric disorders. It affects more than two million Americans and about 15 percent are on the streets or in prison.

As we saw in the movie, first symptoms occur in men in their late teens and early 20s, later in women. The hallucinations you saw may be the most dramatic symptom but are far from the only ones. Most people with schizophrenia become fearful and withdrawn, but sometimes they can become terrified of what happens in their minds.

And because they can act strange or appear frightened, they are at high risk of violence, especially if they are in prison or on the streets.

While we are still far from understanding the exact causes, that doesn't mean the disease is untreatable. New medications are coming out every day, with more awaiting approval from the FDA.

Some cognitive therapies are also showing promise. And with good and consistent treatment, it is estimated that after five years, 50 percent are improved enough that they can function independently. An additional 25 percent are better but require ongoing therapies. Of the remaining 25 percent, about 15 percent are hospitalized. Sadly, suicide accounts for the other 10 percent.

But those statistics are for people who receive treatment. And that is not the case with many people with schizophrenia or other major mental illnesses. They are left to the care of public institutions that are overburdened and unable to meet the needs of those who need their services most.

Which gets us to The Soloist.

Given the Hollywood requirement for drama and simplicity, I think they did a good job of portraying schizophrenia.

The students should know that not everyone with schizophrenia is as successful as Ayers.

But what they did beautifully was portray the humanity behind the illness.

I discovered this as a new psychologist in 1969 when my first patient, Norma, shuffled into my office for the first independent psychotherapy session of my career. Norma had carried the diagnosis of schizophrenia for 30 years. I was 23 and had to prove to both of us that I was a competent psychologist.

As soon as we started talking, she nailed me. She told me in her own confused way that I had no idea what I was doing and that I was making it up!

Of course, she was right. But she wasn't angry or hostile about it as I might have been if the situation had been reversed. Instead, she was more playful, which enabled me to get comfortable with the relationship we had rather than the one we were supposed to have.

Norma and I didn't communicate well with words. Often we didn't understand each other's language at all, but there was a connection. Sometimes when the words stopped, we looked in each other's eyes and smiled.

Norma never really got better, and a few years later, I heard that she died on the streets. I cried as I would for any friend.

Two decades later, I was working with a 20-year-old girl who was suffering with depression and an eating disorder. One day she said, "I feel like my soul is a diamond locked inside of a malignant tumor." I thought of Norma and my eyes welled up with tears.

If Norma's mind had been clearer, I am sure she could have said the same thing. And my guess is that most people living on the streets could also say something similar.

In my mind, these are not street people or schizophrenics; these are people who experience their lives the same way my 20-year-old patient did.

And our responsibility as a community is to do what we can to see that diamond.

Dan's guest on his weekly Web chat at noon tomorrow will be Joseph Rogers, chief advocacy officer of the Mental Health Association of Southeastern Pennsylvania, who spent time living on the street with schizophrenia. Dan will also host a radio show today at noon on WHYY-FM (90.9).