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It didn't to me, anyways. It was like breathing, I didn't think about it much even though I was living out of my decrepit car, a P.O. Box, and a university gym locker. I suppose I was a feral person of some sort -- I was reasonably amicable and good natured, I showered in the gym every day after running some great distance, and people generally looked out for me, even the local police.
Whenever I had someplace to live I would drive my housemates crazy because I'd simply disappear. Sometimes I'd remember the rent, sadly, sometimes not... If I thought I needed to be somewhere else I'd just go without bothering to tell anyone, but I didn't think I was being "secretive."
I'm probably lucky I never started using drugs or alcohol to control my moods, but it wasn't because I had any great self-control, it was simply that drugs and alcohol interfered with my obsessions.
It was all stupid luck for me; there are lots of people who don't get the support they need because their mental illness is not the sort others can be comfortable with. My grandma, for example, drank and refused to bathe. If she hadn't had the support of her family she'd have been a shopping cart lady standing on the corner telling long, disjointed stories to anyone who'd listen. And she was very secretive about her drinking. Even when she was in the hospital she'd figure out ways to get alcohol -- she could instantly spot a fellow drunk, a hospital roomie's visitor perhaps, and cajole them (usually with money) to bring her alcohol. But I don't doubt that she sometimes got the hospital staff to bring her alcohol too, because she was utterly impossible to deal with when she was sober.
The very basic problem here is that being secretive is a survival mechanism in a society that doesn't cope well with mental illness.
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