Category: Homelessness

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Homelessness Medicine Nonfiction Policy Public health psychiatry Seattle

Who Gets to Be Sad?

For those of you who don’t follow baseball, the Seattle Mariners were in the running to go to the finals in baseball, called the World Series. (So American, of course, to call the finals the “World Series” when it doesn’t involve the entire world!) The Mariners are the only team in all of Major League Baseball that has never been to the World Series.

As such, you can imagine how much of a frenzy the city was in. The Mariners flag was hoisted to the top of the Space Needle twice! The downtown skyscrapers coordinated their night lights to glow in Mariners colors. The mayor raised the Mariners’ flag at City Hall.

Game 7 in the semi-finals, which happened last week, was the “win and go to the World Series, or lose and go home” game. The Seattle Mariners lost.

Over the past week, since that loss, the city has been distraught.

Immediately following game 7, there were brutal postgame interviews. Sports journalists, for obtuse reasons, asked weeping baseball players how they felt.

Here’s Cal Raleigh, our inimitable catcher, showing what his face looked like when he was seven years old and heartbroken:

See how he ran his hand through his hair? That was a desperate act of self-soothing while multiple cameras gave him no place to hide his flushed face and wet eyes.

Meanwhile, here’s Bryan Woo, who turned out to be the team’s ace pitcher this year. He’s not crying, but he is also just trying to get through the interview. A wail of despair interrupts him:

The man whose heartache was heard, but not seen, was our cool center fielder, Julio Rodriguez.

So, are grown men allowed to cry or not? Here were professional athletes caught in the throes of disappointment and sadness. They were crying. Sports journalists pushed microphones into their faces and asked them how they were feeling.

On the one hand, I appreciate this exercise: It’s a chance for these robust young men to model (to other males) how to use words to describe internal experiences. They’re not smashing bats into the walls or punching the journalists. You can talk about unpleasant emotions without resorting to violence or destruction.

On the other hand, asking people about their feelings on camera when they are obviously distressed seems unkind. Sure, baseball players, as public figures, have training about and responsibilities to the media. But such pointed questions do nothing to soothe or support the person. Reporters can also learn the exact same information — how do you feel about losing the biggest game of your professional career to date? — an hour later, when people have had the chance to cry and wail in private. Show some respect, give people some dignity!

But we apparently want to see our heroes cry. We want to know that they feel just as sad as we do.

There are many other people throughout the nation who are crying. They are not professional baseball players; they are not famous. Many of us will never know any of their names.

Some of them were looking forward to leaving the street and moving into an apartment! With winter right around the corner, the anticipation of living somewhere dry and warm was thrilling. Because of the government shutdown, though, the mainstream vouchers that would have paid for those apartments are invalid. So they will have to wait for the government to open before they can move inside.

Many of these same people have Medicaid for health insurance. There are also millions of other people with Medicaid who do know where they will sleep tonight.

The federal government has somehow concluded that it’s not worth it to spend money on health insurance for poor people. But, it is somehow cool to take that money to give tax cuts to people who are wealthy. Yes, it is true that, one day, we will all die. Taking health insurance away from poor people, though, is spiteful. It only makes it more likely that they will needlessly suffer while they are alive.

You know what makes suffering worse? Hunger.

The government shutdown, if not resolved by November 1st, will also shut down the Supplemental Nutrition Assistance Program (SNAP). This program, also called “food stamps”, gives financial aid to poor people to help them buy nutritious food. Food banks are already struggling to provide enough food to visitors. Furthermore, here in Washington State, many grocery stores have closed.

Some people are already hungry. More people will join them.

Yes, you’re reading this right: Soon, the same group of people will have increasing struggles to access food, health care, AND housing. What they all have in common is poverty. Literally no one ever says, “When I grow up, I want to be poor and rely on welfare!” Being poor is not a moral failing. No one, regardless of how much money they have, deserves to have the foundations of wellbeing — food, shelter, and health — taken from them.

But we apparently don’t want to see poor people cry. We don’t want to know their sadness. Some people think poor people deserve to be sad. Others think that poor people are not people.

What would we have to admit to ourselves if we felt their sadness? What would we have to change if we acknowledged that their sadness is real?

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Homelessness Nonfiction

Neither Sex Nor Drugs.

While it was happening I recognized that it didn’t look great.

My outreach colleague was driving and slowed down. After rolling down my passenger side window, she leaned over and shouted a name.

The Woman she was shouting at was walking on the sidewalk towards us. Her stiletto knee-high boots were the same color as her miniskirt. The bustier did not fully cover her waist. Bright eyeliner and false eyelashes made her eyes pop. The purse slung over her shoulder swung with each confident step she took.

The Woman didn’t hear my colleague, so I shouted the same name out the window. She turned and took a few steps towards the car. I pointed at the driver. The Woman smiled in recognition, revealing many missing teeth, and came to talk with us through the window.

It could have looked like we were negotiating money for sex.

“I’ve been looking for you,” my colleague said, turning on the emergency lights. “I have a lot of mail for you.”

The Woman and my colleague discussed meeting at the office so she could get her letters. A toothless smile again bloomed on The Woman’s face as she blurted out, “Oh! I haven’t used fentanyl in 14 days!”

Dear reader, I had no idea who this person was; I just met her. That didn’t stop me from bursting into applause. I was the only one clapping. It was a reason to celebrate! She beamed.

“Where are you staying now?” my colleague asked after congratulating her.

“I live in That Neighborhood now,” The Woman said. “Near That Street and That Avenue. There’s a hole in the fence near that intersection. Go through that hole and a little further back through the trees, and you’ll find me there.”

Through a fence and then on a dirt path in stiletto heels!

Don’t judge a book by its cover.

Categories
Homelessness Nonfiction Policy

The Man in the Tiny Village.

Almost 30 minutes had passed, but The Man was still standing outside in the grey morning chill. His soiled tee shirt and loose pants hung from his tall frame. Over the next few minutes, he rarely shifted his feet while staring at a distant point on the ground.

“Hi,” I greeted again. He did not move.

“I’m worried about you,” I offered, hoping for any sign of acknowledgment. None came.

It no longer feels uncomfortable to talk to someone who doesn’t respond. Remember the people in the ICU, their bodies puffy from inflammation and fluid, their respiratory tubes hissing with each mechanical breath? Or the young men tucked into the corners of their jail cells, their heads cradled in their slender arms? Or the people so preoccupied with voices only they heard, their unblinking eyes quivering?

“I’m going to prescribe medicine for you. The goal is to help you think better. I’ll ask the staff to remind you about it. I hope you’ll try it, but if you don’t want to take it, that’s fine. I’ll see you again soon.”

His gaze remain fixed on the ground.

“It’s cold outside. Go back in,” I said. He stirred and mumbled something.

“Go back inside,” I repeated, pointing and taking a step towards his Tiny House. After a beat, he lifted a leg and meandered back to his unit.

Tiny Villages are clusters of small wooden structures, called Tiny Houses. A Tiny House is less than 100 square feet, so most people have only a bed and a storage rack inside. Each unit has heat and electricity, along with at least one window. The door locks. Outside of the two dozen or so Tiny Houses are shared bathrooms, an enclosed kitchen and dining area, plus covered laundry facilities. The houses are usually painted in bright colors. Residents often add personal touches to the small area in front of their house: Wild flowers in small pots; stickers and signs; sometimes inflatable yard decorations. Surrounding the entire Tiny Village is a wood or chain-link fence. Visitors must check in before they enter the front gate.

Village staff had introduced me to The Man about an hour earlier. When The Man opened the door to his Tiny House, the stench of body odor rushed out. For nearly five minutes he stood in the doorway and looked around at the ground. His face was scrunched up in confusion while he mumbled under his breath.

With repeated coaxing we got him out of the morning chill and into a Tiny Office. He didn’t talk to me; he instead talked with someone that only he could see. While seated in the folding chair he laughed, made animated gestures, and muttered about truth and lies. I ended our time together. We all exited the office.

Village staff pulled me aside to tell me more about The Man: Just a few months ago he was able to have a coherent conversation. Before moving into the Tiny House, he lived in a trailer. Before that, he worked in warehouses and lived in an apartment. Alcohol overuse led to problems at work and dismissals. Now he smoked methamphetamine once in a while. Other people in the Tiny Village were worried about his wellbeing, too.

It was when I was leaving the Tiny Village that I saw that The Man was still standing outside. Had he been there, motionless, for almost 30 minutes?

The medications came in a bubble pack, each row marked with the date. One pill for each day, at any time of day, for one week.

On day one, The Man popped a tablet out of its bubble, then swallowed it. Nothing changed.

The e-mail I received a week later contained exclamation points: The Man took the medicine most days that week! He was making more sense! He wanted to take more medication!

Of course I obliged.

The next time I saw him, his unit still didn’t smell fresh. However, he immediately came out and walked with us to the office.

“I’m sorry for having an attitude when we last talked,” he offered. I shook my head; he didn’t need to apologize. What he thought was an “attitude” was actually symptoms of psychosis.

When I asked him what was happening when we last spoke, he replied, “I was annoyed. People kept talking to me.”

“Who?”

He shifted uncomfortably in his chair. “I don’t want to snitch on them…”

I waited. He looked up, took a breath, and continued.

“… but I hear them all the time, 24/7, on and off, it doesn’t matter.” He shared that he had been hearing those voices since he was a kid. “Sometimes I want to tear them apart, I get so annoyed.”

What did he think of the medication? “It helps me ignore them better. When I get annoyed I take it, so I’ll take two a day.”

I nodded serenely. Thank The Universe that nothing harmful happened with his doubling of the dose!

As our time together came to a close, I asked, “Is there anything else I can help you with today?”

A moment passed. He scratched his head. He then quietly asked, “Is there anything that can help me stop using meth?”

When we bring services to where people are, they can make great gains in building the lives they want to lead.

I was worried that, because of The Man’s symptoms, we would have to tread down the road of involuntary treatment. But, the interventions and support of the team prevented this. We avoided the circus of the police and medics coercing him into an ambulance. He escaped the chaos of waiting in an emergency department while restrained to a gurney. Residing in a Tiny Home is not an ideal living situation, but at least he was able to keep the freedoms there that are absent in a psychiatric hospital.

In addition to preserving his dignity, these interventions saved costs throughout the system. First responders were freed up to attend to other emergencies. Because The Man never went to the emergency department, he never received an ambulance or hospital bill. All together that would have summed in the thousands of dollars.

This man, like the women described here, was homeless. Like them, he did not contribute to crime and disorder on America’s streets. He was not a safety threat.

Who was truly unsafe: Us, or him?

Categories
Homelessness Nonfiction Policy Public health psychiatry

Who is Actually Unsafe?

Before she and I reached the gate in the chain-link fence, a man approached us from the opposite direction. A hoodie shaded his face and his hands were in his pockets.

When she and I got closer, we waved first, all smiles. This was intentional. Hello! We are harmless, but we are paying attention!

He slowed down and pulled the hoodie off of his head, revealing the AirPods in his ears and a tentative smile on his face.

He and my colleague started greeting each other at the same time. She deferred to him.

“I’m just out for a walk,” he said. The accent in his voice revealed that English was not his first language.

“So are we,” my colleague said. This was a lie.

“Oh,” he said, his face now soft and kind. “A worker, a government worker, told me yesterday to be careful when walking here. He said that there are dangerous people back there”—he pointed to the area behind the chain-link fence—“people who are homeless.”

“Oh, okay, thanks,” we replied. His intentions were kind; he was looking out for us. He continued on to the parking lot. 

When we arrived at the gate in the chain-link fence, we ignored the sign posted on it: DO NOT CROSS.


Despite years of doing homeless outreach, I still feel my heart beat a little faster and my shoulders tense a bit whenever I approach an encampment. It doesn’t matter if it’s tucked in a wooded area, under a freeway, or behind a building.

Nothing dangerous has ever happened to me when I’ve outreached more remote locations. Sites where I have been at risk of injury were almost all public places with plenty of people milling about, or in spaces where people are literally locked in.

I don’t ignore my anxiety—our emotions are sources of information—but continue to wonder how much of my unease is due to stigma.

She and I followed the worn footpath through the overgrown grass and were soon under a canopy of leafy trees. On one branch hung a jacket that had been singed by fire. As we approached the underpass, the vegetation receded. A small river was on one side; on the other was a slope of rocks and loose dirt that led up to the concrete base of the road.

A small tent was closer to the river. A larger structure was tucked further away, just underneath the roadway. Old clothing, food wrappers, worn blankets, and other detritus were scattered about, evidence of people who were once there. Maybe they had moved on?

We saw no signs of life.

“Outreach!” my colleague called out. The rumbling of the cars overhead muffled her voice.

The small tent shifted back and forth; we heard rustling sounds.

“Outreach, hello?” my colleague called to the small tent.

“Yes, I’m coming out,” a tired voice responded. Within a few minutes, the person inside unzipped the door flap. A young woman wearing a soiled sweatshirt adorned with the name of a law school peered out. Her face was thin and her limbs were slender.

She didn’t need anything, but accepted some snacks and water. She wasn’t the one we were looking for. We wondered if she had seen The Person?

“Yeah, from time to time,” she replied. “She might be up there.”

After thanking her, we plodded through the soft dirt and climbed over wobbling rocks to the larger structure. A multi-gallon clear barrel in front of the tent was about half full of water. Nearby were piles of blankets and clothes.

The tent was wide open. There were no blankets, sleeping bags, or pillows inside. At the back of the tent was The Person. She was sleeping directly on a tarp.

The Person is not well, but aside from sleeping underneath a road, she breaks no laws. She mumbles and often says things that only she understands. In stores she quickly picks up what she wants and pays with cash and coins. 

As far as we know, she’s lived outdoors for years. And now she is over 60 years old.

These two women are homeless, but they do not contribute to crime and disorder on America’s streets. They are not safety threats.

Who is truly unsafe: Us, or them?

Categories
Homelessness Nonfiction Public health psychiatry

Opening Doors.

For our first appointment, she didn’t come downstairs. The building staff, who described her as a high-priority patient, had predicted this.

After I knocked on her door, a gruff voice shouted back, “What do you want?!”

She eventually opened her door. Inside, the room was furnished with only a bed and nightstand. The mattress still looked brand new; no linens or blankets were on it. The only item on her nightstand was a lamp, the shade still wrapped in plastic. The walls were bare; her closet was empty. Blinds kept the sunlight out.

The only personal item in her room was a flattened cardboard box. It was next to her bed. Though she had lived in that unit for almost a full year, she was still sleeping on the floor. She preferred the cardboard to the mattress.

“I don’t need anything, I’m fine, I’m fine,” she grumbled. She pointed an arthritic finger at the door before announcing, “I’m leaving now.” I stepped to the side. She hobbled past me towards the elevator, mumbling to herself. She didn’t close the door to her apartment. I did.

That first appointment was a success! Not only did she open her door, but she also spoke to me. Sure, it was a short and superficial conversation. Her primary goal, it seemed, was to get away from me. But she didn’t yell at me, despite my introduction: “Hi, my name is Dr. Yang. I work as a psychiatrist. I just wanted to introduce myself. How are you doing?”

There was a fair chance that she would talk to me again in the future. I had two goals now: Create conditions so that she would (1) talk with me again and (2) tolerate a longer conversation with me. Maybe two to three minutes next time?

Back downstairs, I tapped out a quick note:

This is a 79yo woman with a historical diagnosis of schizophrenia. She reportedly has a history of street homelessness of at least twenty years, though housing staff believe that she had been homeless for longer. She finally moved into housing about a year ago….