Through the Eides of Love

Police involvement is a factor in solving homelessness.

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Back from the Caribbean with a radiant glow, Jonah is joined by Stephen Eide—senior fellow at the Manhattan Institute—for an outrageously wonky discussion of homelessness in America. The two kick things off by exploring the history of transient labor and the categorical distinctions between hobos, tramps, and bums, before turning to the root causes of the growing homeless populations in big cities. They also explore the relationship between homelessness and changes to psychiatric health care, the loss of affordable housing in big cities, and the idea that homelessness is a natural outgrowth of late-stage capitalism.

Show Notes:

– Stephen’s page at the Manhattan Institute

– Stephen’s recent book, Homelessness in America: The History and Tragedy of an Intractable Social Problem

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  1. Avatar photo
    Medhistprof

    The public, through the elected representatives, will not adequately fund the institutions where people are held a taxpayer expense.

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    Slp

    This was an interesting podcast . Thanks. A couple of comments.

    I just read a book called the Oregon Trail by Rinker Buck. He talks about surges along the Oregon Trail, from the 1850s on that were very much related to bank failures and economic panics. Those emigrants he refers to as essentially homeless. This is an earlier idea of homelessness than I had ever run into.

    I agree that downtown Portland is really unpleasant, but it's also true that many of the stores that used to anchor shopping there have not merely moved out, but have gone out of business or moved primarily to online shopping.

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  3. Payette

    Great discussion. My understanding is that a big part of the problem in the Northwest is a decision by the 9th Circuit that someone cannot be arrested if there is no shelter available. So, even if there were better support of law enforcement (That's a big wish in Oregon and Washington.), the police would have limited options.

    Decriminalization of small amounts of illegal drugs has worsened the homeless and drug problem in Oregon.

    Lowering the bar for involuntary hospitalization/institutionalization (Rather than someone having to be an imminent danger to themselves or others, the decision should be based on their ability to care for self on an ongoing basis. This, of course, would require improving outpatient psych services and increasing the number of inpatient and long-term inpatient psych beds.) might help some of the chronically mentally ill (bipolar, schizophrenic, psychotic) to stay safely off the streets.

    Jonah, we in the Northwest are grateful that you continue to bring out ideas of how this mess might be remedied.

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  4. April

    Welcome back Jonah. Fascinating discussion. Thank you.

    We really need to find answers to these problems. As a New Yorker I applaud Mayor Adams for trying to make some changes. He certainly has his work cut out for him in this Democratic stronghold.

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    Tracie

    Enjoyed the discussion. Chicago, probably due to weather, has less visible homelessness than one hears about on the West Coast. However, before the tourists began to return, homeless people were certainly more visible downtown.

    This discussion seems relevant to a book I bought several years ago. I was trying to understand addiction d/t dealing with many pain med addicted patients
    https://www.amazon.com/Realm-Hungry-Ghosts-Encounters-Addiction/dp/155643880X
    It speaks to how traumatized drug-addicted transient populations tend to be, and how young they succumb to ordinary illnesses.

    It's written by a well-known Hungarian-Canadian MD - Gabor Maté - who worked in Vancouver's Downtown Eastside for many years. If you don't read it, you may imagine it as a straight up endorsement of harm reduction, but in truth he comes off more ambivalent, and he's quite a good writer.

    Before I read it, I had this notion that most transient drug addicts died violent deaths. As a medical professional, who worked in a nursing home serving an affluent population for 10 years, I recognize the conditions described - bacteremia/sepsis, osteomyelitis, heart failure - which one sees in short term rehab patients in their 70s / 80s /+90s. The population described in this book is aged 20s to 50s. Few of them live longer than that.

    Even if you don't agree with harm reduction, the descriptions in this book provide a lens into these short lives. Not lives you'd wish on anybody, but they are no doubt better off the street.

    I don't have any brilliant ideas for solving the problem. Homelessness is definitely not a state of being to romanticize.

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      George.Skinner

      My wife worked at the hospital closest to the Downtown East Side, and would frequently see these cases on her ward. They were tremendously expensive, difficult patients to look after: they'd come in with a bad infection because they'd been shooting up using dirty implements and cooking their dose with puddle water (yes, there were needle exchanges where they could get new stuff, and there were supervised drug injection sites. For whatever reason, those weren't acceptable/convenient/fast enough.) If they needed IV antibiotics, they'd need to be hospitalized for the whole course because otherwise they'd simply wander off and never return for follow-up doses at the outpatient clinic. There'd be heart problems, including weird ones like vegetative growths on their valves. On top of that, they tended to be uncooperative and even violent or abusive patients (my wife had a bedpan hurled at her head at least once by a patient who was mad that they weren't going to get their next morphine ahead of schedule) with complicating factors like HIV and Hep C infections.

      Safe injection sites and naloxone have reduced the number of deaths due to overdoses, but I don't think they've done a thing to reduce the number of deaths due to drug abuse. The deaths are just slower and more excruciating. Meanwhile, society racks up huge costs for medical care, theft and property damage, and general suffering from the social disorder and impact on public safety. It's hard to fathom why we don't simply spend the money on housing street addicts in care facilities until and unless they're rehabilitated.

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        Tracie

        Correct me if I misunderstood you. You're saying people should agree to confinement and treatment, or be released so that they'll die sooner and be less expensive?

        How is that different from the conventional approach?

        Granted, Maté documents the non-compliance and relapses. He also states that patients rarely get better until they move to a half-way house away from their ingrained habits in the Downtown Eastside.

        The argument he makes is that it's quite difficult to convince anyone into rehab if you lose contact with them. So, in these harm reduction environments, the behaviors are observed, vs occurring more out of sight and away from housing and support.

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          George.Skinner

          I mean that drug addicts need to be committed to care if it’s determined they’re unable to manage their addiction, and they aren’t released until it’s established that they can. This should be more a residential facility (like an Alzheimer’s care home) than an old-style institution.
          Drugs can be provided to manage their habits, they’ll have medical care, food, and programs for rehab and life skills. Whether it’s a path to reintegration with society or something like the “Safe Harbor” programs for terminal alcoholics is up to the individual. Addicts and mentally ill people living on the street have proven they can’t live independently.

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            Tracie

            That would be OK, except that I suspect residential rehab is way more expensive than putting people up in hotels and letting them see an MD 1x/month.

            They are no doubt a strain on the healthcare system in the harm reduction scenario. As one who worked in an inpatient facility, I can tell you that it doesn't force compliance.

            You would need pilot programs of the less structured harm reduction approach vs rehabhalf-way househomeless - w/ similar populations - to judge cost and success. There would always be some homelessness with a population this non-compliant. It would take someone more experienced than me to come up with metrics of "success" for such a population.

            The people Maté describes generally don't have much of what Jonah calls "social capital." So, really awful family stories, for the most part.

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    Ben Connelly

    You could have waited 15 days to release this episode and called it “The Eides of March…”

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    1. Jeff.Oster03

      I literally scrolled down to post exactly this, and the comments section did not let me down!

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        Ben Connelly

        Great minds think alike

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  7. Philebus

    Good conversation, please have Mr. Eide back. Kinda missed the Ruminant this week, but that's awright. Sarah is good; the energy of bouncing off other people is always pleasing (She would be a fun date. No intent from this end...just a compliment). She and "Mo" Elleithee are a good combo. To which I suppose the folks at the "Left, Right, and Center" (podcast) have recognized. Anyway, from top to bottom ('piss boy'...just kidding, Guy) you've managed to hire some talent. Kudos...because it's hard to do.

    Sorry to see David French go...good speed dude. Good writing, even though I may disagree at times.

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    Anne W (Raw5254)

    So nice having you back, Jonah! I watched Dispatch Live last night, too, and always enjoy it. However, I’ll admit that you had an extra good lineup last night. So interesting listening to what you and Steve had to say about Fox. I wonder what Mr. Carlson and Hannity are telling their listeners now?

    My husband and I live not too far from Madison, Wisconsin. We don’t see a lot of homeless, but I think that’s mostly because we try to steer clear of the campus area. There used to be a lot of them on State Street ( which runs from the Capital directly to the campus), and that area, in general. I’m assuming there still are, although most of them show up when it gets warmer.

    What we have been noticing a lot more of lately are the people who hang out on street corners with traffic lights. The majority of the time they are young, college age people who don’t appear to really need handouts. They are dressed in decent clothes, have money for cigarettes, and apparently cellphones. I often wonder how much they’re making because cigarettes are expensive! And monthly cellphone data charges aren’t exactly cheap. I also wonder how it is they can’t find jobs when I see so many places looking for help?

    And, I wonder about the men who are just a little older and have signs saying they’re veterans. How many actually are, or have they figured out that saying that gives them an edge? I hate to be so skeptical, but with a few exceptions, I haven’t seen anyone who looks as though he/she couldn’t find some kind of work or help. I mean, if you can find a way to get to these busy intersections, and stand there for several hours each day, it seems like you could be working somewhere. They’ve certainly turned that into a job. It makes me think that it pays a lot better to stand on corners.

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    Kevin Johnson

    Good one, as well as good “nude beach live” last night. Not the line-up I would have picked, but…

    Michael Schellenberger’s San Fransicko” has useful points complementing this chat. He looked closely at Portugal and Holland comparisons. He is an energetic advocate more than an analyst, but very interesting.

    Having lived 3 years each in Norway and Finland and 2 in Germany, one of the starkest differences in culture and policy is the “all or nothing” tendency on individual rights approach in the U.S. This is not a broad criticism. Our comparatively more straightforward defense of freedom of speech is a feature, not a bug. But, as you note, the all or nothing aspect can lead to “all” for certain individuals and “nothing” for society. Oslo had in 2009-12 (when I lived there) a drug problem near train station, but population and authorities would never allow destruction of free use of large public spaces like Ca. does.

    Thanks for policy oriented and smart attention to tough topics.

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      Anne W (Raw5254)

      “All or nothing” is one of our biggest problems these days, and it’s not just individuals. No one wants to compromise on anything.

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