Medicalizing Homelessness: The Production of Self-Blame and Self-Governing within Homeless Shelters

1. Medicalizing Homelessness: The Production of Self-Blame and Self-Governing within Homeless Shelters Ch. 32, Vincent Lyon-Callo

2. Structural violence • Structural violence refers to a form of violence based on the systemic ways in which a given social structure or social institution harms people by preventing them from meeting their basic needs, e.g., • Racism, ethnocentrism, classism, sexism, nationalism, ageism, etc. • Structural violence & direct violence are highly interdependent • In Violence: Reflections on a National Epidemic, James Gilligan defines structural violence as "the increased rates of death and disability suffered by those who occupy the bottom rungs of society, as contrasted with the relatively lower death rates experienced by those who are above them" • these "excess deaths" are "non-natural,“ the result of stress, shame, discrimination and denigration that results from lower status

3. “Home of the Free, Land of the Poor,” Making Sen$e, PBS Newshour, 8/16/2011 • Psychologists Dan Ariely and Michael I. Norton conducted an experiment asking people to identify wealth distribution in the US, by quintiles, or fifths http://www.pbs.org/newshour/bb/business/july-dec11/makingsense_08-16.html

4. Which nations do pie charts A, B & C represent?1/US, Spain, Egypt 2/Freedonia, Sweden, US 3/Luxembourg, US, Somalia Country B Country C Country A Answer: 2

5. Defining Wealth • Wealth is net worth, the sum total of one’s assets minus one’s liabilities • assets: checking and savings accounts, vehicles, a home that you own, mutual funds, stocks and bonds, real estate, and retirement accounts • liabilities: a car loan, credit card balance, student loan, personal loan, mortgage, and other bills you still need to pay • US wealth inequality is even more pronounced than income inequality • overall wealth gap > income gap • gender wealth gap > gender income gap • racial wealth gap > racial income gap • Wealth has advantages that income doesn't have • It can be used as collateral for loans • It can generate further income in the form of dividends or rent, for example • It can be passed down from generation to generation – and this is one of the primary reasons why we see such a tremendous racial wealth gap • It is critical for helping people weather financial crises such as the one we're in now, when people lose their jobs or other circumstances such as medical emergencies

6. “Of the 1%, by the 1%, for the 1%”(Joseph E. Stiglitz, Vanity Fair, May 2011) • Top 1% take nearly 1/4 (25%) of the nation’s income • Top 1% control 40% of the nation’s wealth • While the top 1% have seen incomes rise 18% over the past decade, those in middle have seen incomes fall • For men with only high-school degrees, the decline has been steep, income dropping 12% in the last 25 years • On income equality, US now lags behind countries of “old Europe” , • Among our closest counterparts are Russia with its oligarchs and Iran • Today there’s more upward social mobility in Europe than in the US

7. Unevenly distributed growth, 1979-2007

8. Medicalizing social inequality • Homelessness has become routine during a three-decade period characterized by growing inequality in wealth and income (starting in the 1970s) • Yet policies designed to fight homelessness rarely address such conditions, e.g., • Often shelter rules make it nearly impossible for a person to maintain employment

9. “Continuum of care” model • Develops programs & services, often through shelters, to treat symptoms thought to create homelessness • Reframes homelessness as a condition afflicting those with history of disease and dysfunction, e.g., • PTSD, neglect by foster care system, depression, alcoholism, substance abuse, domestic abuse, etc. • Critique: • Neglects questions of access to and distribution of resources • Focus on “disease” within the discourse of “helping” actually undermines consideration of other explanations of homelessness and hinders strategies focused on altering class, race, or gender dynamics

10. Medicalization of social problems • Medicalization of social problems neglects systemic inequality • plays ideological function of legitimizing existing class relations and serves to “depoliticize what is intrinsically a political problem” (Navarro) • Much of what’s thought of as illness is result of unequal distribution of resources (Navarro) • Social conditions commonly medicalized in popular & scientific discourse, e.g., • Sexual decision-making, depression, credit card debt, sexuality, drug use, gambling, weight problems, teen pregnancy, etc.

11. Homelessness is reproduced by routine, everyday practices in shelter system • Reformative efforts often focus on treatments that fit within constructed views of “normal” and “deviant” • These practices produce subjects who see form of the individualized self as the most reasonable and realistic ways of resolving homelessness •  many homeless people more likely to engage in self-blame and self-governing – a “self-help” approach – than in collective work against structural violence

12. Conclusions • Combination of factors narrow our understandings of “reasonable” and “realistic” solutions to homelessness • dominant medicalized discourse of deviance • belief in inevitability of economic inequality • widespread feelings of powerlessness to change system • Shelter regime of surveillance, discipline, and personal enhancement fosters self-blame • Self-governing can’t be a solution because individuals don’t have control; homelessness, poverty, inequality, racism is not only personal, but also the product of power relations • To understand durability of problem of homelessness, despite well-intentioned efforts of sheltering industry, we must think about how the categories “homeless” and “homelessness” are produced and resisted

13. On turning poverty into an american crime Barbara Ehrenreich, from Nickel and Dimed: On (Not) Getting by in America (Foreward, 2011 Version)

14. Post-meltdown poverty • Around 2000, 29% of American families living in what could be more reasonably defined as poverty, meaning that they earned less than a barebones budget covering housing, child care, health care, food, transportation, and taxes (EPI) • After the 2008 financial meltdown, things are much worse: • Formerly middle-class families who’ve lost jobs now the “nouveau poor” • Brunt of recession borne by borne by blue-collar working class, which had already been sliding downwards since de-industrialization in the 1980s • Low-wage blue-collar workers were especially hard hit because they had so few assets and savings to fall back on as jobs disappeared

15. Coping strategies • Cutting back on health care, prescriptions, or dropping health insurance altogether • Food pantries, “food auctions,” “urban hunting” • “Doubling up” in homes/apartments, renting to couch-surfers • Another response to job loss and debt has been suicide

16. “Torture and Abuse of Needy Families” • Besides food stamps, other forms of welfare are increasingly difficult to access, psychologically abusive, and stigmatizing “Applying for welfare is a lot like being booked by the police.” There may be a mug shot, fingerprinting, and lengthy interrogations as to one’s children’s true paternity. The ostensible goal is to prevent welfare fraud, but the psychological impact is to turn poverty itself into a kind of crime.” (Kaaryn Gustafson, University of Connecticut Law)

17. Criminalization of povertyHow the safety net became a dragnet • The number of ordinances against the publicly poor has been rising since 2006, along with harassment of the poor for more “neutral” infractions like jaywalking, littering, or carrying an open container (Ntl Law Ctr on Poverty & Homelessness) • Sleeping on the streets is considered “criminal trespassing” in many cities • Several cities have passed ordinances banning the sharing of food • In Colorado, a city council is considering a ban on begging

18. Criminalization of the not-yet homeless – by debt and race • Debt • Failing to honor summons from creditor can result in “contempt of court” charges, landing one in prison • Driving with lapsed auto insurance can also result in a summons • Race/racial profiling • “In what has become a familiar pattern, the government defunds services that might help the poor while ramping up law enforcement” • Shut down public housing, then make it a crime to be homeless • Generate no public-sector jobs, then penalize people for falling into debt • “The experience of the poor, and especially poor people of color, comes to resemble that of a rat in a cage scrambling to avoid erratically administered electric shocks. And if you should try to escape this nightmare reality into a brief, drug-induced high, it’s ‘gotcha’all over again, because that of course is illegal too.”

19. The answer? • If we want to reduce poverty, we have to stop doing the things that make people poor and keep them that way. • Stop underpaying people for the jobs they do. • Stop treating working people as potential criminals and let them have the right to organize for better wages and working conditions. • Stop the institutional harassment of those who turn to the government for help or find themselves destitute in the streets. • Maybe, as so many Americans seem to believe today, we can’t afford the kinds of public programs that would genuinely alleviate poverty -- though I would argue otherwise. But at least we should decide, as a bare minimum principle, to stop kicking people when they’re down.

20. “Debt, Slavery, and Our Idea of Freedom,” Interview w/ David Graeber (author of Debt, 2011) On Debt and Double Standards DG: …there is an irony in thinking of a promise made by a stateto pay a debt as something absolutely sacred. After all, a debt is just a promise, and politicians make all sorts of different promises. They break most of them. So why are these promises the only ones that they can’t break? It is considered completely normal for [a politician] to say, ‘well of course we promised not to raise school fees. But that’s unrealistic.’ ‘Unrealistic’ here means ‘obviously there’s no possibility of breaking my promises to bankers, even those linked to banks we bailed out and in some cases effectively own’. It’s striking that no-one ever points that out. Why is a promise made by a politician to the people who elected him considered made to be broken – it isn’t “sacred” in any way – whereas a promise the same politician makes to a financier is considered the “honor of our nation”? Why isn’t the “honor of our nation” in any way entailed in keeping our promises to people to provide healthcare and education? And why does everyone just seem to accept that, that this is just “reality”?

21. The language of debt is not an economic one; it’s a language of morality DG: It has been used for thousands of years by people in situations of vast inequalities of power. If you have a situation of complete inequality, particularly violent inequality – if you’ve conquered someone, or if you’re a mafioso extracting protection money – then framing the relationship in terms of debt makes it seem as though the extractors are magnanimous and the victims are to blame. “Well, you owe me, but I’ll be a nice guy and let you off the hook this month…” Before long the victims come to seem almost generically morally at fault by the very terms of their existence. And that logic sticks in people’s minds – it’s incredibly effective. Not universally effective, because it’s also true that the vast majority of revolts, insurrections, populist conspiracies and rebellions in world history have been about debts. When it backfires, it blows up in a big way. But nonetheless, that’s what people almost invariably do when they’re imposing a situation of complete inequality.

22. “Sacredness” depends on who owes whom DG: The irony of course is that when dealing with each other, rich and powerful people know that debts aren’t “sacred”, and they rearrange things all the time. They are often incredibly forgiving and generous when dealing with each other. The idea of the sacredness of debt is chiefly applied when we are talking about different sorts of people. Just as rich people will come to the aid of other rich people, so poor people also will bail each other out – they’ll make ‘loans’ that are really gifts, and so on. But when you’re dealing with debts owed by people without power to people with power, suddenly the debt becomes sacred and you can’t even question it.