
Almost half of homeless men had traumatic brain injury in their lifetime - pyduan
http://www.sciencedaily.com/releases/2014/04/140425104714.htm
======
blairbeckwith
Just a few weeks ago, I was walking home from work and witnessed one homeless
man suckerpunch another in the face, knocking him off balance on ice and
causing him to fall straight back and crack his head open on the ice. There
was an instant pool of blood that started spreading quickly, with other
homeless people scattering instantly. A cop arrived on the scene almost
immediately.

I was incredibly surprised reading this that 87% had TBI before becoming
homeless. I wonder what the numbers are for repeated TBI after becoming
homeless among those that had their first instance pre-homelessness.

~~~
drawnalong
I'll echo what is said further down; it is good to see a reasonable look into
homelessness here on HN.

I literally just came bsck from a vigil for a man who died in a self-lit fire
in an abandoned moving truck parked in my hometown. The vigil was attended by
homeless advocates of all political stripes, had a local police officer
singing at the beginning and end, and a gubernatorial candidate was around as
well. The "issue of homelessness" is definitely complicated, and amongst the
crowd tonight, all holding candles, were those who take stands for rental
vouchers, more conservative "housing first" policies, expanded mental health
care, and a few other approaches. There were plenty of compassionate Christian
conservatives there who I appreciate for their emphasis on pragmatism and on
human dignity, even though the solutions run against their deeply held
political beliefs.

As someone who has always felt just a day a way from slipping into
homelessness myself, including struggling with alcoholism - the one thing I
can say for certain is that the only way to address this is by continuing to
address the issue honestly, trying the best we can with evidence of what
works. I wish I could say I trust my faculties, but week to week its obvious I
have a problem, even back when I was 9 years into sobriety..

In America, we definitely err on the side of personal liberty and
responsibility, and though I agree with that in some abstract sense, it is
obvious to me that moralizing the issue as one of choice, or as one of
laziness vs. hard work and determination, is a failure. We can do better, and
we will, but in the process we're going to have to accept responsibility for
each other in a costly and politically inconvenient way.

The fact that people came out tonight in my hometown to celebrate our common
humanity, despite another tragic loss, is admirable. It is what defines us as
a human family. Although the circumstances anger me personally, all these
people tonight, and the people here on HN, prove there is a solution, even if
it is a hard process and not a clear destination.

------
Mz
The aftereffects of traumatic brain injury is a very intractable problem that
significantly damages a person's life. People tend to be on the street because
of intractable personal problems, not because of lack of money per se.

I have thought a lot about that and I often wonder what we can do to heal the
bodies and minds of the homeless as our first priority instead of trying to
act like homelessness itself is the problem and like getting shelter of some
sort is the priority. Homeless shelters are often really crappy shelter, with
no privacy and terrible air quality and so forth. I won't go to one because I
am on the street to get myself well and I can't solve my problems if I can't
get well. Homeless shelters are generally not clean enough for my needs. They
would help keep me sick. I can't ever solve my problems by staying chronically
ill. My financial problems are rooted in my health problems.

I never know how to explain that effectively to other people who think a) my
lack of housing proves I am incompetent and thus not credible or worth
listening to and b) housing, any housing, is the single most important detail
to address.

Years ago, I lived for a few months in a crap trailer. My health took a turn
for the worse and in some ways never recovered. I am still trying to undo the
damage of those few months. I have enough income that I could probably go to
someplace super cheap, like rural Alabama or Mississippi, and find a trailer
for rent to live in instead of choosing to be on the street and inexpensive
California where the climate is good for my health but I can't afford housing.
And I never know how to explain to people that I am doing the right thing and
this focus on get a home, any home, is the wrong focus and is part of the
problem.

I am glad to see this posted here. I think this is probably a lot better thing
to post on HN than a lot of stories that wind up here which showcase specific
homeless individuals and, more often than not, seem to convince people that
the individual in question just needs to "be more responsible" or "make better
choices."

------
sys32768
My relative is almost homeless three years after a TBI in an accident he drove
home from. Prior to that he was a talented contractor who supported a family
and had many friends.

Despite herculean efforts by friends and family and even strangers, he is
fundamentally broken in ways nobody seems to understand. He still largely
thinks of himself as the person he was prior to the TBI.

My guess at this grim stage is the mechanisms are broken that allow him to
self-correct his behavior and make accurate, up-to-date "I am" statements.
Clues to this are when you confront him about his behavior or how he never
bathes. He is not offended or worried but rather agitated, as if his brain
short-circuits. At best you get cognitive distortions and at worst he storms
away in a rage he won't remember five minutes later. Interventions and threats
have no postive effect.

He will talk your ear off all day about hobbies he had prior to his TBI, and
if you didn't smell him or notice his pan handling sign, you might not know
there is any problem. But make no mistake, invite this man to live with you
and you will be tearing your hair out after two weeks and kicking him out in
three, if not sooner.

Every TBI is unique just as every person is. My relative does not accurately
remember what parts of his brain was injured, so interviewing him would not
yield much. Besides that, after this happened I read that something like 80%
of TBIs do not even show on common medical imaging devices. In my relative's
case there was evidence "suggestive" of DAI (diffuse axonal injury) which may
explain why his deficits are so profound, but nobody can say. During therapy
there was clear evidence that his deductive reasoning skills were seriously
compromised, so imagine practical consequences if you cannot do simple
deductive reasoning but also cannot realize it.

Then of course TBI survivors are many times more likely to suffer additional
TBIs. Add substance abuse and limited to no impulse control and you have a
person who is a danger to himself and often society, but who also may refuse
to get the level of help they truly need. In his case, he needs assisted
living including someone to manage all of his money, but in his mind he does
not and he appears ready to fight it until his last breath.

I hope studies like this lead to more humane and informed programs to help
people like him. I was just thinking this morning how unjust it is that
murderers and other criminals can get room and board for life yet the best we
can manage for this once talented and caring member of society is a room in a
drug-infested flop house that costs half of his disability income.

~~~
r00fus
It is sad we don't have a safety net any longer - we used to have asylums now
we have homeless people who are mostly mentally ill in some fashion or
another.

I'm not sure how I'd cope if I had a relative with a similar situation. Thanks
for sharing your story.

~~~
cpa
Asylums are better than homelessness, but to go as far as saying they are
"safety net" is a stretch. They were usually not designed to help, but to put
away. Then again, I'm not american and whenever I come to the US I'm amazed by
how many homeless people one see in the streets.

~~~
pavel_lishin
There are people that we cannot help with current medical technology. Letting
them live somewhere safe, with people who can care for them, is probably
better than most of the alternatives - homelessness and prison.

------
ribs
Need a control group - the rate of TBI amongst non-homeless men.

~~~
keithflower
The full paper[1] addresses this to some extent (my emphasis added below):

"Accurate estimates of the lifetime history (prevalence) of traumatic brain
injury within the general population are scarce, which makes it difficult to
compare rates of injury among homeless people with rates among those in the
community. Two community cohort studies suggested prevalence rates of 3.8%
(for experiencing at least 1 admission to hospital for traumatic brain injury
by age 35; northern Finland birth cohort) and 31.6% (for experiencing a
traumatic brain injury for which the person received medical care;
Christchurch, New Zealand, birth cohort). Together, these data suggest that
rates may be higher among people who are homeless than within the general
community. _A recent study estimated that homeless men had rates of head
injury 14 times higher than rates for the general population of Canada, with a
rate 400 times higher among those who were chronically homeless and had
drinking problems._ "

And not oranges and oranges comparison, but[2]:

"Separately, a recent study by Dr. Stephen Hwang of the hospital's Centre for
Research on Inner City Health, found the number of people who are homeless or
vulnerably housed and who have also suffered a TBI may be as high as 61 per
cent -- _seven times higher than the general population._ "

[1]
[http://www.cmajopen.ca/content/2/2/E69.full](http://www.cmajopen.ca/content/2/2/E69.full)

[2]
[http://www.ncbi.nlm.nih.gov/pubmed/24651000](http://www.ncbi.nlm.nih.gov/pubmed/24651000)

------
simonster
While it is quite plausible that brain damage associated TBI can cause
homelessness, the causal influence is probably lower than the given
percentages imply. According to the article:

"In Canada, the leading mechanisms of traumatic brain injury leading to
hospital admission over the decade 1994–1995 to 2003–2004 were motor-vehicle-
related for adults less than 60 years of age and falls for those 60 years of
age or older, with assaults reported as the mechanism of injury at a
substantially lower rate than we have reported here."

The article also shows high prevalence of alcohol/drug-related TBI in the
homeless, whereas in the general population, "being struck by or against an
object, motor vehicle collisions and sport-related injuries were the most
common mechanisms."

Together, the differences in the causes of TBI between the homeless subjects
and the general population imply that, in at least some cases, the TBI and
homelessness are likely to have a common cause (e.g. alcohol/drug addiction or
certain personality traits). The article recognizes this possibility, but
doesn't attempt to correct for it. To get a better idea of the causal effect,
it would be informative to compare the homeless subjects with non-homeless
controls with similar drug histories, personality traits, and socioeconomic
backgrounds.

------
cup
What shocked me when I used to do the soup van run in my local city was how
age didn't discriminate when it came to homelessnes. I saw men (and boys)
across the whole age range living in unnacceptable situations. Some of them
could have been my friends for all I know as they did their best to hide their
homelessness.

Furthermore, I was always perplexed as to why there were far more homeless
males than females. While my local government provides a number of shelters
for men and women, there was never enough room for men. We would frequently
scout the local homeless haunts (under bridgers, besides powerstations or in
church car parks) looking for people who might need some supper.

In this day and age It's pretty disagraceful in my view. I've always thought
it would be nice if someone could come up with a kickstarer/kiva like hybrid
where you could sponsor local homeless people with enough money to find
accomodation _and_ medical/psychological assistance.

~~~
Crake
Women have an easier time finding somewhere to stay because they are
considered more valuable to society. Men are disposable, which is why far
fewer resources are devoted to helping them.

Women also can just get a boyfriend if they lose their job or health and need
money; I've seen my female friends do this loads of times, but have yet to see
it go the other way. Gender roles definitely favor women pretty heavily when
it comes to financial matters.

~~~
apsec112
Ummmm no. Maybe, _maybe_ , on a statistical level, this happens more for women
than for men. But I certainly know women who have been homeless, and there are
even more women who can't get a boyfriend at all, especially if they're sick
or unemployed. Women's magazines are full of dating advice for a reason.

~~~
graeme
Note: To be clear, I do not agree with the OP's characterization of "women
being more valuable to society" and thus treated better. In general, men have
the advantage. But homelessness does tend to affect men more.

Most homeless are men. A couple sources I found places the number in the mid
60% range.

[http://homeless.samhsa.gov/ResourceFiles/hrc_factsheet.pdf](http://homeless.samhsa.gov/ResourceFiles/hrc_factsheet.pdf)
[http://www.nationalhomeless.org/factsheets/who.html](http://www.nationalhomeless.org/factsheets/who.html)

You say some women can't get a boyfriend at all. I expect it's true for most
of them that they can't get a boyfriend _they want_.

But many of them might be able to get a very disagreeable boyfriend, if their
choice was living with him, or living on the street.

It's not a very good choice. In fact, it's generally an awful choice. But it's
still a choice.

Obviously, there are homeless women, but they tend to be less vulnerable to
homelessness. Orwell wrote about this in down and out in Paris and London.
Mind you, this was in the 1920s, but it's evocative:

>Tramps are cut off from women, in the first place, because there are very few
women at their level of society. One might imagine that among destitute people
the sexes would be as equally balanced as elsewhere. But it is not so; in
fact, one can almost say that below a certain level society is entirely male.
The following figures, published by the L.C.C. from a night census taken on
February 13th, 1931, will show the relative numbers of destitute men and
destitute women:

Spending the night in the streets, 60 men, 18 women _. In shelters and homes
not licensed as common lodging-houses, 1,057 men, 137 women. In the crypt of
St Martin 's-in-the-Fields Church, 88 men, 12 women. In L.C.C. casual wards
and hostels, 674 men, 15 women.

[_ This must be an underestimate. Still, the proportions probably hold good.]

It will be seen from these figures that at the charity level men outnumber
women by something like ten to one. The cause is presumably that unemployment
affects women less than men; also that any presentable woman can, in the last
resort, attach herself to some man.

------
keithflower
A link to the actual paper (full text):

[http://www.cmajopen.ca/content/2/2/E69.full](http://www.cmajopen.ca/content/2/2/E69.full)

------
tokenadult
I tried to follow the DOI link to the underlying article, to see at least its
abstract, but that link is dead. I don't see any uptake of this hospital press
anywhere outside Science Daily, a press-release recycling service often
decried[1] by thoughtful readers here on HN. Another kind reader here found
the link to the original paper,

[http://www.cmajopen.ca/content/2/2/E69.full](http://www.cmajopen.ca/content/2/2/E69.full)

which reports

"Methods We recruited participants from an urban men’s shelter in Toronto,
Ontario. Researchers administered the Brain Injury Screening Questionnaire, a
semistructured interview screening tool for brain injury. Demographic
information and detailed histories of brain injuries were obtained.
Participants with positive and negative screening results were compared, and
the rates and mechanisms of injury were analyzed by age group.

"Results A total of 111 men (mean age 54.2 ± standard deviation 11.5 yr; range
27–81 yr) participated. Nearly half (50 [45%]) of the respondents had a
positive screening result for traumatic brain injury. Of these, 73% (35/48)
reported experiencing their first injury before adulthood (< 18 yr), and 87%
(40/46) reported a first injury before the onset of homelessness."

In other words, I think this is an interesting idea that deserves further
investigation (and, for all I know, despite the statement in the article, has
been investigated a lot already), but I have no idea how representative the
patients that Dr. Jane Topolovec-Vranic found are of all the homeless people
in her country, or what the direction of causation is here (could something
that increases risk for homelessness at one and the same time increase risk
for traumatic brain injury? very likely yes). Research on how to help people
who have suffered brain injuries to recover from those injuries is of course a
good idea, as is research on the consequences of those injuries, including
social consequences like homelessness. Best of all is to figure out how to
reduce risk of suffering such injuries. As the article says, "Additional
research is needed to understand the complex interactions among homelessness,
traumatic brain injury, mental illness and substance use." I would definitely
wonder about the substance use part of that.

[1] Science Daily has been decried so often on Hacker News that I have been
collecting those comments for a few years.

[http://news.ycombinator.com/item?id=3992206](http://news.ycombinator.com/item?id=3992206)

"Blogspam.

"Original article (to which ScienceDaily has added precisely nothing):

[http://www.washington.edu/news/articles/abundance-of-rare-
dn...](http://www.washington.edu/news/articles/abundance-of-rare-dna-changes-
following-population-explosion-may-hold-common-disease-clues)

"Underlying paper in Science (paywalled):

[http://www.sciencemag.org/content/early/2012/05/16/science.1...](http://www.sciencemag.org/content/early/2012/05/16/science.1219240)

"Brief writeup from Nature discussing this paper and a couple of others on
similar topics:

[http://www.nature.com/news/humans-riddled-with-rare-
genetic-...](http://www.nature.com/news/humans-riddled-with-rare-genetic-
variants-1.10655)

[http://news.ycombinator.com/item?id=4108603](http://news.ycombinator.com/item?id=4108603)

"Everything I've ever seen on HN -- I don't know about Reddit -- from
ScienceDaily has been a cut-and-paste copy of something else available from
nearer the original source. In some cases ScienceDaily's copy is distinctly
worse than the original because it lacks relevant links, enlightening
pictures, etc.

" . . . . if you find something there and feel like sharing it, it's pretty
much always best to take ten seconds to find the original source and submit
that instead of ScienceDaily."

Comments about both PhysOrg and ScienceDaily:

[http://news.ycombinator.com/item?id=3689185](http://news.ycombinator.com/item?id=3689185)

"Why hasn't sciencedaily.com or physorg been banned from HN yet?"

[https://news.ycombinator.com/item?id=3867348](https://news.ycombinator.com/item?id=3867348)

"A useful rule of thumb is that whenever you see anything on sciencedaily.com
or physorg.com, unless it's absolute nonsense there's another more direct (and
often more informative) source you should link to instead."

[http://news.ycombinator.com/item?id=3875529](http://news.ycombinator.com/item?id=3875529)

"Original source:

[http://www.nasa.gov/mission_pages/hinode/news/pole-
asymmetry...](http://www.nasa.gov/mission_pages/hinode/news/pole-
asymmetry.html)

"What ScienceDaily has added to this: (1) They've removed one of the figures.
(2) They've removed links to the Hinode and SOHO websites. (3) They've added
lots of largely irrelevant links of their own, all of course to their own
site(s).

"Please, everyone: stop linking to ScienceDaily and PhysOrg."

[http://news.ycombinator.com/item?id=3867361](http://news.ycombinator.com/item?id=3867361)

"Those sources don't have RSS feeds, and ScienceDaily and PhysOrg have a bad
habit of not linking to such things."

[http://news.ycombinator.com/item?id=4083766](http://news.ycombinator.com/item?id=4083766)

"Added value in PhysOrg article: zero.

"Please, everyone, stop submitting links from PhysOrg and ScienceDaily. I have
never ever ever seen anything on those sites that isn't either (1) bullshit or
(2) a recycled press release with zero (or often negative) added value.
(Sometimes it's both at once.) It only takes ten seconds' googling to find the
original source."

~~~
joe_the_user
Cheers for a demonstration of how debatable these claims are.

One thing that bothers me about such claims is they hardly explain what seems
to be a secularly rising homeless rate over the last thirty years. Sure, we
haven't seen a brain injury epidemic during that time but certainly we've seen
social and economic policy changes during that time.

~~~
edmccard
>we haven't seen a brain injury epidemic during that time but certainly we've
seen social and economic policy changes during that time

That doesn't rule out a correlation between brain injury and homelessness; the
social and economic policy changes might have the effect that fewer brain-
injured people get the care they need to avoid becoming homeless.

