
Working as a librarian gave me PTSD symptoms - 80mph
https://www.latimes.com/opinion/op-ed/la-oe-oliver-librarian-the-public-movie-20190419-story.html
======
caymanjim
The kind of people who are giving the author PTSD aren't going to be helped by
free housing, free money, or free anything other than free medical care, and
in the extreme cases, institutionalization.

Since we find the idea of involuntarily committing psychiatric patients to be
unpalatable these days, we have to either way until they commit a serious
crime and go to prison, or live with them on our streets and in our libraries.

There are many homeless people who are not socially problematic, but that's
not what this article is about. The problem people are incompatible with free
housing, because they are violently unstable. They're schizophrenic, drug-
dependent, or just plain violent.

All these responses about economic considerations or a lack of homeless
support infrastructure are totally missing the real issue, which is that some
people have such extreme mental illness or other social problem that they are
incompatible with peaceful society, and it's not something than can be solved
with housing and cash. That is a separate problem entirely.

~~~
jdietrich
_> Since we find the idea of involuntarily committing psychiatric patients to
be unpalatable these days_

We closed the asylums, because the long-term detention of the mentally ill is
costly and inhumane. We can do better than just warehousing people in pseudo-
prisons. We completely failed to provide adequate support in the community for
people with severe and enduring mental illness, which is why so many people
are trapped in a cycle of homelessness and incarceration.

Most of these people _aren 't_ "incompatible with peaceful society", they just
need help and can't get it. If any one factor is to blame, it's the systematic
defunding of social work and community mental health. If your local library is
full of mentally ill homeless people, the fundamental questions are _why do
these people have nowhere else to go?_ and _why is nobody here who actually
has the training to help these people?_.

~~~
ascar
> _Most of these people aren 't "incompatible with peaceful society", they
> just need help and can't get it_

Do you have any source that most of these people can't get it? With a father
who outright refused any medical help unless basically forced on him, in a
country where it's completely free, I can absolutely relate to the argument
that not having involuntary psychatric treatment plays a big part here. And
his mental state was only a minor part of his health issues.

It's not nice to be in stationary psychatric treatment. These are horrible
places you want to leave as soon as possible. But it sometimes can't be
helped.

I can even relate to the point that it's better for (some/most of) these
people to live on the streets than in a psychatric facility, while it's
probably worse for society as a whole.

~~~
jdietrich
There's a world of difference between "having access to medical care" and
"having access to appropriate care for a disorder that presents particular
obstacles in accessing conventional care pathways". Access to care in the US
is highly inconsistent, because there's a patchwork of providers and funders.

Effective care for people with severe and enduring mental illness needs to be
patient-led but assertive - we're not going to lock you up unless it's
genuinely in your best interests, but we're not going to let you slip through
the cracks either. Compulsory inpatient treatment is a necessary last resort
where people pose a clear and immediate risk, but it should not be the basis
of care for severe and enduring mental illness.

The issues regarding involuntary treatment in the US are highly complex, but
the evidence indicates that involuntary community treatment does not make a
significant difference in clinical outcomes. Forcing people to attend
appointments or take medication doesn't seem to result in any long-term
benefit on aggregate. Some people do benefit (at least in the short term) from
being treated against their will, but compulsion undermines the relationship
of trust between care providers and service users and discourages people from
engaging with care.

[https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8...](https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8182.pdf)

[https://en.wikipedia.org/wiki/Assertive_community_treatment](https://en.wikipedia.org/wiki/Assertive_community_treatment)

[https://www.cochrane.org/CD004408/SCHIZ_compulsory-
community...](https://www.cochrane.org/CD004408/SCHIZ_compulsory-community-
and-involuntary-outpatient-treatment-people-severe-mental-disorders)

~~~
tathougies
> significant difference in clinical outcomes

But by removing these peiple from the streets nd the libraries, even if they
are not cured themselves, we avoid a librarian -- a productive member of
society -- from developing PTSD.

~~~
scruple
My (controversial?) opinion is that the civil commitment laws aren't good
enough. A (mentally ill) person shouldn't have to become a danger to others or
themselves before a serious conversation about involuntary commitment can be
had.

And I acknowledge and fully accept that this is a very rough position to hold
today. But, it is born out of over a decade of direct personal experience.
It's come from watching the state of California continually fail to provide
adequate support to my clinically diagnosed family member, to our family as
people who care about this person, as well as failing to protect to public
from him time and time again.

------
narrator
The problem with how we treat the poorest people in the country is that we
have a fair number of completely psychotic people who spoil the whole social
support network for everyone else by requiring 100x the help everyone else
does because they are actively destroying the facilities and people that try
to help them.

In Western Europe these people are likely held against their will in mental
institutions, but in America, especially in San Francisco we'd rather they be
out walking around off their meds if they haven't murdered anyone yet. There
are homeless people who regularly randomly assault people for no reason and as
long as they don't use a weapon they are back out on the street in 24 hours.

~~~
jetrink
> especially in San Francisco we'd rather they be out walking around

It's not a question of preference. Our constitution is incompatible with
treatment programs that involve indefinite imprisonment when the individual is
not a serious threat to himself or others.

1\.
[https://en.wikipedia.org/wiki/O%27Connor_v._Donaldson](https://en.wikipedia.org/wiki/O%27Connor_v._Donaldson)

2\.
[https://en.wikipedia.org/wiki/Addington_v._Texas](https://en.wikipedia.org/wiki/Addington_v._Texas)

~~~
Carpetsmoker
I'm not sure if laws in Western Europe are fundamentally different. In the
Netherlands the law[1][2] states you can only be involuntarily committed if
you're a danger for themselves or others and if this is the only remaining
solution. It seems roughly analogous to those two SCOTUS cases, although
details and/or practical implementations may differ.

[1]: [https://www.ggznederland.nl/themas/gedwongen-
civiel](https://www.ggznederland.nl/themas/gedwongen-civiel)

[2]: [https://www.dwangindezorg.nl/rechten/wetten/wet-
bopz](https://www.dwangindezorg.nl/rechten/wetten/wet-bopz)

~~~
dr_dshiv
Any other refs on how the Netherlands deals with homeless? I am shocked by how
few homeless there are.

~~~
Carpetsmoker
I think it's far more involved than just "dealing with the homeless". After I
moved to the UK a few years ago (from NL) was shocked by the amount of
homeless people.

After renting for two years I was evicted with a 2-month notice for what was
essentially a simple disagreement with the landlord. They didn't even attempt
to resolve it: they just evicted me.

It took me over half a year to get half of my £1 100 deposit back; they
initially tried to charge me £1 400, mostly for bullshit general maintenance
and/or lying about either the initial state – even though it was unambiguously
stated in the original inventory – or agreements we had made about the
checkout condition (I asked if I had to fix a few minor issues, they said no,
and then charged me anyway). About £100 was reasonable, the rest wasn't.

My point here is, all of this would be highly illegal in the Netherlands. You
can't just evict people because you feel like it, and you can't just send a
bill well over a month later for all sorts of items (or maybe you can, but
it's certainly not common[1]). It's not hard to imagine how I could have ended
up homeless if I had been more vulnerable – for example by actually _needing_
that £1 100 deposit for a new deposit, or suffering from depression or other
mental illness, etc.

I think homelessness is a complex problem, and dealing with people _after_
they become homeless is a only a part of it. This is not very scientific, but
in general, I've observed that homelessness is correlated with the amount of
empathy in a society, which is something that affects many laws and attitudes.

[1]: A little footnote: technically also not legal in the UK, but they
interpret "notify about deductions within 10 days" as "send standard form
letter that there may be some deductions within 10 days", which is obviously
not the same. But ... what can you do about stuff like this as a tenant,
right? I might have considered the small claims court, but have since left the
UK as I was fed up. Even "notify within 10 days" is already very strange, as
this means they have all the time to collect all the evidence, while robbing
me the chance of actually giving any sort of counter-argument. In NL, it's
always been arranged at the checkout, with both parties present.

~~~
CydeWeys
> After renting for two years I was evicted with a 2-month notice for what was
> essentially a simple disagreement with the landlord. They didn't even
> attempt to resolve it: they just evicted me.

Were you actually evicted, or did your lease simply expire without an option
to renew? Because even here in the US, it's very hard to impossible to evict
someone who has a lease and is still paying rent and isn't flagrantly
violating laws or destroying the dwelling.

~~~
Carpetsmoker
I'm not sure if "evict" is the correct legal terminology; probably isn't. But
it is what it effectively amounts to, so it's what I'll call it.

Details: [https://www.gov.uk/tenancy-agreements-a-guide-for-
landlords/...](https://www.gov.uk/tenancy-agreements-a-guide-for-
landlords/ending-a-tenancy) – tl;dr is that after 6 months you can just end
the tenancy agreement with a 2 month notice.

Assured shorthold tenancies are pretty much the standard; you don't have a lot
of choice. Either sign a contract like this, or don't have a house to live in
:-/

The entire thing is seriously fucked up if you ask me, because at the
slightest hint of being "difficult" (e.g. because you demand they actually fix
things, or because you object when they act like assholes) you just get
evicted :-/

------
bookofjoe
Speaking as 1) the son of a divorced mother on multiple antipsychotic drugs
beginning in her mid-30s for schizophrenia, involuntarily hospitalized
multiple times, who routinely discarded her medications as soon as she was
discharged because of the terrible side effects, and 2) a retired physician
(neurosurgical anesthesiologist x 38 years) who rotated through ERs and
psychiatric wards during medical school and residency, then was occasionally
paged to the ER to deal with critical airway issues/Code Blues in patients
with psychiatric histories: people with major mental health problems are quite
often prescribed medicines whose side effects are so crippling and difficult
to live with, they'd rather do without. This is the root cause IMHO of much
social vexation for the rest of the population. In addition, some homeless
people, offered safe shelter and food in a controlled, supervised setting,
refuse, fearing loss of freedom or worse. I see no solution that doesn't
infringe on their rights as human beings.

~~~
alejohausner
Maybe psychiatry interns should spend a month taking antipsychotics, just to
experience the side effects. It would greatly reduce their faith in big
pharma.

~~~
0xcde4c3db
It's not just the side effects, it's also that antipsychotics don't really
target the "negative" symptoms of schizophrenia such as anhedonia and
avolition, which can be just as destructive to the prospect of a stable and
fulfilling life as delusions and hallucinations.

~~~
bookofjoe
You're spot-on. The hammer-type drugs/aka antipsychotics dull down everything.

------
bayesian_horse
The US seems to be coming to the realization that social welfare is not an
altruistic indulgence, but a necessity for an economically wealthy society.

These library "residents" force the state - and its workers - to help them by
confronting them with their sheer humanity. It is easy to refuse services to
people you don't know, it's harder to send them out into the cold face to
face. Most Human beings can't stand seeing another Human suffering. It just
hurts us. Hurting them, by removing them forcibly, also hurts us.

~~~
robertAngst
Whats the solution? Throw another billion at the problem?

Have 80% of it get sucked up by the bureaucracy? And the other 20% is used on
surface issues.

>social welfare is not an altruistic indulgence

Both sides want to help people, the great question is, what is the best way?

Should we spend 1B on bandaids? Or should we start earlier in life, giving
people opportunities that keep them off the streets?

~~~
bayesian_horse
That's exactly the kind of "self-reliancy" and "small government" BS that
hasn't worked for the US the past 100 years. Well, it has worked for a small
minority which has increasingly enriched itself.

If you promote "giving people opportunities that keep them off the streets" as
a solution, you profess to a total ignorance of how homelessness in the US
(and most developed countries) works.

It's not poverty or lack of employment. It's more about mental health and
substance abuse. You can offer those people all the jobs you want, without
medical and psychological/social help, they don't stand a chance.

So yes, "1B on bandaids", like better mental health care for the poor, more
social workers, more social housing would be a very good start.

------
winkelwagen
This quite touched me, I love libraries and when I traveled through the NA I
often went in every big city to take some time from all the travel madness.
The contrast between the libraries in Toronto and Seattle was quite stark. You
could see the diffence between visitors, and there were a ton more homeless
people in Seattle.

At the time i didn’t think much of it, but I was reflecting back on it after a
awesome episode of 99% invisible (palaces of the people). The guest talked
about how libraries changed and have a different function. And the importance
of something he called social infrastructure as something that doesn’t get
seen as important as let’s say, roads and electricity.

It’s Very related to what the author of the article is saying. We don’t nearly
appreciate enough how libraries function in society. When we keep looking at
as a buildings where you can get books and use the internet we totally miss
the human side of it and if we don’t equip the people with the skills or
experience to deal with it. They are going to be burned out.

Hopefully we can recognize the importance libraries have and support them in a
way it benefits whole cities.

------
alvalentini
There have been, and continue to be, social experiments proving that giving
homeless people a house ends up being less expensive to communities and way
more humane.

Maybe it's lack of understanding. Maybe lack of knowledge. Maybe selfishness.
But it's doable, more efficient and decent.

~~~
praptak
It's the idea that making someone else's life too easy is somehow immoral,
especially if they obtain something valuable without the hard work.

~~~
kobayashy
You can always make their life easier by giving them YOUR money. Heck, you
could even adopt them and house them in your own home. I would respect that.
But I don't want one cent of my money to go to these kind of programs, and I
think that my stand on this issue should be respected.

~~~
viivaux
>I think that my stand on this issue should be respected.

But I don't think it's remotely worthy of respect. You want to live in a
society like that, go somewhere with no public schools or roads or
firefighters.

------
hugh4life
The last place TempleOS's Terry A Davis did a video before he died was outside
a library.

[https://www.youtube.com/watch?v=oH41gGBVpkE](https://www.youtube.com/watch?v=oH41gGBVpkE)

"I really like this library. So uh, come here use their computer and smoke out
here. They must have been freaking out because such an impure person was in
their presence."

------
CryptoPunk
>>Money for low-income housing and social service programs has dwindled for
decades.

This is not true. Money for low-income housing and social services has
massively increased over the last 40 years.

The problem is, this approach is not working. The state psychiatric hospitals
were closed because of the deinstitutionalization movement which was strongly
supported by advocates of the mentally ill.

Now they don't want to acknowledge the consequences of that advocacy, and keep
blaming the phantom menace of austerity and social spending cuts.

------
greedo
My wife started working at a downtown library 6 months ago. We live in a
relatively small Midwest city (300K pop) that is a big college town, as well
as the seat of the state government. Everything in this article is familiar to
me; nothing is shocking in any way. This is the norm for urban libraries.

------
sizzle
This is HN, home to some of the smartest problem solving minds. Is there a
startup opportunity to make a dent in solving homelessness while also making a
profit or is that wishful thinking?

~~~
ken
I don't care for the idea that HN or programmers or engineers or doctors or
NASA or _any_ particular subset is home to "the smartest problem solving
minds". I've met smart and creative problem solvers in all fields.

People tend to solve problems with the tools of their field, and it's telling
that your first idea was "a startup opportunity". Really? Our solution for
homelessness should also make a profit? We're going to bring our neighbors out
of poverty by earning a buck in the process? Where does this money come from?

First, start by "doing things that don't scale": solve homelessness for one
person. Then do it for 2, 5, and 10. My impression is that, like many human
problems, a real solution might never scale.

~~~
sizzle
"Our solution for homelessness should also make a profit?"

Profits are merely an incentive to getting more individuals involved and VC
capital backing is unlikely unless there is an eventual ROI I'd imagine. How
that ROI is determined is beyond the point, it could be government subsidies,
cryptocurrency/blockchain related, etc.

------
harryf
Having been lucky enough to grow up in Western Europe, in a “socialist”
democracy, I’ve read a lot about the state of poverty in the US and been
shocked by visits to San Francisco and Washington to see so many homeless
people. I’d thought that seeing a street full or homeless people literally one
block over from the Whitehouse was the most shocking thing - it is
inconceivable in Western Europe that homelessness would be tolerated near a
national monument.

But reading this, the idea that libraries are doubling as homeless shelters is
the most shocking thing I think I’ve ever encountered about poverty in the US.

Sorry to provoke anyone from the US reading this but how badly does your
society have to be broken to allow this to become an accepted norm? Given it’s
an extremely wealthy country, the cruelty of the system that lets this happen
is hard for me to even imagine.

This whole “survival of the fittest is what makes America great” crap needs to
stop. Period. Because to me that seems like that’s the root cause, the excuse
for treating a societies weakest so cruelly. The only discussion should be
“how do we fix this?”.

OK rant over ... apologies to anyone triggered but genuinely shocked.

~~~
keiferski
The homeless problems in America have absolutely nothing to do with “survival
of the fittest” and your comment is nothing but stereotypes. US cities spend
massive amounts of money on social issues and the US is in fact the world
leader in terms of donations as a percentage of GDP.

[https://en.wikipedia.org/wiki/List_of_countries_by_charitabl...](https://en.wikipedia.org/wiki/List_of_countries_by_charitable_donation)

The homeless problem is mostly attributable to laws in the 70s and 80s which
released mentally ill patients from hospitals and prevented their future
incarceration.

~~~
frostburg
The US also spends a lot of money on healthcare, but it doesn't really work,
because the model is flawed.

~~~
keiferski
Yes well that means that the system is broken, _not_ that Americans have some
sort of “too bad, the weak should die” mentality (as the OP suggested.)

~~~
ben_w
The “too bad, the weak should die” mentality is, unfortunately, very much the
impression I get whenever discussing healthcare with Americans. It’s easy
(availability heuristic) to forget this says more about the sort of Americans
who are likely to engage in discussion about healthcare than about Americans
as a whole.

~~~
war1025
The main thing I've noticed, as someone who works at a company too small to
have cheap insurance and is too well off to get subsidized insurance, is that
people who work for big companies genuinely don't think health insurance is a
problem in America because their employer is able to get bulk plans where they
are paying something like $100 a month out of pocket for absolutely amazing
coverage.

Then you have the people who used to have great coverage, but it's slowly
gotten less good and more expensive over time. They are mainly worried about
doing something that will make the problem even worse.

Then you have people like me, who are paying ridiculous money for what is
basically "catastrophic" insurance, and like to complain loudly any chance we
get, mostly on deaf ears because people hope the problem won't come their way
if they just ignore it and carry on.

~~~
ben_w
Interesting perspective, thank you.

------
haidut
Why is nobody in this thread mentioning the the 800lb gorilla in the room??
That is, in a capitalist system the homeless, mentally-ill, "problematic",
disturbed, troubled, etc are simply considered useless and frankly
purposefully pushed to the edge with the hope that they will simply...die.
That is the fundamental truth in any capitalist society - you either deliver
value or you perish. Who will pay for these people to be housed, treated, re-
integrated, educated, fed, etc in times of largely non-existent real economic
growth, where almost 80% of Americans live paycheck to paycheck?
[https://www.cnbc.com/2019/01/09/shutdown-highlights-
that-4-i...](https://www.cnbc.com/2019/01/09/shutdown-highlights-
that-4-in-5-us-workers-live-paycheck-to-paycheck.html)

The answer is, of course, nobody. For all the talk about caring for the
homeless and in general those who are at the bottom of society, the sad/brutal
reality is that society as a whole does not want these people around. So, they
keep getting squeezed and in turn keep squeezing the few who are willing to
help them or at least listen to their woes. That is what is giving the author
PTSD, not interacting with mentally ill every day. Namely, the realization
that a sizeable minority of the US population are simply considered junk and
are purposefully pushed towards death. But she only saw part of the story. The
scarier truth is that almost 80% of Americans (all those people living
paycheck to paycheck) are only one job loss or chronic illness away from the
same faith. More than 2/3 or all banckrupcies are related to medical bills.

[https://www.cnbc.com/2019/02/11/this-is-the-real-reason-
most...](https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most-
americans-file-for-bankruptcy.html)

And when you add to the above that empathy in general has declined by almost
50% over the last 2 decades you'd have to be a psychopath not to start getting
PTSD symptoms or at the very least a very serious case of clinical anxiety
disorder or even psychosis.

[https://www.reddit.com/r/psychology/comments/bedj96/the_end_...](https://www.reddit.com/r/psychology/comments/bedj96/the_end_of_empathy_young_people_measure_40_less/)

Just think about this for a second. If most people around you do not give a
rat's *ss about you even when you are doing OK, what happens if you meet with
bad luck and go downhill?? Anxiety, depression, bipolar, psychosis, suicide,
etc - all of these can be explained rather easily by the simple reality that
most people live in terror every day to be surrounded by people they do not
care about and those do not care in return.

------
robertAngst
My only gripe about this story, is that they act like Public Libraries are the
only places that have crazy people.

Working in retail making 7.85$/hr, we had plenty of crazy people.

There is something noble about being a librarian, and this article discusses
that phenomenon.

There was nothing noble about serving enraged customers, customers that stole,
or creepy customers.

------
Haga
If I follow a twin-ideology and the world falls to ashes, at what point does
that love affair fall apart? Does it ever? There are people in Venezuela who
support true socialism even right now. That such comfortable dualism might
result in such horrific results, almost as if both had a wrong concept of
human nature.

~~~
robertAngst
We can have conversations about the free market fixing these problems.

I have money, lets talk about what can be done to solve it.

No one gives a care that socialism fails, the problems still exists, and as a
result, people will keep trying to solve problems.

