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Homeless in Silicon Valley (billmoyers.com)
156 points by lavrentia 724 days ago | 142 comments



A large majority of people that are persistently 'homeless' in the US, by which I mean completely destitute and sleeping outside, have serious mental disease AND/OR are alcoholics, AND/OR are addicts. In fact, most became homeless due to one of these three reasons, rather than turning to alcohol or drugs to cope with their situation.

No amount of social justice can cure someone's schizophrenia. Some treatment is available to homeless people, but again the vast majority are not willing to participate (the drugs have very unpleasant effects, so this is unfortunate but you can empathize with someone not wanting to experience those side effects).

If someone becomes an alcoholic, loses a job because of it, becomes alienated from their family and social support network, and ends up deciding, under the influence of that addiction, that they prefer to drink at the expense of everything else, even housing, what can social justice do to help them?

There are ways to improve the situation. Decriminalization of drugs, more research into how to treat people with mental health issues and addictions, more resources smartly applied to treatment.

TLDR; People don't become homeless because of poverty or a regressive tax code, they become and stay destitute because of mental illness and addiction. Finding ways to intervene is important, but the existence of homeless people does not imply social injustice. There may be social injustice in the US, but this is not a symptom of it or proof of it.

References:

http://www.psychosocial.com/policy/dualdx1.html

http://bjp.rcpsych.org/content/162/3/314.short

http://onlinelibrary.wiley.com/doi/10.1034/j.1600-0447.2001....

http://barrettfoundation.org/causes-of-homelessness/

Quoting from that last link:

> In addition, approximately half of people experiencing homelessness suffer from mental health issues. At a given point in time, 45 percent of homeless report indicators of mental health problems during the past year, and 57 percent report having had a mental health problem during their lifetime. About 25 percent of the homelessness population has serious mental illness, including such diagnoses as chronic depression, bipolar disorder, schizophrenia, schizoaffective disorders, and severe personality disorders.

> Substance use is also prevalent among homeless populations. In a 1996 survey, 46 percent of the homeless respondents had an alcohol use problem during the past year, and 62 percent had an alcohol use problem at some point in their lifetime. Thirty-eight percent had a problem with drug use during the past year, and 58 percent had a drug use problem during their lifetime.

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Not quite right. In fact, you may not realize it but you're basically saying, "let them eat cake".

By the numbers, the children of wealth who happen to be alcoholics or who have mental health problems, do not end up on the streets.

By the numbers, those that end up on the street are from lesser means. If they could afford a roof over their head they would have one.

If you were a rich man, and it was your child that couldn't hold a job, you would spend whatever it took to house him, to find him treatment, to make sure he's at least safe at night.

We're a rich nation, these are our people on the streets, not some "other" that somehow deserves a different set of standards.

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You can vastly improve the success rate if you make an effort to make homeless-reduction initiatives provide options that are not actually worse than being homeless. American homeless shelters are extremely unpleasant and not particularly safe; there is very little effort put into individualized assessment or following up; and there are very few resources oriented towards getting someone back on track in any kind of productive sense.

If a country takes harm-reduction more seriously, results improve. The anti-homeless program here in Copenhagen is much more successful than the one in San Francisco, in part because it assigns case workers to specific people, and gives them fairly wide authority to take action as needed, including things such as renting people small apartments, setting them up with counseling, or enrolling them in skills-training programs. This gets many people off the streets. Not everyone, but the success rate is much higher than in SF's case. Not coincidentally, Copenhagen is a lot nicer (and safer) to live in than San Francisco, so the results even benefit us well-off people.

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> renting people small apartments

This just in: renting homeless people small apartments (and paying rent for them) decreases homelessness.

Denmark's safety net is not all roses. A nice article about it: http://www.humanityinaction.org/knowledgebase/9-homelessness...

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Your link appears to argue that Denmark isn't 100% successful in eradicating homelessness, as evidenced by the continued existence of homeless people. That is certainly true, and I acknowledged as much in my comment. My claim is simply that Copenhagen's approach to homelessness is (much) better than San Francisco's approach to homelessness.

And yes, the solution is not particularly complex: if you want to get people off the streets, you need to make a credible effort to get them off the streets. Apartments are a good step, partly because they do literally get people off the streets, and partly because they vastly increase the odds of the person getting into some kind of routine: they have an address, regular access to a shower, a place to store possessions with less risk of them being stolen, etc. I'm not arguing it's any kind of magic.

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> if you want to get people off the streets, you need to make a credible effort to get them off the streets.

I think the goal should be to get people living healthy, satisfying lives, not a simple 'get them off the street'.

Some homeless in SF choose to be homeless, and they're explicit about that fact (there was an article about the kids in the park here on HN a few weeks back, I can't find it). The goal of getting homeless off the streets does nothing for that population.

So if the goal is to increase the happiness of the well-off folks in a city, then by all means, get people off the streets by renting them apartments. But if the goal is to help the homeless find meaning in their lives by participating in society, that's a whole different ballgame that nobody has solved yet.

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Homelessness could be divided in to two groups -- one of necessity and one of autonomy. Separating these reasons seems to be an important start.

In general, we see the US as a place even the bottom tier of society can get by without dieing outright in the streets. We produce so much consumable garbage even the non-homeless go dumpster diving (freegans.) Cities such as Detroit are bulldozing thousands of homes that fell apart because they were simply abandoned. In this sense, the US has excess capacity.

The second issue becomes one of autonomy. Do we force the homeless out of public parks? As pointed out above a lot of homeless people have mental illness issues (arguably all long term homeless do.) Deinstitutionalization means we just don't lock people away in insane asylums anymore.

One thing I've learned from running a business is that its ok for things to be broken some of the time. What we need to be aware of is the little broken things that turn in to big broken things.

Homelessness could grow out of control. The monetary and economic growth policies governments pursue can force people out of their homes (legal and extra-legal private property) and in to urban slums. My concern is what happens when "normal" people can no longer afford the cost of living in a wide geographic region.

I am a big advocate of deflation, being driving prices lower rather than up. We recognize and expect this in technology. Indeed, that is the very basis of our growth. On the contrary, pretty much the entirety of government policies globally the past 50 years has been optimized solely around growth in annual GDP records.

These policies can create big problems as wealth from the working class is re-allocated to the business class through lower interest rates, property forfeiture for development, low bank lending standards, and outright subsidies. Ultimately they have to re-balance but the process is not pretty or enjoyable.

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> In this sense, the US has excess capacity.

I saw a recent claim that there are 22 empty houses for every homeless person, though the citation was one like "National homeless association" and not incredibly specific.

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Even if true, those houses don't move around, get people to grocery stores or jobs, and don't sit on arable land

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Your paragraph about deflation and GDP muddles a few different issues and distracts from your main point. Even if prices drop due to productivity, there is still good reason for monetary inflation, and population growth should drive total GDP growth, or everyone is poorer. But this is really off topic.

I think what you mean is that cost of living should drop each year, and that is a good idea.

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Some homeless subcultures do choose homelessness (in Denmark, also). If it were just them, the problem would be small. I'd like to do something about the rest, though.

I agree helping homeless find meaning in their lives is different from helping well-off folks. I don't suggest that anyone should be forced into apartments against their will. But I'd make the option available. I would be surprised if SF's homeless are, on the whole, actually happier and more fulfilled than Copenhagen's ex-homeless. So I suspect making the option available to them would benefit them in addition to the rest of us, certainly relative to the status quo, which is bad for everyone.

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http://blog.priceonomics.com/post/43085729257/the-street-kid...

Which is about the community aspects of current day youth homeless in Haight-Ashbury district of SF. This sort of homelessness is different than the Tenderloin [1].

[1] http://en.wikipedia.org/wiki/Tenderloin,_San_Francisco

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The fact that many of San Francisco's homeless are suffering from mental illness in some way doesn't ameliorate the damage caused by the growing divide between the haves and the have-nots in the region. While it's fine to address the causes of persistent homelessness, and to look for solutions to it, it's a completely different phenomenon compared to intermittent or temporary homeless the average middle-class family works to avoid.

The video mentioned that many middle-class families are one paycheck away from financial ruin. That is, rent and expenses in the city are so high in relation to wages, that missing a single paycheck or being out of work for just one week will result in a family losing their apartment and possibly being homeless.

As an outcome of the disparity between incomes and housing costs, low-income families are living 2- and 4- families to an apartment. 40x rent for a 3-bedroom (family) apartment in SF is $120,000 a year - a wage that is more than double the median household income in the US.

This is the more pressing of the problems the video addressed, and I think we would benefit more from discussing solutions for this than we would from wringing our hands about the myriad causes of persistent homelessness.

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If you can't afford to live in San Francisco, generally the advice I would offer would be: Move away from San Francisco.

Is it harsh? Not really. People move all the time for economic reasons, there is no basic human right to live in a neighborhood you can't afford, even if you are used to living there.

San Francisco is going to be expensive when the economy is up. It's very geographically constrained, and earthquakes drastically limit the kinds and density of housing you can build. We can pretend that there is some silver bullet, but any program that artificially subsidizes or restricts the cost of housing just displaces someone else who would live there and be able to afford it better. It produces a drastically inefficient and expensive mess.

I guess what I'm saying is, it's far better to help people adapt by finding a place they can afford and where their family can thrive without assistance.

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This is a nice hypothesis but fails to account for the reality on the ground - foremost being transportation.

So you are displaced out of SF - great, where to? You still need to be able to get to work in the city - after all, it'd be pointless to move somewhere cheaper just to end up out of work.

So, let's head south. Oops, due to the overflow of demand in SF, as well as the sheer number of tech workers looking to straddle the peninsula and the city, prices down there are only slightly less insane than in the city proper.

Okay, let's head north - well, nope, Marin is not exactly poor man's territory.

West is water. Humans float, but not that well.

Let's head east - Oakland is rapidly being gentrified and colonized by tech workers also. On a relatively low income you can probably still scrape by - but not for long, in a year or two you'll be priced out yet again.

Further out? How do you get to work? The toll on the Bay Bridge is ridiculous, and it's not like you can afford parking in the city so you can work anyways. Your only options are along the BART, but park and rides are few and far between, and properties within non-driving distance of BART are all rising rapidly in price. Not to mention, BART fares are distance-based (rather than flat on, say, MUNI) so the further away you move the more expensive your commute gets! For a tech person making six figures a year the price difference isn't even noticeable - but for someone scraping by?

This whole problem has played out this way because San Francisco (or really, the Bay Area in general) is the most frustratingly myopic place I've ever lived when it comes to transportation. Unlike cities like Chicago or New York (or even Seattle, which is primarily bus-based), the transportation network is in such poor shape that it actively penalizes the poor. The well-heeled, like ourselves, can afford cabs and Ubers to bridge the gaps where the transportation grid fails. The poor cannot.

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You're not wrong, but you're overlooking a bunch of things. Suppose you grew up in San Francisco - does that count for anything at all, or should you be subject to the same economic headwinds as people who just arrived? What about the costs of relocation and re-establishment elsewhere? As someone who has moved several times in search of opportunity (which is how I came to SF, in fact), you need a minimum of about $2,000 to move and get through the first month or two, and that's assuming you have no dependents and are reasonably street-savvy. Indeed, I'm underestimating that slightly because I've always moved to places with fairly high levels of density and moderately good public transport. If you move to somewhere that you need a car just to get around, then those costs are a lot higher, not to mention the opportunity costs of the time you now have to spend driving. If you move somewhere where you have no connections you're at an economic disadvantage fora while until you can build your personal network, especially if you don't have an obvious marketable skill.

At bottom, the problem is that the people who are in the most tenuous economic position are the least likely to have the skills and resources needed to just up and move somewhere else. It's true that subsidies do display other people who would like to move to SF and could afford it better, but they don't have any right to move there either. In general I'm strongly in favor of efficiency, but I think you're over-discounting the economic value of cohesive communities and internal economic diversity. Also, you're overlooking another alternative, which is to loosen constraints on development and allow the city to build upward more. Earthquakes are not that big of a limiting factor, considering that large parts of SF consist of two-story housing...a great deal of which is seismically unsafe compared to more modern apartment buildings of 3-6 floors.

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This is a common refrain but rings a bit hollow without particular advice. Where specifically should people go?

As a couple talking points, in western North Dakota there are jobs but there is no place to live. Oil field workers live in their cars in the Walmart parking lot in the dead of winter. In Atlanta, there are inexpensive houses but there are no jobs. Most of America is somewhere in between - not a lot of work to be had and not inexpensive, either.

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How are you supposed to afford a move when you can barely pay your bills?

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I think you can look at any immigrant community and see the answer to this question, almost all first generation immigrants managed to move when they had almost no money, so you have tens of millions of people you can ask right now.

I think your opinion here is too paternalistic and fatalistic. People can and do adapt when the incentives become strong enough.

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I'm an immigrant and moved to the Bay Area in the 90s with no network, and no desire to plug into my ethnic (Irish) network for political reasons (when I moved here first the Irish community was tilted heavily towards support of of the IRA and its associated political arm). My in-laws moved here from North Vietnam via Hong Kong in the 70s, and were also somewhat socially isolated by choice (most Vietnamese people in the Bay Area are from South Vietnam and as you can imagine this would make for some political friction).

It's certainly possible, but it also helps to be young and healthy; not to have any particular life obligations; to be a bit alienated from your native environment in the first place; and to have a somewhat unrealistic view of your own capabilities :) It also helps if you're moving from lesser to greater opportunities. If you're moving from SF (for example) to somewhere much cheaper, you're likely also facing a narrowing of your available economic, academic and other options.

So although I share your views to a certain extent, I think you're also taking a rather rosy view of things. It is certainly possible to move and adapt, but there are significant costs involved and it's not equally easy to move in any direction.

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> People can and do adapt when the incentives become strong enough.

Is the argument that SF's homeless have it too good, and if we made their condition worse (i.e., increased the "incentives"), that would solve the problem? Which incentives exactly do you have in mind? They are already subject to shockingly high levels of violence, which the police appear incapable of protecting them from. Do the levels of violence need to be even higher?

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Those communities also had beachheads to move to: neighbors and family to support them while they moved. It's not really comparable. Also, during that time, we _really_ needed manual laborors here, so you had a known target (the States) with a support network in-place and an clear path to a job.

None of these things are true for low-income people today.

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>>Those communities also had beachheads to move to: neighbors and family to support them while they moved.

It also helps that they are willing to take almost any job and work their asses off. It will keep you from being homeless.

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They also didn't have crippling mental illness to deal with.

> It will keep you from being homeless.

It does help, but it will not always keep you from homelessness. There simply aren't enough jobs.

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Are you saying mental illness makes someone broken, like a cripple? Foucault! Come quick!

Seriously though, 'there aren't enough jobs' is just a weird thing to say. Aren't enough jobs for what? For everyone to not be homeless?

Let me paint you a picture. You are homeless. At night, when it rains, you get wet. After a day of panhandling, you have $30.

Do you:

1. Buy a meal (loaf of bread and coffee, $4) and save as much as possible for bus fare.

2. Buy a tent, so at least you can stay dry and avoid illness.

3. Buy 2 fifths of rotgut vodka and drink it on the sidewalk.

The problem has absolutely nothing to do with jobs. If you had 5 open jobs for every person in the country, the same people would still be homeless.

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> Are you saying mental illness makes someone broken, like a cripple? Foucault! Come quick!

Yes, I am saying that the way that we treat people who have mental health issues discourages them even further.

> Aren't enough jobs for what?

I have friends from college who had to move back in with their parents because they literally could not find a job. They applied everywhere, even McDonalds. No work.

> If you had 5 open jobs for every person in the country, the same people would still be homeless.

No, they wouldn't. _Some_ people would be, there's always the travel punk kids. But even your hypothetical is giving me a decision between rational choices. You left off the 'the voices from your paranoid schizophrenia are so loud that all you can do is lie there in a ball' option.

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>>I have friends from college who had to move back in with their parents because they literally could not find a job. They applied everywhere, even McDonalds. No work.

I have another anecdote to counter your anecdote. I have a friend just arrived a couple of weeks ago. In the first week she was able to find two jobs. One in a hotel in the buffet area and another in a clothing factory.

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> 40x rent for a 3-bedroom (family) apartment in SF is $120,000 a year

I know plenty of families (with kids) who live in 1-bedroom apartments (in Poland). 3-bedroom apartment are considered lavish.

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I don't know about SF, but many localities limit the ratio of occupants/bedrooms. A family of four might not (legally) be able to rent a 1-bedroom apartment even if they were willing to live in one.

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You skipped a level. 2 people per room is standard housing limits in most places. A poor family should only need 2 bedrooms and a vasectomy.

There's the really problem: 2 underemployed adults producing 3 or 5 underemployed-to-be children, while resourcr-ful adults shower their resources on 1 or 2 children.

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$10,000/m for a 3 bedroom? You can get a 3 bedroom in the city for much less than that. It might not be the most desirable neighborhood or the biggest apt but let's be realistic. If you don't have a lot of money you're not going to spend $10k on an apt.

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>>People don't become homeless because of poverty or a regressive tax code, they become and stay destitute because of mental illness and addiction.

These must be the kinds of rationalizations that allow the upper class to sleep at night.

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Are the facts wrong or the conclusion?

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That makes no sense, because homelessness is just one part of poverty. If the upper class don't care about folks making minimum wage and getting killed in gang warfare or Iraq, they wouldn't care if some were homeless.

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It must be nice to know all the answers without having to know any of the facts.

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Facts like:

* unemployment is 53%?

http://www.businessweek.com/articles/2013-04-05/who-works-an...

* There is no shared vocabulary to describe "homelessness"

"Because research studies GAO reviewed often used different definitions of homelessness, relied on data collected at a point-in-time, and focused narrowly on unique populations over limited geographical areas, the studies cannot be compared or compiled to further an understanding of which factors are associated with experiencing homelessness." http://www.gao.gov/assets/310/306203.html

* The Reagan administration closed mental institutions, gamed the system, and homelessness became the new normal for the mentally ill:

"Combined with a sharp rise in homelessness during the 1980s, Ronald Reagan pursued a policy toward the treatment of mental illness that satisfied special interest groups and the demands of the business community, but failed to address the issue: the treatment of mental illness "

http://sociology.org/content/vol003.004/thomas_d.html

"June 1986 The Supreme Court upholds a finding that Social Security officials had a 'fixed clandestine policy' to deny disability benefits to people with mental illness. "

http://www.nytimes.com/1988/11/16/us/social-security-program...

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"The new emphasis was on "supply side" economics, which essentially "blamed the nation's ills on 'big government' and called for lower taxes, reduced federal spending (military exempted), fewer government regulations, and more private sector initiatives" (Abramovitz, 1992, 101). Thus, to effect a change in the political economy, Reagan was able to win major concessions regarding social policy that continue today. By taking away the safety net, the working class was effectively neutralized: workers no longer had the freedom to strike against their employers or depend upon the social welfare system as a means of living until finding employment. Business was thus free to lower wages, benefits, and the length of contracts. The overall result was that the average income for the average American dropped even as the average number of hours at work increased (Barlett and Steele, 1996; Schor, 1992)." -- Electronic Journal of Sociology (1998) ISSN: 1198 3655

How much have a worker's real wages dropped? Minimum wage should be around $20 an hour, $10 for context of this clip: http://www.youtube.com/watch?feature=player_embedded&v=D...

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Unemployment isn't at 53%. The link you posted puts unemployment at between 5-8 percent depending on how you interpret the data.

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Is it relevant that America's incarcerated population (mostly working age) is not included in that %? (I mean the shadow economy is statistically significant here)

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Incarcerated aren't homeless.

And stats about US's horrible mental.health care undermine your claim that mental illness doesn't drive homelessness.

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> A large majority of people that are persistently 'homeless' in the US, by which I mean completely destitute and sleeping outside, have serious mental disease AND/OR are alcoholics, AND/OR are addicts.

Also, 16% of homeless are vetrans: http://www.foxnews.com/politics/2011/04/01/report-finds-vete...

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No doubt severely overlapping. I wonder how militsry-induced mental illness compares to naturally occurring.

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"People don't become homeless because of poverty...they become and stay destitute because of mental illness and addiction."

If you're right the 20 percent increase in homelessness over the last two years (according to the article) should correspond to a similar increase in mental illness and addiction. I highly doubt the data would support that.

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Yes - these are the reasons why somebody becomes homeless. However, these are not valid excuses for us not to help them.

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Your points are good, but

> No amount of social justice can cure someone's schizophrenia.

I think one of the issues here is that mental illness carries so much stigma. It's hard to even get help at times due to this, and social change about the way we discuss and treat mental illness would be incredibly helpful.

I posted a link to a new startup here a few hours ago specifically designed to help people diagnosed with schizophrenia deal with their symptoms, and it got no upvotes. (for anyone interested, it's https://copingtutor.com/ Not mine, but a friend's)

We ourselves have a member of the community who's living with schizophrenia, and they're shadowbanned due to their illness. It's probably for the best, but it's a really shitty way of dealing with it.

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> I think one of the issues here is that mental illness carries so much stigma. It's hard to even get help at times due to this

I'm going to come off like an arrogant ass, and perhaps I am, but... source?

It's been my experience -- a whitebread, middle-class American in liberal California experience, granted -- that seeking treatment for mental health issues is met with waves of support and encouragement. Therapy and Prozac are ubiquitous in our pop culture.

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This should be common knowledge, but then again there are folks who believe we're a color blind society, so I'll assume it's just a simple lack of awareness on your part.

If you google "psychiatric stigma" you'll get plenty of peer reviewed research on the topic dating back at least 50 years. Prior to that stigma was less of a concern because we simply locked these people up, outside of our collective view and societal awareness. Better than being burned at the stake I suppose (we also used to do that).

Here's a good place to start: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489832/

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I don't have any sources, but I suspect you are correct only up to the certain point. People are largely ok with mental illness which doesn't impose on them. Depression, yes, Schizophrenia, no.

My impression is that if the condition involves quiet angst, everyone will sympathize -- but if it's about real heavy duty craziness, no one wants to hear about it (or look at it or think about it, etc.).

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People aren't okay with depression. They don't care about depression because it doesn't affect them directly, but it still carries a stigma.

Try having a casual office conversation about how you were sick last week. Compare the tenor of the conversation when the sickness is 'the flu' versus 'depressive episode'.

Every mental illness is stigmatised, it's just that some are more stigmatised than others because they're 'louder'. Part of this is due to mental illness being really hard to understand if you've never been exposed to it (as a sufferer or a loved one of a sufferer).

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The other part is that whereas the flu knocks you out, mental illness can make you harder to predict, which is potentially more dangerous. Some of that stigma is probably built in by evolution.

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Particularly bad depressive episodes are similar to the flu/mono/etc.: you are incapacitated, feel like shit, and can't get anything done. Yes, they can flare up without warning: so can the flu. Yes, they can last a long time (DSM diagnosis requires more than 2 weeks): so can something like mono or cancer, which get sympathy, not fear.

Stigma is almost entirely a cultural thing: I know of someone who's first manifestation of mania (bipolar disorder, type 1) was in a religious setting... so when she said she heard God talking to her, they were reportedly thrilled. It didn't come out that it was a problem until she was on the plane home and was blessing the passengers (edit: details slightly obscured/changed).

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The huge eye opener for me was when I read that if someone has a habit of crying during stressful work disagreements, and you give them a hard time about it, you are being abusive toward someone's mental challenges, not being a tough businessman.

That really got me thinking about how deeply "aggresive confrontational competition" infects our intuition about the world, even in supposedly collaborative environments.

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My anecdata on this is that level of stigma varies a lot based on the mental illness involved. Some mental illnesses (e.g. schizophrenia, bipolar disorder, borderline personality disorder) appear to be labeled very harshly by our culture and have a huge amount of stigma attached to them.

I'll see if I can dig up any journal articles or research on this.

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There is some limited info from the CDC below.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5920a3.htm

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So.

I will spare you the Foucault/etc discussion about how 'mental illness' is even defined in the first place, and just assume the mainstream narrative on this. But that's one avenue for this discussion.

Let's talk about that. I know someone who was diagnosed with a mental illness. They got medical care for their condition, but due to the way we discuss mental illness, it harmed more than it hurt. They gave me an account of how, once they started working with a different doctor, the change in language was revelatory towards resolving their symptoms. The first doctor (and the most 'normal' one) used language such as "You are a schizophrenic." This defines the person by the disease, and begins from a place where they are already limited. It's as though it's a life sentence, and they're just making time until they die. Even the small shift to "You are living with schizophrenia" did wonders for their condition: instead of being limited by the disease, they were just another person, working to limit a negative aspect of their life. The relationship was turned upside down.

(to be clear, I am obscuring details to protect their identity.)

Secondly, you are absolutely right that therapy and Prozac are ubiquitous. But the _representation_ of them is the issue. Therapy is for someone who's _crazy_. Someone who can't deal with life. Someone who's deviant. Nobody wants to admit that they are mentally ill. The image of someone who pops Prozac and goes to therapy is not a positive image; it's a profoundly negative one. Rather than celebrate taking steps to overcome a disease, they're just another drug-addicted loser who 'needs help.' The Protestant ideal is still quite alive in our culture.

I'll also leave the issue about if drugs are even the best way to treat every instance of mental illness, and if doctors are too quick to write a 'script.

Anyway, that's the TL;DR from my current understanding around this issue, both from study and discussion with people close to the issue.

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I generally find that rephrasing "you are" to "you have" is powerful. "You've said something racist" vs. "You're a racist"; "This paper is written badly" vs. "The authors write badly"; "You have an addiction" vs. "You are an addict". etc.

Separating the action from the actor seems to make us a lot more willing to quit/change our questionable actions.

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My experience is that this is true as well. It's hard not to equate the two in practice, given that it feels like shorthand.

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See also the Fundamental Attribution Error.

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> But the _representation_ of them is the issue. Therapy is for someone who's _crazy_.

I guess my own upbringing (which is irrelevant from a cultural perspective, I suppose) colored me differently on this. I see therapy as being on the same level as going to your family doctor -- when something is malfunctioning, go take care of it.

And honestly, I don't see a lot of characterizations of therapy as "for the crazies", except from people who say we need to fight it. That could just be because of the way my sensors are tuned, I guess.

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That sounds like a very healthy attitude, I'm glad you've managed to escape from the broader societal one. :)

Try this: pay attention to the things you say, and make a note every time you say one of these things:

- That's nuts!

- That's so crazy.

- That's retarded.

- She's hysterical! (double whammy: sexist and abelist!)

- Wacky!

- Wow, that schedule is insane.

- That code is idiotic.

- You're an imbecile.

- You're a lunatic.

- This place is a madhouse!

- He's a psycho.

- What a spaz.

It might be my age or my speech patterns, but I say these things a lot. Working on it. But all of these phrases being common and acceptable is part of this issue. (abelism, if you're curious. Some of these bleed into mental capacity as well as health, I figured I'd include them anyway.)

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Many people avoid physical health doctors for the same stigma.

Good on you. Spread the healthy attitude to all your friends.

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Oh, please tell us all about Foucault. Then explain what he could possibly know about the attitudes toward mental health in 2013 when he was writing about it in the early 70's (over 40 years ago).

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Yes, obviously any strain of thought that is < 5 years old couldn't possibly speak to our current position. </sarcasm>

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Yeah, marijuana and marriage are legal in all 50 states because the anti-social attitudes of the 70s are ancient history.

Oh.

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Yea, and gay marriage is unthinkable and ... oh my god, I can cherry pick examples too!

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People with schizophrenia are still perceived as dangerous and unpredictable, and these perceptions have increased in recent years. JD Hancock

http://theconversation.com/either-mad-and-bad-or-jekyll-and-...

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I understand that a mental illness stigma can interfere with a middle class career. And that is bad.

But does someone with no job, assets, or home face a stigma that discourages him from getting care?

I suppose the foolish pride we all have is a factor-- not wanting to admit you are broken. But that isn't a social stigma , it is a personal stigma. But social, um, "anti-stigma" could perhaps help?

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Please see my other comments in this thread.

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I've read reports that suggest addiction becomes a trait in homeless people after the fact instead of homelessness being a result. It's unfair to paint everyone with the same brush.

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Then why does America have so much more homelessness than other developed countries? I'd bet it's because there's no universal health-care system to treat mental illness or addiction.

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Just a guess, but might part of it be because in other countries it's easier to die from it? Particularly the Nordic countries you're probably referring to, you can't sleep outside for as long as you can in California.

While we do have sub-par healthcare for it, I personally think part of it is that people still don't "get" that mental illness is an illness. Even my wife, who recently started treatment for depression, finds herself "explaining" to her family "why" she was depressed, instead of really understanding that what makes it an illness is that it lacks an explanation. You aren't expected to have a reason for your flu. But for some reason in this country you are expected to have a reason for your depression (or insomnia, or psychosis, or whatever).

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> Just a guess, but might part of it be because in other countries it's easier to die from it?

Exposure is a relatively small percentage of the CoD among homeless people in Scandinavia. Homeless people can get food and shelter here. Alcohol-abuse related illnesses are by far the major killer.

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One of my friends in Madison, WI said that there was some sort of 'days since a homeless person has frozen to death in Madison' site, though a preliminary search can't find it.

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I think you are right. A universal healthcare system would dramatically help here.

However, the lack of a universal healthcare system isn't social injustice either.

Even if something universally good, efficient, wise, and improves everyone's life, that doesn't imply that it's unjust to not have that thing. Decisions can be foolish without being unjust.

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To the extent that people are living poor lives because of issues completely beyond their control, such as bad luck in the genetic lottery, it seems like injustice to me that we don't do much about it. I would consider providing a level playing field that ameliorates differences in birth a minimal requirement of social justice.

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Have you visited the UK? There is universal health care, and there is rampant homelessness

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[deleted]

SF is incredibly bad even by US standards

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People intentionally move to SF (and Seattle) because homeless life therr is better than elsewhere: weather and social services.

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Uh, there's free lots of mental health care and medication for the utterly destitute but they're just not willing to participate?

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Kurt Cobain was homeless during a period of his life and was a drug addict and arguably also had mental issues; what I want to say is that is not "social justice" what many of them need but help finding passions that can provide at least for their basics needs (of course also some level of help with their addictions and mental issues)

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Clearly this nation can support a few hundred thousand chart-topping rock stars as a solution to homelessness.

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There must be a name for the logical fallacy of taking analogies way too literally.

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What I want to know is why can't rent be cheaper in the Bay Area for simple apartments? There's plenty of vertical space to build more housing. But instead everything is small one or two story homes that cost a million bucks at minimum.

Part of Silicon Valley's original magic was that it was just farmland and affordable to live there. Now it's a terribly expensive place to live. Imagine how conducive to startups it would be (on top of existing success) if people could actually afford to rent a place. Right now all $1000/mo gets you is a BUNK BED! https://www.airbnb.com/rooms/134016 In other places in the US $1000/mo would get you a newly constructed apartment with all amenities and granite counter-tops.

This could be the ultimate startup: just build housing and correct the supply/demand balance!

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Because nobody can build such apartments due to a unique confluence of all the space already taken, NIMBY zoning codes and the expense of earthquake proof taller buildings.

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In that case maybe VCs should stop investing in the next Facebook and instead look at earthquake-proof building technology. Clearly there's a market for it.

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I absolutely love this logic. If VCs would just invest in it, then they would magically appear! Maybe VCs should stop investing in the next facebook and instead look at cancer curing technology. With the high insurance premiums there's clearly a market for it. And since VCs are the only people with money its obvious that no one else is funding/researching cancer medicine!

I really hate this thinking, do you really believe that earthquakes is such a trivial issue that no one is working on it? What the hell do you think the architects/structural engineers are doing at MIT/Berkeley/every university on the planet? They aren't trying to build Instagram for Skyscrapers, I'll tell you that much.

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Earthquake proofing technology exists, it just makes building more expensive. I probably shouldn't have mentioned it. It seemed too vague to just say "it's a pain in the ass and too expensive," even though that is what new construction in the Bay Area boils down to.

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Excellent point. I suppose I'm just frustrated that the current entrepreneurial hype seems to be overweighted towards time-wasting tools vs. stuff that could really advance society.

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When a housing spike appears then land becomes expensive, and as land becomes expensive and demand increases prices rise. That's a function of a capitalist focused economy.

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Local regulations often have a very significant effect on housing prices and building. See: New York Rent Controls

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Are some people being over compensated?

"the average American CEO now earns 319 times as much as the average American worker"

http://abcnews.go.com/Business/walmart-ceo-pay-hour-workers-...

Japanese Business leaders are making way less then American CEOs around 16 times as much as an average worker.

http://thinkprogress.org/politics/2010/07/08/106536/japanese...

If the average worker makes, say, 30K. I can see someone making 10x, maybe 50x that. But really 300x ??

Making decisions at the top is no doubt difficult and requires experience and expertise etc. But can you really say a CEOs time is worth 300x?

Like everything else, the pay at the top affects the pay scale at the entire management tier.

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That's completely bogus.

The average CEO is running a business that won't exist in ten years, and doesn't earn more than six figures.

You're talking about an extreme minority business group, a few hundred individuals are used to skew that stat to the moon. It'd be like comparing Single A baseball players to the top 100 paid players in the MLB; or NBA vs the development league. And even that doesn't get you close to the real exaggeration in the CEO stat.

There are over 20 million businesses in the US, none of which are Fortune 500 companies that always are used to abuse that CEO stat.

The average CEO is not earning $15 million per year (median income is $50k+, mean is over $55k (was $60k in 2004)). Indeed, how can the average CEO earn that much, when only a few dozen in the entire country earn that much?

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I'm not sure that actually makes it any better. This further re-enforces the idea that a huge amount of wealth is horded by a small number of people. This means that there are a small number of CEOs earning well in excess of 300x salary. Of course there are also going to be many small business "CEOs" making less than many salaries.

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Yeah. It seems more useful to talk about "median CEO salary" rather than average.

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No, the average and the count are multiplied together to determine he taxable base. The median is irrelevant and is used as a human shield by the 1%.

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There are places you can buy a $100 hamburger. Is it worth it? I doubt it. But it's not my money, so I don't lose sleep if someone else buys one.

If you own stock in such a company, consider selling.

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Making decisions at the top is no doubt difficult and requires experience and expertise etc. But can you really say a CEOs time is worth 300x?

My theory; It isn't about difficulty or experience. It is about impact. Apple's revenue last year was $36B, and net was $8B. A CEO who increases their revenues by just 5% would thus immediately justify his or her salary, up to $400M, as he or she increased profits by $400M.

Bottom-rung employees don't have that kind of scope of impact.

Of course, this isn't always what happens- not every CEO can boost revenues, let alone stop them from falling- but it is why you see such high salaries, why they are even on the table.

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My theory: it's about risk.

The CEO of Apple or Google has an inordinate effect on the net worth of a number of wealthy individuals. It is impossible to predict whether that effect will be positive or negative, yet people have a strong incentive to ensure it will be positive.

Thus, a number of people who would do perfectly fine at running these companies are disqualified immediately, simply because they've never had experience at running a large company before. Nobody will take a chance at a random unknown when billions of dollars are on the line. And this artificially restricts the supply of CEO candidates, while the amount of money available to pay them remains high, artificially driving up wages.

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All too often pay is not tied to performance. Few people begrudge a CEO who takes all pay in the increases of his/her stock, but nearly everyone sees a problem with golden parachutes.

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Of course, I'm not saying it is an effective system. Just trying to theorize why it is so. We like to think people are exploiting the system at-will, but don't forget about Hanlon's Razor.

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It is well documented that big CEOs and Boards are a back-scratching class that siphon money from public companies with ownership too diffuse to control management.

How much did the last 5 CEOs of Yahoo take home? HP?

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Japanese culture has a much smaller 'power distance' than US culture, we pay our CEOs so much because our individualistic culture rewards the superstar unlike almost any other nation in the world. You can debate over whether this is good or bad (it's probably bad when taken to this extreme), but it is an essential part of The American Dream.

See http://en.wikipedia.org/wiki/Hofstede%27s_cultural_dimension...

for more info on Power Distance and other variables that can broadly define a society.

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The American Dream is owning a house, not a small island nation.

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The divide in wealth is surely something that will continue in America. I think in less than 15 years, big cities will have at least Hong Kong's wealth disparity. Put simply, I just can't think of the middle class jobs of the future. Even the labor laws in Italy are becoming more lenient in face of a down economy.

I think that companies like Exec, Lyft and TaskRabbit provide a window into what lower class jobs are in the future.

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I think this is the most important question in politics right now. Politicians seem to think that our current woes can be fixed by tweaking tax codes and interest rates and hoping that the private sector will pick up the slack eventually.

However I don't think that this is a foregone conclusion. With such high unemployment I would have expected services to have gotten worse due to business being understaffed. In fact the opposite seems to have happened, I can access services and products much more easily and conveniently than ever before. Apart from essentials like energy and housing which have become proprietorially more expensive.

I'm not even sure programmers are safe, salaries at SV startups may be high now but I wonder how much of that is because of companies desperately making a landgrab for digital space.

For developers not wanting to play the high stakes game and simply wanting a middle class income from writing enterprise java code it's going to become increasingly hard to compete with growing numbers of skilled developers in countries with lower costs of living.

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> it's going to become increasingly hard to compete with growing numbers of skilled developers in countries with lower costs of living.

This argument has been made for a very long time, and I don't think it's any closer to being true today.

Overcoming the 1) time differential, 2) language barriers, and 3) culture differences of working overseas takes a very special kind of person. They absolutely do exist, and in my experience they tend to simply move to the US where they can command hefty salaries.

Just my opinion, but I think skilled developers in countries with lower costs of living might be propping up the salaries of stateside devs. The higher you pay stateside devs, the more money you're "saving" in comparison by hiring a team somewhere else.

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Yes and no, I can see this gap tightening as foreign teams learn better english to gain competitive advantage. Also translation software is improving and I see more contract jobs where the client is from china or some other country.

Time differential can be easily overcome if developers simply move their sleep schedule around. I've developed software for people in different timezones and it's not a problem if the software is clearly specified. Since I can just send an progress report email and wait for them to pick it up.

I agree that the best developers will probably seek to emigrate but at some point immigration will be tightened up and more talented devs will stay in their home country.

And out sourcing is just one piece of the pie. With more people being encouraged to learn to code (which I think is great) programming jobs will face more competition.

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That's really handwavy. When we get Star Trek level translation, or perfect specs, or devs decide to sleep all day and work all night (because who needs a family?).

Every very-large business I know of has offices and teams in other countries, and it works best when they're "just" another office. Branch in SF, branch in NYC, branch in London, branch in Chennai, branch in...

When you turn to other countries to grow your business, you can win; when you turn to other countries to replace the workers you built your company with you usually lose. IMO, YMMV, etc.

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Well translation software is getting better, and plenty of people in the first world with families work weird shifts.

The point is that this stuff (global working) is going to get easier , not harder in the future as is eliminating the needs for some jobs entirely.

What we need is a new industry that requires a lot of workers and can pay a middle class salary. Otherwise we risk having a global proletariat fighting over an increasingly shrinking slice of pie.

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> I agree that the best developers will probably seek to emigrate

I think the truly best developers will stay in their countries while earning States-level wages via telecommuting. Why pay $1500/mo in rent when you can pay $300?

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Why would unemployment understaff business? Unemployment means all the jobs are taken.

Either there is enough wealth in total, and taxes can fix the problem , or there is not enough wealth, and everyone is doomed.

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> I just can't think of the middle class jobs of the future.

If by "middle-class jobs" you mean a job that pays 1) enough to keep you off the government dole and 2) not enough to pay for a new mercedes, I can think of a lot of them:

-Knowledge worker (programmer, project manager, analyst, etc)

-Some retail, e.g., middle-management of most large retail stores.

-Energy worker, as population grows demand for energy increases

-Housing work & maintenance (plumbers, electricians - the work is blue collar but those guys make great wages)

-Healthcare worker, again as population grows demand increases. Nurses make great money.

edit: wow, almost forgot these:

-Law enforcement/park ranger

-Government worker

-Fire, paramedic

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"Even the labor laws in Italy are becoming more lenient in face of a down economy": Would you care to explain how this is related? Just curious, as an Italian.

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Employment law in Italy (as you probably know) makes it really difficult to lay off workers. Recently, a new law passed allowing companies to let go of up to 4 people per quarter (I'm a bit fuzzy). I think there will be increased relaxness in labor law in Europe in general.

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What I'm curious about is how the relaxing of Italian labor laws (technicalities aside) is a proof of the demise of the middle class. By the way, the reasoning behind that change is that it should bring more middle-class jobs, not less.

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If I was homeless through choice or bad luck I would also pick San Francisco due to the climate, the existing homeless community and the state of California being liberal and more generous with support programmes. In other words despite its success SF will only gain homeless.

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California tends to criminalize homelessness more than other states, due to this exact mindset.

I'd head for the mountains.

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Yes, and the people who own the "mountains" and cabins will love having you around, and they are even better armed than most city-dwellers. And don't think the National Forest Service will take kindly to squatters either. In our modern-day society, "dropping out" is not an option.

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> And don't think the National Forest Service will take kindly to squatters either.

Actually, for the most part, they really don't care. Particularly so if you do not build any permanent structures or have a permanent camp. They cite people from time to time, but that is the extent of it the vast majority of the time.

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I take it you haven't seen "First Blood"?

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And yet look at the homeless population of Santa Cruz. Something like 1 in every 20 residents are homeless, last I checked.

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I found that number hard to believe, but then looked it up. The estimate is 2700 homeless in Santa Cruz out of a population of 60,000. In comparison, SF has estimated about 7000 homeless in a city of 800,000.

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Oh, I guess it's down, so my ratio is a bit off. Used to be above 3000. The ratio was 1 out of 17 in 2005, looks like now it is 1 out of 22.

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While it may be down, by 1 out of N, problems related to drug use, dealing, and the petty theft that comes with it has exacerbated issues around homelessness here in Santa Cruz. It is a complicated issue, but those seeking help are often overshadowed by the guys stripping bike parts to sell for scrap to get their next fix or very obvious drug dealing going on in and around the homeless services center.

A number of people in Santa Cruz are in a bit of an uproar due to an uptick in crimes; as well as needles littering parks, beaches, and other public spaces.

In the 20+ years I've been here, it certainly at a low point over that span of years.

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Yes, as far as impact I'm sure the change in ratio hasn't affected much. I was just attempting to be completely accurate.

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I'd go to San Diego. The weather is much nicer there.

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Tax codes and wealth differences didn't cause this problem.

Let's start with a little history. We once had mental institutions, but those became evil. The solution was really to take those people in institutions and move them to residential programs. Well, it seems many residents don't what mentally ill people in their neighborhood. So, along came in-home and out patient programs. None of which actually worked as well as a well run institution.

Both political parties did their own damage to get us here.

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Having had to sleep in my car when I lived in the Bay Area in the 2005/6 timeframe - this is spot on. Even though I was making 18.50 an hour (when minimum wage was either 6.75 or 7.25 an hour) I was unable to find an apartment that I could afford to rent, or could meet the deposit requirements (First/Last/Damage). I eventually found a room to rent in Sunnyvale/Mountain View for something I could afford, in the mean time, I was couch surfing, and sleeping in my car when needed.

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Part of the problem is defunding of programs to help them.

It's not like homeless/mental-illness has a lobby before congress or even a local level and is not exactly a strong voting block, so it's an easy target to axe.

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Make a free accelerated web development course for these folks and in a matter of months they'll be no more a concern and you'd have done something right

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Oh for god's sake HN, learning to code is not the ultimate and perfect solution to every problem. It's not just a matter of providing training and jobs, you also have to treat the substance addictions and mental illness that run rampant in the homeless population.

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I think your sarcasmometer needs calibration; it's clearly not blinking lights when it should.

(I really didn't think of this, but when googling up, there actually seems to be an Android application called Sarcasm-O-Meter...)

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Poe's Law strikes again. It seems fairly reasonable to me that someone in this community could actually think/say something that profoundly dumb.

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Of course the part where you could almost believe it wasn't sarcastic...

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That's exactly it. When we had that article recently about how so many Americans are on unemployment, we had people saying, "Why don't they just learn to code?"

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can't say for sure, but it looks like the parent comment is just sarcastic, not serious

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The relative terseness is a clue, I think ;)

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This is a... very dry joke?

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This issue was one that I was very surprised with when I first came here myself... I lived all my life pretty much in NYC (Bronx and Manhattan) and at one point it was bad as well but around the time of Giuliani terms', the total visibility of the problem had dropped... but like said from SJ to SF, it is something to get used to...

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I hear you but I would suggest that we should not "get used to" homelessness around us. It should bother us enough to prompt us as individuals and a community to come up with solutions that address the problem.

For area companies, the problem can also be seen as an opportunity: CSR (corporate social responsibility) programs can be leveraged to make an difference by supporting the best organizations (shelters, recovery programs, and worker training programs) which I believe will more than pay for itself by gained goodwill through social innovation and impact.

A good starting point for thinking about approaches to social innovation programs on a higher level can be found in this Stanford Social Innovation Review article:

Rediscovering Social Innovation http://www.ssireview.org/articles/entry/rediscovering_social...

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Well made video that articulates an argument well, and has a positive call to action at the end. Very sensitive topic as well, wonder what potential solutions would or could be.

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this is coming up 404 now : even when you click the link to the article on the front page of the listed domain.

Anyone have a cache of the content?

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