Say-So

Malcolm Gladwell’s article Million Dollar Murray reverberates across the web in multitudes of blogs. Homelessness has been quantified, a new distribution curve has been found, a scientific approach may help solve a deep social problem with which modern cities have been struggling with for decades. Based on a research by Dennis Culhane Ph. D. , the power law as applied to homelessness suggests that roughly 10% of the dispossessed are chronically so, and they are the ones straining the resources of health care and social services. Those very few can cost the system hundred thousands of dollars a person per year. In medical terms here is a typical scenario as described by James Dunford, the city of San Diego’s emergency medical director:

“If it’s a medical admission, it’s likely to be the guys with the really complex pneumonia. They are drunk and they aspirate and get vomit in their lungs and develop a lung abscess, and they get hypothermia on top of that, because they’re out in the rain. They end up in the intensive-care unit with these very complicated medical infections. These are the guys who typically get hit by cars and buses and trucks. They often have a neurosurgical catastrophe as well. So they are very prone to just falling down and cracking their head and getting a subdural hematoma, which, if not drained, could kill them… . Meanwhile, they are going through alcoholic withdrawal and have devastating liver disease that only adds to their inability to fight infections.”

In a radical program to end homelessness advocated by the executive director of the U.S. Interagency Council on Homelessness Philip Mangano folks like these and the titular persona of the article - Murray Barr, are handed keys to their very own rented apartments. In exchange they are required to comply to the monitoring of case workers who are in touch with them every couple of days. They expectation is that as soon as the participants stabilize and find work they can start covering their rent in portions incremental to their overall progress.
As shocking as the description of those hard case homeless beneficiaries whose mental state allows for such profound disregard to their very own wellbeing is, the solution appears abysmally inappropriate. It isn’t a problem of the undeserving being treated to comfort, or the fact that this solution is meant to save the system 2/3 of presently incurred costs and sweep the homeless out of the view of the average american, it simply is a question of feasibility and common sense. Before the Murray Barrs are assigned their homes and are expected to rehabilitate they need to be placed under psychiatric care and possibly on lifelong medication which in turn would inflate the cost of their care, not decrease it. Malcolm Gladwell, muddies the homeless issue and the proposed solution with other power law conforming examples in his trademark sexy panoptic style. He invokes cases like the Rodney King beating and the subsequent Christopher Commission report and a mobile smog emission testing proposed by Donald Stedman, a chemist and automobile-emissions specialist at the University of Denver which is meant to replace the current comprehensive smog test. The only thing the three examples thrown into the article’s mix have in common is the pattern of their distribution, it should not be implied that a simple solution to decrease overhead on smog testing by targeting and policing the most serious offenders is also an applicable working model to end homelessness. In his book “The Tipping Point”, Mr. Gladwell produces an example of the Broken Windows theory which states that dilapidated environment invites crime, the solution to which among others is “quick replacement of broken windows “. It comes in a chapter about “the power of context” in which he also relates a Princeton University Good Samaritan study. The study concludes that even seminarians thinking of the biblical story of a good samaritan, under certain circumstances such as pressure of time, will act against their predisposition. This example is meant to prove that human behavior is malleable by the surrounding context. Drawing on this train of thought the author seems to suggest in the Million-Dollar Murray article, that simply giving homes to chronically homeless and placing them in an environment free of “broken windows” and signs of decay, will be enough to rehabilitate them. It is erroneous, ignoring the fact that it is the hard case homeless people themselves who are “broken”, in need of psychiatric care. Simply placing them in a new context will do very little to cure the self destructive streak which lands them in emergency rooms and intensive care time and time again.