Dej - Psychocentrism and Homelessness
Dej - Psychocentrism and Homelessness
Dej - Psychocentrism and Homelessness
Introduction
1
I use the term “distress” to recognize the difficult physical and emotional situations people find
themselves in while de-privileging medicalized discourses (Tew, 2005).
2
The observation that distress is pathologized and managed through techniques of social control
ISSN: 1911-4788
118 Erin Dej
2
The observation that distress is pathologized and managed through techniques of social control
emerged from the anti-psychiatry movement (Laing, 1960; Szasz, 1974) and the contemporary
mad movement (Burstow, LeFrançois & Diamond, 2014; Burstow & Weitz, 1988; Shamrat,
1997).
3
An abundance of research demonstrates the widespread use psychotropic medication in the
prison system, particularly among women prisoners (Kilty, 2012; Maidment, 2006). Although
there is scant literature on the number of homeless individuals with a prescription for
antipsychotic medication, the overlap between the homeless and prison populations (Fischer,
Shinn, Shrout & Tsemberis, 2008), the plethora of research on the subject of medication non-
compliance among the homeless (Bradford, Gaynes, Kim, Kaufman & Weinberger, 2005; Muir-
Cochrane, Fereday, Jureidini, Drummond & Darbyshire, 2006), and results from this research on
the number of homeless individuals using psychotropic medication suggest a high proportion of
psychotropic medication prescriptions in the homeless community.
4
The Housing First model is built on the premise that individuals should receive immediate
access to housing of their choice with supports without having to meet housing readiness
requirements (such as sobriety or medication compliance). Housing First recognizes that in order
for people to work through trauma, mental illness, and/or substance abuse, it is imperative that
they feel safe and secure in a stable home (Goering et al., 2014).
The will to empower may be well intentioned, but it is a strategy for constituting
and regulating the political subjectivities of the ‘empowered’. Whether inspired
by the market or by the promise of self-government and autonomy, the object of
empowerment is to act upon another’s interests and desires in order to conduct
their actions toward an appropriate end; thus ‘empowerment’ is itself a power
relationship and one deserving of careful scrutiny (Cruikshank, 1999, pp. 68-69).
A Note on Methodology
I triangulated among three main methods in order to capture the nuance and
contradictions in the practices and subjectivities represented in the homeless
Many of the mental health and addiction services offered in the homeless
community rely on a psychocentric perspective that targets individual deficit
as the source of, and solution to, homelessness.5 The call for marginalized
people to be accountable for their homeless status is counterintuitive given
that the same system promotes the pathologization of common problems
facing people experiencing homelessness (e.g., sadness, aggression, trouble
sleeping, lack of motivation). If mental illness, its symptoms, and potentially
deviant behaviour are destined through bodily make-up, then blame is
diverted and the pathologized character is guilt-free but hopeless (Bauman,
1988; Feldman, 2004). A poignant example was the sustained pressure in the
1990s and 2000s to find a “gay gene” that would supposedly reduce the
stigmatization of homosexuality, but instead created the conditions to further
pathologize sexuality (Hamer & Copeland, 1994).
Several focus group members equated distress with physical illness, as a
way to reduce stigma and legitimize a medicalized approach to the issues
facing those experiencing homelessness. A member of shelter management
noted that no one feels embarrassed seeking medical care for a broken arm,
and the same should be true when accessing mental health care. In contrast,
5
The challenges of using the homelessness industry to tackle social inequality are expertly
analyzed by Lyon-Callo (2000, 2004).
6
Briefly, Maté argues that a variety of biological and environmental factors influence mental
illness and addiction, but at its core they are a manifestation of an abnormality in the brain
caused by undeveloped or impeded dopamine receptors in the cerebral cortex, the part of the
brain responsible for rational decision making and emotional control. Maté uses this logic to
account for the symptoms of both attention deficit disorder (ADD) and addiction.
I was raped by, uh, by men, you know. It wasn’t in prison, this was when I was
younger and uh, several times. And I’ve a really hard time blaming my life and
my addiction on something that happened forty years ago, but everybody says,
that’s what people say, no it’s, that’s what you need help with, but to me that’s
too much of an excuse, that gets me off too easy... You know ’cause we all, you
know, I don’t think there’s anybody without problems. Some, you know… I think
it’s a factor but I don’t, I don’t think I can let myself off that way.
This discourse harkens back to the 19th century vagabond typology (Castel,
2003), which presented the homeless as manipulative and lazy. Upon further
probing, Seamus remarked that despite recently becoming homeless himself,
he maintains his opinion that homeless people are weak, and their position as
homeless is at least in part deserved because of a failure to take action to
solve their mental and emotional distress when it first appeared. Significantly,
however, Seamus did not identify as having a mental illness or addiction,
although he recognized his drinking as a factor in losing his wife, children,
and home, and that he lost several bartending jobs because he drank too much
while working. Seamus has trouble identifying himself as “lazy” and “weak,”
but acknowledges his increased social exclusion as coming from his poor
decisions. Regardless, he is adamant that citing any mitigating socio-political
and structural factors detracts from the autonomy of the individual to make
decisions, which to him amounts to excuse-making for poor decisions and
inappropriate behaviour. This rhetoric was echoed by many study participants
who characterized other homeless individuals as failing to live up to the
modern neoliberal project of the self that accepts personal responsibility and
factors such as social inequalities as counterproductive to the goal of self-
governance.
Well instead of complaining all day long, make steps to improve your life, you
know? All there is, is complain, complain, complain I hear. Just go and change
your life, do something about it. If you want to be here, or if you don’t want to be
here, just don’t complain about it.
For Milan, people who blame factors external to themselves are missing key
opportunities to work on the project of the self-reformation. Change is found
at the site of individual action, and homeless men and women must find ways
to “do something about” their personal deficits rather than “complain” about
structural inequality that seems insurmountable, especially for those
struggling to meet their basic daily needs. Milan attempts to be a “prudent
subject” (Hannah-Moffat, 2000, p. 31), by taking psychotropic medication for
his bi-polar diagnosis and participating in out-patient addictions treatment in
order to pursue his education. His sense of empowerment comes from
focusing on what resources he can use to achieve personal success. He
believes that striving for a socially acceptable form of self-improvement
(Cruikshank, 1999), such as obtaining a university degree, will allow him to
escape marginality. Acknowledging the structural barriers that come with his
decade of homelessness would minimize, if not eradicate, this sense of
freedom and hope for a promising future, and so Milan accepts the
reductionist quality of the psychocentric model of empowerment.7
Given the prominence of self-blaming discourses revealed above, it is not
surprising that participants found that the psychocentric approaches advanced
by mental health and treatment programs in the homeless community worked
to boost their self-esteem and encourage a responsibilized lifestyle
(Cruikshank, 1999; Rimke, 2000), regardless of the programs’ poor success
rate in moving people out of homelessness. Daniel offered compelling
insights into how his therapy with a life coach and participation in an out-
patient addiction treatment program reinvigorated a sense of responsibility
that he lost before he “stepped out of the machine”:
I’m breaking myself down to nothing and I was really given the opportunity to
assess who am I? You know and without any pressure, no, no inner fear or
persuasion. It’s all up to me... So I can say ah those guys aren’t doing this and this
but, really it’s all a choice. Life is all choice. Every day, you know as soon as you
open your eyes you make a choice… That empowers you when you realize that
everybody is in life exactly where they’ve chosen to be…But you constantly have
to take responsibility, take ownership over your choices and realize that nobody
did this, nobody caused that. It was the way I reacted. Instead of responding, you
know and on and on and on. Then it becomes empowering because you click, I’ll
choose different next time.
Daniel echoes Seamus’ sentiment that personal problems derive from bad
individual choices. His narrative brings together the notions of self-blame and
responsibilization as well as empowerment discourses that are reinforced
7
The importance of hope in encouraging marginalized individuals to be managed by mental
health and treatment programs regardless of the outcomes is noteworthy. In an environment
characterized by many as hopeless, the optimism these programs provide is powerful.
Conclusion
Acknowledgements
The author would like to thank the guest editors for their dedication to critical
psy studies and in particular to Heidi Rimke for her support in seeing this
paper to publication. Thanks to the anonymous reviewers and David Butz for
their helpful feedback, and to Jennifer Kilty for her guidance in earlier drafts.
Finally, the author wishes to acknowledge the financial support of the Social
Sciences and Humanities Research Council.
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