Recovering from Homelessness

Revised: January 2019

By Sarah Owens and Michael Livingston

A veteran's camp off Portland Road in 2016

Stephen Goins, Director of Transitional Programs for Northwest Human Services, gave a talk titled  "Homelessness, Trauma and Reintegration" at a recent meeting of Salem's Downtown Rotary Club.  The talk touched on four areas: the homeless experience (overwhelming loss, basic needs going unmet, constant danger, little if any sense of self, control, or belonging), the effects of trauma (social, emotional and cognitive impairment, often secondary to disrupted neurodevelopment), the homeless brain (abnormal processing between stimulus and response) and recovering from homelessness.  This post focuses on what Stephen had to say about the last two areas: the homeless brain and recovering from homelessness, which are relevant to an understanding the City's Homeless Rental Assistance Program.

All slides courtesy Stephen Goins

It should be said at the outset that the homeless brain that Stephen talked about is no different from the ACES brain and the PTSD brain.  The long-term effects of trauma/toxic stress on the brain are basically the same:  you're gonna find a trunk line running from sensory intake area to the amygdala, which responds before anything from the atrophied hippocampus or cortex can get through.  So, why talk about the homeless brain, specifically?  Because too many people say ignorant things like, "Why don't they just get a job?" and, "Some people choose to be homeless, you know."  As a community, we have come to understand (somewhat) that traumatized children and combat veterans need specialized care, but, for reasons discussed previously, we have been slow to apply the same scientific principles to programs serving the homeless. 

From a public policy and common sense standpoint, no one "chooses" to be repeatedly traumatized.  Stephen says about 40% of the youth coming to HOST have left home believing they will be safer in the streets than at home.  They're not, of course, but the point is, those youth are not "choosing to be homeless" in any meaningful sense, any more than a victim of domestic violence "chooses" to stay with her abuser.  So, why do so many people hold to the belief?  The same reason they say they don't believe it's possible to end homelessness.  They're uncomfortable, they don't know what to do, and they don't want to think about it.

Now, back to the homeless brain.  Eighty percent of HOAP clients need help making a phone call, Stephen told us.  Out of, say, 30 people asking to use the phone, only 5 will actually manage to put a call through.  They'll sit there, he said, anxiously staring at the phone, trying to think of what they will say, fearful of what may happen if they manage to start a conversation.  Most of the time, they can't go through with it.

"The homeless live in their mid-brain," he says, "everything is a threat."  He says he and the rest of the staff at HOAP essentially "become"  consumers' prefrontal cortex.

Persons experiencing homelessness, like children experiencing abuse and neglect, must eventually adapt to the constant need, whether actual or perceived, to protect self.  They become chronically hyper-vigilant and defensive, cease to trust anyone, and feel intense fear, guilt and shame from which they seek any relief that might be immediately available, including alcohol, drugs and sex.

What one can expect from a person in this situation is, according to Stephen, aggression and poor impulse control, fear and resistance in the context of rule enforcement, including safety rules, and coping by disengagement, avoidance and numbing.  Seemingly minor events can readily precipitate catastrophic reactions in the homeless brain.

"Complex Trauma"

Their bind, Stephen says, is that, while fearing and blaming the external world for everything that's wrong, they must depend on it completely if they are going to be able to enact any kind of positive change.  In short, they must trust, but they can't trust, so they don't move; they're "stuck."

Without intervention of some sort, whatever bonds a homeless person has with society, its structures and institutions, will, with time, begin to fade away, and eventually all that's left is whatever is needed to manage daily life, e.g., through sharing, bartering, even taking.  Instability characterizes all relationships, including employment.  Stephen describes these adaptations as the "nomadic lifestyle" and "harvesting economy."

  
The mainstream economic view that one should save when resources are scarce, not spend or lend, much less give money away, assumes one has resources to produce and conserve, and the ability to meet basic needs while doing so, which, of course, homeless people for the most part do not.  In the harvesting economy, it makes perfect sense to spend, share and consume immediately that which one cannot conserve or store, which is mostly everything.  So, Stephen seems to be saying, if you try to judge the economic actions of the homeless brain according to the standards of mainstream economic principles, you're not going to get very far in your understanding.

Stephen says that the homeless brain (or maybe we should call it the nomadic brain) also experiences time differently.  Time is perceived as cyclical (night-day, rainy season-dry season, plenty-want) versus linear.  Future or long-term planning requires linear time perception.  Life lived in cycles, on the other hand, is focused on "meeting the next need" and "the future" becomes no more than meeting the next need.  The word/concept "future" eventually ceases to have any meaning.

So, that's more or less what a person recovering from homelessness is having to deal with.  Kinda makes you realize how important relationships with other people are going to be to the process of reintegration.  Stephen says reintegration is possible, but it's not linear (see his slides on reintegration here).  He says you can think about reintegration as occurring in three phases:  first, the experience of safety, followed by a period of remembrance/mourning, then the process of reconnecting (which is not  necessarily linear).  Aside from housing, a person seeking to reintegrate is going to need structure (which produces predictability, which builds trust), pro-social relationships (more trust), the chance to be productive in some way (self-respect), and integrated and trauma-informed care/healthcare.

There are lots of different reintegration programs, but most probably include these elements.  For Stephen, it comes down to treating everyone, no matter how bad a day they are having, like he or she is a human being, which is not something the homeless get a lot of.  That, one may suppose, is what makes the strategy so successful.