Once you understand what homelessness is, you can develop programs to fight the problem. Most people who end up in homeless shelters are just going through a rough spot -- divorce, job loss, mental breakdown -- and what they need is some transitional assistance to get back on their feet. Since over the past 15 year we have re-oriented our whole welfare system around providing such assistance (rather than long-term benefits), help is available for many of these people.In the nineteen-eighties, when homelessness first surfaced as a national issue, the assumption was that the problem fit a normal distribution: that the vast majority of the homeless were in the same state of semi-permanent distress. It was an assumption that bred despair: if there were so many homeless, with so many problems, what could be done to help them? Then, fifteen years ago, a young Boston College graduate student named Dennis Culhane lived in a shelter in Philadelphia for seven weeks as part of the research for his dissertation. A few months later he went back, and was surprised to discover that he couldn't find any of the people he had recently spent so much time with. "It made me realize that most of these people were getting on with their own lives," he said.
Culhane then put together a database—the first of its kind—to track who was coming in and out of the shelter system. What he discovered profoundly changed the way homelessness is understood. Homelessness doesn't have a normal distribution, it turned out. It has a power-law distribution. [i.e., the curve is shaped like a hockey stick.] "We found that eighty per cent of the homeless were in and out really quickly," he said. "In Philadelphia, the most common length of time that someone is homeless is one day. And the second most common length is two days. And they never come back. Anyone who ever has to stay in a shelter involuntarily knows that all you think about is how to make sure you never come back."
The next ten per cent were what Culhane calls episodic users. They would come for three weeks at a time, and return periodically, particularly in the winter. They were quite young, and they were often heavy drug users. It was the last ten per cent—the group at the farthest edge of the curve—that interested Culhane the most. They were the chronically homeless, who lived in the shelters, sometimes for years at a time. They were older. Many were mentally ill or physically disabled, and when we think about homelessness as a social problem—the people sleeping on the sidewalk, aggressively panhandling, lying drunk in doorways, huddled on subway grates and under bridges—it's this group that we have in mind. In the early nineteen-nineties, Culhane's database suggested that New York City had a quarter of a million people who were homeless at some point in the previous half decade —which was a surprisingly high number. But only about twenty-five hundred were chronically homeless.
It turns out, furthermore, that this group costs the health-care and social-services systems far more than anyone had ever anticipated. Culhane estimates that in New York at least sixty-two million dollars was being spent annually to shelter just those twenty-five hundred hard-core homeless. "It costs twenty-four thousand dollars a year for one of these shelter beds," Culhane said. "We're talking about a cot eighteen inches away from the next cot." Boston Health Care for the Homeless Program, a leading service group for the homeless in Boston, recently tracked the medical expenses of a hundred and nineteen chronically homeless people. In the course of five years, thirty-three people died and seven more were sent to nursing homes, and the group still accounted for 18,834 emergency-room visits—at a minimum cost of a thousand dollars a visit. The University of California, San Diego Medical Center followed fifteen chronically homeless inebriates and found that over eighteen months those fifteen people were treated at the hospital's emergency room four hundred and seventeen times, and ran up bills that averaged a hundred thousand dollars each. One person . . . came to the emergency room eighty-seven times.
"If it's a medical admission, it's likely to be the guys with the really complex pneumonia," James Dunford, the city of San Diego's emergency medical director and the author of the observational study, said. "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, and it's the guy who falls down and hits his head who ends up costing you at least fifty thousand dollars. Meanwhile, they are going through alcoholic withdrawal and have devastating liver disease that only adds to their inability to fight infections. There is no end to the issues. We do this huge drill. We run up big lab fees, and the nurses want to quit, because they see the same guys come in over and over, and all we're doing is making them capable of walking down the block."
Gazing around me at all the modernist buildings that depress me with their functional plainness, and all the copies of ancient masterpieces that I like better but have to admit are out of time and place in the 21st century, I have often wondered what sort of architecture could be contemporary without being grim. What has occurred to me is a sort of return to nature. I was fascinated by some of the architectural details at Disney World -- columns like trees, squirrel-tail capitals, carved animal heads -- and that set me wondering about how such an aesthetic could be rendered fully grown-up.
Renzo Piano, it seems, has been wondering the same thing. The New York Times loves his new building for the California Academy of sciences, and I have to say it does look interesting.
I also wonder about the museum's highly touted "green" design. The dirt and plants on the roof are supposed to be great insulation, but they're no better than fiberglass. The museum has solar panels, but they will only produce 5 to 10 percent of its electricity consumption. (Of course, it is in San Francisco.) They have a recharging station for electric cars, but wouldn't it have been better to put the museum near a metro or streetcar stop? The interior insulation is made from recycled blue jeans, which is kind of cool, but if you've ever read about recycling you know that the energy costs of collecting and transporting heavy materials often outweighs any savings from recycling them.“I’m ready,” Ms. Palin answered without any hesitation in an interview with ABC News on Thursday, saying she had felt no doubt about accepting Senator John McCain ’s offer to run as his vice-presidential nominee.
“I answered him yes, because I have the confidence in that readiness and knowing that you can’t blink,” Ms. Palin told her interviewer, Charles Gibson. “You have to be wired in a way of being so committed to the mission, the mission that we’re on, reform of this country and victory in the war.”
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Is this sort of confidence a good thing or a bad thing in a political leader?
Certainly a lot of Americans are impressed by it. They like people who believe in themselves and radiant certainty about what they are doing. People loved W after 9-11 because he came across as absolutely certain that we are right, our enemies are wrong, and we will defeat them. And maybe it was good for the country, in that time, to have something to believe in. Come to think of it, Roosevelt showed the same kind of confidence in opposing the Depression, and in fighting fascism.
But W's confidence led us into the disaster of Iraq. His belief in the justness of his cause obscured the realities of world politics and led him to see close allies like the French and the Germans as enemies. His confident pose hid a deep ignorance of world affairs, of the nature of warfare, and of the difficulty of establishing democracy.
And what about Sarah Palin? Her confidence has carried her from hockey mom to mayor to governor to vice presidential nominee in a decade. People see her and think, wow, she is something, she is going somewhere, she can change things -- because that is how she sees herself, and she projects that self-image to the world. Actually, so far as I can tell, she has been a mediocre mayor and a worse governor, and the thought of her having any real influence on US foreign policy is chilling. But she won't blink.
I think she is a narcissist, maybe even a sociopath. She believes that she deserves to lead others because she is just that special. She is incapable of thinking that she has done anything wrong or of understanding her own faults.
But I don't think she is alone. I would say exactly the same thing about W, John McCain, Bill Clinton, Hillary Clinton, and Ronald Reagan. The reason I have a soft spot in my heart for Bush I is that I never thought he saw himself as a demigod. Now, there are some people who have good reasons to be full of themselves -- Churchill thought he was the man to lead the opposition to Hitler, and if this sometimes led him to interfere stupidly in the decisions of his generals, he really did show extraordinary leadership in one of the world's greatest crises. And there are a lot of politicians who think that mastering government policy is part of their job as leaders, which is why I always forgave Bill his outrageous vanity. He believed he was a man of destiny, but he saw his own very hard work as part of that destiny. I suppose that is part of why Hillary appeals to so many people -- she has always been willing to do the work that goes along with power. Other leaders attach themselves to causes and come to see themselves as the representatives of those causes, as Reagan saw himself as the leader of anti-communism.
But the whole lot of them, as far as I can see, are sociopathic narcissists. And maybe, really, that is almost a requirement for being a political leader. Who else would make decisions that might condemn thousands to death, or millions to poverty? The questions that hangs in the air whenever any leader makes an important decision for others is, "Who does he think he is?" And if he didn't believe himself to be some kind of superman, how could he do it?
I don't know about Obama. To believe, as a fatherless black man, that he could be President, he must have an extraordinary ego. People talk about how cool he has been throughout the ups and downs of the campaign, never getting upset when things look bad -- is this just the reflection of a belief in his own destiny? But he seems to like listening to advice, and he has a fondness for consulting the top academic experts in everything. His books suggest a degree of real self-reflection and a keen sense of his own deficiencies. So maybe, just maybe, he is that rare thing, a man who reaches the top without being in some way seriously deranged.
Which raises another question: if he really doesn't believe in himself at a positively made level, can he make the decisions necessary for a President? I suspect so, but I guess you never know.
But to get back to Sarah Palin and John McCain: I think they are a very dangerous pair. They are both absolutely certain of their own superior morality and judgment, convinced that their opponents are corrupt and wicked. McCain, at least, has a disturbing fondness for violence and war, and from what little Palin has said on the issue she also seems fond of acting out God's will on the battlefield.
I am not sure what disaster will befall the nation if they are elected, but I am sure it will be bloody and expensive.
