Ed Durgan: Lessons from Vancouver in homelessness and mental illness
This past fall, after eight years at UBC, I finished an interdisciplinary PhD on homelessness and mental illness in urban environments. I was mainly interested in comprehensive solutions. I had advisors in architecture, philosophy, and psychiatry. It is well established that the prevalence and severity of mental disease is greater in urban environments than anywhere else and there is little agreement on the reasons for this. I went to one of the epicentres of the crisis, the Downtown Eastside, to try and figure it out. My study benefitted from collaboration with the Downtown Eastside Residents Association and the Vancouver Area Network of Drug Users.
Besides studying the histories and current state of the arts in psychiatry, asylum architecture, and social housing, I had 12 severely mentally ill research participants living in a variety of impoverished dwellings in the DTES. Those participants fit diagnostic criteria for a wide range of mental disease. I recorded interviews and analyzed them with qualitative research methods. I found many themes, but focused on these five: distressed personal time, homemaking, management of mental health, contingencies of being poor in the DTES, and fundamental human rights.
Distressed personal time: Homelessness, mental illness, addiction, and poverty have at least this in common. Participants struggled to overcome past trauma. They could not break free from drug-seeking obsessions in the present, or make plans for the future. The difficulty of these struggles seemed to be related to their dwelling places: the worse the dwelling, the worse the distress of personal time. This captures the slippage from sanity to madness, the transition from good health to mental and physical suffering. To the temporally distressed person something may appear to be happening in the present that actually happened in the past, or that they fear will happen in the future. They are plagued with anxiety and may slip into hallucination and delusion. Psychiatrists call this “psychosis”. This may lead to a diagnosis of “schizophrenia” and a loss of freedom or worse.
Homemaking: Achieving the basic tasks such as cooking and eating meals, cleaning, decorating, hosting guests and/or pets, lying down, and sleeping soundly all appeared to moderate the day-to-day severity of mental disease. These tasks were more or less demanding depending on the dwelling type. Possessions with sentimental value help to keep one’s biography and identity intact; when these are stripped away so is the personal sense of time, and this may make psychotic depression more likely. The growth of self through homemaking seems to be crucial in overcoming the worst aspects of mental disease.
Management of mental health: In some cases there was severe tension between legal, social, psychiatric, and medical authorities’ demands and the participant’s own coping strategies. Psychiatrists and social-housing staff want to help, but they also want to control people living in the DTES. Veterans of the system get what they want and need either from their doctors or at the corner of Main and Hastings.
Contingencies of being poor in the DTES: Besides being one big “dope opera” the criminalization of “hard drugs” in the DTES means that psychiatrists/MDs, police, and violent syndicates combine to control people’s lives in the area. The drug market is tied to the sex trade, which is also criminalized. Therefore, survival sex-trade workers have multiple vulnerabilities; they’re caught between the police on the one side and drug and sex-trade syndicates on the other.
Fundamental human rights: The rights taken for granted by most people in our society such as access to nutritious food, adequate housing, or basic medical care are mostly out of the reach of poor people living in the DTES.
Some of my arguments include these:
Vancouver Coastal Health and UBC psychiatry have a deficient understanding of addiction and mental illness among the poor of the city. Use of hard drugs can be seen as adaptive behaviour that conditions the body in a way like an adequate home would. This helps people keep it together (or stay “well”) as long as they can keep consistent levels of dope in their system. This insight also helps explain how and why pharmaceuticals (like anti-psychotic and anti-depressants) sometimes work. This is also why the North American Opiate Medicalization Initiative (NAOMI) could work. In the absence of adequate dwelling spaces, drugs become the dwelling. Unfortunately, the researchers with the most political clout do not see understand it this way.
Psychiatrists tend to reify the American Psychiatric Association’s outdated Diagnostic and Statistical Manual (DSM) while pushing eugenics-style theories of inheritance and genetic counselling instead of recommending the eradication of poverty. In my opinion, the behavioral geneticist and city councillor Kerry Jang personifies a kind of bad science and hucksterism that complements billionaire developer-dominated civic politics. Taking the Woodward’s project as an example, I showed how architects, planners, psychiatrists, and nonprofits have re-institutionalized mentally ill people while reducing social housing and low-income rental stock. Patsy organizations like the Portland Hotel Society help fabricate an ethical narrative that is swallowed hook-line-and-sinker by the public. I call this “Vancouverism” and my research indicates that it is common in neoliberal cities around the world.
There are no comprehensive solutions to these problems from within our socio-political system. Despite political parties’ promises to “end homelessness”, it just isn’t going to happen in “Canada” or any other nation. Modern architecture, psychiatry, and psychology all suggest an abundance of solutions to these crises. However, they are appropriated by politically powerful coteries to further entrench their positions. It is possible that psychiatry can be salvaged in a stateless, classless society. It may then provide a sufficiently complex model to diminish, if not eliminate, severe mental illness. The Olympic Tent Village was an example of how resistance efforts can stem the crisis. That success compared with others from around the world, suggest a grassroots-led revolutionary transcendence of the nation-state model could lead to a “homes for all” situation. So the solution may lie in some combination of resistance and complexity.