California Forum

Why we gladly tackle other big social problems, but recoil from homelessness

A homeless man pulls a cart with his belongings across X Street near 16th Street on Friday, September 28, 2017 in Sacramento.
A homeless man pulls a cart with his belongings across X Street near 16th Street on Friday, September 28, 2017 in Sacramento.

It’s impossible to ignore that a growing subset of our fellow citizens faces a daily life without the security of a solid roof or walls. We’ve all seen the stats on homeless people: the hospitalizations, the impact on public services, the losses in economic productivity.

And mostly, we see them. They’re under bridges, sprawled in makeshift shelters along the parkway, and huddled in dank alleys.

Many subplots weave into this tragic story, including the declining affordability of housing, technological and global trends leaving some unable to find self-supporting work, and a toxic knot of mental illness, substance abuse and an inadequate mental health system.

Yet other complex problems – drunk driving, smoking, teen pregnancies – have been productively addressed via a communitarian tide of action. So it could be with our region’s homelessness issue. There is even some money identified to make a difference.

But this issue seems to get stuck. What’s the interference?

I’d suggest that there’s an under-appreciated aspect of the problem. It’s about empathy – “getting into someone else’s shoes,” as the saying goes.

In the same way that we might be uncomfortable around people confronting death or serious illness, it is naturally difficult for many of us to get into the shoes of those whose shoes are their only home.

Empathy has been framed clinically as a kind of parallel imagining of another’s experience. Research has examined “mirror neurons” able to encode witnessed feelings and even the possibility of an actual “field” of communicated experience. However formulated, empathy is generally cast as a positive.

Yet in a strict sense it only represents one’s resonance with the felt state of another, not necessarily what one does with that feeling. The resulting reaction may be positive and caring. But it may also be an impulse to escape, not necessarily because of self-centeredness or cruelty, but because of gross discomfort.

In my own clinical practice and work with the palliative care nonprofit, Snowline, I’ve seen the struggle for families to hold the shock and grief of bad medical news. I can also relate personally: I have bone cancer (luckily stuck in neutral, currently). Most show kindness and support, but many otherwise good-natured people also have quickly made themselves scarce, I suppose fleeing the perceived emotional “contagion.” So it may be with sincerely attending to what it must be like to be homeless, if we haven’t been there ourselves.

It’s difficult to listen to, and be present with, the experience of those who are homeless. Some of their behaviors and choices make little logical sense, driven by desperation, mental confusion, and/or substance abuse effects.

But one blunt impact to understand is trauma. Try these shoes on: the daily, personal sense of minimal safety and belonging. Imagine the strong likelihood that at some point, violence will visit upon you. Imagine enduring the energy-sapping vigilance of that risk despite terrible conditions for sleep and basic hygiene.

Further, imagine that you are, like many of the homeless, suffering from under- or untreated depression, anxiety and especially psychosis. Decompensations of these mental states of misery are themselves traumatizing. Those of us accustomed to thinking clearly and coping with emotional states would be deeply challenged and shocked by our very own minds running out of our control.

These are just the traumata of the present. Getting into those shoes would also include coping with the shame and grief of having lost a past, stable dwelling and a reasonable childhood expectation that adult life would include a roof, safety, and stability. Looking forward, it would also likely generate a sense of helplessness and dread.

Empathy is even harder to hold when it involves a homeless child. Try to appreciate the sheer terror of that child’s daily uncertainty, and the eventual warping of that young individual’s worldview when brutal uncertainty is the steady state of the day-to-day.

These are the shoes of some of our fellow citizens, our sisters and brothers in this big-hearted community. Dare to walk in them. Let the state resonate in heart as well as head.

Such empathy takes some courage and effort, but less than for many without the means to lift themselves out of homelessness. As with attending to those who are ill or dying, it can bring a range of tough stuff to the heart: fear, disgust, a sense of contamination. But it also can bring some compassionate energy, passion, and drive.

It’s okay, just being human really, to feel all of that, deeply. But tuning out from the issue is not helping anyone.

Dr. Greg Sazima is a Roseville psychiatrist and senior behavioral faculty at the Stanford/O’Connor Family Medicine Residency Program. He can be contacted at

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