[SomeStupidPoint]

It's just a very hard problem to deal with, and places like CA attract homeless people from other places, because they have good services. The US lacks a comprehensive national plan to deal with homelessness.

Part of the problem is that even when services exist, they're often fragmented and hard to administer. That's what led to ideas like "Housing First", where they've found just providing a home for a year fixes most homelessness problems (particularly when combined with other services). Having a home gives them a base to operate from to organize the rest of the services, finding a job, etc.

Part of the problem is that the US doesnt have a good plan for what to do with crazy people. We had a lot of problems with long-term institutions, but when we shut them down, we didn't actually start a new solution. We just left them on the streets.

Part of it is just social myth that people deserve their caste. If the homeless don't deserve their place in the increasingly vitrified social system, then perhaps the wealthy and powerful don't either, and so a large amount of anti-poor propaganda has been generated in the US by the elite.

[tcj_phx]

> places like CA attract homeless people from other places, because they have good services.

California's winter weather is more survivable than most parts of the country.

> Part of the problem is that the US doesnt have a good plan for what to do with crazy people. We had a lot of problems with long-term institutions, but when we shut them down, we didn't actually start a new solution. We just left them on the streets.

Institutions were replaced with drugs. In 'Anatomy of an Epidemic' [1], Robert Whitaker says that before the drugs were available, many people were able to recover enough to get out of the institutions.

The book makes the case that commonly-used psychotropic drugs take an episodic illness and make it chronic.

[1] https://www.madinamerica.com/anatomy-of-an-epidemic/

This HN submission was from 2 days ago: Psychiatrists Must Face Possibility That Medications Hurt More Than They Help (scientificamerican.com) - https://news.ycombinator.com/item?id=13186201

This has been my observation of the system... My friend was doing well until they got hold of her.

[eltoozero]

This is getting downvoted with no explanation, rude if you ask me;

The points are salient: I personally know a man in care who's been seemingly "kept stupid" with drugs while in an assisted living facility receiving treatment, and yes you can sleep outdoors most winter nights in CA, not comfortably but it's doable.

[tcj_phx]

> This is getting downvoted with no explanation, rude if you ask me;

If I check my comments frequently enough I sometimes notice oscillations. That one was voted up once, then down twice, then I didn't check for a while. 2 people have since appeared to cancel out those two downvotes.

After I posted that comment I thought about editing it to say something about how the nicer weather is "in addition to the state's services...".

Perhaps some of the downvoters thought I was disagreeing with the comment I was replying to, whereas I actually meant to supplement his/her good points with my experiences.

Edit: changed his to his/her.

[appleflaxen]

Where is the data for the point about making psychotic chronic? Because there is peer-reviewed medical literature (meaning double-blind clinical trials) about their effectiveness in reducing symptoms, and "longer lasting symptoms" would have been a reportable adverse event that could/would have been seen.

Additionally: to advance this model, you have to think that the people caring for these individuals (both families and doctors) are either unable to see that the treatments make it worse, or that they see it but are motivated by something other than the patient's best interests. My uncle had schizophrenia. In my experience, neither of these were true.

Finally: these symptoms are chronic and intractable by nature, if you talk to people that have them. Look at the homeless people who are clearly mentally ill: they react to things we can't see all the time; not episodically.

Asking iconclastic questions like Whitaker does is important; we need to have a discussion about it and make sure we're not completely off base, but when you look at a persons total ability to function and their global quality of life, antipsychotic medications are helpful.

[SomeStupidPoint]

Just to comment on a case I know personally: the person had semi-regular psychotic episodes, a few per quarter, but every day meds to prevent them definitely made him less smart and... "there" on the good days (in addition to stopping episodes). That's how he was treated until about 20, when he managed to convince a doctor he should just have an as-needed supply of fast acting ones.

I know it's anecdata, but my experience is that there are a fair number of borderline cases where they can't hold it together sporadically, but the meds definitely lower the quality of the "good days" to fix that. Sometimes there's a fast acting med that can work; often there's not and patients are faced with a stark choice.

I think we see a lot more homelessness in that group of people than we should, because we basically trap them there after one or two episodes, even though if we fixed it and got them some help (usually better coping techniques; occasionally meds), we'd see a lot less homelessness.

I do think that meds have become a substitute for real coping technique teaching, and that in many of those cases, the caregiver isn't making the optimal choice for the patient, because they're optimizing cost or time invested, rather than long-term quality of life.

There are obviously things like hardcore schizophrenia where that isn't the case, but even for more sporadic delusion disorders, it can be.

[tcj_phx]

Thanks for sharing your anecdata. I also replied to that comment: https://news.ycombinator.com/item?id=13206356

> I think we see a lot more homelessness in that group of people than we should, because we basically trap them there after one or two episodes,

yes, this exactly: the system "traps" its patients with medications that do not address the cause of their psychotic presentations.

My friend just needed sobriety, but all she got were tranquilizers and other "bad prescriptions". She briefly escaped from her court-ordered medications, but then she got an SSRI which destroyed all the progress I'd made with her. See my comment history.

[tcj_phx]

> Where is the data for the point about making psychotic chronic?

The term for psychosis which is worsened by its treatment is Supersensitivity psychosis, or tardive psychosis [0]. I think it originated in the early 1980's. Whitaker references some of the early studies in 'The Case Against Antipsychotics' (link in several of my earlier comments).

[0] https://en.wikipedia.org/wiki/Tardive_psychosis

There is no controversy that some psychotic presentations are caused by alcohol, cocaine and meth amphetamine, and other substances [1]. Emergency departments typically test for substances, and also for urinary tract infections.

[1] https://en.wikipedia.org/wiki/Substance-induced_psychosis

When the cause of a psychotic presentation is determined, the psychosis is said to be 'secondary' to its cause. If no cause is determined, the psychosis is said to be 'idiopathic' [2]:

  Finally, we discuss how careful studies of secondary 
  psychotic disorders can help elucidate the 
  pathophysiology of primary, or idiopathic, psychotic 
  disorders such as schizophrenia.

[2] Secondary psychoses: an update, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3619167/

> but when you look at a persons total ability to function and their global quality of life, antipsychotic medications are helpful.

When I met my friend, I figured she was "high as a kite", because she fluttered from topic to topic like a butterfly. I gradually learned that she really was supplementing her methadone (an opiate) with cocaine, and a constant dose of alcohol.

At the time, I didn't know anything about psychosis. But looking back, I now recognize that were times that she became psychotic due to cocaine, and that she recovered with sobriety.

Methadone is known to cause sugar cravings, but I think it also contributed to the 2-bottle-a-day liquor habit she developed after a month on the drug.

When my friend ran out of alcohol, she became profoundly psychotic. The hospital she was taken to used anti-psychotics. But these drugs were not indicated because they do not treat the cause of the presenting symptom (they found cocaine metabolites, and ought to have found evidence of alcohol use, which I think can be detected at up to 3 days).

There was a story submission here about how cocaine destroys mitochondria. I think this is fairly well-established. Today there's this:

Frequent sauna bathing can reduce the risk of dementia (sciencebulletin.org) - https://news.ycombinator.com/item?id=13204396

Dementia is the name for a type of psychosis, when it is experienced by old people [3]. Sauna bathing is good for dementia because it supports the metabolism. Old people frequently become cold, which indicates poor metabolism, and reduced ATP (energy molecule used by cells to power everything).

[3] http://www.medscape.com/viewarticle/564899_3

From my observations, anything that helps the metabolism is also good for psychosis.

Neuroleptics (so-called "Anti-psychotics") are palliative medications that just slow people down to match their reduced energy capacity. They hurt people, and should all be withdrawn from use, in favor of treating the cause of their condition.

Edit: Adding a link to "Psychosurgery as Brain-disabling Therapy" [4], for my own future reference:

  Psychosurgery merits special attention 
  because, as the prototype of brain-
  damaging therapeutics, it can shed
  light on the clinical effects of other
  brain-disabling treatments such as
  electroconvulsive therapy (ECT) and
  the major tranquilizers [aka neuroleptics -tcj_phx].

[4] http://psychrights.org/Research/Digest/Lobotomy/PBregginPsyc...

[grardb]

>It's just a very hard problem to deal with, and places like CA attract homeless people from other places, because they have good services. The US lacks a comprehensive national plan to deal with homelessness.

Do you have a source for this? My understanding is that California is awful when it comes to homelessness. Quite a few cities have higher rates of homelessness than every city in California, but have lower rates of unsheltered homeless people than them (especially SF and LA)[1][2]. I interpret this as meaning that Californian cities are generally worse when it comes to the homeless.

On top of that, many cities in California make it illegal to feed the homeless, which is something you don't see as much in the Northeast[3].

I'm also curious as to how a state "attracts" homeless people. I could be wrong about this, but I highly doubt that a person becomes homeless and then thinks, "San Francisco is where I should go," and then somehow travel hundreds or thousands of miles to get there. I feel like given the numbers I'm seeing regarding homelessness per 100k people, people generally don't go to Californian cities for their homeless services.

I'm open to learning more since I'm sure that there's context I'm missing, but from what I've read, California is not the best place to be if you're homeless.

[1] http://acsh.org/news/2016/10/13/which-cities-have-most-homel...

[2] http://projects.sfchronicle.com/sf-homeless/numbers/

[3] http://anonhq.com/illegal-feed-homeless-city/

[Spooky23]

People absolutely do. Spending the winter outside in Syracuse, NY or Chicago is not fun. We used to give stuff to a homeless guy who would migrate south for the winter. I have cop friends who say it's not uncommon for some people to deliberately commit a crime in front of them to get a warm bed.

Also, some places run people out of town. Las Vegas in particular was caught putting homeless in busses to LA and SFO.

In still other cases, there are many documented incidents were social services people in red states like South Carolina sell the benefits of moving to New York or Massachusetts where services like Medicaid are much better. (Medicaid is cost shared with the state)

[eltoozero]

I personally know a man who moved to CA from the NJ (fellow HAM I met on the air) who is getting treatment for his neuropathy here in CA via Medi-Cal whereas he was homeless "back home" with no relatives to support him.

Anecdotal, but I don't question his story.