Are we comfortable with homelessness?

Abstract

THE AMERICAN poet John Bishop Peale wrote: most tragic thing about the war was not that it made so many dead men, but that it destroyed the tragedy of death. 1 Two articles in this issue of JAMA give evidence that the greatest loss of the 1980s is that American homelessness and poverty are no longer tragedies but the acceptable cost of our affluence. Behind the cold statistics that Breakey et al 2 document lies human pain we who are affluent can scarcely imagine. Comorbidity is the operative term. The 9.2 medical problems per homeless person, the 91% rate of Axis 1 psychiatric disorders in women, the 85% rate of substance abuse (chiefly alcohol) in men: all testify to enormous suffering, much of it preventable. What is it like to suffer even from simple diarrhea when there are no public toilets and one must walk the streets from morning