Of Others Inside: Insanity, Addiction And Belonging in America

5. Twilights

5 Twilights The Origins of Twilights Twilights was founded by behavioral scientists at the Rand Corporation to facilitate rigorous comparative research into the costs and benefits of residential and nonresidential care for dually diagnosed homeless adults. Toward that end, Twilights was designed to exactly replicate Canyon House in a nonresidential setting. Canyon House was itself included in the study because it had earned both local and national renown for offering high-quality care to dually diagnosed clients. But before moving further into the details of the research project itself, it will be useful to first briefly consider the broader sociopolitical crucible within which this project was forged. Beginning in the early eighties, Americans came to view homelessness as one of the nation’s most pressing domestic problems (Snow and Bradford 1994). As the magnitude of the problem grew more evident both on the streets and in the media, interest groups galvanized across the country to promote their respective solutions. The first two interest groups to achieve widespread notoriety were advocates for the homeless and spokespeople for local businesses and property owners. Their advocates cast homeless Americans as victims of a heartless society and demanded solutions to the various problems homeless people themselves suffered. Business and property owners cast homeless people as miscreants and a menace from which they deserved public protection (Stern 1984). Before long, politicians also weighed in. Conservative politicians claimed homelessness was a deviant lifestyle or symptomatic of personal pathology. Liberals blamed Republican welfare cuts, economic recession, and shrinking low-income housing markets . Scholarly experts from various disciplines echoed and elaborated upon these claims, but, in the early eighties, community mental health researchers were particularly well placed to claim expert authority. The venerable history of sociological skid row research had abated in the seventies (Shlay and Rossi 1992), leaving sociologists to scramble back to the study of homelessness only after it began garnering greater public attention in the early eighties. Community mental health 144 Twilights 145 researchers were more advantageously disposed. To those with little understanding of the American job and low-income housing markets, it seemed reasonable to assume that rising rates of homelessness in the early eighties simply reflected the failure of deinstitutionalization and community mental health in the sixties and seventies. The demographically heterogeneous “new homeless’’ of the eighties also looked more like the mix of people now known to community mental health researchers as “young adult chronic patients’’than they appeared to resemble the elderly white men featured in classic sociological skid row research (Bassuk and Lamb 1986). But still more fundamentally from a public policy standpoint, community mental health research was well placed to facilitate a political compromise between those who looked to societal failings and those who looked to personal failings to explain rising homelessness in America. By the lights of community psychiatry, one could simultaneously emphasize the community’s responsibility to more effectively look after homeless people and the putative personal deficits from which many homeless Americans were observed to suffer. Working to relieve homelessness could thus be cast as the noble works of a righteous society to meet the needs of its disabled citizens rather than meager and delinquent restitution for the country’s political and economic assaults on the poor. This outlook proved congenial to a wide variety of stakeholders in the question of homelessness in America. And, hence, when public and private funding agencies began sponsoring research on homelessness, they overwhelmingly sought to know the numbers, personal characteristics , and disabilities of homeless people. Coincidentally, psychiatric epidemiology had grown prominent in the world of community mental health research during the early eighties and appeared perfectly suited to discovering the extent to which personal disability and homelessness overlapped. The principal investigators on our study were proficient in state-ofthe -art epidemiological research methods and the latest program evaluation methods. Long before they set to work on our study, they had established distinguished records of public policy research concerning community care. Their appointments at Rand had afforded them a variety of organizational resources that advantaged them in the pursuit of research funding as well. But, as noted in Chapter 3, the availability of research funding in the early eighties was shrinking and becoming tied ever more closely to the provision of services to politically conspicuous populations. Beholden, as they were, to funding agency initiatives, my 146 Chapter 5 eventual supervisors sought, and were awarded...