Análisis de los resultados

Interwoven in the narratives of homeless women’s lives are the themes discussed in the previous chapters that have contributed to their risk for homelessness. In particular their often fraught relationships with family and friends and the losses they have experienced define the vulnerability that shaped their lives. Their lives are complicated by physical and mental illnesses brought on by a lifetime of individual and structural factors at the heart of a Critical Medical Anthropological theoretical perspective. Social, political, and economic issues define homelessness, but it is the people who have experienced it directly who can speak most poignantly to the underlying causes of the problem.

Loss is one of the overarching themes I identified in this research. The women describe endless losses from loss of their childhood to loss of possessions when they lost their home to loss of custody of their children. They suffered from emotional loss, material loss, and loss of love, freedom, privacy, and self-esteem; all of these affected their feelings about themselves, their ability to organize their lives and their inner resources to cope with daily living. Instability was prevalent throughout their lives. The women moved frequently as children, their parental relationships often changed as parents divorced or different father figures came into their lives, and they relocated to escape or engage in relationships. These interconnected factors—social conditions and a set of interacting health problems—form a syndemic that defines the lives of homeless women, which they cannot escape without financial, educational, and social resources that, for most, have never been attained in the first place. As one woman noted, most poor people only know other poor people who are barely scraping by themselves and not in a position to offer much assistance. Thus, personal resources and social connections fail them as does the state,

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which offers an inadequate, piecemeal system that is not aimed at lifting people out of poverty, but functions to maintain them in it.

Several classic ethnographic accounts of homeless women’s lives have been published. I drew from these narratives and utilized their findings as a framework for my exploration. Elliot Liebow’s book, “Tell Them Who I Am: The Lives of Homeless Women” (Liebow, 1993) is a wonderful perspective on homeless women in emergency shelters outside of Washington, D.C.

He recognizes that “Most homeless women are engaged in an unremitting struggle to remain human in the face of inhuman conditions,” (Liebow, 1993:3) The women I interviewed exemplified this notion as they experienced social suffering in their lives.

I found that not all women staying in a homeless shelter consider themselves to be homeless. Some were comfortable with having a roof over their head, hot meals, and a safe place to sleep. They were also content to have their basic needs meet for their children. They felt that since they were not on the streets and thus they were not literally homeless. Many had spent time “doubling up” with family or friends, trying to remain housed. Most of the women were working diligently to get out of their homeless situation. They spent each day looking for jobs, housing, and child care for their children. They expressed the need for dignity in the face of their living situation.

Their relationships in the past, currently, and in the future will most likely affect who they become and shape their success after they leave the shelter. Family relationships were the most tenuous. Some were sources of great joy and others were destructive. According to Liebow, “Shelters and streets are littered with the bits and pieces of broken families. Some of the women are desperately trying to rebuild family relationships, some are just as desperately trying to run away from them, and others are struggling to hold on to what they have. This

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complex pattern is further complicated by the fact that a family relationship is not a single strand but a collection of many, and each strand can itself be complex and slippery in its own right.”

(Liebow, 1993:82). The women whose lost or fractured relationships were fresh in their minds or who were at the shelter without their children were the most emotional. Very often family ties had been broken and the women were no longer able to return to the home they once knew or to return to their childhood home. They were lacking family support and this rejection caused anger, resentment, frustration, and sadness. The older women who had been homeless for a long time and whose relationships had been broken for many years seemed to be more accepting of being family-less.

My research focused on homeless women who face unique obstacles to dealing with homelessness. Women are affected by personal issues such as physical and mental illness, substance abuse and intimate partner violence, as mentioned above. Personal trauma, identified as sexual, physical or emotional abuse, was a universal factor in most of the women’s lives and it caused profound loss. Many of the women had destructive family relationships filled with trauma and abuse. Because I did not interview men I cannot assume that their lives were void of these issues but based on my review of the literature it would appear that women are

disproportionately damaged by abuse and violence in their lives. The trauma that homeless women have experienced needs to be recognized and dealt with. Only after this occurs will the women be able to build secure, trusting relationships.

My interviews were conducted predominantly with White women (n=23; 77%) since that was the majority of the women staying at the Entré shelter. This differs from the racial/ethnic distribution of homeless women in more urban areas. This distinction is noteworthy since it is possible that the perspective of the women I interviewed is not representative of all homeless

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women or even of homeless women in Connecticut. Relationships between residents that developed at the shelter were sometimes affected by issues of race and social class. In his work with homeless women, Liebow also found that “Friendships turned on many axes. Sometimes two women seemed to pair up because they were both black or white, or of the same age, or were perhaps both better educated or more refined than the others. But for the most part, race, age, and social class appeared to be low-lying boundaries easily crossed rather than deep structural faults that separated the women cleanly from one another.”(Liebow, 1993:162). I witnessed very little outward discrimination by the women toward the residents of different backgrounds but it may have existed. As in society as a whole, “race [can be a] divisive and destructive force in shelter life, although in practice it was usually contained…Public expression of racial animosity was against the rules – the informal rules by which the women governed themselves as well as the formal rules that prevailed in every shelter. The formal and the informal, working together, generated a strong moral force….” (Liebow, 1993:190-191)

Parenting

Motherhood was, by far, one of the most frequently discussed issues. Homeless women's lives are quite chaotic and they need to find stability to raise their children. Attempting to

maintain a stable life for their children is of utmost importance. The shelter, although preferable to being on the streets, is not conducive to raising children. Specific issues such as finding child care and keeping their children clothed, fed, and safe are huge challenges for all mothers, but these were complicated by homelessness. Donna Haig Friedman (2000) in her book on parenting in public discusses the complexity and difficulty of dealing with personal problems while living in a shelter since most people would prefer to deal with these in their own home.

Shelter policies affect their ability to parent and their confidence in being a parent. The rules and 182

policies of the shelter require that the women are responsible for round-the-clock supervision of their children and the staff reinforce these rules and monitor how the women carry out these responsibilities, including the way they discipline their children. Speaking for the homeless mothers she interviewed, Haig Friedman asks “Does becoming homeless mean that I am unable to parent? How am I to explain to my child that I have to get staff approval for getting them a baby-sitter? My children see me being treated like a child. They lose respect for me.”

(Friedman, 2000:95)

The Shelter

The shelter, itself, and the staff affect the woman’s well-being and her ability to be a good parent. The “location, size, facilities, amenities, and layout all contribute to the quality of life and personality of any given shelter, but these can easily be overridden by the people who staff the shelter and the philosophy that defines their jobs and shapes their relationship to the homeless clients.” (Friedman, 2000:115). Shelter staff can be a major source of support. In addition to providing them with a safe, warm place to sleep at night, maintaining order, and seeing to it that they have food and other essentials, they also listen to them and provide advice and encouragement (Liebow, 1993). This positive support is tempered by the underlying tension created by the power struggles between the staff and the residents. The staff can provide these amenities but they can also take them away. Liebow noted that the “unequal power

relationship tended to put a ceiling on the development of personal relationships, even when the impulse to build them was present. For some staff relationships were inhibited by the desire to maintain a more or less professional relationship with their “clients”. In addition, many of the staff both paid and volunteer were separated from the women by the real or imagined abyss of social class.”(Liebow, 1993:161)

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Theoretical Models

I selected two theoretical models to guide my research. These models assisted in identifying and delineating the culture of homeless women. Mary Douglas’ (Douglas, 1992;

Douglas & Wildavsky, 1982) writings on the social construction of risk was a useful framework for describing the experiences of homeless women. Some of the women took personal blame or responsibility for their homelessness while others felt they were “wronged” or dealt a “bad hand”

by society. The women’s individual risk factors for homelessness, including substance abuse or mental illness, were influenced by their interactions with the environment around them. Neither can operate in isolation and neither can be completely responsible for homelessness. Risk generally deals with dangers in the future. Risk factors for medical conditions are generally equated with objective clinical risk and with epidemiologic risk. Gifford, in her discussion of

“the meaning of lumps” about women’s conceptualization about breast cancer says, "Scientific risk is quantitative, objective and relatively unambiguous. Lived risk is qualitative, subjective and highly ambiguous." (Gifford, 1986:220). She goes on to say, “Lay risk will always possess an inherent quality of unmeasured ambiguity and uncertainty as a central characteristic. It

emerges from an individual’s subjective feelings about the meaning of scientific and clinical risk mediated by their social and cultural background, context, and experiences. Lay risk is not objective, cannot be quantified or measured, and is not static. Rather, it must be understood as a dynamic experience of personal uncertainty about one’s future.”(Gifford, 1986:231). Risk, when associated with homelessness, can be considered lay risk. It is the lived experience of women who have been vulnerable to their surroundings and the people with whom they associate. It also becomes a factor in their future, which will be further defined by their environment and their social experiences. It is incorrect to say they were “at risk” for homelessness since they were

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already staying at a homeless shelter, regardless of how they perceived their living situation. Yet they faced risk daily, primarily due to their vulnerable condition brought on by poverty,

unemployment, or a lack of housing. I sought to identify the risk and resilience factors in their situation (Moxley et al., 2012) . Self-efficacy determined their ability to adapt to their situation and move forward. Their resilience helped to reduce their vulnerability. The women were functioning at levels where they could endure their current situation and adapt to their environment while they were at the shelter. They were able to set personal goals and move forward. Their positive outlooks were often surprising but inspirational as they navigated the system, dealt with their losses, and attempted to alter their life path to move forward to recover from homelessness and the many other wrongs in their lives.

From the CMA perspective, homelessness is influenced by social, political and economic factors, including poverty, unemployment, and a lack of affordable housing. The women I interviewed expressed their frustrations with dealing with “the system”, entitlement programs, and often DCF. These macro-level factors affected their health and well-being in numerous ways. For example, the women spoke about anxiety, depression, and physical health problems associated with their lack of housing and unemployment. Several had applied for disability due to physical or mental illness that prevented them from working. Some of the providers I

interviewed were part of the system that affected the women’s ability to attain support and housing.

Structural violence (Farmer, 2004; Lyon-Callo, 2001) is evidenced by power differentials in the women's personal lives and within the shelter and social service system. Lyon-Callo (2001) addresses this unequal power distribution that affects homeless women and contributes to structural violence, “Domination through processes of class exploitation, racial injustice, unequal

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educational opportunities, and gendered inequality are also all fairly easy to document components of homelessness.” (Lyon-Callo, 2001:295). Relationships can be premised on a power dynamic that leaves one member of the relationship in an inferior or subservient position.

These relationships can be detrimental to the individual’s self-esteem when one partner is

domineering. A consequence of this risk environment for homeless woman is a need for support and belonging. While at the shelter the women are at the mercy of the shelter staff. They rely on them for food, shelter, and “normalcy”. Too often the shelter staff utilizes their power to create obstacles for the residents to attain their goals. Residents spent a gross amount of time playing a waiting game while they were waiting to hear about jobs, housing, and disability decisions.

Susser describes this dynamic clearly, “Poor people are practiced at waiting, operating on institutional time, a requirement that creates unequal power relations between poor people and service providers” (I. Susser, 1996:418). Waiting develops into boredom, frustration, and discouragement with the system, the shelter staff, and the situation. This is one example of the structural violence they endure.

A Syndemic Approach: PHAMILIS

A syndemic approach is a theoretical perspective that helps in understanding the complexities of homelessness and provides a window on its causation. According to Singer, a syndemic is the “…concentration and deleterious interaction of two or more diseases or other health conditions in a population, particularly as a consequence of social inequality and the unjust exercise of power” (Singer, 2009:xv). In a syndemic there is a synergistic interaction of two co-existing diseases that contributes to an excess burden of illness (Singer & Clair, 2003).

The clustering of diseases in a population, and hence the conditions that foster the potential for disease interaction, are facilitated by physical and structural violence, including poverty,

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