Sarah Oliver dissertation

Institute for Clinical Social Work

Narratives of Veteran Homelessness

A Dissertation Submitted to the Faculty of the Institute for Clinical Social Work in Partial Fulfillment for the Degree of Doctor of Philosophy

By Sarah E. Oliver

Chicago, Illinois February 2015

Abstract

This research interviewed 20 homeless or recently housed veterans to ask them about their subjective experience of being homeless. The veterans were interviewed using Narrative Theory by Riessman (2008). Significant findings include that homelessness inhibits feelings and affect, veterans feel they are viewed differently, veterans had different versions of their narratives and this appeared to be connected to whether or not they were housed, veterans relationships were characterized by disruptions, and most notably, all veterans interviewed did not know they were eligible for health care through the Veterans Health Administration or VHA.

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For my veterans, may your voices be heard.

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The ache for home lives in all of us, The safe place where we can go as we are and not be questioned.

~Maya Angelou

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Acknowledgements

I am grateful for the support of my Dissertation Committee, Dr. Joan DiLeonardi, Dr. R. Dennis Shelby, Sherwood Faigen, Dr. Denise Tsioles and Dr. Dau Shen Ju. In addition, those who assisted me in the development of this project—Constance Goldberg and Joe Palombo.

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Table of Contents

Page Abstract……………………………………………………………………………..ii Acknowledgements………………………………………………………………....v List of Abbreviations………………………………………………………………xi Chapter I.

Introduction……………………………………………………….…1 Formulation of the Problem Significance for the Study of Clinical Social Work Statement of the Problem

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Table of Contents—Continued

Chapter

II.

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Literature Review……………………………………………………3 Introduction Population Description Combat Veterans Self-Selection for Military Service Population Demographics Traumatic Brain Injury Criminal Involvement Homeless Women Service Delivery Health Service Use and Perceptions Psychoanalysis and the Homeless Theoretical and Conceptual Framework Question to Be Explored Theoretical and Operational Definitions of Major Concepts

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Table of Contents—Continued

Chapter

III.

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Methodology…………………………………………………………39 Type of Study and Design Scope of Study, Setting, Population and Sampling, Sources and Nature of Data Data Collection and Instrument Recruitment Procedures Sample Selection Sample Type Guided Interview Questions Plan for Analysis of Data Statement on Protecting the Rights of Human Subjects Limitations of the Research Plan

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Table of Contents—Continued

Chapter IV.

Page Results………………………………………………………………….54 Description of Sample Summary of Findings Finding 1: Homelessness Inhibits Feeling and Affect Finding 2: Veterans Feel They Are Viewed Differently Finding 3: I Didn’t Know I Was Eligible for VA Finding 4: Versions of Homeless Narratives, Long Story Short Finding 5: Relationship Disruptions

V.

Discussion and Conclusions……………………………………..….98 Discussion Implications for Social Work Practice Conclusion

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Table of Contents—Continued

Appendices

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A. Informed Consent for Participants…….…………………………………......124 B. Guided Interview Questions…………………………………………….....…128 C. Recruitment Flyer………………………………………………………….....130 D. Check List for Veteran Participation…………………………………....……132 E. Veteran Resource Card……………………………………………….…....…134 References…..………………………………………………………………....….136

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List of Abbreviations

AVF

All-Volunteer Force

HUD

Housing and Urban Development

HUD/VASH

Housing and Urban Development Veterans Affairs Supportive Housing

OTH

Other Than Honorable

PTSD

Post Traumatic Stress Disorder

TBI

Traumatic Brain Injury

US

United States

VA

Veterans Affairs

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Chapter I

Introduction Formulation of the Problem The purpose of this study was to examine the subjective experience of homeless veterans generally with a specific emphasis on why veterans believed they were homeless. While public policy has centered on the eradication of homelessness among veterans, the researcher chose to focus on an element little explored, the subjective experience of a homeless veteran. The researcher was interested in what it was like to be a homeless veteran and how veterans described how and why they became homeless.

While this study did not speak to the experience of all homeless veterans, it gave an intimate view of the lives of a small sample. Narratives about the experience of homeless veterans were collected to examine the subjective experience of homeless veterans.

Significance of the Study for Clinical Social Work There was a gap in the literature about homeless veterans. There were no studies that attempted to highlight the personal subjective experience of homeless veterans.

There was extensive quantitative data about homeless veterans, but little qualitative data.

Increased knowledge about homeless veterans may help us with service delivery, staff training, treatment strategies, direct homeless funding initiatives and direct new policy.

2 In a narrative examination, homeless veterans were able to tell us in their own words their experience and the type of services and treatment they needed. This information could assist in the creation of new homeless services. Nationally, Veterans Affairs is under a Five Year Plan to End Homelessness announced by the Secretary of Veterans Affairs, Eric K. Shinseki in October of 2009. This study hopefully contributed information toward that mission.

Statement of the Problem Studied and Specific Objectives Achieved What is the subjective experience of homeless veterans? The research objectives were to learn about veteran homelessness: the story of why a veteran became homeless, what it felt like to be homeless, whether being a veteran influenced homelessness, and what the positive and negative aspects were of having been homeless. This study described a small population of veterans, so that there was a clearer picture of who homeless veterans were and what their stories told. The narratives helped the researcher understand what happened to a homeless veteran before, during and after their military service and where homelessness intersected with their lives. Again, the homeless veterans interviewed were not a representative sample of all homeless veterans.

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Chapter II

Literature Review Review of Significant Literature The literature review highlights some of the relevant literature. The literature was organized into subheadings, each of which represent various narratives or ways of describing homelessness. Riessman (2008) stated “In a word, narrative is everywhere, but not everything is a narrative” (p. 4). The subheadings which follow were the researcher’s groupings of topics, or one might say, various narratives of the problem of homelessness. Homelessness was at times viewed from the stand point of demographics, the result of addiction, a head injury, services or housing provision, past combat experiences or gender. Each of these narratives was a different way of attempting to describe the ‘problem’ of homelessness among veterans. Each narrative sought to narrow the variables to lead to a definitive cause. This research aimed to examine the personal narrative of homeless veterans, where a definitive cause may be absent and all causes could be relevant to consider.

Population Description Why are veterans homeless? This question has puzzled researchers and enraged the public. However, themes in the literature offer many reasons for this. Homelessness

4 was viewed in a variety of ways and described as the result of many social ills. Research seeks to describe the demographic of this population, housing programs have been developed and studied to prevent and end homelessness—all narratives that lend to the idea that homelessness is a problem that can be isolated, fixed or eradicated. Politically, the US Department of Veterans Affairs has a Five Year Plan to End Veteran Homelessness that placed this issue is in the public spotlight. For this reason, why veterans were homeless was even more important to study. This public plan highlighted that it was unacceptable for a veteran to be homeless and represented a detailed plan to get to ‘functional zero’ for homelessness among veterans. With this issue in the public eye, the question about why veterans were homeless needed to be answered. The narrative that mattered most for the purposes of this study was the individual narrative of the homeless veteran. What follows are other narratives or ways of examining homelessness among veterans.

To begin, some statistics about veterans from the US Department of Veterans Affairs (2012) may give a context for the homeless population. The VA projected a veteran population of nearly 23 million living veterans as of September 2012, where 10% of whom were women. There were about 37 million dependents (spouses and dependent children) of living veterans and survivors of deceased veterans. Together they represented 20% of the US population. Most veterans living today served during times of war (US Department of Veterans Affairs, 2011). The Vietnam Era veteran, about 7.9 million, was the largest segment of the veteran population. In 2007, the median age of all living veterans was 60 years old, 61 for men and 47 for women. The median ages by

5 period of service were: Gulf War, 37 years old; Vietnam War, 60; Korean War, 76; and WW II 84. Sixty percent of the nation’s veterans lived in urban areas. States with the largest veteran population were CA, FL, TX, PA, NY and OH, respectively. These six states accounted for about 36% of the total veteran population. As the previous data showed, veterans were considered to be 20% of our nation’s population. This was disproportionate to the 43% of the adult male homeless population that served in the military (US Department of Veterans Affairs, 2007).

Combat Veterans Rosenheck, Gallup & Leda (1991) studied homelessness among Vietnam era combat versus non-combat veterans and concluded that there appeared to be a misconception in the public that homelessness among Vietnam veterans were due to combat stress or Post Traumatic Stress Disorder (PTSD). The authors outlined that combat was not an indicator of homelessness among the veterans studied. This study used an intake form used by VA Medical Center staff when a veteran sought services.

The national sample was collected using the Homeless Chronically Mentally Ill program at the VA Medical Center at 43 different sites where a total of 10,193 veterans were sampled. The authors noted the differences in those veterans who served during the Vietnam Era versus being a Vietnam combat veteran. Results indicated that homeless Vietnam theater veterans had similar rates of combat experience (40%) than nonhomeless Vietnam theater veterans and this did not appear to be disproportionate to homeless veterans. However, the authors cited research from the National Vietnam

6 Veterans Readjustment Study (NVVRS) which took place in 1988, indicating that those veterans who were diagnosed with PTSD due to combat were at greater risk of homelessness. However, this conclusion was not supported by the Rosenheck et al. study. Results also revealed that non-white homeless combat veterans were more likely to have psychiatric, alcohol and medical problems than non-white non-combat homeless veterans. This study indicated that combat was not a significant factor in determining homelessness, and specifically non-white combat veterans may likely have complex challenges that might lead them to homelessness. In addition, whether or not combat veterans were drafted or volunteers for service was also identified as a risk factor for homelessness.

Self-Selection for Military Service In a study Tessler, Rosenheck & Gamache (2003) the authors offered information that within the all-volunteer force (AVF) of the military, there was a greater likelihood of homelessness. Veterans who self-selected to serve in the military were more likely to be homeless and have longer duration of homelessness than non-veteran homeless or veterans from other eras. Three hypotheses were tested, including, 1. AFV veterans will report a greater number of months of being homeless than non-veterans; 2. Homeless veterans of the AVF will have more behavioral risk factors that interfere with community adjustment than homeless non-veterans; and

7 3. Odds of becoming homeless are less if there was a history of employment, marriage and family support.

This study excluded those veterans who served after having been drafted. Data were collected in 1996 from a National survey of homeless providers and clients which the authors indicated was a sample that was nationally representative of providers and homeless. The sample size was 1,691 homeless men. Results supported each of the three hypotheses—that AFV veterans reported greater numbers of months being homeless, that AFV homeless veterans had more behavioral risk factors and that homelessness among AFV veterans was decreased by employment, marriage and family support. This study distinguished the notion that those who self-selected to go into the military were possibly more likely to become homeless, and that this group of veterans may be defined by their historical period. In addition, this subgroup of homeless veterans appeared to have some differing characteristics than the rest of the homeless veteran population. Another study which further differentiates demographics of the homeless veteran population follows.

Population Demographics In 1994, Rosenheck, Frisman & An-Me, sought to study the demographics of the homeless population. In this study the percentages referenced earlier in this paper were discovered. Male, Caucasian veterans were 4.76 % more likely than the general population to be homeless. The authors reported, “National data on this cohort reveal higher rates of unemployment, substance abuse, and antisocial personality among veterans than among non-veterans� (p. 1). The major focus studied the difference

8 between veteran and non-veteran homelessness. The authors hypothesized since veterans were entitled to special benefits, such as, home loans, medical care, and education, therefore, they should be less likely to be homeless. Rosenheck et al., completed this study to determine whether veterans were disproportionately represented in the homeless population. Also, within the veteran group, whether veterans were more likely to be homeless due to a factor such as age or race. A national survey completed in 1987 by the Urban Institute was used for data in addition to three single-city surveys in Los Angeles, Baltimore and Chicago. The sample size was N=2223 homeless veterans. The authors, through secondary analysis, found greater numbers of homelessness among male veterans 41% as opposed to 34% rate of non-veterans in the US general population. Another significant finding was that veterans aged 20-34 and aged 45-54 were significantly more likely to be homeless than non-veterans of the same age. There was no significant difference in the other age categories. The authors tested for socioeconomic factors, psychiatric risk factors and military characteristics. The authors were some of the most informed researchers regarding homelessness among veterans and appear to have found more significant data to contribute to the body of knowledge about homeless veterans.

This work helped to dispel the assumption that all homeless veterans were combat veterans and indicated some significant areas for further study to help determine causes of homelessness among veterans, such as physical or psychiatric problems.

9 Traumatic Brain Injury In the world of homeless service delivery, there is budding research to suggest that homeless individuals are more likely to have the diagnosis of traumatic brain injury (TBI), cognitive problems or problems with executive functions. In addition, they were more likely to be at risk for sustaining an injury that results in cognitive limitations or executive function problems. The rates of cognitive issues were largely unknown although there are some studies that suggest up to 80% (Burton, 2008; MacReady, 2008) of homeless individuals have sustained some type of head injury that causes them cognitive limitations or executive function problems. This literature examined some facets of this silent problem and cited studies that indicated the different types of head injury and the results, treatment considerations, the high rates of head injury among the homeless, some possible causes, and indicates that veterans were at a greater risk within this population- especially if they have had exposure to combat. The concern of TBI or cognitive problems among the homeless veteran population had special implications if one considers our current population of veterans from Iraq and Afghanistan.

Executive function was described by Palombo (2002) as general problems of functioning. He cited Lezak (1983) who categorized executive function into behavioral manifestations in four major areas. These are goal formation, effective performance, carrying out, and planning. When one considered the predicament of a homeless veteran who needed to set some basic goals of housing, improving their health and stabilizing themselves financially and these areas were impaired one could see how difficult climbing out of homelessness would seem. The daily tasks necessary to conduct oneself

10 in the world are executive functions. So, whether the difficulty was due to childhood issues or an adult trauma, having limitations in executive function were of grave concern for a homeless person. Limitations that were invisible could cause service delivery systems to misunderstand a person’s motivation to change and improve. In addition, no matter how a TBI, cognitive problem or executive function problem was defined, it remains an incredibly complex problem with a multitude of facets and possible causes.

Hwang, Colantonio & Chiu (2008) sought to determine the prevalence of TBI in homeless individuals in Toronto, Canada. Over 900 homeless individuals were interviewed and asked to self-report any known head trauma including “feeling dazed, disoriented or unconscious” (p. 779). In addition, the Addiction Severity Index was also administered to assess drug and alcohol use in the past 30 days (p. 779). The authors cited that head injury and cognitive problems were the leading cause of disability in the US. In addition, an addiction may increase the risk or likelihood of a head injury or that the two co-exist. The authors selected a cross section of the homeless population across the city. The results revealed that a history of TBI was significantly associated with seizure, mental health and drug problems and poorer physical and mental health status.

In addition, TBI was found to be more common in homeless men (58%) than in homeless women (42%). The author concluded that homeless people are “five times greater than the 8.5% lifetime prevalence rate of traumatic brain injury in the general population in the United States” (p. 782). Another significant finding was that participants often reported that their first TBI occurred at a young age. For this reason the authors suggest that TBI may be a risk factor of homelessness. The study’s strengths were the large

11 sample and the careful cross-sectional nature of the sample selection. As other studies have suggested, the study further elucidates the need for clinicians to take a careful, detailed history and ask specifically about trauma when interviewing homeless clients.

The need for individually catered interventions and treatment and rehabilitation services were advised.

MacReady (2009) interviewed staff who do street outreach to homeless.

MacReady collected observations from homeless outreach staff that indicated many homeless who do not have brain injuries prior to homelessness often sustain injuries from assault, riding bicycles and auto accidents after homelessness.

MacReady (2008) referenced a study conducted in Milwaukee, WI, where 80% of the participants surveyed showed evidence of some kind of impaired cognitive functioning. The author noted that overall, little was known about the neurological problems among the homeless. She cited that 22% of returning veterans from Iraq and Afghanistan have a traumatic brain injury (TBI). The full effect of which could take years to reveal. Due to the social functioning problems of these individuals the author cited that and interventions would be complex and costly. Other cited afflictions among the homeless were higher rates of schizophrenia, diabetes and hypertension—all of which were risk factors of a stroke which may cause a brain injury. Other contributors to cognitive problems in the homeless were HIV/AIDS, epilepsy, learning disabilities, poor education and limited intelligence and reading. Whatever the reason, cognitive problems caused a myriad of limitations in the homeless. When trying to learn, remember, plan, organize, concentrate and attend to activities of daily life, these individuals were easily

12 overwhelmed, emotionally impulsive and often more likely to need help in regulating their behavior—and certainly help in planning a path out of homelessness. The author suggested some method of assisting TBI individuals or cognitive impairment via interventions with memory aids “errorless learning” and psychosocial rehabilitation techniques (p. 229), as cited by other authors.

Spence, Stevens & Parks (2004) reviewed existing literature to examine the prevalence of literature about homeless adults and cognitive problems. In the literature search they found 17 articles about the topic. The authors note that they used “liberal inclusion criteria” and the sum of all articles selected represented about 3300 individuals (p. 375). Despite these low numbers, the authors found consistent results across studies—that individuals who were homeless have a high rate of cognitive dysfunction or poor executive function. As other authors in this review, these authors sought to make a connection between homelessness and cognitive dysfunction. Although their study contained some general weaknesses, it appeared as though the articles they examined supported this hypothesis. The limitation of including this article was that it was dated and there appeared to be greater attention to this body of literature currently. The areas for further study indicated including not only the determination of cognitive or executive dysfunction, but the extent to which homeless individuals were limited. This was relevant to the study of homeless veterans as the research continues to grow and elucidate the problems and associations between homelessness and cognitive function. These studies were relevant to this research when considering how to create careful interventions to assist homeless veterans.

13 Criminal Involvement Benda, Rodell & Rodell (2003) intended to study crime rates of homeless veterans enrolled in a VA Medical Center domiciliary program, the context surrounding the incarceration and the implications for treatment and care. The study sampled was N=188 veterans using an inpatient program for substance use. The average length of stay was six months. Veterans were interviewed twice and later completed an Addiction Severity Index (ASI) to assess criminal history charges. Some of the sample characteristics include a mean age of 44 years old, 44% co morbidity rate of substance dependency and mental illness, 50% Caucasian, 36% African American and 41% admitted to committing crimes in the past year. This appeared to give an indication of the link between homeless veterans and involvement in our legal system. Benda et al., (2003) used variance inflation factor and principle components analysis to analyze the differing aspects of the data. Results found that those veterans who had alcohol or drug abuse problems and previous psychiatric hospitalizations were more likely to have criminal activity than those who did not. The authors found that veterans who were hospitalized for psychiatric reasons were 1.27 times more likely to be involved in crime per hospitalization than those without psychiatric hospitalization. Similarly, those with a co morbid diagnosis were 1.51 times more likely to be involved in crime compared to those who reported no psychiatric issues. Some of the strengths of the study were the multiple interviews possible with the researchers and the greater balance of ethnicity than the previous study examined. In addition, this research sought to examine an incredible variety of information. However, this made the reporting of results cumbersome. Some

14 limitations of the study were that the program was located within one VA medical center in the Southern US. This program may not represent all programs or populations to use the program across the nation. Although the study sought to draw connections between crime and substance abuse, there was no indication about the sequence of events. As in all studies in this literature review, veterans gave self-reported history regarding criminal activity and other information. This study had implications for care (and for this study).

Service delivery to homeless veterans and the timeliness of it was brought to light in this study. In addition, this study also highlighted the need to treat multiple, complex problems of homeless veterans such as mental illness and dependency in one setting.

Traditionally, service delivery had separated the two issues. Finally, the authors suggest an integrated approach to the psychiatric rehabilitation of substance abusers.

Homeless Women A study conducted by Gamache, Rosenheck & Tessler (2003) was a compilation of three different surveys of homeless women. The authors wrote about the disproportionate number of women veterans among the homeless female population. The authors concluded that women veterans were at greater risk for homelessness than nonveterans, but the study was inconclusive in determining whether increased risks for veterans were a product of military service or reflect volunteers' self-selection into the armed forces. This study was significant to the body of knowledge about homeless veterans and appears to relate to a study by Rosenheck et al., (1994) about how male veterans were more likely to be homeless. The same rationale was used as women

15 veterans should be less likely to be homeless with available benefits for housing and education. Despite similar increased likelihood to be homelessness, this study differed with no significant finding were related to age of the veteran. Hamilton, Poza & Washington (2011) completed a series of focus groups among homeless women veterans.

The study included 29 women veterans. Results of the study showed six precipitating factors for homelessness. These were: 

pre-military adversity (including violence, abuse, unstable housing);

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military trauma and/or substance use;

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post-military interpersonal violence, abuse, and termination of intimate relationships;

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post-military mental illness, substance abuse, and/or medical issues; unemployment; and

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criminal justice involvement (p. 204).

The authors contend that women veterans are “caught in a web of vulnerability” (p. 207). This information was relevant to this study as homeless women veterans may need special, integrated, individualized care to move out of homelessness or prevent it.

Service Delivery A study by Applewhite (1997), using of focus groups and an exploratory method, sought to find information about social service use by homeless veterans. Specifically, the author wanted feedback on social services needed, and barriers for the needed services. A convenience sample was used at an outreach event for homeless veterans. A

16 total of 60 male veterans volunteered for five focus groups held over a three day period.

Veterans’ responses were grouped into three categories: health and mental health, resource related and public perception problems. Because this study was exploratory, no specific hypothesis was tested. Results of the focus groups offered some important opinions from homeless veterans. Continuing issues of health and mental health feedback, veterans cited specific problems with addiction, depression, PTSD, self-esteem issues and frustration. Concerning resource related issues, veterans cited specific problems with employment and wages, lack of affordable housing, housing eligibility barriers, transportation, and unavailability of assistance. Concerning public perception, veterans identified specific problems with public rejection, prejudice, lack of respect, fear and dehumanization. This study offered insight into some areas of needed improvement for the care of veterans experiencing homelessness. These areas included case management services, advocacy, employment services, affordable housing, empowerment practice by service providers and sensitivity in service delivery. While many of the studies in this review relied on self-report, this is one of the few that ask veterans what was needed to assist them.

Hopper, Bassuk & Olivet (2010) wrote about the trauma associated with being homeless and the importance of trauma informed care. They underscored the need to be aware of the previous trauma and the additional trauma that homelessness caused. The authors suggested that solving the problem of homelessness would be impossible unless underlying traumatic experiences were addressed. Some of the trauma that homeless individuals experienced included stress due to lack of housing, food and financial

17 resources, transportation, abuse, neglect or community violence, combat trauma, domestic violence, accidents and disasters. Trauma is universal and happens to all people across all ages, race and gender. The authors contended that a lack of understanding about the causes and interventions to trauma among the homeless may lead to frustration among providers and clients. The increased awareness and education could provide a greater understanding and pave the way for creating better interventions, services and support. This supports previous articles which summarized a need for careful history and individualized intervention.

Health Service Use and Perceptions Another study attempted to examine health service use by homeless veterans.

O’Toole, Conde-Martel, Gibbon, Hanusa & Fine (2003) sought to gain insight into the complicated needs of homeless males. They summarized it best “The aims of this project are to compare the demographic characteristics, co-morbid conditions and sources of usual care among homeless male veterans and non-veterans and to specifically look at characteristics of homeless veterans who report needing VA benefits” (p. 929). The sample of 531 homeless individuals where veterans made up 127 of the sample. The study was conducted in two cities—Pittsburgh and Philadelphia, PA. The data were collected using face to face interviews. The authors used an instrument called National Technical Center Telephone Substance Dependence Needs Assessment Questionnaire but modified for in-person interviews. The researchers then compared social service use by non-veterans versus veterans.

18 O’Toole et al., (2003) found that homeless veterans in this study were more likely to be older and more educated than the non-veterans in the study. In addition, homeless veterans were more likely to report a chronic medical condition and a mental health condition, such as higher rates of hepatitis, cirrhosis, and post-traumatic stress disorder (PTSD). Homeless veterans were more likely to either earn money from odd jobs or full time employment. However, the rate of alcohol or drug abuse/dependence between the groups was similar, but 60% of the veterans interviewed in the study required greater care and VA benefits because the severity and complexity of their needs. In addition, veterans expressed desire for greater access to benefits from the VA for their complicated conditions that they did not receive.

Some limitations to this study need to be mentioned. First, the study appears to be an abbreviation of a larger study and is fragmented in presentation. Also, the veteran status in the study was not verified. The authors used the homeless individual’s report of military service. These self-identified veteran might not meet the criteria for veterans benefits, and therefore, could not receive care for their conditions. This was worth noting as the authors offered incentives for the interviews with cash and bus passes. A homeless person may have indicated they were a veteran for the incentive. One could also argue that since the interviewees were self-reported interviews there was no additional source to verify their responses. However, the study highlights that creative, individuated responses to homeless veterans are needed for service delivery. This was directly applicable to this research as asking homeless veterans for their subjective responses

19 included a requirement that veteran status was verified. That way results are connected to veterans if homeless services were needing to be approached and offered in a new way.

Another study by Nyamathi, Sands, Pattatucci-Aragon, Berg, Leake, Habn & Morisky (2004) examined the perceptions of health status among homeless veterans.

This research was part of a larger study that examined a homeless case management program for those who have tuberculosis. The study included 331 homeless males in Los Angeles, CA, with a mean age of 41. Eighty-two percent of the subjects were African American and 19% were veterans. The authors used Mean, T-test and Chi-square to examine the results. The authors found that veterans were less likely to report their health as fair or poor (8%) than non-veterans (19%). This has important implications for any subjective study, interview study or survey as a veteran may downplay the severity of his health status. Veterans were asked to rate their perceived health status on a scale of excellent to poor. In addition, the authors found that more than half of the veterans studied were more likely to have a regular source of health care than non-veterans— perhaps reflected in the results. The veterans could have indicated a lower need due to being aware of the VA benefits afforded to them. The authors found no difference in the rates of alcohol and drug dependency between non-veterans and veterans. Limitations of the study included a convenience sample and relying on homeless individuals to be accurate reporters. The sample was not random or representative as it was mostly African American and a convenience sample. However, important implications which mirror the previous study highlight a need for unique services to take care of the diverse and subjective needs of the homeless veteran. Another facet of working with the

20 homeless that required a unique service approach was psychoanalysis with homeless individuals.

Psychoanalysis and the Homeless Due to the uncertain and often traumatic nature of homelessness, psychoanalysis may offer support to homeless veterans. The literature on psychoanalytic work with the homeless individuals was brief and none of the articles were specific to work with homeless veterans. Of note was that in this literature review, two of the five articles pertaining to homelessness and psychoanalysis summarized treatment with children and the value of play and were by the same author. All articles contained themes of holding, containment, self-regulation and trust.

Smolen (2001 & 2006) wrote about her analysis of homeless children. The author chronicled her work with two different homeless children housed in a transitional housing program. The transitional housing program housed homeless women and their children.

The treatment focused on making a connection with highly traumatized toddlers and then working to make the connection between the toddler and her mother.

The author borrows from Winnicott and Greenspan for the ideas of holding environment and self-regulation. In several examples, Smolen wrote about how she operated outside a typical treatment frame to treat the child and mothers. Some examples included going to her client’s apartment to wake the mother and client to make therapy happen, which she termed “mother chasing” (p. 6). Another example was the author’s description of many sessions spent holding the 3-year-old, allowing her to sleep and feel

21 safe as part of treatment and “holding”—literally and figuratively (p. 3). These unusual methods caused the author to be concerned that what she was doing was “not really analysis” (p. 10). Other highlighted parts of the therapy included the authors’ work with self-regulation (p. 9), and at times her worry about the child’s analyzability (p. 4).

Because of the mother/child relationship, Smolen also discussed the mother’s “inner homelessness” as a concept preventing the mother from adequately forming strong attachment to the child (p. 4). Upon further exploration, Smolen described how the mother detached from child’s needs because to get close to the child would open her back up to her own painful experiences—neglect, abuse, in her early life. The author personally acknowledged that she had to address her own issues regarding the death of her own child, and personal growth resulted as a piece of her work. In addition, she explored idea related to being available and able to withstand the trauma and pain that the client brought and how this spoke to the author’s personal journey. Both articles also highlighted the value of play and how fostering the environment where play could happen was challenging and at times the author explained that she had to teach both the mother and child to engage in play. A particularly compelling piece of the article was the notion of ‘inner homelessness’ which the author highlights. This resonates with the researcher’s experience of homeless veterans reluctant to examine personal issues at time as it may cause them to feel a depth of vulnerability that was not tolerable. The author also suggested the extreme difficulty with engagement and withstanding powerful, traumatic emotional content while working with the client population.

22 Young-Bruehl (2006) highlighted how the therapeutic process was adapted for the homeless youth population. The author described therapy with two homeless, gay, youth.

In the article Young-Bruehl acknowledged her work with homeless youth as a “treatment mix—part psychoanalytic psychotherapy, part sex education and part social work” (p. 1).

She wrote, “You have to be focused on the difficulties that most clearly stand in the way of survival” (p. 3). In this way, the author had to pay attention to the elements most needed—safety and providing for basic needs. In referencing the therapeutic frame the author indicated “One of the most important features of the treatment was that it was free; it was a reparative, a corrective economic experience” (p. 8). A second issue was the matter of communication. “By working with their English . . . I could show them both respect. I often asked them to teach me the meanings of expressions that were used that I did not understand” (p. 8). The author makes reference to a “shared lexicon,” or development of a shared language was built with the teens over time. After listening for a few sessions and learning about them, the author made the offer to explain what she thought she could do for them, by helping the teens to identify the patterns in their behavior (p. 8). In this article the author pointed to a valuable part of engagement with the homeless by learning the language of the world in which they live. Veterans often have extensive knowledge about training, rank, weapons, vehicles, etc. all of which often were acronyms. In taking the time to learn about the best way to communicate, the author removed herself as an “expert,” and worked closely to help the youth feel understood. While this was happening, she worked to ensure the safety and provide a holding environment where the youth could feel safe. The author acknowledged the

23 importance of providing basic needs first before therapy. This article resonated with the researcher’s experience of having to ensure basic needs were met with homeless veterans prior to being able to discuss their inner life. It is relevant to this study as homeless veterans are often difficult to engage and keep engaged in services.

Campbell (2006) wrote of homelessness and containment. The article was an examination of a psychoanalytic case formulation as an alternate process to evaluating homeless client’s behavior in Edinburgh, Scotland. The author gave two case examples where after team consultation a psychoanalytic case formulation was applied. The team members were given psychodynamic and unconscious concepts to consider what was going on with their homeless clients. This made them more able to individualize treatment options and led to greater understanding and empathy for the clients. The article focused on clients with personality disorders, that the author suggested, made up a large portion of the homeless population in Edinburgh, Scotland. This article was relevant to this study as it reinforced the idea that taking care of homeless individual is complex and as the literature had highlighted previously, requires an individualized, empathic approach.

In this article, Campbell (2006) discussed a key idea that enactments took place on the streets, involving those who care for the homeless, the setting, the past, societies view on homelessness and the client (p .6). For this reason, the clinicians did not always recognize the many facets that contributed to the enactment. Rigid agency rules may activate or replicate early traumas by causing the client to feel powerless, especially in bureaucratic systems. The author wrote about clients that had countertransference

24 reactions to these many facets of homelessness, at times causing negative exchanges to happen between agencies due to “staff trying to be a good object at all costs” (p. 7).

Campbell proposed an idea of an “internal state of ‘unhousedness’” (p. 7). This idea plays out externally in the lack of housing but involved finding out what constitutes home for the individual by an in depth understanding of history, behavior, defensive strategies and how they related to others. Once these were gained, a strategy could be formed from the increased understanding. The author’s contribution of a psychoanalytic examination of homelessness, lent depth to the stories.

However, it is here, situated on the boundary [doorways], that paradoxically, many homeless people do feel at home. Their impaired ability for inner selfreflection, finds expression in their desire to make sense of themselves through the responses of others, and thus passers-by, support workers and other become drawn into enactments, in which mutual anxieties are experienced (p .9).

In addition to enactments, the author’s examination of clients through a psychoanalytic lens served a purpose of allowing better “holding and containing” while acknowledging the difficulty of doing so for the variety of intense emotions such as fear, anger, and contempt. The formulations used by the author also provided “holding” and cohesion for “carers” (p. 12), that is, the staff who looked after these difficult individuals.

The author summarized: Bringing psychodynamic thought to bear on the problems of homelessness in society carries with it the inevitability of entering into the dark spaces of trauma

25 and of being in the midst, and on the receiving end, of powerful and disturbing projections (p. 12).

These ideas are especially relevant to the research as the VA medical services and other services veterans use are often large bureaucratic agencies with many possibilities for enactments on many levels.

Campbell (2006), while bringing psychoanalytic ideas to bear on the homeless situation, raised many important contributions that often went overlooked. Like Smolen (2001 & 2006), Campbell wrote about an inner state of homelessness as contrasted with the physical arrangement. In addition, he addresses the significant toll that working with chronically, personality disordered, homeless clients may have on staff. Use of psychoanalytic methods not only lent comfort to the “carers,” but allowed a framework of understanding that assisted in unique interventions for homeless individuals.

Merlino (2002) wrote about his experience of using dream analysis with the homeless. He reported barriers with regard to having only a few sessions with homeless individuals but found that, using dreams from the individuals he met with, helped to get to the most pressing issues the clients faced or as he termed the “here and now issues of immediate concern to homeless patients” (p. 592). He advocated for use of psychoanalytic methods with the homeless to promote insight to interpersonal barriers that contributed to people staying homeless.

Themes evident in the literature were overwhelmingly about containment, holding environment, loss, trauma and the idea of being able to withstand intense, painful feelings with homeless clients. Another compelling idea was a psychological homelessness. The

26 authors repeatedly followed their intuition. Most expressed some discomfort with their methods as they attempted to reach and or provide for their homeless clients by unique ways of engagement. The authors all disclose feelings of worry as they extended outside of their believed frame to provide care. The literature suggested that a different approach was necessary with homeless individuals and that psychoanalytically informed methods were beneficial.

Summary A review of the literature revealed that veterans were, in fact, more likely to be homeless than those who are not veterans. Although there were specialized services geared to prevent homelessness and care for homeless veterans, the existence of these programs do not necessarily predict success. In the psychoanalytic review, it is important to fully understand the impact of trauma and the possible ‘inner homelessness’ that may be carried by homeless veterans. Interviews asking for personal, subjective experience may add to the small qualitative body of literature. The experience and information give clues to the ‘what happened’ of veteran homelessness and service delivery or service use.

A subjective and personal view from veterans interviewed will add to this body of literature that was strangely without subjective content.

Overall, these articles reinforced a theme throughout that service delivery to homeless veterans was difficult, complicated and must be highly individualized. Service delivery was complicated because of the variety and severity of problems that veterans have, their personal attitudes toward their health and the personal history of homeless

27 veterans that is fraught with mental illness, chronic physical illness, alcohol and drug dependency and legal involvement. The challenge remains to create an aggressive, comprehensive, unique, educated and engaging service delivery system to reach this vulnerable population.

Theoretical and Conceptual Framework of the Study The study used Self Psychology as the clinical framework through which the results were interpreted. The researcher was familiar with other theoretical viewpoints and ways to examine veteran narratives. However, it was the researcher’s view that psychodynamic theory provided the best orientation towards understanding human behavior due to the focus on development, motivation and behavior and the importance of unconscious mental phenomenon. In particular, Self Psychology’s focus on early life development, the role of the caregiver and theory of cure made it particularly useful in the examination of homeless veteran narratives. For instance, for veterans, the military itself may be experienced as a selfobject. Loss of or exit from the military could be seen as a withdrawal of self cohesion and continuity and therefore result in anxiety or fragmentation of the self. The withdrawal of the selfobject functions of the military could then cause a crumbling of the continuity and self-cohesion. In Self Psychology, healthy human development was a framework characterized in the following ways.

Elson (1986) described these basic concepts in her book about Self Psychology. She wrote about Heinz Kohut’s description of a central structure in the individual that was called the nuclear self—a part of the self that was “cohesive and enduring.” The self was

28 then seen as bipolar or containing two parts. They were an individual’s motivation for success and motivation for basic idealized goals (Kohut & Wolf, 1978, p. 417). The self was seen as being molded and created by the responsiveness of the caregiver. Kohut believed that the early caregiver’s personality or “who they are” was more important than their behavior or “what they did.” The selfobject functions the caregiver provided for the child were vital. A caregiver who lacked empathy and attunement failed the child, and impacted the development of the child in the development of a stable self. Therefore, it is what a child received from caregivers during developmental years that impacted functioning later in life (Elson 1986; Siegel 1996).

Some concepts of self-development as informed by Self Psychology must be mentioned. The selfobject functions provided by caregivers are mirroring, idealizing and twinship. They contribute to a cohesive self by creating an empathic milieu. In the selfobject function of mirroring, the child is responded to and the caregiver confirms the child’s need to feel emotionally linked with the calmness and omnipotence of the caretaker. In the selfobject function of idealizing, the availability of the caregiver to supports the child’s needs to admire and idealize the caretaker and for the child’s needs to experience greatness and grandiosity. In the selfobject function of twinship teaches the child the abilities to get along with others in the world and to feel similar to the caregiver as though they are the same in various ways (Elson, 1986, p. 21). These three functions orient a child to his or her place within a social structure but lend to the development of their sense of self and their nuclear self. The way that a child is able to internalize these functions into his or her self and make these abilities uniquely his or her own is by a

29 process called transmuting internalization. A vital piece of this learning process is called optimal frustration. This process is the way in which a selfobject function provides for the child but gradually withdraws, “Thus, selfobjects and their functions are gradually replaced by a self and its functions” (Elson, 1986, p. 21). From this process, the child feels supported and encouraged to provide for him/her selves the functions that the caregiver normally provides. Interestingly, the development of the self is thought to be a process that was ongoing throughout life as the selfobject needs of an individual shift and change throughout the individual’s lifetime (Elson, 1986, p. 21).

In Self Psychology, pathology is viewed as the result of the failure of the selfobject milieu during various stages of development. The failures can occur in a variety of ways, for example having an unresponsive caregiver, an overly responsive caregiver or a situation of neglect or abuse. Therefore, when a child is not provided the needed functions, a selfobject failure occurs. These failures occur between the child and caregiver and are often the source of ongoing difficulty. The deficits can lead to fragmentation of the self which people attempt to defend against in a variety of ways; these are typically called symptoms. Symptoms develop in response to a person’s attempt to maintain some form of a cohesive self.

The theory of cure in Self Psychology involved the use of sustained empathy (Goldberg, 2011). For Kohut, empathy was the only way to understand a patient’s experience. It is through this careful understanding and examination that a person can feel deeply understood. The experience of this understanding and empathy is viewed as transformative and healing for the patient.

30 In the present study, the author was informed that the early life of the homeless veteran was often fraught with disruption. Through Self Psychology the ideas about selfobject needs and functions, self-development and empathy in early life are important to consider; they may inform how a person functions later in life. As homeless veterans tend to have problems interacting with others, with some social settings, with mental illness, with addiction and with repeating the pattern of homelessness, Self Psychology appears to be a useful way to examine these challenges. An examination of the way some deficits in the self or unfulfilled needs play out over the life span is fitting within the Self Psychology paradigm and in the way homeless veterans may function. In Self Psychology, the symptoms veterans display are viewed as an attempt to heal the self.

The symptoms were a solution to not receiving something they needed during development. Elson (1986) wrote: Much of social work practice is with seriously disadvantaged populations whose difficulties reflect generation of untreated psychical and emotional illness and the economic deprivation and family disruption which flow from these difficulties.

Many individuals who seek agency help or who are mandated for treatment are highly vulnerable to narcissistic injury and fragment readily. They are described as “multiproblem” individuals and families, “hard to reach,” “early dropouts.”

And yet we can observe in our work how the in the initial phase of treatment there is exposed the earliest need for mirroring, for affirmation, for guidance as well as the earliest wish for merging with idealized wisdom and strength (p. 58).

31 Elson (1986) went on to speak of the social worker’s role with clients who have such deficits. She wrote that social workers become the new selfobject whose soothing and calming attention allows structure building to begin or to resume (p. 153). This reflects the ideas from Goldberg’s (2011) paper wherein he speaks at length to the empathic connection as a healing force between helper and client.

In the examination of the data collected, Self Psychology was used in this present study to evaluate the narratives through an examination of veteran’s past experiences as told to the interviewer and the way veterans relate to the interviewer during the present.

As homeless veterans were asked about their experience of homelessness and their story of how they came to be homeless, relationship disruption was frequently mentioned in the narratives including early relationships. The context of growing up and the empathic successes and failures were be noted. At times, the steadiness or predictability of the veteran’s early childhood experience was interfered with, causing interruption in the internalization of the early selfobject functions. Possibly there was limited mirroring or idealization by a neglectful caretaker, depriving the veteran of the ability to internalize needed structures and processes.

As there was only one researcher, the other main area of evaluation was the interaction between the interviewer and the veteran. How the veteran related to the researcher in the present was possibly indicative of early relationships or how the veteran related to others. The researcher considered what was happening in the present with the veteran. Was there transference or countertransference with the veteran in the telling of

32 his/her narrative? Was the transference or countertransference indicative of a way that the veteran was seeking to have selfobject needs met?

Another consideration regarding Self Psychology when considering homelessness among veterans was that the concept of home could be considered as a selfobject.

Possibly, an early disruption or problem in the early ‘home’ would lead a person to want to find an ideal home. The military offers the promise of a home and for some offers a solution to the psychologically bankrupt early life development that was experienced, therefore giving an individual a psychological home. Another consideration might be that homelessness served a selfobject function by allowing a freedom from a structured, conventional life with an overly attentive or impinging caregiver. The Department of Veterans Affairs as a medical home once veterans were discharged from the military gives another way of considering selfobject functions as way to meet the needs of care with idealizing providers who assist veterans out of homelessness. The links between narratives of veteran homelessness and the research were further elucidated in the Results and Analysis section.

Self Psychology lends some deeper insight into the lives of homeless veterans.

The stories veterans shared when viewed in this theoretical light allowed the researcher to consider alternate ways in which the cycle of homelessness affects veterans.

Research Questions Explored This research sought to answer why veterans are homeless or how do veterans understand their homelessness. This was an exploratory, qualitative study which

33 attempted to answer a question about the subjective experience of homeless veterans.

Narrative analysis methods were used to gain an intimate view into the lives of homeless veterans. This study explored information on why veterans were homeless and what it was like to be homeless. The subjective view is an important view that is currently lacking in the literature.

Theoretical and Operational Definitions of Major Concepts This section explains the definition of a veteran, and the definition of homelessness. The central concepts to this study are veteran, homelessness as a condition and the subjective experience of a person who was both a veteran and was experiencing homelessness or who had experienced homelessness A veteran in this study is an individual who served in the active military and received an honorable or general discharge. This includes the Army, Navy, Air Force, Marines, Coast Guard and National Guard and Reserve soldiers (US Department of Veterans Affairs, 2007). Some of the veterans screened for interview had discharge statuses that made them ineligible for veterans’ benefits. These statuses, considered “bad paper,� include other than honorable discharges (OTH), bad conduct discharges (BCD), and dishonorable discharges. For the purposes of this study only veterans eligible for VA health care were included as veterans as they have access to a wide range of assistive services for their homeless situation. This was also the method that was used to access the veterans, by asking the VA or community programs that assist homeless veterans to offer the participation for the study. There may be debate in other forums as to whether

34 or not individuals with OTH or bad conduct discharge are truly veterans. According to the US Department of Veterans Affairs (2015) defines eligibility for VA health care as:

Veterans Eligibility For the purposes of VA health benefits and services, a person who served in the active military service and who was discharged or released under conditions other than dishonorable is a veteran.

Basic Eligibility If you served in the active military service and were separated under any condition other than dishonorable, you may qualify for VA health care benefits.

Current and former members of the Reserves or National Guard who were called to active duty by a federal order and completed the full period for which they were called or ordered to active duty may be eligible for VA health benefits as well.

Minimum Duty Requirements Reserves or National Guard members with active duty for training purposes only do not meet the basic eligibility requirement.

Most veterans who enlisted after September 7, 1980, or entered active duty after October 16, 1981, must have served 24 continuous months or the full period for which they were called to active duty in order to be eligible. This minimum duty requirement may not apply to veterans who were discharged for a disability incurred or aggravated in the line of duty, for a hardship or “early out,� or those who served prior to September 7, 1980. Since there are a number of other

35 exceptions to the minimum duty requirements, VA encourages all veterans to apply so that we may determine their enrollment eligibility.

The concept of homelessness was taken from the definition put forth by the US Department of Housing and Urban Development or HUD. The Homeless Emergency Assistance and Rapid Transition to Housing Act of 2009 (HEARTH Act) revised the definition of homeless for HUD’s homeless assistance programs, and on July, 2012, HUD implemented its final rule implementing this definition. The Veteran’s Health Administration adopted this definition of the definition for their homeless programs.

According to the US Department of Housing and Urban Development (2013), an individual who experiences homelessness is an individual or family who lacks a fixed, regular, and adequate nighttime residence, meaning: 1. An individual or family with a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings, including a car, park, abandoned building, bus or train station, airport, or camping ground; or 2. An individual or family living in a supervised publicly or privately operated shelter designated to provide temporary living arrangements (including congregate shelters, transitional housing, and hotels and motels paid for by charitable organizations or by federal, state, or local government programs for low-income individuals); or

36 3. An individual who is exiting an institution where he or she resided for 90 days or less and who resided in an emergency shelter or place not meant for human habitation immediately before entering that institution; Category 4: Any individual or family who: 1. Is fleeing, or is attempting to flee, domestic violence, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions that relate to violence against the individual or a family member, including a child, that has either taken place within the individual’s or family’s primary nighttime residence or has made the individual or family afraid to return to their primary nighttime residence; and 2.

Has no other residence; and

3. Lacks the resources or support networks, e.g., family, friends, and faith-based or other social networks, to obtain other permanent housing The only exclusion from this definition involves those who are incarcerated as they were not considered to be homeless by the US Department of Housing and Urban Development, (2007). The veterans that the researcher met and interviewed were a mix of those who stayed in permanent housing programs, transitional housing programs, shelter, doubled up with others, and those who also lived outside without a residence.

Because the researcher was seeking to obtain information about the subjective experience of homeless veterans, this researcher used narrative methodology in an exploratory approach to the material collected. This method not only examines the content of what the veteran says, but also the context in which the interview takes place,

37 the presence of the interviewer and an element of performance to the interaction. In collecting narratives the researcher sought to find common themes among the respondents that led to some answers to the research questions.

The Assumptions of the Study 

A significant portion of the homeless population were veterans. This amount was disproportionate to the number of veterans in the general population.



There is no significant qualitative studies that examined the struggles and subjective experience of homeless veterans. Much is available in the form of quantitative data, but little qualitative studies are available in the literature.



Veterans who were selected for this study were homeless and staying in a shelter, transitional program, permanent housing program, doubled up or outside or in a place not intended for housing.



Veterans are honest about their opinions and the information they shared regarding their history and were able to relate this to the researcher.



An improved understanding of homeless veterans and their early life could lead to improved, more targeted services to assist them.



The results were not able to be generalized to all homeless veterans but gave unique insight into the lives and subjective experience of individual homeless veterans.

38 

That there were many theories or ‘narratives’ of homelessness in regards to cause, solutions, and service delivery.



The researcher’s methodology helped to identify common themes and articulate them in depth.

39

Chapter III

Methodology Type of Study and Design This study used narrative analysis methods as described by Riessman (2008) to discover the subjective experience of veterans experiencing homelessness. More specifically, Riessman’s chapter on dialogic and performance analysis, chapter five, was selected for the emphasis on context and an idea of how one performs for the other.

This study used narrative analysis methods as described by Riessman (2008) to discover the subjective experience of homeless veterans. Narrative analyses are a family of methods for interpreting text that have a common storied form. This type of analysis attends to sequences of action, including people, places and context, and the use of language as to how and why incidences were storied. As opposed to other methodologies, such as grounded theory, the narratives were not broken down or fragmented into themes as the unit of analysis. Narrative methods attempt to preserve the story as a whole or to describe the essence of the subject by using the narrative.

Narrative analysis seeks to uncover what was spoken and how it was spoken. In the text by Riessman (2008), several types of narrative analysis were examined. In narrative analysis, the researcher asked the questions of “who,” “when,” “why,” and “for what purpose?” The researcher listens to how the stories were composed and attempted

40 to hear it in context. The narratives are seen and examined as a representation of the society and culture, and the researcher is seen as an active participant in the interaction.

The construction of reality through interaction is a focus of the analysis. An assumption of this method is that the ‘truth’ is produced in these interactions and is studied in regards to reality construction. Narratives were polymorphic (p. 107.) They are recognized in various ways depending on who was participating and who was interpreting the data. All readers were viewed as part of the interpretive process as every person’s interpretation and meaning were all equally plausible.

Riessman (2008) described a particular type of narrative analysis called dialogic and performance analysis which is a departure from the other types of narrative analysis.

She noted that this type of analysis incorporates components from thematic and structural analysis (p. 136). Thematic analysis has a main feature (among others) of keeping a narrative story intact and paying attention to the individual story (p. 53). Structural analysis methods “are concerned with content, but attention to narrative form adds insights beyond what can be learned from referential means alone (p. 77). So, using features of these two types of narrative analysis, dialogic and performance analysis was “a broad and varied interpretive approach to oral narrative that makes selective use of elements of the other two methods (thematic and structural analysis) and adds other dimensions” (p. 105).

Narrative analysis, regardless of the subtypes include the context of the situation but this feature is particularly important to dialogic and performance analysis. The conversation is spoken and heard in a context which must be taken into account. The

41 influence of the researcher, setting and social circumstances surrounding the interview are all relevant to the analysis. Stories are composed and heard that speak to society and culture, as well as to the individual or group interaction. Narrative analysis is a study of how social reality is constructed through interaction because, in the interaction, “truth” is produced.

Although language is the main focus of the narrative analysis, bodily form and nuance are also included as part of the analysis. Dialogic and performance analysis is based on the idea of performance. Riessman (2008) stated “one can’t be a “self” by oneself; rather, identities are constructed in ‘shows’ for others” (p. 106). This narrative method is at once an act and an enactment. The conversation among the speakers is dually produced and performed as a narrative. This lends to the idea of a performance through dialog.

Riessman (2008) considered the concepts important to the performance analysis and these were: direct speech, asides, repetition, expressive sounds and tense (ie. historical present, past tense). In a particular example in Chapter 5, Riessman wrote about Burt. He was wheelchair bound and his narrative included ideas about disability and masculine identity (pp. 108-116). By highlighting relevant parts of his personal story, each of the concepts was highlighted. Direct speech by the subject demonstarted direct action and “pulls the listener into the narrated moment” (p. 112). Riessman also noted asides by the subject where the direct narrative was stopped to engage the listener and often to explain the context of the direct action. Repetition was used to address a key moment by going back to the topic repeatedly. Expressive sounds were used in concert

42 with words to emphasize and highlight “pivotal turning points in the action” (p. 113).

Finally, tense was often alternated during the telling of the narrative and lent to the evaluation.

In part of the chapter outlining dialogic and performance analysis, Riessman (2008) gave several examples to highlight the methodology and a way of evaluating it. In one example, a group of young girls were interviewed about their experience. The steps by which the narratives were examined and called this the “five listenings.” To highlight how she used the “five listenings,” Riessman referenced a study by Lyn Mikel Brown (1998), a psychologist who studied pre-adolescent girls in Maine. In her first examination Riessman studied the context in which the narratives were taken, or the “overall shape of the dialog or narrative” (p. 117). Second, she examined the first person account from each of the girls or “the way they speak to and about themselves” (p. 117).

Next, Riessman paid attention to the social critique the girls offered and the emotion behind this critique, otherwise named the, “thematic content” of the narrative (p. 117).

Then, on the fourth and fifth listening of the narrative, Riessman focused on the way the subjects defined and spoke about the subject matter but also how they accommodated and resisted the definitions in the context (p. 118). In addition to these methods of listening, Riessman indicated that she does not necessarily decide before an interview what categories of information from the subject may be relevant; this emerges from the narrative and interaction. In this way, stories were viewed as dialogs and identities that evolved in the telling.

43 In this research study, homeless veterans were interviewed to explore their subjective experience. The interviews were recorded and transcribed by the researcher.

Once the interviews had been recorded and transcribed an examination of the narrative was completed. Riessman (2008) described dialogic and performance analysis in two ways, a detailed examination and a macro approach. Both of these were employed in the consideration of the narratives.

In a detailed examination, Riessman (2008) wrote about the concepts noted. First, the researcher examined the narrative for the direct speech, what was said by the veteran in the interview. Next, the asides or parts of the narrative where the veteran digresses to add to the narrative were noted. Parts of the narrative that were repetitive were noted as were any expressive sounds made during the telling of the narrative. Another facet of the narrative was the tense used in the telling of the story, whether it be present or past.

Also, a careful examination and explanation of the context or setting of the interview was included and described by the researcher.

In addition, in a macro examination, Riessman (2008) wrote of the listening perspectives or “five listenings� that were employed in the evaluation of the narratives.

When the narratives were collected from the homeless veterans, they were first listened to for the determination of the overall shape or feel of the narrative. Then, the first person account of each veteran or how they told their narrative about themselves was considered.

The thematic content or social opinions of the veterans was recorded by the researcher.

In the fourth and fifth listening of the narrative, the researcher noted the way the veterans defined and spoke about their subjective experience, but specifically how they identified

44 and resisted the definitions that they have laid out in the context. By using both the detailed and macro perspectives of the dialogic and performance analysis, the narratives were used to discover the experience of the homeless veteran.

In summary, dialogic and performance narrative analysis takes into account the dialogic environment and all of the complex parts that make up the interaction. As the dialog between the subject and listener evolves, an identity begins to form and a story is created. This unique narrative methodology allows for the subject and listener to cocreate a dynamic performance between them.

Scope of study, Setting, Population and Sampling, Sources and Nature of Data The sample involved 20 veterans who were homeless or had been recently housed. All veterans were interviewed by the researcher for consistency. In addition, the researcher transcribed the data. Eligibility for the interview was verified by the researcher as each veteran had to show proof of military service via a VA Medical Center card, DD Form 214 or military discharge certificate, (Department of Defense document which shows a veterans date of service) a VA Home Loan Certificate, or an award letter showing proof of VA disability. These are forms of documentation that a person would not have if they had not served active duty in the military and their service dates had not been verified by a federal agency. In addition, if a VA social worker referred the veteran for the project, these veterans were verified to be included in the electronic patient chart and verified to be eligible for VA medical care before being contacted for the study.

45

Data Collection Methods and Instrument Recruitment procedures.

The veterans were recruited by the researcher. The recruitment process went as follows. Veterans responded to a research study via flyer, through announcement, by VA Outreach staff or by information from the shelter staff. Veterans who were interested were asked to call to volunteer to participate. The calls were received by the researcher and an appointment was made to speak to the veteran. Verification of eligibility for the study was determined prior to meeting the veteran. The researcher met the veteran at a common point that would allow for confidentiality, such as an interview room in a shelter or public library. The study was explained to the veteran. If the veteran expressed an interest in the study after a basic explanation, the interview would proceed. The informed consent was read out loud to the veteran. The veteran verbalized understanding of the agreement including the ability to stop the interview at any time. If the veteran signed the consent, the interview started. The researcher was interested in the subjective experience of homeless veterans who were able to consent fully, see Appendix A. Therefore, a checklist (Appendix D) was created to make sure that all elements of the interaction were indicated. The checklist reminded the researcher to verify veteran status, verify homeless status, and verify safety and confidentiality of the meeting place. If it appeared as though a veteran may be unstable mentally, limited cognitively, using alcohol or substances of any kind, the interview would not proceed. If the veteran met all the criteria on the checklist, the interview would proceed. The interviews were recorded

46 digitally and by use of recording device on a cell phone in case one method fails.

Veterans volunteered their participation for the interview. They were asked to sign an informed consent allowing the researcher permission to record the interview. See Appendix B for informed consent document. See Appendix D the Checklist for Veteran Participation. After the interview, the veteran was issued a $20 gift card for their participation. In addition, a Veteran Resource Card was issued (Appendix E). This card was catered to the geographic location of the veteran. Because, in the event that our interview caused the veteran any discomfort, the resource card contained a comprehensive list of resources—both veteran and non-veteran to assist the participant.

Sample selection.

The sample was found by distributing flyer, See Appendix C, to places where homeless veteran seek supportive services. Also, eliciting the assistance of VA Homeless Outreach Social Workers assisted in recruitment. In the homeless veteran population, typically the fastest way that information spreads is by word-of-mouth. The researcher spoke with Outreach Social Workers at the VA Health Care System in Iowa City, IA, to request that they assist in finding a convenience or availability sample of veterans. The researcher was also a social worker employed at a VA Medical Center in the homeless program and had access to these employees and population. However, none of the flyers were posted on VA property and no work toward this research project was conducted on paid work time.

47 Sample type.

Rubin & Babbie (2010) defined a convenience sample as a biased sample, sometimes called availability sampling (p. 146). This method is often used because other approaches are not as effective with certain populations or it is inexpensive, or when subjects were readily available to the researcher. Homeless veterans could be difficult to approach. Often word-of-mouth transmission of information is how they gathered information about resources. Also, the researcher has gone to places where homeless veterans were (e.g. shelters, programs specific to veterans, etc.) which made convenience or availability sampling the best method for this research.

VA Homeless Outreach Social workers offered the study to any interested veterans and to shelter staff. In addition, a flyer was circulated to recruit homeless veterans. VA Homeless Outreach Social Workers distributed flyers to shelters and known homeless veterans in the Iowa City, IA, and its greater area (See Appendix C).

Veterans self-selected to be interviewed and as long the veteran was interested they were verified for all items on the Checklist for Veteran Participation and interviewed. The veteran was compensated for the interview by a $20 gift card. This compensation may have assisted in the recruitment process. The researcher later learned that many homeless veterans attempted to decline the gift and expressed an interest in helping the researcher.

In these cases, the researcher insisted the veteran take the compensation with thanks.

Homeless veterans are in need of financial resources. No interviews took place outside, ‘on the street’ or in a homeless camp. The homeless veterans in the study were interviewed once with the exception of one veteran who called and indicated he had more

48 to add. The researcher traveled to the shelter or location of the homeless veteran to conduct the interview. Due to the transient nature of the homeless population, multiple follow up interviews seemed unlikely. However, the researcher gathered contact information for each veteran in hopes of being able to follow up if needed at a later date.

The researcher anticipated that additional referrals by word of mouth would happen after several interviews and this did result in a more veterans contacting the researcher.

The first question of the interview often became the majority of the interview.

The researcher asked guided questions and sought to understand the feelings that the veteran described about his experience. The interviews were recorded using a digital recorder and cell phone recorder. Two recording devices were be used in case one failed.

The researcher transcribed each interview and examined them for themes with regard to each question.

Guided interview questions.

The interviews were guided by several structured questions. See Appendix B for the question guide. The researcher allowed veterans to speak on the topic of homelessness to get to the subjective experience of what it is/was like to be a veteran experiencing homelessness. The data collection occurred as follows. A veteran called the researcher or was given a flyer by a VA Outreach social worker. The veteran and the researcher arranged to meet, preferably in a public, yet confidential space allowed by a library, shelter or meal site location. The veteran was introduced to the study and its goals. The researcher used the Checklist for Veteran Participation to ensure eligibility. The veteran

49 was asked for contact information in the case that they permit the researcher to contact them at a later date. The veteran was given the informed consent and the researcher read it out loud to the veteran. If the veteran expressed their understanding and signed the form giving consent, the interview began. The interview was recorded. Once the interview was completed, the veteran was given a gift card by the researcher, with thanks.

In addition, a Veterans Resource Card was given after the interview. In the event that the interview caused the veteran any uncomfortable feelings, the resource card contained a comprehensive list of resources—both veteran and non-veteran to assist the participant.

The research questions were: 1.

Tell me the story of how you came to be homeless.

2.

Is this the first time you have been homeless?

3.

What do you think caused you to be homeless and why?

4.

What is it like to be homeless? or, How does it feel to be homeless?

5.

Was there anything that surprised you about being homeless?

6.

What has been positive about your experience of being homeless?

7.

What has been negative about your experience of being homeless?

8.

Do you feel that being a veteran influenced your becoming homeless in any way? If so, how? If not, why?

9.

Do you think that being a homeless veteran is seen differently than being a homeless person?

10.

Are there any other comments you would like to make regarding the experience of being homeless?

50 The first question, Tell me the story of how you came to be homeless, was being asked in an effort to gather the “whole picture� of the veteran. In working with homeless veterans the researcher discovered that it was rarely just one event that causes a veteran to become homeless. The story usually chronicled a series of events and constellation of problems that resulted in homelessness. The researcher was curious about common themes among individual stories regarding how veterans became homeless.

The second question, Is this the first time you have been homeless? If not, how many times have you been homeless in your life? This question was intended to understand if homelessness had been a long-standing pattern or a short term situation for the veteran. Veterans who are chronically homeless may have different ways of functioning or thinking about their experience.

The third question, What do you think caused you to be homeless and why? This question was asking the veteran directly what they believed the cause of their homelessness was.

The fifth question, What is it like to be homeless? Or, how does it feel to be homeless? This question was asked in an effort to discover the feelings of veterans who were homeless. This question intended to discover feeling states associated with homelessness.

The next few questions were similar: Was there anything that surprised you about being homeless? What has been positive about your experience of being homeless?

What has been negative about your experience of being homeless? These questions were intended to solicit self-reflective and subjective information about what the experience of

51 homelessness. The researcher sought to solicit responses of insights veterans might have about their homelessness.

The ninth question asks, Do you feel that being a veteran influenced your becoming homeless in any way? If so, how? If not, why? This question was asked to seek understanding about the relationship between veteran’s homelessness and their military background or experience.

Finally, the interviewer asked each veteran if there was anything we did not cover and that they would like to add to the content of the interview.

Plan for Analysis of Data The interviews were recorded and transcribed. The transcribed interviews were then be read and examined for narratives and themes in common with other interviews.

Narrative theory by Riessman (2008) was the guiding text for analyzing the interviews.

Using the chapter on Dialogic and Performance Analysis, the narratives were analyzed for different meanings, paying particular attention to the elements noted previously.

Statement on Protecting the Rights of Human Subjects Homeless veterans were considered a vulnerable population by Institute for Clinical Social Work Institutional Review Board (IRB). This researcher took precautions via a Checklist for Veteran Participation to ensure they possessed the ability to consent and meet with the researcher in a confidential yet populated space. This research was approved by the Institute for Clinical Social Work IRB process, Chicago, Illinois, to

52 ensure no harm to human subjects occurred. This study did not include anyone that the researcher had assisted or worked with clinically as a patient to avoid a power differential. In addition, an informed consent was read out loud and explained in case veterans might miss critical information due to reading difficulties. Veterans were verbally explained the risk and their right to decline participation in this study. See Appendix A for Informed Consent Document. See Appendix D for the Checklist for Veteran Participation. In addition the researcher created a Veterans Resource Card (Appendix E). In the event that our interview caused the veteran any discomfort, the resource card contained a comprehensive list of resources to assist the participant. veterans were told that they could opt out of this study or cease to participate at any time without any negative impact to their eligibility and availability of benefits and services.

Limitations of the Research Plan As mentioned previously, because this study was on the subjective view of homeless veterans, the results might not be able to be generalized to all homeless veterans. However, Riessman (2008) asserts that narrative methodology reveals the truth about human experience (p. 10). In addition, the guided questions were simply that, not an instrument that had been used previously so the validity and reliability was not known or tested. As the researcher was an employee of the VA Medical Center Homeless Veterans Program for the past fourteen years, there were many client contacts over time.

However, due to the large geographic area of the population served, the researcher had access to a wide variety of places to encounter homeless veterans so no problem was

53 encountered in finding the sample. Also, if follow up interviews had been needed to complete the data collection, this would have been assumed to be difficult due to the population selected and the transient nature of some of them.

54

Chapter IV

Results Description of Sample This research study included 20 veterans. The veterans were informed about my study from social workers who work for the VA Health Care for Homeless Veterans Outreach team, shelter staff at three different homeless shelters with veteran programming, and one employment support agency that served veterans in the Midwest Region. The veteran participants responded to a flyer posted at shelter or shown during a group meeting, and veterans called the number on the flyer. Once their VA eligibility status and lack of previous contact with the researcher was verified, the researcher scheduled a time and place to interview the veteran in compliance with the Institutional Review Board’s (IRB) direction. The IRB’s direction included making sure the interview was private, but held in a setting where others were present.

Of the 20 veterans, 17 were male and three were female. All veterans interviewed were eligible for VA care as verified by a member of the VA Homeless Outreach Team at the researcher’s place of employment. The veterans were all verified to have had no contact with the researcher prior to the research interview. Eleven veterans were homeless and staying in a shelter at the time of the interview. Of these 11, four veterans indicated it was their first homeless experience. The remaining seven veterans ranged from two homeless episodes prior to the current event to several indicating it had been a

55 pattern of living for more than 30 years. The other nine veterans in the sample were housed with a history of homelessness at the time of the interview. All of the housed veterans were participants in a VA permanent housing program which enabled them to use a HUD Section 8 voucher, called HUD/VASH. HUD/VASH allows veterans to live the in community with a rent subsidy and receive case management from a VA social worker.

Some basic demographics were collected by observation. No information was requested from the veteran other than their age and branch of service. The mean age of the participants was 51 years old. The mean age of the men was 52 and for females the mean age was 44 years old. Two of the women identified as being lesbian. While race was not requested information, the veterans were mainly Caucasian (14), African American (2), Native American (2) and of Mexican descent (2).

All of the branches of service were represented with the exception of the Coast Guard. There were eight Army veterans, two Navy veterans, four Air Force veterans and three Marine Corps veterans. Three of the veterans interviewed served in more than one branch of service. One veteran served in the Marine Corps Reserves and the Army and two participants served in the Army and the Navy. In addition, one of the veterans who served in the Marine Corps served at two different periods of time. Three of the veterans interviewed reported having combat experience (two from the Vietnam Era and one served in Iraq during the Global War on Terror). These three were all US Army veterans.

In addition, the two Army veterans who served in the Vietnam Era both indicated that they were trained in Special Forces and were cautious about disclosing too much about

56 their military history. One Army veteran indicated that he was involved in special services by serving for the National Security Agency (NSA).

Of the 20 veterans interviewed, 12 served during a peacetime era. Two veterans had periods of service where the majority of time served was in peacetime, with several overlapping years in the Persian Gulf era. Neither of these veterans served in combat.

Six veterans served during a combat era, three from the Vietnam Era and three from the Persian Gulf Era. However, as indicated earlier, three veterans actually reported combat experience.

Fourteen veterans mentioned their job or training while serving in the military during the narrative. This data was not requested but emerged during the telling or their story. The jobs that veterans worked in were as follows: six veterans did not indicate what their job was while in the service; two indicated they were infantry; two reported working in supply and logistics; two indicated they were military police; two indicated they were in artillery or weapons; two indicated they were trained in Special Forces operations and were reluctant to expound on details; one veteran indicated he had a special clearance and worked for the National Security Agency or NSA; one veteran reported being an operating room technician; one veteran reported being first a field radio operator and later training for payroll; and one reported he did not complete his basic training and was not assigned an official job.

All of the information gathered for this sample description was from veterans narratives. Other than veteran’s age, gender and branch of service and service time, no other information was directly requested from the participants.

57

Summary of Findings Homelessness inhibits feelings and affect.

One of the findings that emerged after the first five or six interviews was that veterans experiencing homelessness had immense difficulty answering questions about their experience of homelessness, especially exploring feelings, while currently being homeless. These veterans were unable to reflect on their experience because they were in the midst of their experience. From this finding, the researcher then began to include veterans who had experience with homelessness but were recently housed. The interviews were deepened and there was greater exploration of feelings and thoughts in many aspects of the interview.

Veterans feel they are viewed differently.

One of the research findings revealed was that veterans felt and thought they were viewed differently than other individuals who were homeless. These veterans were likely to respond in four different ways to this question. Some veterans saw no difference in their homeless situation from another person who was homeless, whether they were a veteran or not. The second common response was that veterans were seen differently by outside observers because there was less of a judgment upon them than towards nonveterans. Often, veterans mentioned how they were viewed by others and the stigma of

58 homelessness and the discomfort they felt. Lastly, veterans reported feeling seen differently by others that they shared shelter or programs with.

Didn’t know I was eligible for VA. The veterans interviewed indicated they had difficulty accessing veteran’s benefits or did not know they were eligible for VA services. This theme emerged repeatedly. The majority of participants were involved in a medical crisis; therefore, eligibility for VA benefits is vitally connected to support and prevention efforts for them.

Many participants reported that VA resources assisted them in exiting homelessness due to the wide array of services available such as shelter, employment, housing, support, health care, mental health care, addiction services and basic needs. Some suggested that it took getting to be homeless for this network of resources to be available. Veterans also commented repeatedly that being a veteran really had nothing to do with their homelessness. On the contrary, VA eligibility enabled them to climb out of homelessness.

Versions of homeless narratives.

All veterans interviewed had a story or narrative that appeared to have a rehearsed quality to it. The participant’s narratives had similar elements such as veterans’ description about the experience of homelessness, similarities to military life, positives, negatives and surprises about the experience; and some veterans also added comments about advice they have for other individuals regarding homelessness.

59 Relationship disruptions.

All of the veterans interviewed for this study mentioned relationship disruptions in their narrative. The participants spoke of relationship disruptions in a variety of ways. veterans talked about early life disruptions that seemed to set the tone for future disrupted relationships, relationship disruptions with the military, and relationship disruptions in their adult life with partners and children.

Finding One: Homelessness Inhibits Feelings and Affect One of the findings that emerged after the first five or six interviews was that homeless veterans had immense difficulty answering questions about their experience of homelessness. This was especially evident during the veteran’s exploration of feelings as the answers were relatively superficial. For instance, when asked how homelessness felt, a 58-year-old Army veteran stated, “If I had to tell somebody [what homelessness is like] let folks help you. Just let ‘em help you as much as they can because there’s no fun out there on them streets. It’s no fun.”

A 46-year-old male Air Force veteran replied to the same question: Yeah, but I don’t [long pause] for me it was just kind of another, just, another part of my life. It was like, I knew everything that happened, brought me into that life there were things that took me out of staying in my truck. But again, there’s good and bad about, I guess everything. And I don’t know that I was, delusional about, getting an apartment and some kind of utopia.

60 A 61-year-old male Air Force veteran said, “Just that I highly recommend against it! If at all possible.”

These veterans were unable to reflect on their experience, possibly because they were in the midst of their experience. The first interviewee, a 46-year-old female Navy veteran, resisted being considered homeless. She stated: Nah, I’ve never actually been homeless—I always had a place to stay. It’s just not my place, you know it’s been the last year and a half, two years it’s pretty much been in and out you know? I got two months I can stay with this friend, but it’s never been to where I’ve been in a shelter or out on the street.

This veteran resisted the definition of homelessness and did not explore or elaborate her feelings in any depth.

With the consideration that feelings and affect might not likely be shared if the veteran was homeless, the research expanded to include veterans who had experience with homelessness but were recently housed. A greater range of affect, emotion and reflection were reported from the housed veterans versus those who were homeless. This is not to say that some veterans who were homeless were not able to explore feeling in depth, but that more of the housed veterans appeared to be able to access deeper feelings and thoughts. Possibly, once the homeless experience was in the past, the veteran was more able to consider and speak about the experience. For instance, a 57-year-old, male, Army veteran spoke of his experience: V: I ended up, I got fired for absenteeism. Well, even better now because now I got all this time to do what I want to do and, I don’t need this job because now I

61 can sell drugs and be my own boss! Well, that doesn’t work out so well if you’re your own best customer. So, ah, that didn’t work and sooner or later ah, things spun out of control and, um, I had, the money that I did have was gone and the people I thought were my friends were gone and if you want to find out who your friends are, party till the money runs out. And you’ll find out real fast who they are. But I still had you know, this cocaine habit that I had to deal with and um, there was no warning label on any of the packages I ever bought telling you that so…

S: On the cocaine packages?

V: Yeah, no little, disclaimer at the bottom saying this could be addictive. So, anyway, I continued to party and scheme and scam and um, hustle and do what I had to do to support my drug habit. And, wound up, um, I lived with my mom for the last 10 years of her life. And, not worried about income because I’m sponging off my mom. I lied to her. I stole from her. I cheated her and took advantage of her in every way.

The veteran was able to expound on details of the narrative once no longer in a homeless situation and having perspective and sobriety.

Another housed veteran, a 53-year-old male Army/Navy veteran, talked about his feelings about homelessness: V: So it’s like a real smack in the face. But it was a real wake up call for me too, it made me realize a lot. A lot of things. Ah, about my life and where, what I needed to do with it and where I needed to go.

62 S: So if you had to put feeling words on your experience what would you say?

How did it feel to be a homeless person?

V: Ah, depressing. Ah, angry. Ah [pause], very humbling experience. Ah, that you know I, I was like I said I was mad, I wasn’t happy about anything, I was always angry about a lot of stuff. You know especially I was pissed off at myself more than anything. You know? Because I put myself in that predicament, it’s nobody else’s fault but mine. And you know it is, a lot of anger there. And um, sorry. I was very sorry for a lot of things I had done in my past. That you know, put me where I was at. And it’s, um, I had it was embarrassing to at the same time so yeah.

The interviews were deepened and there was greater exploration of feelings, thoughts and more prevalence of affect, in many cases this was a tearful time during the interview where veterans cried or fought back tears as they expressed themselves.

Finding Two: Veterans Feel They Are Viewed Differently One of the research findings revealed was that veterans felt and thought they were viewed differently than other people experiencing homelessness. Veterans responded in four major ways to this question. Some veterans saw no difference in their homeless situation from another person who was homeless—whether they were a veteran or not.

The second common response was that veterans had a perception that they were seen differently by outside observers because there was less of a judgment upon them than towards non-veterans. Thirdly, veterans mentioned how they were viewed by others and

63 the stigma of homelessness and the discomfort they felt. Lastly, veterans reported feeling seen differently by others that they shared shelter or programs with. Veterans reported those who could not access the resources that veterans have access to were frustrated or jealous of them.

Veteran responses in the first response category were that ‘homeless is homeless’ from an outsider viewpoint. A 58-year-old Army veteran stated, “There’s no difference.

Homeless is homeless. You can tell ‘em look, I’ve been a vet, but, umpteen years, homeless is homeless!” (Emphatically) A 57-year-old male Army veteran reported: Actually, no, its not. They just ask you if you’re a veteran and they ask you what kind of stuff you been through in the military and some you tell and some you don’t. And then, like you, they got people out there that, kinda interested in it, ask them how do they go about doing it and some of them say “I just got out of the joint,” “I can’t get a job,” or anything else. So I come down here [referencing living on the river] and he’s helping me out. This guy’s helping me out. And you know it’s about the same thing you know. We’re, jobless, homeless, even though I’m a veteran that still doesn’t make any difference, still homeless [chuckles] you know?

Other veterans interviewed indicated that they were seen less critically by those outside the homeless community. A few veterans stated that the public were generally more empathic to veterans who were homeless, presuming that there was a reason that they were homeless. Veterans reported outsiders assumed problems were connected to

64 their military service whereas non-veteran’s experiencing homelessness were viewed as doing something wrong to end up homeless. One veteran, 57, male, who served in the Marine Corps said: Because if you’re a homeless veteran, you got people that look back and say alright, he’s a veteran he helped us, let’s help him. Other people that are homeless, that aren’t veterans, the same people have a tendency to look at it like well, you did this to yourself.

A 57-year-old male Army veteran echoed this sentiment by saying: Oh I think sometimes people might think, another misconception, Oh that guy’s fucked up from being in the military, give him a break, he just can’t deal with society. Um, or something must have really, terrible must have happened to him in Vietnam or wherever he was at.

A 51-year-old male Army veteran indicated: Oh, if I were to like meet somebody on the street and say I’m homeless, is that what you’re saying versus being in the military or not? I think a lot of people would say ‘Wow! What’d you do to get there? God! Need any help?’ I know for a fact that, other people would say they had not served, I know people would say well, what did you do? You steal something er, you know? You not know how to take care of business or? And I think too, I talked to a lot of people and there’s some guys that are in the military that are, really have a lot of issues.

Whether it be PTSD or you know, just some of the stuff they did that may not be service connected at all but I think I’ve seen a couple guys that care through here

65 already in our room that, we got one in there now, he’s got some serious, serious issues. But you know he was a Vietnam era Vet and wow! He’s got some problems, he needs help and I think they’re sending him to [treatment] but back to your, yeah, I think outsiders see it different.

In addition, the response of considering how the public may view homeless veterans versus non-veterans often led to a discussion of what participants perceived people thought of homeless veterans or homeless people in general and the stigma that resulted. Veterans focused on how they were seen and appearances were very important.

A 61-year-old male, Air Force veteran stated: I don’t know, I’m trying to think in my own mind, you know, I always knew, that there were homeless veterans and I always knew that a surprising number of homeless people are veterans. Um, so that was no surprise to me. Ah, the fact that I became one was a very major surprise. Whether they’re viewed differently?

I don’t know. I, I honestly don’t know. I know I absolutely hide the fact that I’m homeless wherever I possibly can. No, I, I use an address for mail and everything, my sister’s address over in [city], you know. I’m not telling anybody I’m homeless. I think the only way that I would look down on a homeless Vet is if they were dirty and grungy and didn’t take care of themselves. Now you know that there are certain guys who are out on the street you know and that they can expect to have a little grunginess and dirtiness but if you know you can find someplace like I found out there are places you can take showers that sort of thing, and you can go into the Y and get like a day membership or something and,

66 use a shower and, even though you might be homeless, you know, there’s no reason to be totally grungy. You know, I happen to use an electric razor—you can usually find a place to recharge those. If worse comes to worse you know they’ve got disposable Bic razors for cheap. You can always go to into a gas station, use the, bathroom, get a shave, and wash your face. Wash your pits with soap and water. Um, there’s no reason you should be grungy and stinky. My mother always taught us you might be poor, but that’s not a reason to not be clean. So from that perspective I might tend to look down a bit. And say have pride left and I, I think with some of these guys they are to that point- they have no pride left. You know, they’re just so down and out.

A 56-year-old Marine Corps veteran talked about the stigma that he and his 16year-old daughter felt when they lived in their van “The way people look at you. When they know that you are homeless. Or they know that you’re struggling. Less than them or beneath them.”

A 58-year-old male Army veteran, described his experience in this way, Those barriers you know, it’s like, it’s like when [city], or [another city] like I was always dressed up. I probably had 30 suits, nice ties and, but, even, I could go up and go in anywhere I wanted to go. No questions asked. They wouldn’t even bother to look at me. Because I was dressed like they were I looked same as they, my shoes were shined as well as theirs and my clothes were probably more expensive. [chuckle] You know I’d walk through the door and, they would come and serve you and take, and you know, and treat you different. But when I was

67 homeless and I had my backpack and something like, you know I wanted to get something to eat and I had the money well, I’d be sitting there 30 minutes waiting on somebody to bring me a water or, or they’d say well we can’t serve you or, whatever. But on the other side of that coin when I was dressed up and I was sharp and, didn’t even, [snaps fingers] right, instantly they were there you know, taking care of me.

S: You were “a normal customer.”

V: But I could have all of my, I could have a pocket full of money you know?

S: Right. So it’s the public perception, I mean, in addition to the shame?

Internally there’s that external stigma, what, what is, which you have no control over, what somebody else, what somebody else’s idea is of a homeless person.

And that that ends up affecting your, your situation. You’re going to sit there for 30 minutes while they go to get a glass of water because they apparently think something about your situation, V: Right. They’ve already made up their mind. The, the, when, when you come in they make up their mind if you’re all dressed up and you know you’re looking good you know.

Stigma and public judgment were often mentioned as difficult to manage for homeless veterans.

The other avenue veterans chose to address this question was to identify that within the homeless community. Non-veterans were at times jealous or hostile of the preferential or special treatment that veterans received. At times this meant differences in

68 how veterans were treated while using homeless services or that veterans had more opportunities and resources than others. A 59-year-old Navy veteran stated: By normal people, I don’t think so. Maybe by the homeless I think they do [get viewed differently] because they know that they have a lot more, benefits that they can get. There’s different places you know? The outreach and the welcome center and stuff and, they were always jealous you know? Well, you can do down there and sit all day, we [non-veterans] got to go to the library.

Another veteran, a 58-year-old Navy/Army man stated: In some ways yes and in some ways no. But here [shelter], they’re seen as different because they [veterans] get to stay longer. So some of the people that don’t have the opportunity. It used to be they could stay here a month, now the, its only 2 weeks. So some of them kind of resent that. When you go into the veteran’s rooms. You know they can, down here, they can stay in their rooms during the day and stuff.

A 56-year-old female Army veteran also housed at the shelter reported, “I think it is only because we have veteran’s rooms. That’s the only thing that separates us.” She later adds: And you have more space. You got two lockers, not one. I mean there are advantages to that but I never raised, I never raised a flag and said, “Oh my God, I need to be in that Vets room,” I mean there was other deserving people out there too.

In another example, an Air Force veteran, 30, stated:

69 I don’t run around telling people I’m homeless so I couldn’t tell you that. But, I could tell you to the people that are there, they’re jealous. They’re very jealous.

Because I am held to a higher standard and higher regards. It’s also a respect thing too. You know, I respect monitors, not all of them. But I do respect the ones that I like. And they know that I’m also, they also know that I have a voucher to get out of there [section 8 housing voucher]. And, they know I have income. It is because I’m a veteran and I have more respect. Then, that is the big one because I always get [sarcastically] “Oh, she’s a vet, she gets all the privilege.”

A fourth way that veterans talked about being seen differently was within the research project and in relation to the researcher. Veterans explained that the story of homelessness they were about to disclose was unlike any other story the researcher had ever heard. It was as if they participant wanted to be viewed by the researcher as an individual who faced circumstances that were unlike anyone else. A 57-year-old, male, twice-enlisted, Marine Corps veteran said: Well, I’m afraid, I may be something of an outlier, ah, among your data. I, my perspective on my homeless men or homeless in most cases is not popular. I share the common belief when I first began last—let’s see 29 November 2010 and within a matter of weeks—ah, I had an education. So, I may be saying things that don’t please people when you ask me about, um, the reasons for homelessness and such.

70 A 30-year-old female Air Force veteran talked about her differences “You know and it’s like those people over there are over there for a different reason than I am.” She later comments: Ah, obvious drug deals right in front of your face. Um, stealing, lying manipulating, ah, the “How you doin’?” [NY accent] you know? Hitting on me, constantly you know? It’s just, I am not, they’re used to the streets. You know?

I’m not.

A 61-year-old Air Force veteran when asked how he came to be homeless informed me about the differences between himself and other shelter guests: Ah! [big sigh, small sigh] Totally unrelated to the way most people do. Just bad, bad, bad judgment. I sat there and tried to maintain my company way beyond where I should’ve maintained it. You know I should’ve realized it was dead and let it go and buried it. And I didn’t. You know, I had it for 36 years and it wasn’t just till the last few years that I was getting in trouble.

In a different facet of this, a 46-year-old female Navy veteran, resisted being categorized as homeless. Despite having no permanent residence for many years, she did not consider herself homeless. She reported: Nah, I’ve never actually been homeless, I always had a place to stay. It’s just not my place ya know? It’s been the last year and a half, two years it pretty much been in an out you know. I got two months I can stay with this friend, but it’s never been to where I’ve been in a shelter or out on the street.

71 Finding Three: I Didn’t Know I Was Eligible for VA Eighteen of 20 veterans interviewed for this study indicated they did not know they were eligible for VA services. This theme emerged repeatedly as veterans would indicate they were unaware of the VA benefits they had and community resources available to veterans. A couple veterans reported being told erroneously that they were not eligible for VA care. The majority of veterans interviewed had been involved in a medical crisis that led to their homelessness, illustrating how critical VA eligibility can be to prevent a veteran from being homeless. Many veterans reported that VA resources assisted them in exiting homelessness due to the wide array of services available such as shelter, employment, housing, support, health care, mental health care, addiction services and basic needs. Every veteran interviewed at one point indicated problems with knowing how to access VA benefits.

As stated previously, 18 of 20 of the veterans interviewed reported that they had no idea they were eligible for VA care. All participants indicated difficulty accessing VA benefits. A 46-year-old female Navy veteran was out of the military for 17 years before she accessed VA health care. It was particularly important to her as she is diabetic: V: I say I got my discharge in ’94. I didn’t even go to the VA for my medical care till 3 years ago.

S: Why so long?

V: Well for one, when I got discharged we were told nothing about what kinda benefits that Vets could apply for, which I know is a big issue all the way around.

But the guy was somebody that I ended up hooking up with just before my

72 divorce was final. He was military. And he actually did work as a VA rep. So he’s the one who actually helped me get hooked up with VA. No one told me there’s, not a program or anything set up so you know, saying you were a ‘short dog’, which is what we called it when you, you’re in the single digits before your discharge papers, short dog! Would it hurt to set up a class that you could attend?

A 58-year-old male Army veteran reported: Years and years. I didn’t start using it until I got here [shelter]. And Kevin uh, asked, “Are you a vet?” and all this and, said, “Yeah.” He said “Do you got any’ ah, ah he said ‘Well, we gonna do this—we gone check see what’s going on with you.” He check, he said “Have you ever won the lottery?” I said “No.” [chuckle] He said, “Well, I tell you what, today you just did.” I say, “What?” He say “You got your health care!” I said “No stuff!”

This veteran left the military in 1975. In the case of both veterans, neither knew of their eligible status until they accessed homeless resources. A 56-year-old male Marine Corps veteran said: Right. A lot of them don’t know they are eligible. I didn’t know. You know I just figured my short time in service and, don’t worry about it you know, just move on. You know, take care of it yourself and that’s what I’ve always done.

And then I got to a point where I couldn’t.

Veterans spoke at length about the network of resources made available to them and how comprehensive they were. Often, they were surprised and delighted to learn

73 what benefits they were eligible for and could use. Another 53-year-old male veteran who served in the Army then Navy indicated: They helped me get the res, because I had no idea of the benefits I had through VA, which was you know, pretty astounding! I just did my time in the military you know, go down to the VA whenever I needed get something done. But, they helped me get my, ah, I have a 20% service connected disability on my right shoulder and they did some surgery on my foot. And, I’ve had two surgeries on my right shoulder due to the accident I had while I was in the Navy.

It is important to note that most veterans noted that the reason for their homelessness was a medical crisis, undiagnosed mental health problem, or addiction.

Equally enlightening was the fact that many veterans start the story of their homelessness with the story of their medical crisis. Some veterans said having VA care as prevention might have changed their situation dramatically. Many veteran narratives began similarly where veterans began at the point of their medical crisis. A 53-year-old male Army veteran stated: Well, I had been living with my daughter and son-in-law and he decided he didn’t want me around anymore so I moved back to [town] and then I had my open heart surgery, that was in, I got booted out of their place in July and then the 12th of August I had open heart surgery, triple bypass.

A 46-year-old male Air Force veteran described a similar problem: I um, [long pause] was in [town], I had been there since ’96-97 and I was working at a restaurant [clears throat] and I had went to the emergency room cause I

74 thought I had had a stroke. And so I went there and they said well you didn’t have a stroke but you had a heart attack. And they were going to do a balloon catheter, I think they were going to do the balloon catheter but they couldn’t.

And, they said that four of my, I had four arteries or four blocked vessels or whatever.

In a similar scenario, an Army veteran age 51, talked about his medical struggles.

“And then um, well, all about the time I got over that [MRSA infection] was on my birthday. I got up in the morning and let the dog out, came in and had a heart attack!” [laughs] Other conditions that contributed to homelessness were mental illness, alcoholism and drug problems. An Army/Navy veteran, 58, talked about his problem: Now, if I’d have saved up more money I would’ve been in a little bit better shape but the drinking would have still been a problem. Ah, that just made it a little bit worse and so, ah, then in that time somewhere around 2000, 2001 or so, I forget the exact year. I had family members starting to get sick.

This same veteran later reported he had lived with undiagnosed Obsessive Compulsive Disorder and a mild form of Asperger’s syndrome. A female Army veteran, age 56, spoke of a similar problem: Um, what’s my story? [pause] Let’s see. I think it was ah, you’ll get me crying, um, [begins to cry] just building from depression, and then I lost my job. And um, I just started drinking something terrible! [sobs] After about a fifth of vodka a

75 day I went from 0 to 100, just overnight, because I hadn’t drank in 25 years. [scoffs, tries to pull herself together] This veteran then suffered multiple medical hospitalizations and pancreatitis due to her excessive drinking.

Another veteran, a Marine, age 47, talked about his spiral down when he was being processed out of the Marine Corps for flat feet: Yeah, yeah, so, they told me I had to go. [his voice breaks] Now, [breathless and fighting back sobs] some, so [sobs], I don’t know what to do. I go outta town. I smoke some marijuana. I pop positive on the piss test. So my last 45 days in the Corps were on restriction. Everybody else is going to the field so there’s nobody around. You get pretty isolated. So I get out. And, nothing is like being in the Corps, as far as allegiances with people, [sobs and inhales] work ethic, [sobs] none of that. So, I go home, and you know, start doing harder drugs [still crying and then gathering himself] PCP, cocaine, but you know, my mind was racing so fast that I came back out to California. I stayed. I came back out and, started other, doing other drugs. I was doing, started doing crystal meth, had a baby in ’89, [sniffs] ’91, came back home. And being that I was still in that military frame of mind and getting high, I said the only way I am going to survive this is, I went into, like military mode. I’m talking reconnaissance. Learning how people were moving and because I knew that, I mean, in my heart of hearts if I didn’t learn how things were out, there, the thought of stopping getting high didn’t even cross my mind. But, you know, how everything was so I spent 2 years, like in the

76 trenches. We call it split to the white meat, hanging out with people that usually get their skulls split to the white meat cause of indiscretions in the street. But, socially I am very astute so I know that if I hang with those people two things will happen. They will show me how to move around and they’re going to show me the ins the outs of everything. And I’ll tell you: when you run with that crowd, nobody messes with you.

The discussion about VA benefits and eligibility was often tied closely to these chronic medical, mental health or addiction issues. These topics would often then lead to comments by veterans that being a veteran had nothing to do with their homelessness.

Nineteen of 20 veterans denied that their military service had anything to do with being homeless. On the contrary, VA eligibility enabled the network for them to climb out of homelessness or at least to persevere during their situation. A 56-year-old Marine veteran responded: Well, I’ve, I’d say the only thing that [being a veteran] really influenced was standing up for myself. Taking care of myself. I did the best I could as long as I could. And then the only reason it became where I couldn’t do it was because of my health.

A 53 year-old Army veteran who struggled with depression, medical problems and addiction, stated it this way: I don’t think it did. Because I never used being a veteran as a crutch. Ah, uh, as far as an excuse for anything. I’m very proud of being a veteran. And I will never, you know, have no regrets. Um, if I had to do it all over again I would’ve,

77 probably stayed in and retired. Yep. But um, you know I, I had never, I don’t know being a veteran ah, that really, that really wasn’t, that was the last thing on my mind you know I was, when I was homeless I mean, if anything it helped me out, my, getting to where I needed to be.

Finding Four: Versions of Homeless Narratives, Long Story Short All veterans interviewed had a story that they told when talking about how they came to be homeless. In many cases, the narratives appeared to have a rehearsed quality to them. In addition, the narratives took shape containing similar elements such as veterans’ descriptions about the experience of homelessness, including the similarities to military life, positives, negatives and surprises about the experience and some veterans also added comments about advice they have for others regarding homelessness.

The narratives from veterans had been told many times and the veterans attempted to tell the story in a way which showed them as the victim of circumstance. As mentioned previously, the most common explanation for the majority of veteran’s homelessness was a medical crisis. The remainder outlined problems with an addiction or mental health problem, at times, undiagnosed and untreated. The veterans’ narratives appear to have been carefully crafted to assist them in making some sense out of what happened.

While the interviews were genuine, some had the quality of being told over and over. A 53-year-old Army veteran talked about his experience:

78 And then I was living with some friends, she turned out to be psycho. And was pushing it so bad I just couldn’t take it anymore and I called the Veteran’s Crisis line and they had me go to [hospital]. And then [hospital] said “No, we don’t want you going back to [city] to face that” because of, the crap that was going on.

So then, they sent me down here and I’ve been here since, like, the 10th of September.

Another veteran, Air Force male, 46, stated: Well, they were going to put a balloon there. I don’t think they got to stent; they didn’t get to the stent. They kept that in there and they drove me in an ambulance from [city] to [another city] and that’s where I had the bypass a couple days later.

Um, and that was, you know, making pretty good money but spending it like it was always going to be there and, then it wasn’t. And that’s why I became homeless.

In another narrative by a 58-year-old Army-Navy veteran, he tries to explain the circumstances that brought him to homelessness: So, because for a period of time I was working at [store] and then quit. In [city] because we had basically put a bed in the living room and mom stayed in that because she didn’t want to go to a nursing home. But the underlying thing is, I hadn’t really put as much effort into saving money as I should have. And really didn’t have any money as a cushion then. That really contributed to being homeless.

79 In these three examples the veterans had significant problems but summarized them quickly and gave an explanation for their homelessness, as if the one event was the only factor in their complicated story.

Veterans spoke repeatedly about the aspect of homelessness that was most troublesome to them, facing the uncertainty of day to day life. A 33-year-old Army veteran described homelessness in this way “I was going to say it’s like that moment when you realize there’s no God. I don’t know if everybody can relate to that.” An Army and Navy veteran, age 58, commented: Well, it doesn’t feel good. I mean because you’re worried about, you know, and if you’re not working, you’ve got, ok, where am I going to sleep? Where am I gonna eat? And that puts a certain amount of stress on you. I mean, I can tell it.

If you’re devoting a lot of your time to thinking about where you’re going to stay and, where you’re going to get food.

A 57-year-old male Army veteran talked about describing his experiences to another: I’d just tell ‘em why don’t you come out there for three days and be in my shoes.

That’s all I can tell ‘em. Because you can’t explain it. Every day is a new beginning and a new ending to everything.

A Marine Corps veteran, 40, said it this way “Right, desperate, the unknown.

Desperate for all kinds of stuff, need something to eat, new clothes, shower, shave, everything.”

80 An Army veteran, age 33, who had talked about the uncertainty he feels, described his experience in this way: How can I say this? I just kind of knew what to expect, not that homelessness was coming but what to expect out of homelessness. Not having anywhere to go and, I don’t know. Just kind of the word homeless. It felt, I mean right now I feel kind of homeless but I still have a house.

While the unknown circumstances were a main topic of discussion, veterans also talked about the other challenging aspects of being homeless. These topics include the unpleasantness of group living, lack of privacy and the feeling of shame. An Army veteran, 50, termed it this way: Yeah, we can make the best of it but the fact of the matter is, is what’s a lot harder is [sniffs, long pause] the, how should I say? The mental stability of half the people that are upstairs [shelter].

This veteran went on to talk about the empathy that he had for the shelter staff and the obstacles they faced while trying to help other homeless.

An Army veteran, age 51, talked about his experience at shelter: Just the outlook of some of the people, I don’t know. Man, uh, crude, rude, you know and just don’t care, slobs. I mean, don’t get me wrong not everybody’s like that but there are some people that don’t even care and I can figure out why they’re here now.

The same veteran later comments “Privacy is one of the big things.”

81 A 46-year-old Navy female talks about her experience “The privacy. Yeah, it kinda knocks into the social life too. [laughs] Well, no, none of that cause you can’t come home with me!”

A 56-year-old female Army veteran stated: The negative part, I mean, you’ve got to get along with people. You got people from all walks of life. We’re all in here for a reason, [scoffs] one reason or another, whatever it may be. And that everybody needs to, and that doesn’t always happen till it gets to be frustrating as far as everybody needs to pull their weight. When you got chores and you got rules to follow. Everybody gets excited about rules. I’m like [scoffs] you got this many people to deal with, everybody has their own idea of a rule, and you got to have set rules for everybody. To have some control over this place. Otherwise it would be in total chaos. I have a mental disability, and it’s called depression. And I take medicine for it. They’re other people in here with mental, whether it be bipolar that they’re not having control of, schizophrenia da, da, da, da da, that they don’t need to be in here, they need to be in, you know, it’s not even fair to the staff, it’s not fair to the rest of us who are homeless.

A 57-year-old twice Marine, used a reference to quantum physics to talk about homelessness. He described it this way: There is this thing called Singularity. It’s the local shrinkage of time and space to a single point. Nothing escapes it. It’s everything in the region just one point, we can’t prove it exists yet, it may not I don’t know, I’m not a physicist. But, the Me

82 Now is like that. I’m sorry to say, the average homeless guy lives by this principle. If a given action does not provide an immediate spike in physical pleasure, monetary gain or most importantly of all, interpersonal dominance it must under no circumstances be done. They’ll take a dump on the floor and walk away from it. They, they’ll be trying to hit the toilet but if it misses, hey, that’s not my problem. Walk away. Ah, they brag about beating women, the pleasure it gives them, too much to go into and I get negative but, long story short, I have come to believe that the reason 99.9% of the homeless gentlemen I have ever met and it may be different for the ladies because we live separate from the them, is that very attitude. I came into homelessness my first day believing what I had been taught about our culture. That the average homeless fellow is a victim of circumstance. That something is happening in his life that he has no control over and that it’s laid him low and that to escape the pain of that experience he’s turned to drugs, alcohol, what have you. It’s the other way around. That habit of choices that leads him to drugs and alcohol in the first place is the very same one that leads him to the life of homelessness. And I would not have believed this but by conservative estimate I have lived among 13,000 homeless, living with them, volunteering on their behalf, what have you. And I have not met a one that has not and has never used drugs and alcohol. There have been 5 out of those 13,000 who don’t presently use either one. Ah, and this is not a moral judgment on them because there’s not swinging human being on this planet who doesn’t have a moral flaw, a dark shadow on his soul.

83 In other ways, some veterans talked about their homelessness as resembling the military experience as living in shelter resembled barracks, and living with strangers was like basic training. An Army veteran, age 53, said: Oh yeah, be it summer or winter you had to be out in that you just learn to deal with it. And then like I said upstairs with the SRO’s you know, the single rooms, it reminds me a lot of like when I was NCO and having my own room in the barracks.

Another male, a 50 year old Army veteran, talked about it this way: Most of the time [in service] we were pretty much, let’s just say, I was homeless pretty much the whole time I was in the military. This is the barracks. It’s easy.

If it wasn’t the barracks I’d be out there in the field.

Despite the uncertain and negative nature of homelessness, veterans talked about the ways in which homelessness was positive. Comments in this area had to do with veterans being exposed to the resources they needed. Some veterans discussed how homelessness had made them pause and consider their lives in a way they had never done before. A 50-year-old male Army veteran said “So, and, not having the information.

That’s why today anybody wants to talk with me, anybody got any, you know, ideas.

Information is power.” A 30-year-old Air Force veteran said “Well, no, you know what, let me rephrase that, yeah because I got a chance to come over here [outreach center] and meet everybody, so yeah.”

An Army/Navy veteran, 53, spoke of it this way:

84 Yeah, yeah I definitely, it definitely puts things in perspective I mean, ah, where, you know you got, you know, you think about what you should have done, and you know, what, what you can do and what you don’t do. And you know like I said, that two whole years I never used once. I guess ah, I was really surprised at myself.

This veteran talked of the growth in his thinking from being angry and isolated to maintaining his sobriety- a fact he is proud of. Another veteran talked about her perspective and the shift it made during her experience.

A 56-year-old Army veteran talked about her experience: I think you appreciate the smaller stuff. A lot more. You do! You don’t, I mean some people complain about what they’re being fed or, I thought [scoffs], well, go live under the bridge, see what they feed you there! You know? [we chuckle] Probably nothing!

A frequent part in most stories was the effect of shame in their homelessness. In talking about the paralyzing aspect of shame, a 58-year-old Army veteran said: I think most homeless is ah, it grips somebody. Takes them, doesn’t want to let them go. And then be in, I’m not saying in my case because I wanted to be there but some people don’t want to be there but they’re ashamed to try to get out of it.

They’re ashamed to ask for help.

A 30-year-old female Air Force veteran stated, “It’s like you don’t even feel human sometimes. You know, you’re just like, like you’re a scumbag.” A 56-year-old

85 Army veteran lived in his van with his daughter for a period of time. He described it this way: You do. Not you feel like, you actually do get looked at like you’re a piece of dirt. Like you’re insignificant as a person. And that’s one of the most miserable feelings that you can ever, have. To feel insignificant around other people.

Finding Five: Relationship Disruptions All of the veterans interviewed for this study mentioned relationship disruptions in their narrative. These veterans spoke of relationship disruptions in a variety of ways.

They talked about early life disruptions that seemed to set the tone for future disrupted relationships, relationship disruptions with the military, and relationship disruptions in their adult life with partners and children.

Many veterans spoke of a disrupted early life. In an extreme example, one veteran talked about his early life “Yes, my dad died when I was 3 and then my mom tried to kill us, when I was 3 and my sister was 2.” This Army veteran, 57, then talked about further getting into fights with his grandparents who raised him. Due to a fight with his grandfather, his grandmother signed him into the Army at age 16. Another veteran, a 59 year old Navy male, described early family disruption with a step-father: V: We got into it all the time. And I either got kicked out, or left. For all that time, the whole time I was growing up I mean, I’d get mad and I’d leave. Take my tent and go down to the, pasture and pitch my tent and, when they weren’t home I’d go steal food. [laughs] My friends would bring me food, or my sisters.

86 S: So in a way, this sort of homeless pattern was harkening back to being a kid in the house again.

V: Yeah, I’d, he kicked me out one time. I lived in the barn for six, seven months. [pause] I had a job. Where I had made enough money you know, to feed myself. Go round with friends and shower and stuff. [coughs] S: So did you then, did you go into the military right out of high school? Wait, you said— V: No, I quit school like I said, you know and I went in when I was 17.

Another veteran, a 56-year-old male Marine said: My parents were divorced in 1970. And, my mom was a real violent, barbiturate amphetamine addict when I was a kid. She was real violent. She shot me with a 22 and she shot me with a 12 gauge. That’s how violent my mom was. And I was only six years old when she shot me the first time. So, I kinda grew up around abused, non-wanted family members, you know? Family essential kinda stuff, you know? Everybody was worried about themselves.

It is possible that the early disrupted experiences contributed to problematic relationships within the military. An Army veteran, age 58, who did not complete boot camp talked about his brief time in service: Well, they said I was talking back and, uh, that um, I was allergic to the poison ivy around there and they wouldn’t give me nothing really to, they’d give me a plastic bag and we’d go right back out there and I’m telling them, “Look, I’m itching, I’m scratching.” Then, I forgot my weapon on the bed and they hid it

87 and, I had an Article 15. So they said, “We can either, send you to Leavenworth [prison] or we can let you go.” Since you got a couple of Article 15s and this here.

An Article 15 is given to soldiers for minor disciplinary offenses, usually by a commanding officer. This veteran reported he left the service without completing basic training.

One veteran while talking about his struggle with alcohol identified that at the end of his enlistment, he was not allowed to re-enlist. He said, “Oh, yeah, it’s caused problems you know, before then too. In the military, I mean I got an honorable discharge and stuff, RE4, not recommended for re-enlistment. Drank, drank quite a bit there.”

A 50-year-old Army veteran struggled with undiagnosed depression and Attention Deficit Disorder during his enlistment. He described the issues regarding his failure to re-enlist: S: Now if you had, tried to enlist, you didn’t have your promotion so they wouldn’t have considered you anyway? Is that it? Do I understand that right?

V: That wasn’t even an option. [scoffs] No one even brought that up to me. The commander even when I was trying to go to ACAP (Army Career and Alumni Program) and everything we were supposed to help you out by getting you ready to be an inspector, he wanted to pull me out of ACAP and told me to go check on my soldiers make sure they knew everything they needed to be doing, be sure things were squared away for when you leave. And I was in the battalion Orderly room I had to tell him right there, I was like you know, I need this. I said as far as

88 everything is concerned the way everything has been messed up even the sergeant major knew that. The sergeant major chewed the first sergeant out right in front of me which was ridiculous cause it ain’t gonna do me no bit a good to make him feel good cause he got to chew someone out. But, it was the first sergeant’s mistake. Cause he was supposed to inform me and he thought it was a mistake the DA (Delegated Authority) put me on a QMP (Quality Management Program) list because I was in a DA select school. And that’s why I didn’t inform him that’s why I was in the situation I was in. But overall, it was my fault to begin with because I didn’t update my 201 file.

S: Ok, so there was some tracking whether it was yours or the first sergeant’s that went by the wayside?

V: Uh, it didn’t matter to me, I was in that situation I can’t say that it was 100% his fault. I’m not, but I’m not going to lay it all on his shoulders because I have to take responsibility for some of it myself, I didn’t update my 201 [personnel] files.

But then again if he would’ve informed me in time I could’ve updated it while I was up there and it would’ve been fine. But, it’s neither here nor there.

S: So then at that point was there, were you given a, you weren’t able to reenlist at the point because of what was going on?

V: Right. I couldn’t re-enlist. They had a freeze on everything. So, I got out in ’95. Uh, paid off all my bills that I had, pretty much, with the money that I got. I had to work at an automotive garage there at the town. Didn’t have any money to go back. I planned to go back later on, but it didn’t work out that way.

89 In this narrative, the veteran talked about having to leave active service. This was traumatic for several of the veterans in the study, particularly for those with relationship disruptions. The military seemed to provide a containing function for many veterans, leaving them bereft when they had to return to society which required them to be selfdirected instead of told what to do.

A 47-year-old Marine Corps veteran talked about entering the military to avoid a future he felt doomed him to drug use, gang involvement and drug sales: V: Well, [sighs], ok, looking back in hindsight, ok? I’m, I was in the Marine Corps. [Long pause] And uh, I wanted to be a Marine, So I went in and you know, I went through boot camp, didn’t have, and I went in on a waiver, a medical waiver. Cause I had flat feet. So I get in the Corps, you know, I got in a little trouble but not like, uh, break-the-rules trouble. But like money management trouble. But I, but other than that you know as far as, we go overseas.

S: What were your service dates? When did you go?

V: November ‘85 to November ‘87. Two years, honorable discharge, general under honorable conditions. [sighs] And uh, um, so, they tell me there, well, mind you I come from south suburbs of [city]. And this was my way of getting out of an environment that, I mean, my only way of getting out of the environment. So I was ready to make the Corps my life. So we’re overseas and something happens, and my feet started bothering me. Now, like I say, I haven’t, I’ve never been to the doctor for my feet, maybe they just weren’t trying to give

90 me enough time, for them to heal, or, you know I’ve never fell out of a hump, never had to go, except for, and then so they were like well, since you came in on the waiver you probably should go ahead and get out. So, and I’m like, well, you know, I didn’t want to go.

S: Didn’t want to leave the service?

V: Correct. Did not want to leave. And the only thing I was thinking of that was going to happen that I was going to have to come back out here. And it just, it weighed heavy because, you know I mean the guys that I met, you know, um this was my family. The guys that they said that you know, you know you have to follow your peers because these are the people that are going to save your life, these are the people that you’re going to have to protect.

S: They do become, family…

V: Yeah, so, they told me I had to go [voice breaks].

Another major relationship disruption that veterans spoke of was marriage and divorce. All veterans interviewed for this study spoke of either a divorce or a loss of a very significant intimate relationship, or multiple ones over time. A 40-year-old Navy veteran stated, “Even though I really haven’t got back into the whole dating scene since my divorce. But, after three failed marriages before you’re 40, it’s kinda like maybe...?”

An Army veteran, 57-year-old female spoke of her loss of a 25-year relationship with her partner:

91 And so when I walked in, it was quiet when I walked in and I started walking down the hallway. And they were weren’t doing anything but they were in bed.

And I just turned around and left. What, what was I going to say?

A 53-year-old Marine Corps veteran, the veteran whose mother had shot him twice as a child, had a similar story. This possibly affected his ability to have healthy relationships. He talked about his first wife “She was a bus driver. So she ended up pregnant by one of the mechanics out there at the bus barn. So, that’s the reason I have four ex-wives [coughs] and I pretty much stayed single since then.”

A 53-year-old Army/Navy veteran talked about how his relationship disruption then interfered with his military career: V: So, yeah, then um, and in ’88 I think it was, um my first wife left me and I got kind of, kind of went off the deep end over that. [clears throat] But, I wound up [clears throat] changing my mind, I attempted suicide. Um and then they ahh, changed my rate, declassified me as a weapons technician down to a gunners mate, and ahh, [knocks on table] they…

S: So you were too risky to be around weapons if you had a suicide attempt?

V: Yeah, and they, plus you had to have a secret clearance to do all that. But um, they declassified me, re-rated me as a gunners mate. And I transferred ships—I was on a carrier, I went to what they call an amphibious ship. Ah, [clears throat] had ah, what they call 3 inch 50 mounts on them, they’re a shell about like that [holds up his hand showing the size of a golf ball] that big, that big around. And,

92 I just, I just kind of went off the deep end, starting using drugs a lot. And I wound up going to Captain’s mast and that’s when everything started falling apart for me I guess. So, they, [clears throat] pretty much ah, they administratively discharged me. I didn’t, you know, I got an honorable discharge um, but due to a, they called it a personality disorder. And so, yeah, I spent like 2 weeks at Portsmouth Naval hospital. Psych unit there and uh, then I came back here, to [state] and, ah, started doing roofing work and you know, I was a roofer for, from like for about 10 or 15 years, for 15 years then I got remarried. Um, we got four kids and then ah, I kind of screwed that up I was, ah, got in, got into meth. And I was on meth for about 5 or 6 years. And went to rehab in 2002. And, my, ex-wife now, she wanted a divorce so we got a divorce. And then when I came back from rehab she wanted to try to work things out so we did. And that’s when I found out she was doing things that you know, she was cheating on me and stuff and I had to, I couldn’t, not the way my, you know, I guess that kind of set things off for me too it was, kind of a, I just started getting social anxiety, having, having real bad nightmares. When I was a child and I think things that happened to me as a child started popping back into my head that I’d never, ever thought would you know because I tried to block them out as long as I could. And, so, we got divorced and, well, we got divorce and then we got remarried and in October of 2005, we got remarried. Then we moved up to a farm in [city], which is north of [another city].

93 Unfortunately, this marriage then failed as well, as did the one after it. As stated previously, not only did veterans speak of disrupted marriages and relationships, but usually multiple ones over time. The disruption was often external relationships with others—but many times also internal—the veteran’s own view of themselves based on these disrupted relationships. All these disruptions lend support to the concept of inner homelessness from the psychodynamic part of the literature review.

94

Chapter V

Discussion and Conclusions Many of the findings in this study were consistent with the literature on homeless veterans. Once found to be eligible, homeless veterans are high utilizers of the range of services that the VA has to offer due to the multiple, chronic problems they experience.

The literature concluded that creative, individualized, trauma-informed care was necessary to engage and assist veterans in regaining housing and stability. In addition, in the literature on psychoanalysis and homelessness, the ideas of containment, holding, empathy and being able to withstand powerful emotions were supported.

Evaluation Criteria Narrative analysis by Riessman (2008) was used to consider the results.

Riessman described narratives in social science research as units of the research instead of dissecting the narrative into parts, such as what is done in other qualitative methodology. In this way, for the information in the narrative “Attention shifts to the details—how and why a particular event is storied, perhaps, or what a narrator accomplishes by developing the story that way, and the effects on the reader or listener� (pp. 12-13).

In this research study, homeless veterans were interviewed to explore their subjective experiences with a focus on why they felt they had become homeless. Once

95 the interviews had been recorded and, after transcribed an examination of the narrative was completed. Riessman (2008) described dialogic and performance analysis in two ways, a detailed examination and a more macro approach. Both of these were employed in the consideration of the narratives.

Riessman (2008) discussed the steps by which the narratives were examined and called this the “five listenings”. In her first examination she studied the context in which the narratives were taken or the “Overall shape of the dialog or narrative” (p. 117).

Second, she examined the first person account from the participant in order to see “the way they speak to and about themselves” (p. 117). Next, she paid attention to the social critique offered and the emotion behind this critique, otherwise named the “thematic content” of the narrative (p. 117). Then, on the fourth and fifth listenings of the narrative, the author focused on the way the subjects defined and spoke about the subject matter but also how they accommodated and resisted the definitions in the context (p. 118).

In using narrative methodology for the research, Riessman’s (2008) steps were followed. First, the researcher examined the narrative for the direct speech; that is what was said by the veteran in the interview about homelessness. The majority of veterans interviewed accounted for their homelessness by directly linking the event of homelessness to a medical crisis, addiction or mental health issues or a combination of several. The range of narratives revealed that some veterans had a lot to say about being homeless while others sought to avoid talking about it as much as the researcher would allow.

96 Then the asides or parts of the narrative where the veteran digresses to add to the narrative were noted. Digressions from veterans interviewed often included reflections of early life, relationship disruptions or military experiences or special conditions to the leaving of the military. On several occasions, it appeared as though the entire narrative for the veteran was an aside or digression from the question asked by the researcher.

Others answered briefly and directly with no added detail.

Parts of the narrative that were repetitive were noted as were any expressive sounds made during the telling of the narrative. Many veterans paused during the telling of the narrative or had nervous tics such as ‘ahh’ or ‘um’. Some sighed or cried and a few tapped on the table, clicked a pen or clicked open and closed a Zippo lighter. One veteran chain smoked through our interview.

Another facet of the narrative that was noted was the tense used in the telling of the story, whether it be present or past. Most of the veterans interviewed told their story in the past tense as the narrative was about their journey into homelessness. When housed veterans were included into the study, some of the narrative would include a mix of past tense language and present tense.

These five areas of examination, according to Riessman, (2008) are a more micro view into the narratives and what was happening within them. Also, a careful examination and explanation of the context or setting of the interview was included and described by the researcher. These were seen as the macro view of the narratives. The context was highly important and even contributed to one of the findings: that those who

97 were homeless during the time of the interview had more difficulty accessing feelings and affect.

In a more macro examination, Riessman (2008) wrote of the listening perspectives or “five listenings� that were employed in the evaluation of the narratives.

When the narratives were collected from the homeless veterans, they were first listened to for the determination of the overall shape or feel of the narrative. Then, the first-person account of each veteran or how they told their narrative about themselves was considered.

Next the social critique and any thematic account was included. How homelessness was spoken about was considered as well the ways that veterans embraced and resisted definitions of homelessness.

The first way veterans’ narratives were studied in the macro approach was for the overall shape and feel of the narrative in context. Eleven veterans interviewed for this study were housed at the time of the meeting and nine were homeless in a shelter or living outside on the streets. Veterans interviewed for this study framed their homelessness as a set of circumstances that they endured or had happened to them; very few saw the part they may have played in becoming homeless. In addition, most attributed their homelessness to a failing of their physical health, mental health or addiction. In addition, with the exception of one subject, veterans saw no connection between their homelessness and their military service. This veteran felt he had only the streets to turn to after discharge. Several other veterans attributed unemployment or child support as the overall reason for their homelessness.

98 The next “listening” was the first-person account of how veterans spoke to and about themselves. The range of responses included one veteran who refused to identify as homeless despite having nowhere to go and veterans who had lived their lives in a mostly homeless state. A common response included veterans’ attempts to make the narratives they shared to have a unique set of circumstance accompanying it. Again, in this first-person account the reasons for being homeless focused on medical crises, mental health and addiction issues. The range of responses included one veteran who admitted he missed being homeless due to the freedom it allowed him. Another veteran expressed empathy to the staff that work at the homeless shelter where he stayed. All agreed that the resources provided to them by the VA would assist them in leaving homelessness.

The social critique offered by homeless veterans came through in a variety of ways via their narratives. The main theme that emerged repeatedly was how aware veterans were of the stigma of homelessness, even if they did not think it affected them in a negative way. Many veterans commented on the isolation, shame and ambivalence that homelessness caused them. One veteran highlighted how important basic appearances were. The three combat veterans interviewed comment in their own ways of the difficulty involved in reintegrating to society. Two veterans shared that they were gay and that this contributed to a sense that they needed to remain hidden—especially in the military. A couple of veterans commented on how poorly they felt Vietnam veterans were treated. Several other veterans cited that their entry into the military was an escape from a life they knew held no hope for them and their future.

99 In the fourth and fifth listening of the narrative, the researcher noted the way the veterans defined and spoke about their subjective experience, but specifically how they identified and resisted the definitions that they had laid out in the context. Veterans spoke about homelessness as having a primary characteristic—the unknown qualities about it—disconnected, hopeless, shameful and lonely. Discussion of stigma and how veterans felt that outsiders had pre-conceived notions of what had happened to them.

Veterans repeatedly reported that staying in a homeless shelter resembled the barracks or basic training which bothered some and was comfort to others. As stated previously, one veteran did not identify with the homeless label despite having no residence. Some veterans admitted they expected homelessness, and thought it was a fairly normal way of functioning while for others it was completely foreign and traumatic experience for them.

Others reported they felt that homelessness was a result of their own fault, a choice they made but all were grateful for assistance in finding their way out.

By using both the detailed and macro perspectives of the dialogic and performance analysis, the narratives were used to discover the experience of the homeless veteran.

Dialogic and performance narrative analysis takes into account the dialogic environment and all of the complex parts that make up the interaction. As the dialog between the subject and listener evolves, an identity forms and a story is created. This unique narrative methodology allows for the subject and listener to co-create a dynamic performance between them.

100 Discussion of Findings Central ideas for homeless or newly housed veterans in this study as summarized in the findings were: veterans’ difficulty in exploring feelings about homelessness while currently being homeless; veterans’ feeling they were viewed differently than other homeless individuals; veterans who claimed they did not know they were eligible for a range of VA benefits; relationship disruptions—especially in early life—and the differences in the narratives that veterans shared. These findings and the central problems for homeless veterans can be thought of in a more clinical way.

Self Psychology (Kohut, 1982) lends deeper insight into the lives of homeless veterans. This study used Self Psychology as the clinical framework through which the results were interpreted. In particular, Self Psychology’s focus on early life development, the role of the caregiver, empathy and theory of cure made it particularly useful in the examination of homeless veteran narratives. Self Psychology was useful in considering some of the findings such as relationship disruptions and the role of the military in veteran’s lives.

All findings are below. Two of the findings appear to go together clinically and were included in the first section. This finding had to do with veteran’s inhibition of feeling and affect while in the state of homelessness and how veteran’s narratives had different elements based on whether they were currently homeless or recently housed.

101 Homelessness inhibits feelings and affect (Finding #1).

Finding #1 and Finding #4 (Versions of Homeless Narratives, Long Story Short) share similar ideas, that veterans had difficulty with affect while still homeless and that they told different versions of their narrative depending on their housing circumstance.

Possibly, the researcher had an effect on the process because the veterans were told of the researcher’s long history of working with homeless veterans and this affected this process by increasing the veteran’s comfort. Riessman (2008) wrote that “One can’t be a self by oneself. Narrative theory is at once an act and an enactment” (p. 106). Riessman highlighted how in the narrative, all participants contribute to the creation of the narrative and that meaning emerges between the participants (p. 107). Narratives were a way that veterans used to transform their story from the traumatic experience that homelessness is or was, to an event that gave meaning to their lives. Riessman (2008) quoting YuvalDavis (2006) “Identities are narratives, stories people tell themselves and others about who they are (and who they are not). But the identity is fluid “Always producing itself through the combined processes of being and becoming, belonging and longing to belong. This duality is often reflected in narratives of identity.” This was another function of the narrative veterans told—to develop their view of themselves and a way of understanding their own behavior and feelings.

Kohut & Wolf (1978) wrote about foundational pieces of the self and how these are tied to the responsiveness of the caregiver. Based on these ideas, it is possible that the researcher provided the welcoming empathic milieu that allowed veterans in the study to be more comfortable disclosing personal thoughts and feelings. Kohut (1982) wrote

102 about empathy as a neutral mode of observation which not only gathered information but manifested in a powerful bond between people. He indicated this was an essential element to being in a therapeutic and supportive relationship. He wrote, “The mere presence of empathy, has also a beneficial, in a broad sense, a therapeutic sense—both in the clinical setting and in human life, in general” (pp. 396-398). For some, their internal structures may not have allowed them to disclose to anyone, no matter the circumstance.

This could point to the lack of an empathic caregiver in early life, traumatic experiences and an inability to go to this level of affect in their current circumstances.

In a discussion of context surrounding veterans’ ability to disclose, it would seem remiss not to acknowledge a section of the Literature Review which indicated the high prevalence of traumatic brain injury (TBI) and hence, executive function disorder among the homeless. One could consider that an injury to the brain could also be responsible for a veteran’s inability to regulate behavior, affect and impulse in addition to plan and organize. The prevalence of TBI and executive function disorder was another factor to consider when examining why veteran’s narratives are stunted.

Veterans made sense of their experience in a variety of ways. They appeared to have a specific way of telling their narrative of homelessness, and the story contained certain elements. They talked about what they learned about others and themselves during homelessness. The narrative was used as a way to set the veteran apart from others either by military experience or by unusual experiences. It appeared to organize the veterans experience and to make sense of what happened to them. They often began their narratives with the main event that they feel contributed to their homelessness:

103 usually a medical crisis. For the veterans in shelter or homeless at the time of the interview, the narrative had a rehearsed quality to it, an abbreviated cause-and-effect summary of the reason for homelessness. Possibly this was due to the veteran having to live the narrative at the time of telling the researcher about it. Riessman (2008) summarized this in her chapter about Dialogic and Performance Analysis: We are forever composing impressions of ourselves, projecting a definition of who we are, and making claims about ourselves and that world that we test out and negotiate with others. In situations of difficulty, social actors stage performance of desirable selves to preserve face (p. 106).

Homeless veterans often told abbreviated versions of their narrative, many of which started with the medical crisis that precipitated their homelessness. This abbreviated story appeared to be one that a person would tell to another who did not want the full version of the story, or possibly that one might share with a service provider who had needed services. Riessman (2008) wrote about the context as having a vital impact on the narrative. She wrote, “[Narratives] illustrate the profound importance of context in the construction and performance of the narrative� (p. 137). Possibly, for some veterans, it was difficult to share a story with any depth because the interview was held at the shelter where they stayed. The context of being within the walls of the shelter may have had an impact on the information that the veteran chose to share. Those veterans that struggled with a detailed story and had no accompanying affect may have deeply held beliefs that no one wanted to hear their story. Perhaps they believed that they were not worth the time for the extended version. Directly or indirectly, they may have gotten a message

104 that their story could not be heard. These stories had a superficial quality to them—as if the veteran needed to protect themselves from accessing too much affect while still in the trauma of homelessness. In this way, the abbreviated story with few elements was a protective factor, a defense to the homelessness which they were still amidst. Emotions and powerful affect may have been too dangerous a prospect for these individuals to access in a setting where they were still not yet safe in their own housing. Perhaps once they were safely housed they still may not acknowledge these feelings and affect as the management of the emotions may be too difficult and fragmenting to the self. Kohut (1959) talked about this resistance “Resistances against free association are properly discussed as a consequence of the defense function of the mind” (p. 465).

Kohut & Wolf (1978) wrote about the effect of repeated selfobject failures by way of failure of the caregiver or empathic context. He wrote “Faulty interaction between the child and his selfobjects results in a damaged self—either a diffusely damaged self or a self that is seriously damaged in one or the other of its constituents” (p. 2). The result would be an unstable sense of self where symptoms emerge. In this discussion of abbreviated narratives and stunted affect, it is unclear whether the symptoms were the findings or homelessness itself. Living a marginalized, invisible, abbreviated existence was a normal phenomenon for some veterans—not just an experience related to homelessness. Farrell (2012) writing from a Self-Psychological perspective on chronically homeless individuals wrote, “People living in homeless shelters are subjected to a complex system that may not always work in their best interests.” He goes on to describe how shelter life “produces a social disadvantage for the individual” as shelter

105 can usually meet basic needs of the inhabitants, but not meet the psychological needs. He wrote “A homeless shelter will more often than not contribute to faulty, fragmenting experiences� (p. 339).

The abbreviated narrative, once understood as a finding, led to including formerly homeless or newly housed veterans into the research. Housed veterans appeared more able to tell a lengthy version of their story and to explore their feelings more. They displayed more affect, usually tears. Possibly, the sense of safety these veterans experienced by having the researcher in their home or by knowing they had a home, allowed them to reflect on their experience more clearly and with less need to defend against the experience. Farrell (2012) described how homeless individuals may become solidified in their role of homelessness: People who are chronically homeless have been able to carve out an existence and, at times, feel empowered by their life on the street or in a homeless shelter, thus successfully adapting to a homeless state. The protective and cohesive functions of this state may preserve a fragile core self and protect a person against disintegration anxiety (p. 340).

From this perspective, difficulty adjusting to being housed, or the rejection of housing, can be seen as adaptive. So, once housed and with a newfound sense of safety, new adaptive strategies were being formed and possibly veterans were able to reflect on their experience more. As the need for survival, both literally and psychologically decreased, veterans may have felt that it was safe to explore their inner feelings. Several veterans explained that they had never disclosed parts of the narrative to anyone else or

106 that the interview setting had brought up memories and feelings they had not considered in a long time.

Another possibility was that because the researcher was an empathic, attuned listener, the veterans were able to sense or feel this and it allowed them to feel comfortable. An empathic and introspective response could have created a sense in the veteran that their ideas and thoughts really mattered to the researcher, allowing them to disclose more than they would otherwise. Farrell (2012) wrote, “It is the worker’s empathic understanding of the homeless person’s experiences that allows for the full expression of self experience, even in a life of homelessness” (p. 345). Veterans’ stories when heard with an empathic ear, appeared to have a validating effect on the veteran— for that time their narrative was seen as valuable. Kohut (1959) wrote of empathy as having a healing principle to it, that by the very act of the other listening empathically and the veteran feeling understood helped with the healing process and was the healing process. He wrote, “The essential ingredient of our observation is introspection and empathy” (p. 460). He called the healing properties of empathy and introspection transmuting internalization. (Kohut & Wolf, 1978, p. 4) Goldberg (2011) wrote about the empathic process and in particular, sustained empathy. He wrote, “Being empathic in the ‘here and now’ is but an entrance into the overall task of understanding.” He goes on “The ability to sustain one’s empathy during the course of the analytic process allows the analyst to replicate the history of an individual’s developmental life” (p. 294). It was possible that the researcher provided this empathic function and by allowing the veterans to feel genuinely understood, even for a short period of time, had a stabilizing, soothing

107 and validating effect on the veteran. It was possible that the researcher provided the function of mirroring to the veterans interviewed.

Another way of considering the differences between the narratives that the veterans told is the concept of continuity by Goldberg (1990). In his work he described psychic continuity and how disruptions of this continuity were highly fragmenting and problematic for his clients. Possibly, in some of the circumstances of the veterans interviewed, entry into homelessness or entry into housing represented a break in the continuity they were used to. The disruption then could be considered as a possible explanation for the differences in the length and depth of the narrative.

Several of the veterans who told more lengthy versions of their story attempted to return the gift card to the researcher. This appeared to be a gesture of gratitude, possibly because they felt heard and listened to. Possibly, the interview was a place where the veteran had felt worthy and genuinely cared for—if only for a brief time. This empathic, understanding presence in an ongoing way appeared to be lacking for most of the veterans interviewed. One veteran talked for over 2 hours, anxiously looking at the clock, repeatedly saying, “I know you need to get home to your family. I appreciate your time!” Another veteran disclosed he had Attention Deficit Disorder and coached me to “keep me on track because I tend to ramble.” Yet another veteran repeatedly stated, “So, long story short—“ as if she was constantly trying to bypass parts of her experience that she felt the researcher would not want to hear or would not be relevant to the interview.

This gave the researcher a glimpse into these lives devoid of meaningful contact and how grateful these veterans were for a genuine experience.

108 An element to the narrative that was repeatedly observed was that veterans who were interviewed for this study were more likely to be peace time veterans than wartime veterans. This appeared to challenge a societal assumption—that many veterans are homeless or have disruption as a result of war experiences and Post Traumatic Stress Disorder (PTSD). This informed the idea that trauma from war or military life was not a predominant factor in a veteran becoming homeless. And, while traumas occurred in everyday life, and especially when veterans were homeless, this indicated that there must be other reasons for homelessness. As veterans in the study described, homeless veterans or homeless people were not simply people who have no housing—they were significantly challenged by medical, mental health, addiction and disrupted relationships.

The National Coalition for the Homeless further reported that the two main reasons individuals end up homeless are the shortage of housing and poverty (National Coalition for the Homeless 2014) and both of these reasons, especially poverty, seemed to be wellrepresented in the sample for this study.

Veterans feel they are viewed differently (Finding #2).

Veterans felt they were viewed differently than other homeless individuals and the findings fell into several categories of responses. Some homeless veterans felt that despite being veterans, there was no difference between their experience of homelessness and others. Veterans in this group downplayed their military service as ‘something I did’ and maintained that their experience was the same as others. This response could be seen as protective or defensive as the veterans who stated this were in a shelter. A different

109 response could set the veteran more apart from the group and more outside of society than they already felt. This response could be an attempt at cohesion. As will be developed, veterans indicated that others at shelter were jealous of the privileges that they received. As mentioned previously, Riessman (2008) wrote about the importance of context and meaning making within the narrative process. She further stated: What we as members of a culture take to be “true” (meanings that are taken for granted, for example, or social conventions such as taking turns in conversation) are actually produced in face to face exchanges every day, and the process of reality construction can be systematically studied (p. 106).

Veterans in the study indicated that they felt that outsiders who heard about homeless veterans would be more likely to be sympathetic to their situation. Veterans speculated that outsiders might feel that they were more deserving of help than regular homeless individuals due to their military service. Possibly this was akin to the veterans’ own feelings about their own military service. Many veterans noted that their military service was a proud period in their life—a time when they were successful and felt useful. If their military service was a positive experience, and for most it was, the military was for a time a responsive other, providing some of the functions that were never received in early life. For this reason, veterans may value their military service as they received the selfobject context which made it possible for them to feel worthy and needed. Kohut & Wolf (1978) wrote about selfobjects: There are two kinds of selfobjects: those who respond to and confirm the child’s innate sense of vigour, greatness and perfection and those to whom the child can

110 look up and with whom he can merge as an image of calmness, fallibility and omnipotence (p. 2).

Possibly this feeling was imposed on outsiders as veterans had a need to feel that they were seen in a positive light. Homelessness was an uncertain and, at times, frightening experience for veterans. Perhaps thinking that others see them as deserving of help may assist the veterans in coming to terms with their homeless situation. It might also mean that acceptance and use of help would be easier if they felt they had earned the help. Some veterans gave examples of how they came to believe this by referencing acts of kindness from strangers and specialized services for veterans which they used as proof to their theory that they were viewed positively.

In contrast, some veterans talked about how they felt the negativity and stigma associated with homelessness. Riessman (2008) discussed this as she described that narratives and the commentary they make about life in general “The social role of stories—how they are connected to the flow of power in the wider world—is an important facet of narrative theory” (p. 8). The discussion of stigma that veterans felt appeared particularly painful as they talked about how negatively others viewed them.

Possibly, this was so difficult to weather because veterans already had fragmented, negative or unstable definitions of themselves. The negative comments or perception of disrespect from others may have matched a negative view the veterans already had of themselves and for that reason, were particularly had to endure.

However, for many veterans the event of a medical crisis defended against the homelessness being their fault, rather it was a fault in their body that caused them to be in

111 a homeless state. Kohut’s idea of the vertical split might also apply in situations where veterans were unable to examine any actions by them that contributed to their homelessness. Spiegel (1996) described “The vertical split is a sector of the personality that is split off from the central sector. It is maintained by the defense of disavowal, which makes possible the simultaneous knowing and not knowing of something that is unacceptable� (p. 92). The vertical split has been described as a psychological concept which operates unconsciously for the veteran and has two conflicting ideas that operate side by side. Repeated traumas or failures of the caregiver contribute to this psychic structure that protects against painful, fragmenting information. Veterans who spoke of issues with their health may not have been able to acknowledge addiction, untreated mental health or neglect of self-care as the reason for their homelessness. In addition, traumatic early experiences or a traumatic life overall could inhibit making secure, validating relationships. No matter what the reason, the veterans all felt the stigma associated with homelessness and understood it on some level.

Finally, veterans talked about the experience of living with non-veterans in shelter and how non-veteran homeless were jealous of the special treatment that they received.

For all of the veterans interviewed, their shelter stay was in one of several shelters in the area that had a veterans transitional programs within shelter. For this reason, veterans had different rules for their stay at shelter once they were enrolled into the transitional program. These veterans noticed how they were treated by other, non-veteran guests.

Because being a veteran enabled most of them to different privileges at shelter such as modified curfew, and the ability to have a longer length of stay; this caused some other

112 non-veteran homeless to be jealous, and at times, hostile towards them. Perhaps this was the reaction that the veterans in the first group feared—that homeless is not homeless and that once there was difference, there would be hostility—which was one more difficult uncertainty to bear after homelessness. Add a negative shelter stay to an already uncertain, unstable situation and it may have been too much for some veterans to endure psychologically. Especially when one considers that the veteran may have a sense of self or inner structure that was compromised and lacking of developmental structures. The veterans who noticed this attitude from other guests at times downplayed their veteran status or took it as warning to stay to themselves or in the company of other veterans.

Homeless veterans spoke repeatedly of the uncertain and unknown qualities that living as a homeless veteran required them to endure. They talked of the worry that accompanied the uncertainty of food, shelter, income, clothing and other basic needs.

Farrell (2012) wrote, “Another factor may be that life on the streets or in shelters is so precarious that the focus of a homeless person’s intentions must be on day to day survival activities” (p. 339). This uncertainty seemed to cause a deep sense of anxiety among veterans. Spiegel (1996) wrote about one of the consequences to early life disruption in the 0-18 month or pre-oedipal stage, according to Kohut, which had to do with regulation “The early lack of attunement to the child’s emotional needs deprives the child of maternal functions such as stimulus barrier, tension regulation and optimal stimulation” (p. 73). As many veterans spoke of a disrupted early life, this idea may give clues as to the inability to regulate and hence the anxious and traumatic nature of the event of

113 homelessness. It may also indicate why veterans had difficulty navigating in the world and why shelter life was so fragmenting for veterans.

One of the ways that veterans seemed to combat or defend against this uncertainty was by talking about the uniqueness of their personal situation and how it was unlike any other homeless person’s experience. This appeared to be a self-preservation tool to stave off the isolation they felt. This uniqueness position seemed to allow veterans to recognize their specialness—whether it be by their story of by their military service or another life event. Farrell (2012) wrote about how homeless individuals may become ‘embedded’ in a life a homelessness which serves a coping function. He wrote, “For example, they may organize their experiences by creating normalcy in the seemingly chaotic world of homelessness” (p. 338). For Farrell, these attempts at mastering the life of homelessness are strengths, but also pitfalls as homeless individuals may become very attached to the experience of homelessness as coping.

Didn’t know I was eligible for VA (Finding #3).

All veterans interviewed for this research acknowledged that at some point they were unaware of the VA benefits for which they were eligible. Riessman’s (2008) discussion of context was particularly relevant here as veterans appeared to be making a consistent commentary on information that was lacking as they left the military. Riessman noted that the context in a narrative was the specific focus of the methodology for this research.

In addition, the thematic content was noted for any relevant social commentary (p. 117). veterans’ narratives included the military as part of their story and exiting the military

114 was a vital piece of each narrative. It represented the time when veterans who had been (mostly) held in regard by peers, and a larger institution were exiting to a world with a different set of rules. The transition that veterans spoke of here showed the disparity in life with and without the military.

Veteran’s lack of information about resources suggested that knowing about this network of resources might have prevented their homelessness in a few cases. Most commented that it took the event of becoming homeless for a vast network of support and assistance to become available. There could be a wide array of reasons for this. Veterans who talked about discharging from the service usually talked about their enlistment time coming up and their departure from the military as a good idea at the time. Many later comment that they wish they had stayed in. Because many talk about processing out individually, it may be that that proper information was not given because the military did not consider educating veterans a priority, or the information was optional. It could also be that veterans were given some information but were anxious to leave the service and did not retain the information. Several veterans talked about leaving the service with behavior problems or a family hardship. They most likely had a rushed out-processing with minimal information. Other veterans could have left the service, gotten jobs with decent pay and insurance and figured they would never need benefits from the military.

Possibly their leaving the military was negative and accessing benefits would bring this experience back, so it was avoided. In most cases, although veterans did not talk about their intent to go into the military, their early lives were, at best marginal. Possibly the military was one of the highlights of their lives and they did not feel worthy of the

115 benefits that came with service, particularly if the discharge was under negative conditions. In addition, when one considers the possibility of the prevalence of both TBI and executive function, it is easy to see how veterans could not have picked up the needed information prior to their departure from the military and due to difficulty with memory, retention, planning and carrying out the information could not be assimilated in a useful way.

Another facet of this finding were veteran’s comments that being a veteran or military service had nothing to do with their homelessness. Most veterans saw the Veterans Affairs (VA) services as a positive support, a way out of homelessness. In these interviews, VA and staff were supportive, providing selfobject functions and who met their needs of food, clothing, housing and support. In addition, medical, psychiatric and addiction services were offered to these veterans allowing them to feel taken care of, noticed and cared for. They were very complimentary of the services and support they received from VA social workers and medical center staff and homeless care providers.

Veterans in the study seemed to struggle with self-worth. For most, the military was a proud period of their life where they functioned relatively well. This seems to be connected to self-esteem in some ways. Because service provision was connected to veteran status, veterans seem to be able to accept the help that was given or embrace more of a deserving stance for help because they have served. Some veterans described the military as a pseudo-homeless culture where they were often moved from place to place and relationships were intense but fleeting. Perhaps this setting prepared these veterans to be homeless more so than non-veterans. Kohut & Wolf (1978), as mentioned

116 earlier, talked about early life disruption and how not getting early developmental needs met, may bear out in symptoms. Perhaps low self-esteem and self-worth had to do with a lack of inner structures. A failure of selfobject functions, especially mirroring, could leave the veteran with an unstable sense of self which could not hold up on its own once the presence of the military was not imposed. This lends to an idea that the military provided more of a containing function than a selfobject function as the functions were not able to be transferred to the veteran once they left the military. Or, possibly the selfobject functions were provided, but for whatever reason, the functions would not be integrated into the veteran’s self structure.

Relationship disruptions (Finding #5).

All veterans interviewed for this research talked at length about relationship disruptions. Typically, these took place as ‘asides’ which Riessman (2008) indicated was a way that interviewees departed from the narrative to give extra information or context to the larger story (pp. 112-113). Asides took place in a variety of ways. Several of the veterans talked about traumatic early life experiences, including abuse, neglect and violence. Self Psychology helped us understand what development could be arrested by caregivers who were neglectful or violent toward the child. It was possible that the milieu necessary for development for these veterans was non-existent in their early lives.

Elson (1986) wrote about Self Psychology’s central structures called the nuclear selfcontaining two parts. The two parts were an individual’s motivation for success and motivation for basic idealized goals (pp. 20-21). The self was seen as being molded and

117 created by the responsiveness of the caregiver. Kohut & Wolf (1978) believed that the early caregiver’s personality and ability to provide selfobject functions were more important than their behavior or ‘what they did’. The selfobject functions the caregiver provided for the child were vital. A caregiver who lacked empathy and attunement failed the child, and impacted the development of the child in the creation of a stable self.

Therefore, it is what a child received from caregivers during developmental years that impacted functioning later in life (Elson 1986, Siegel 1996).

Children in these settings not only do not receive the selfobject functions necessary for development, they become desperate for them. If the primary connections were not formed with their primary caregivers, veterans may have gone to others for these needed developmental pieces. Possibly, this could give clues as to why the veterans interviewed for this study decided to go into the military. The military represented a stable place where rules and structure and a predictable schedule could be attained. One could see how a child from a disruptive, abusive childhood would gravitate toward this environment. The military would be the constant parent that was never present, the reward system by rank, medals and certificates of appreciation that were never experienced by the child and be ever present in the life by the wearing of the uniform and expectations for behavior.

Another relationship disruption that occurred was when veterans left the military.

Many veterans spoke of their time in service proudly. They often lamented that they should have stayed in “to get my 20” and retire. However, several of the veterans were not so successful and left the military due to a failure to adapt. Possibly this could have

118 been due to early life disruption and not getting the functions needed from a caregiver which did not enable them to function in the structured life. On the contrary, perhaps it gave them a life to fight against. Other veterans speak of a very successful experience but then a marginal life of disruption post-military. Interestingly, if one considers that the military served as selfobject functions then it was curious that after some veterans left the military, the functions did not remain or sustain. For this reason it may be more reasonable to consider that the military provided a containing function more so than a selfobject function. Or, as mentioned previously, a selfobject function were provided but unable to be integrated due to the struggling self structure of some of the veterans. A few veterans interviewed for this study were successful in their military careers and then successful for many years afterward. However, these veterans reference a medical crisis bring them to the point of homelessness. With so many successful years post-military, it is interesting to consider what caused them to fragment after such a long period of success. Possibly, supportive structures were in place or were being performed by other relationships and when the relationship failed, the fragmentation began.

Other relationship disruptions that veterans spoke of were marriages, children or parents and siblings. Veterans spoke repeatedly of multiple marriages that ended in divorce, strained or estranged relationships with children, and problems with siblings.

The veteran’s narratives appeared to be punctuated by problems with getting along with others. And, at times, an inability to think critically about who they were partnering with.

119 Implications for Social Work Practice This research was an in-depth look into the lives of homeless and recently housed veterans who experienced homelessness. Based on the insight from homeless veteran in this study, there appears to be a need for more exploration into why veterans are not being informed about the benefits they are eligible to use post-military. In addition, the subjective experience of veterans who are homeless and have seen combat, are gay or lesbian, or younger might be needed to compare how their experience differs. As early life disruption appears to play such a vital part in military service and life afterwards, more study is needed about the effect of early life disruption on future outcomes such as poverty or homelessness. Perhaps the military should be mindful of the early life of recruits as a condition of enlistment. A study of people’s perceptions of homeless veterans and stigma may be useful to consider when working with homeless veterans.

Or, the perceptions of homeless and veterans versus non-veteran homeless might be useful to consider.

Conclusion This research highlighted some important information from homeless and recently housed veterans. The primary findings: veterans difficulty in exploring feelings about homelessness while currently being homeless; veterans feeling they were viewed differently than other homeless individuals; veterans who claimed they did not know they were eligible for a range of VA benefits; relationship disruptions—especially in early life—and the differences in the narratives that veterans shared—were told in veterans’

120 own words. The purpose of this research was to hear these veterans in their own words, to help explain the subjective experience of each veteran.

Kohut’s Self Psychology lends extra dimensions to the narratives that homeless veterans shared. Ideas about how and why veterans become homeless seem to be connected to early life development and selfobject failures. The psychoanalytic literature supports that homeless veterans need unique treatment approaches and individually crafted interventions to assist them. Riessman’s (2008) narrative methodology set the stage for the consideration of not only the veteran’s stories but the context surrounding their narrative—to help with the whole picture.

In their own words, veterans described their subjective experience so that we might understand what it is like to walk in their boots. The narratives are complex and interesting, sad and revealing and show the humanity in a group of people who are homeless and who also are proud to be veterans.

This research has been a dream of the researcher for over a decade. After many years of hearing veterans’ amazing stories day after day, it seemed the world needed to know what these journeys entailed. The narratives, filled with hope, triumph, the horrors of war and the beautiful way that veterans persevered, spoke of the strength and versatility of the human spirit. It needed to be heard, seen and shared. Homeless veterans, and homeless individuals in general are the invisible souls of our population.

No one wants to see them and at times they do not want to be seen. And yet, they are us.

Most of us are several paychecks away from facing the terrible uncertainty that homelessness is.

121 Veterans signed away their freedoms and made sacrifices on behalf of others.

That selflessness came through in the interviews. Veterans who had never seen the researcher before opened their doors in hopes that it might prevent one more veteran from going through a homelessness experience. This was where the first finding emerged: that veterans while still amidst their homelessness had a difficult time reflecting upon it.

And yet veterans opened their hearts and spoke about the hurt and questionable choices they made in their lives with no previous history with the researcher. Veterans were so grateful for being heard they offered to return the research compensation so that someone more deserving could have it. They spoke of proud moments of wearing their uniforms or coming home to waiting family. They talked about their downward spiral with breathtaking detail and honesty.

The second finding, that veterans felt they were viewed differently during their homeless experience had many facets. Perhaps the most surprising was that other homeless individuals found veterans to be at an advantage and were envious of this. veterans interviewed for this study grappled with the idea that they had earned enhanced benefits and respect from others. Many felt the pain that all homeless do—the stigma and assumptions made by others. They challenged the researcher and hopefully the reader to look beyond these ideas to see the person behind the label. Each veteran interviewed was a brother, sister, father, mother, uncle and wanted nothing more than to be remembered as a person who may have fallen on hard times. Whether or not military service had gone well for them, for most it was a proud period where they felt they had contributed to something positive, a greater good larger than themselves.

122 The third finding, that veterans were not aware of the benefits they are eligible for, was striking. Most of the veterans in this study had difficult, chronic, serious medical, mental health or addiction problems. Almost all of them went many years before they accessed any benefits they were eligible for. Despite countless VA programs designed to provide aggressive outreach and information, these veterans were not connected with sustaining benefits until they became homeless. The information was alarming and indicated a severe gap in information for veterans.

The fourth finding, that veterans had different, prepared versions of their narratives, gave insight into the positive and negative aspects of homelessness from a veteran perspective. In some ways it seemed that the military prepared veterans for homelessness by an atmosphere of quick relationships and a readiness to move at all times. In addition, forcing veterans to be accustomed to group living and group tolerance seemed to be strong areas. However, the negatives they pointed out were the same as any person might indicate—uncertainty, unknown, lack of privacy and the difficult personalities of others.

Finally, veterans talked about disrupted relationships. These relationships spanned their lifetime. Sadly, many veterans had difficulty dating from their earliest memory. The military was often the most stable relationship that many of them had. The relationship, unlike others had qualities of predictability, stability and security which many veterans had never had in their lives prior to service.

The findings reveal that homeless veterans have some unique limitations whether that be a history of abuse or neglect, a lifetime of unstable relationships, a mental illness,

123 medical problem or an addiction. We as a nation have committed to these men and women the right for concern and care. And yet this was another barrier—knowing what one was eligible to receive upon leaving the military. The staggering finding that over and over veterans attributed their homelessness to a medical crisis means that this area warrants further discussion and study.

At the conclusion of the research, we have the strong message that homeless veterans cannot be dismissed into the background. They are people—just like everyone else. More importantly, their lives mean something, they have something to say, enhanced by their service in the military. It was an honor to sit with, talk to and live the narratives that homeless veterans shared. They are to be admired for their strength in spirit, perseverance and pride. The researcher is forever grateful for the gift of the experience.

124

Appendix A Informed Consent Document

125 Individual Consent for Participation in Research INSTITUTE FOR CLINICAL SOCIAL WORK

I,____________________, acting for myself, agree to take part in the research called: “Why Are Veterans Homeless? The subjective experience of homeless veterans.”

This work will be carried out by Sarah E. Oliver. (Principal Researcher) under the supervision of Joan DiLeonardi (Dissertation Chair).

This work is conducted under the auspices of the Institute for Clinical Social Work, Robert Morris Center, 401 South State Street, Suite 822, Chicago, IL 60605. Telephone 312.935.4255.

Purpose The purpose of this study is to ask veterans who are homeless about their life experience of homelessness. The study is designed to find out what it is like to be a homeless veteran.

The goal of this research project is to provide insight into the lives of homeless veterans and could be used to help people understand homeless veterans better.

Procedures Used in the Study and the Duration You will be interviewed and asked some questions. The interview will last about an hour and will be recorded. Later, these stories will be written down word for word and the stories studied. The results will be summarized for the purposes of my PhD. You will be paid for the interview by a $20 Wal-Mart gift card. The gift card is the researcher’s way of thanking you for your time and participation in the study.

Benefits The benefits for your participation in this study is a $20 Walmart gift card.

Costs Other than your time, this study will have no cost to you.

Possible Risks and/or Side Effects

126 It may be possible that due to talking to the researcher about your life events, you may have some uncomfortable feelings. You are being asked about your life experience and can stop the interview at any time.

In order to be sure you are okay, the researcher will be aware of any signs that you look uncomfortable. In addition, if you need help as a result of the interview, help will be readily available and a resource card outlining this help will be provided to you.

Privacy and Confidentiality You will be identified in the research study by your branch of service, age and gender.

Your stories will be shared in your own words at times. No identifying information that you reveal will be shared in the research results. This is to protect your privacy.

The interviews, notes and results of the research study will be stored on one laptop and a backup on a flash drive. These items will be kept by the researcher. In addition, all files will be password protected. All paper documents will be kept in a locked container of which the researcher only has access. This material will be destroyed in five years.

Subject Assurances By signing this consent form, I agree to take part in this study. I have not given up any of my rights or released this institution from responsibility for carelessness.

I may cancel my consent and refuse to continue in this study at any time without penalty or loss of benefits. My relationship with the staff of the ICSW will not be affected in any way, now or in the future, if I refuse to take part, or if I begin the study and then stop.

If I have any questions about the research methods, I can contact Sarah E. Oliver (Principal Researcher) or Joan DiLeonardi (Dissertation Chair), at this phone number 312.935.4255 (day), 563.340.7821 (evening).

If I have any questions about my rights as a research subject, I may contact Judy Aronson, Co-Chair of Institutional Review Board; Institute for Clinical Social Work, Robert Morris Center, 401 South State Street, Suite 822, Chicago, IL 60605.

312.935.4255.

Signatures I have read this consent form and I agree to take part in this study as it is explained in this consent form. _________________________________ Signature of Participant

_____________ Date

127 I certify that I have explained the research to _____________________ (veteran) and believe that they understand and that they have agreed to participate freely. I agree to answer any additional questions when they arise during the research or afterward. ________________________________ Signature of Researcher Revised 6 Sep 2006

______________ Date

128

Appendix B Guided Interview Questions

129 Guided interview questions

1) Tell me the story of how you came to be homeless.

2) Is this the first time you have been homeless? If not, how many times have you been homeless in your life?

3) What do you think caused you to be homeless and why?

4) What is it like to be homeless? or how does it feel to be homeless?

5) Was there anything that surprised you about being homeless?

6) What has been positive about your experience of being homeless?

7) What has been negative about your experience of being homeless?

8) Do you feel that being a veteran influenced your becoming homeless in any way?

If so, how? If not, why?

9) Do you think that being a homeless veteran is seen differently than being a homeless person?

10) Are any other comments you would like to make regarding the experience of being homeless.

130

Appendix C Recruitment Flyer

131

 

Would you like to participate in research by telling your personal story about being a homeless veteran?

Compensation will be provided in the amount of a $20 Wal-Mart gift card.

If so, please contact Sarah E. Oliver at 563.940.8547 for more information.

Sarah E. Oliver

Sarah E. Oliver

Sarah E. Oliver

Sarah E. Oliver

Sarah E. Oliver

Sarah E. Olive r

Sarah E. Olive r

Sarah E. Olive r

Sarah E. Olive r

Sarah E. Olive r

563.

940.

8547

563.

940.

8547

563.

940.

8547

563.

940.

8547

563.

940.

8547

563.

940.

8547

563.

940.

8547

563.

940.

8547

563.

940.

8547

563.

940.

8547

132

Appendix D Checklist for Veteran Participation

133 Checklist for Veteran Participation

1. Verify veteran status

2. Verify that veteran does not appear intoxicated/under influence

3. Veteran appear unstable mentally in any way, oriented x 3

4. Verify that veteran is homeless

5. Verify that others are present at the location where the meeting is held

6. Verify that in location of interview, confidentiality can be maintained

7. Verify that the researcher has never had clinical contact with the veteran

8. Informed Consent completed, copy to veteran

9. Walmart gift card issued

10. Resource Card issued

134

Appendix E Veteran’s Resource Card

135 Veteran’s Resource Card (This data was different for each geographical area where a veteran was interviewed.

This card is an example of what I would issue to a veteran that I interviewed in Cedar Rapids, IA.) Cedar Rapids Community Based Outpatient Clinic 2230 Wiley Blvd SW Cedar Rapids, IA 52404 Phone: 319-369-4340 Fax: 319-369-4341 (medical and basic mental health needs)

Cedar Rapids Vet Center 4250 River Center Court NE, Suite D Cedar Rapids, IA 52402 Phone: 319-378-0016 Or 319-378-0016 Fax: 319-378-8145 (Counseling for combat theater veterans) Main Medical Center Iowa City VA Health Care System 601 Highway 6 West Iowa City, IA 52246 319-338-0581 | 800-637-0128 (ask for the POD or Psychiatrist on Duty if you are in crisis)

136 National Veterans Crisis Line

National Homeless Veterans Hotline Homeless veteran in need of help?

Call 1-877-4AID VET (1-877-424-3838) Nearest local ER St. Luke's Hospital 1026 A Ave NE Cedar Rapids, Iowa 52402 (319) 369-7211 Mercy Medical Center 701 10th Street SE Cedar Rapids, IA 52403 319.398.6011

137

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