What is our obligation to the homeless?

[Anasazi23]

I'm not sure about you guys, but I've seen hundreds, maybe a thousand homeless people over the course of my residency. An interesting article on the cover of the Wall-street journal brings to light an old problem, now in my opinion made worse:

http://online.wsj.com/article/SB121764142520706635.html.html


And a somewhat related article in the Times about illegals in the healthcare system, and what to do with them:
http://www.nytimes.com/2008/08/03/us/03deport.html?pagewanted=1&_r=1&sq

I'm interested in opinions on this.

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[whopper]

I don't want to subscribe online to the WSJ, so I couldn't read the full article. So forgive me if I missed an important point.

However given what little information it did have without reading the full article, it LA wants to make it illegal for a hospital to "dump" homeless patients to the shelter, let them. If LA wants to drive up their costs & pay approx $1500 a day so a homeless person can live in the hospital for as long as they want, let them suffer that fee. (I don't know how much it really costs them to house a homeless person in the hospital but at the hospital in my residency it cost approx $1500 a day).

I don't agree with it, but then again I'm not living in LA nor paying taxes that as far as I know will cover them. Meanwhile, they'll see what it costs them.

If its the hospital's duty to make sure all homeless patients get a place to stay for the night, every night, simply based on the reasoning that they're homeless, they're going to find themselves not being able to pay for things like surgeries, treating chest pain, or treating people not being able to breathe.
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As for illegal immigrants being deported by hospitals, I'm neutral on this. I'm not an advocate of illegal immigration. My thinking is that immigration should be done through the existing system. If you want more immigrants coming in, then advocate for the system to make it easier & faster, not for illegal immigration. Whether or not you want illegals to be in here based on amnesty or booted out--one or the other needs to be done, not this looking of the other way which is causing several other problems not just for us but for all immigrants that no one is properly addressing.

A friend of mine, a cop was almost killed by a gang of illegal immigrant drug dealers when he tried to arrest them. He literally had a gun put to his head & he was saved at the last moment by fellow cops who arrested those drug dealer scum. They were tried, & deported back to their home country.

In less than a week, he saw those same exact drug dealers on the street. He made a decision to not arrest them again because he knew the same exact thing would happen again. That's just screwball. I of course realize that several of the illegal immigrants who enter the country have good intentions & want to earn their money through hard work. I've met several of them and many of them are good people who deserve a chance at citizenship IMHO.

The hypocrisy of the situation goes on several levels. Mexico for example isn't doing much to keep Mexicans from leaving their country to the US but have little tolerance for poorer Guatemalans who want to enter Mexico for the same reasons that the Mexicans want to enter the US.

But in regards to how it relates to us as clinicians, it oversteps our ethical boundaries when we police our patients short of them causing direct physical harm to themself or others. So. i.e. I'm neutral on this. I wouldn't rat out an illegal immigrant just for being so who is under my care, but I don't think as a nation the current situation is working either--whether you are for letting them in or not. This is a solution which needs to be addressed through our government & enforcing existing immigration laws, or changing them.

& unfortunately I don't think this will be addressed. It was an issue a little over a year ago, now no one seems to care about it anymore.

 

[mgdsh]

Re: the homeless give em a few shots to get fixed up for the same problem, after that they should be on their own. I'm all for helping the less fortunate but when they make the same mistakes over and over and... I mean come on. For the most part they are a drain on society.

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I can't say I read the 9-10 page long article on illegals, but something is definitely wrong with the system when there are hard working Americans with out healthcare and treatment in our own hospitals when we're giving it out to any illegal who can make it over the border. (I'm not saying we should have UHS or that healthcare should be free etc, but something definitely doesn't add up.)

 

[Decepticon]

I don't know what you should do with the homeless. I don't really care, as long as I don't have to think about it, or have to be confronted with it. I care just an eenie weenie bit more about them than I care about some slender kids being slaughtered in Sudan, or some slum kids being sprayed with shaving foam and pissed on in Rio de Janeiro. But I would be most interested to hear the view of you guys, why I should care. That could be interesting.

 

[OldPsychDoc]

I don't know what you should do with the homeless. I don't really care, as long as I don't have to think about it, or have to be confronted with it. I care just an eenie weenie bit more about them than I care about some slender kids being slaughtered in Sudan, or some slum kids being sprayed with shaving foam and pissed on in Rio de Janeiro. But I would be most interested to hear the view of you guys, why I should care. That could be interesting.

Why should you care about anyone then?
What if it is your kid being urinated on?

I'm as frustrated with providing care for the homeless as anyone--right now literally half of my inpatient service wouldn't need to be in the hospital if they had a safe, sober, and stable place to live. However, the question comes down to what does it mean to care for a fellow human being in need, using the resources you have in your hand at a given moment in time. Last week I could afford to not care about kids orphaned by HIV in Zambia--but this week, since my friend and pastor returned from 2 weeks there being devastated by their need, I have an obligation. I know about them now, and I know that with a few dollars sent to a reputable NGO I will make a difference in the lives of one or two.

At the end of the day, the immigrant, the orphan, and the recalcitrant homeless are all human beings. The question of "what is our obligation to the homeless?" can only be answered when we've answered the question "who is fully human?" in our own world view.

 

[Solideliquid]

We sure do have our priorities don't we? I spent about $300 in the Apple store last month on a new iPhone. Do I really need it? How could $300 benefit starving children in Zambia or dozens of places on this earth where human beings are treated as less so, starving, losing their lives at the whim of more powerful men?

It's sad that we have alienated ourselves from the rest of the world's need and in doing so we have adopted a brand new neutral stance within our society.

So, when IS the next playstation coming out anyway??

 

[Anasazi23]

Why should you care about anyone then?
What if it is your kid being urinated on?

I'm as frustrated with providing care for the homeless as anyone--right now literally half of my inpatient service wouldn't need to be in the hospital if they had a safe, sober, and stable place to live. However, the question comes down to what does it mean to care for a fellow human being in need, using the resources you have in your hand at a given moment in time. Last week I could afford to not care about kids orphaned by HIV in Zambia--but this week, since my friend and pastor returned from 2 weeks there being devastated by their need, I have an obligation. I know about them now, and I know that with a few dollars sent to a reputable NGO I will make a difference in the lives of one or two.

At the end of the day, the immigrant, the orphan, and the recalcitrant homeless are all human beings. The question of "what is our obligation to the homeless?" can only be answered when we've answered the question "who is fully human?" in our own world view.

I agree that with unlimited resources, it would be nice to help everyone. But, we can't.

The illegal immigrant cost that L.A. hospital over one million. You mulitply this by a few in each hospital, and they all go bankrupt. Hospitals are skating on thin ice when it comes to revenue and bankruptcy. I heard a CEO of a NYC hospital state the other day that unless something changes here, a large portion of the NYC hospitals will be looking at bankruptcy. Now add in the fact that the homeless guy has to stay for 2 months to wait for an SRO, or the illegal refuses to be discharged and stays for 6 months and costs the hospital a million. Then nobody gets care, and the situation becomes much more dire.

Something's gotta give soon, or the whole thing's gonna come crashing down.

 

[Anasazi23]

So, when IS the next playstation coming out anyway??

They're anticipating around 2010-2012, depending.

 

[Solideliquid]

They're anticipating around 2010-2012, depending.

Oh gooood! By then I should be a fully board certified Child and adolescent attending! Which means (the way things are going) I should be able to afford a controller.

 

[HCE]

Re: the homeless give em a few shots to get fixed up for the same problem, after that they should be on their own. I'm all for helping the less fortunate but when they make the same mistakes over and over and... I mean come on. For the most part they are a drain on society.

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I can't say I read the 9-10 page long article on illegals, but something is definitely wrong with the system when there are hard working Americans with out healthcare and treatment in our own hospitals when we're giving it out to any illegal who can make it over the border. (I'm not saying we should have UHS or that healthcare should be free etc, but something definitely doesn't add up.)

At least from the psychiatry perpective, I'm not so sure you want to give mentally ill homeless and immigrant populations a few shots and send them on their way....things could get dangerous....and of course, then you have homeless and immigrant children....are they "on their own"?

(I'm expecting a post here from BabyPsychDoc )

 

[HCE]

They're anticipating around 2010-2012, depending.

Too many of these threads are coming back to gaming....

Very disconcerting...

 

[TheWowEffect]

There is a huge difference between our obligation to do individual charity work and obligation of hospitals and physicians taking care of homeless. When you have a homeless person staying put in the hospital for non-medical and non-indicated reasons, something is not right there. The politicians should focus on providing funding for, may be, subsidized housing etc. for these people rather than dictating to hospitals that homeless should not be discharged to shelters....and then what are the shelters for?

The situations in many urban and inner city hospitals is already too bad, and having to accommodate more homeless even if they are not sick is asking for too much. What are we doing next? Taking them to our houses and feeding them warm meals? This parasitism and facilitation of irresponsible behavior has to be somehow stopped. Arbitrary and adhoc policy making like this is not going to solve the problem. It'll only make things worse.

 

[Solideliquid]

I hear California treats their homeless really well...

 

[Decepticon]

Why should you care about anyone then?

I show that I care about people who matter to me → people who matter to me show they care about me. Me happy.

I show that I care about other people → people do good for me in return. Me happy.

Really, from a neurobehavioral perspective, what more can there be? Why does it make sense for me to bother caring about some homeless, when I can play ostrich and don't give a damn about it.

What if it is your kid being urinated on?

I wouldn't like that.

You think we are automatically driven to help homeless, from a tits-for-tats perspective? That doesn't rhyme with how little most of my anquaintances really do for homeless people. They and me are more likely to invest in an new xbox, than sponsoring clean needles, blankets, shelters, whatever.

Let's be honest here, shall we? Some of you are psychiatrists. I thought you were striving for insight.

 

[Decepticon]

The situations in many urban and inner city hospitals is already too bad, and having to accommodate more homeless even if they are not sick is asking for too much. What are we doing next? Taking them to our houses and feeding them warm meals? This parasitism and facilitation of irresponsible behavior has to be somehow stopped. Arbitrary and adhoc policy making like this is not going to solve the problem. It'll only make things worse.

Look at the two last sentences. You make it sound like the reason you don't take homeless people home to feed them warm meals is a non-egotistical one.

Seriously. Do I need to excuse not taking homeless people home for a meal? Do I need to say that it would only make things worse (for whom)? Yeah, I don't help homeless- for their own good. I see the bigger picture. Helping homeless would be awarding laziness. That would lead to hell. Look to europe. Their welfare systems are crumbling. The best for ALL, including the poor is: less help, less cushions.

I admire you folks, and your interest in common good. I don't take homeless people with me home, cos it isn't any good for me. No helper syndrome here.

 

[futuredo32]

Seriously. Do I need to excuse not taking homeless people home for a meal? Do I need to say that it would only make things worse (for whom)? Yeah, I don't help homeless- for their own good. I see the bigger picture. Helping homeless would be awarding laziness. That would lead to hell. Look to europe. Their welfare systems are crumbling. The best for ALL, including the poor is: less help, less cushions.

I'm definitely not one to favor helping the lazy, but so many of the homeless are mentally ill, not lazy. Mental hospitals close their doors and people that were previously patients are now living on the streets. They absolutely can't function in the real world and provide for themselves.

 

[HCE]

Look at the two last sentences. You make it sound like the reason you don't take homeless people home to feed them warm meals is a non-egotistical one.

Seriously. Do I need to excuse not taking homeless people home for a meal? Do I need to say that it would only make things worse (for whom)? Yeah, I don't help homeless- for their own good. I see the bigger picture. Helping homeless would be awarding laziness. That would lead to hell. Look to europe. Their welfare systems are crumbling. The best for ALL, including the poor is: less help, less cushions.

I admire you folks, and your interest in common good. I don't take homeless people with me home, cos it isn't any good for me. No helper syndrome here.

When you finish your residency and open you're own private practice, I'm sure you will be the first to employ one of these homeless, urine-soaked guys you see on the street having a full blown discussion with absolutely no one....face it, some folks are mentally ill..you can try leaving them high and dry with no help (for their own good), and not award them for "laziness", if this is the culture in which you want to live. By the way, most people in the United States on Welfare are children...I'm not sure how this "for their own good" and "laziness" thing applies to them, but I get a bad feeling about what would be the result in our society.

 

[Decepticon]

The laziness phrase was part of my putting words in the mouth of "TheWowEffect." It was a straw man. Look at the part about Europe and how their welfare systems are "crumbling." The reasoning is supposed to be bull$h*t, exaggerated, suggesting that I don't refrain from helping homeless due to their laziness, but due to simply not wanting to.

I was trying to be funny on his behalf and make the point that helping homeless is not something you decide upon based on the effects on the economy, and implications of more welfare, but simply that we cynically don't have anything to gain by doing it.

 

[HCE]

The laziness phrase was part of my putting words in the mouth of "TheWowEffect." It was a straw man. Look at the part about Europe and how their welfare systems are "crumbling." The reasoning is supposed to be bull$h*t, exaggerated, suggesting that I don't refrain from helping homeless due to their laziness, but due to simply not wanting to.

I was trying to be funny on his behalf and make the point that helping homeless is not something you decide upon based on the effects on the economy, and implications of more welfare, but simply that we cynically don't have anything to gain by doing it.

got it.......it was too subtle for me....

 

[TheWowEffect]

The laziness phrase was part of my putting words in the mouth of "TheWowEffect." It was a straw man. Look at the part about Europe and how their welfare systems are "crumbling." The reasoning is supposed to be bull$h*t, exaggerated, suggesting that I don't refrain from helping homeless due to their laziness, but due to simply not wanting to.

I was trying to be funny on his behalf and make the point that helping homeless is not something you decide upon based on the effects on the economy, and implications of more welfare, but simply that we cynically don't have anything to gain by doing it.

Congratulaions on your facetiousness If you had read my post more carefully, I was making a comparison between individual charity and the charity of a health care system bogged down by the whims of inefficient policy makers. Don't worry about me; I am doing an enough share of forced charity during this residency. It is one thing being an arm-chair philanthropist, and another being in the thick of things and seeing the reality.

P.S.- My mouth is neither for sale nor for rent....and you probably know my views on forced charity. So, keep those words to yourself.

 

[Decepticon]

I guess I got a bit carried away with the lunatic fringes.

I don't really know much of anybody's political positions, as I haven't been around for too long. But I understand that some of you support helping homeless, and voluntary charity.

I am not saying homeless deserve their misery, are lazy or whatever, but why would it make sense for me as an organism, to help homeless? What is in it for me? Does it make any sense from a biological perspective, helping anybody where there is no visible personal gain? Or is there a gain, I am just to stupid to see it? Preservation of self-image? Anybody having a psychological perspective on that?

 

[Doc Samson]

I'd suggest reading Vaillant's papers on defenses. The single most mature defense: altruism. Number 2: sublimation. Either way, you gotta do some good in this world to get by without reverting to the coping styles that end up with you in therapy (or maybe even homeless).

 

[erg923]

Hmmm..."What's in it for me?"
I was will ask my brother this when he comes back from his 3rd tour of duty in Iraq. I will let you know his feelings on sacrifice when I ask him. I should ask my Grandfather why he left college to volunteer to fight in WWII while I'm at it. I might argue that he didn't get alot out of it, but WE (i.e.,the world) sure did. Right? If everyone had this attitude about the world in 1941, you might be speaking German right now. Obviously, the homeless aren't taking over the word here, but I'm sure you see what I'm getting at. This attitude can turn out to be quite dangerous to live by, both for yourself and for others. And trust me, the world won't always accommodate this expectation you know. Just wait till you have kids..... What do you get out of spending 4 hours at Chucky-Cheese? Making someone else happy? Perhaps preservation of self image? Whatever it is, they sold me on it! And I love it!

I was brought up to take a certain (reasonable) amount of sacrificing in order to help a fellow human being and make the world a better place. I am not sure why the home ownership status of a person makes them less important to you, or somehow less deserving of of kind helping hand? What makes a person "matter to you?" Perhaps, if all of us were focused less on our own needs and just a little bit more on others needs, it possible that we wouldn't have to have this debate in the first place. Part of this value system comes from church and charity work, but more influential was the philosophy I was raised with with by my parents and community. "Love thy bother"...."The love you make is equal to the love you take" kinda of thing. It's the golden rule, right?

This is why I have chosen this profession (except I'm clinical psych). It sure as hell wasn't to get rich. And if I only bestowed my compassion and empathy on those who I deemed deserved it, I would burn out fast. And you will too. And trust me, people are perceptive and your patients will able to spot this attitude a mile away. It not good for you (professionally), and it certainly doesn't help them any. When people are in trusting you with their lives, its comforting to know that your doc truly cares about you because you are a person. (whether I live on Rodeo Drive or skid row). Not caring is easy. Trying to care about everyone is hard....and a rewarding challenge in life.

In addition to the wonderful read suggested by Doc Samson, I would recommend reading the social psych literature on the psychological constructs of Agency and Communion. It truly makes the world go round.....):

 

[OldPsychDoc]

I show that I care about people who matter to me → people who matter to me show they care about me. Me happy.

I show that I care about other people → people do good for me in return. Me happy.

Really, from a neurobehavioral perspective, what more can there be? Why does it make sense for me to bother caring about some homeless, when I can play ostrich and don't give a damn about it.



I wouldn't like that.

You think we are automatically driven to help homeless, from a tits-for-tats perspective? That doesn't rhyme with how little most of my anquaintances really do for homeless people. They and me are more likely to invest in an new xbox, than sponsoring clean needles, blankets, shelters, whatever.

Let's be honest here, shall we? Some of you are psychiatrists. I thought you were striving for insight.

My point in raising those questions is that I believe that it is a very short distance from "the homeless are a useless burden on society" to "let's pour gasoline on them and light a match for fun."

I don't believe it's fair that a hospital bears the burden of a million-dollar cost to care for a patient they can't legally discharge. Such should be accompanied by funding and/or other resources (e.g. long term care funding for those not covered by traditional sources) from the level of government that that mandates the care. We're a long way from utopia, I agree, but we cannot resort to dehumanizing people just because they aren't related to us, or don't have a direct benefit to us.

 

[Decepticon]

Right? If everyone had this attitude about the world in 1941, you might be speaking German right now.

But then again, everyone doesn't have that attitude, and that is something that I could capitalize on. What is keeping me?

I am not sure why the home ownership status of a person makes them less important to you, or somehow less deserving of of kind helping hand?

It is not the home ownership status. It is the not-in-my-aquaintance group that make them less important. I can easily close my eyes to horrors taking place elsewhere on earth, and as long as I don't know about it, I don't have a problem with it. Unless I am confronted or manipulated into defending myself in a debate with idealistic people.

What makes a person "matter to you?"

I don't know the exact mechanism, that is what I am asking you guys about! But it seems that people I maintain contact with, are people where I benefit from having contact with, or people I would get bad conscience for not having contact with. Homeless people, not in my circle of aquaintances wouldn't trigger this bad conscience.

Perhaps, if all of us were focused less on our own needs and just a little bit more on others needs, it possible that we wouldn't have to have this debate in the first place.

OK. Pretend you could mould our brains into whatever you wanted, how would you program us (tits for tats? tits for two tats?) and how would our society look like? And would we be able to break out of our programming, if we gained insight, e.g by some psychotherapy?

And if I only bestowed my compassion and empathy on those who I deemed deserved it, I would burn out fast. And you will too.

Hmm... But don't you direct a bit more attention towards people you find sympathetic, and a bit less towards those striking you as a-holes?

And trust me, people are perceptive and your patients will able to spot this attitude a mile away. It not good for you (professionally), and it certainly doesn't help them any.

I don't know. I imagine a lot of judgemental, barking, authoritarian and intolerant doctors are pretty much able to live good lives with their attitudes. As long as they can pin the chain reaction results of their attitude on someone lower down in the hieararchy, why not be intimidating to patients. Saves you from a lot of trouble. People that have a high tolerance to what they accept from others, but are mild in return, might strike you as sympathetic, but are they employing a winning strategy?

When people are in trusting you with their lives, its comforting to know that your doc truly cares about you because you are a person.

I am sure it is comforting. I am sure kids are comforted by believing their parents love them unconditionally. But is it true?

I would recommend reading the social psych literature on the psychological constructs of Agency and Communion. It truly makes the world go round.....):

Cool. Copied for looking in to later.

My point in raising those questions is that I believe that it is a very short distance from "the homeless are a useless burden on society" to "let's pour gasoline on them and light a match for fun."

Oh. I was more like thinking; shotgun and chainsaw...

I am sure the eugenics movement employed thinking like that. You then have to decide upon, what people are in the good group, and what people are in the "supposed to be weeded out group." I am not saying this is w.r.o.n.g, but I don't like it, and I think it could affect me negatively as well.

My point was strictly individual. I don't care what is good for society. I am merely wondering, why would my brain control my body to do actions towards people that have neither immediate, nor distinct benefit to myself?

Seeing as some of you guys do act like that, just like their are some people donating money to wikipedia and other projects, there must be some biological explanation.

...but we cannot resort to dehumanizing people just because they aren't related to us, or don't have a direct benefit to us.

[wiseguy modus] yes, you can [/wiseguy]

 

[deleted77919]

…

 

[OldPsychDoc]

But then again, everyone doesn't have that attitude, and that is something that I could capitalize on. What is keeping me?

It is not the home ownership status. It is the not-in-my-aquaintance group that make them less important. I can easily close my eyes to horrors taking place elsewhere on earth, and as long as I don't know about it, I don't have a problem with it. Unless I am confronted or manipulated into defending myself in a debate with idealistic people.

I don't know the exact mechanism, that is what I am asking you guys about! But it seems that people I maintain contact with, are people where I benefit from having contact with, or people I would get bad conscience for not having contact with. Homeless people, not in my circle of aquaintances wouldn't trigger this bad conscience.

OK. Pretend you could mould our brains into whatever you wanted, how would you program us (tits for tats? tits for two tats?) and how would our society look like? And would we be able to break out of our programming, if we gained insight, e.g by some psychotherapy?

Hmm... But don't you direct a bit more attention towards people you find sympathetic, and a bit less towards those striking you as a-holes?

I don't know. I imagine a lot of judgemental, barking, authoritarian and intolerant doctors are pretty much able to live good lives with their attitudes. As long as they can pin the chain reaction results of their attitude on someone lower down in the hieararchy, why not be intimidating to patients. Saves you from a lot of trouble. People that have a high tolerance to what they accept from others, but are mild in return, might strike you as sympathetic, but are they employing a winning strategy?

I am sure it is comforting. I am sure kids are comforted by believing their parents love them unconditionally. But is it true?

Cool. Copied for looking in to later.



Oh. I was more like thinking; shotgun and chainsaw...

I am sure the eugenics movement employed thinking like that. You then have to decide upon, what people are in the good group, and what people are in the "supposed to be weeded out group." I am not saying this is w.r.o.n.g, but I don't like it, and I think it could affect me negatively as well.

My point was strictly individual. I don't care what is good for society. I am merely wondering, why would my brain control my body to do actions towards people that have neither immediate, nor distinct benefit to myself?

Seeing as some of you guys do act like that, just like their are some people donating money to wikipedia and other projects, there must be some biological explanation.

[wiseguy modus] yes, you can [/wiseguy]

What you're discussing is basically the difference between a tribal village and a civilized society. If you reap the benefits of the latter (e.g by being trained in universities, driving on roads, having some degree of peace and safety) and you do not see yourself as contributing to the costs thereof, then you are a bigger leech on society than the homeless person you pretend to ignore.

 

[Doc Samson]

What you're discussing is basically the difference between a tribal village and a civilized society. If you reap the benefits of the latter (e.g by being trained in universities, driving on roads, having some degree of peace and safety) and you do not see yourself as contributing to the costs thereof, then you are a bigger leech on society than the homeless person you pretend to ignore.

Nicely done.

 

[Decepticon]

What you're discussing is basically the difference between a tribal village and a civilized society. If you reap the benefits of the latter (e.g by being trained in universities, driving on roads, having some degree of peace and safety) and you do not see yourself as contributing to the costs thereof, then you are a bigger leech on society than the homeless person you pretend to ignore.

1. How many homeless people do I need to take home and feed, or how much do I need to donate in order not to be a "leech" on society, according to you?
2. Why should I not be a leech on society if I can? What is keeping me?

 

[Doc Samson]

1. How many homeless people do I need to take home and feed, or how much do I need to donate in order not to be a "leech" on society, according to you?
2. Why should I not be a leech on society if I can? What is keeping me?

It seems that you're looking for a biological/evolutionary explanation for contributing to (as opposed to only draining from) society. On that level, it boils down to humans being social organisms - we went through an evolutionary branchpoint where it was determined that functioning as a group is better than functioning as individuals, i.e. each individual's potential (on average) is better realized as a part of a larger group (that provides for your needs when you are too young/sick/old to be able to do so) than as a group of "free agents" in simple competition with each other. It's John Nash's game theory - we all do better if we're not in direct evolutionary competition.

 

[HCE]

1. How many homeless people do I need to take home and feed, or how much do I need to donate in order not to be a "leech" on society, according to you?
2. Why should I not be a leech on society if I can? What is keeping me?

"Leech" is a somewhat harsh term. We all get benefits from the government or larger society that we wouldn't receive on our own....a military, the post office, fire and police protection. If we should become disabled, there are benefits there for us. Heck, residency funding....I don't think its productive to call people leeches when they use benefits provided by the larger society....if we do, then perhaps we are all leeches.

 

[Decepticon]

....I don't think its productive to call people leeches when they use benefits provided by the larger society....if we do, then perhaps we are all leeches.

You're so right. It's a pyramid game

each individual's potential (on average) is better realized as a part of a larger group (that provides for your needs when you are too young/sick/old to be able to do so) than as a group of "free agents" in simple competition with each other. It's John Nash's game theory - we all do better if we're not in direct evolutionary competition.

I totally agree. Game theory computer modelling, as described in this book of robert axelrod → http://en.wikipedia.org/wiki/The_Evolution_of_Cooperation suggests that people will cooperate from a pure egotistical viewpoint.

Now, I wonder. What kind of programming/modelling could describe how much, and under which conditions, you are willing to fork out $$ for homeless? Is there any rational model that can explain why some people spend money on donations, like donating to homeless, when they neither know the guy, nor do they believe that they can get anything out of him personally. What is the gain? Is it an adverse effect of another program in the brain that does give you gain? Does the donation behaviour satisfy schemas like:
I want to be loved
I won't be loved if I don't show that I care
caring in general is good
I should care about the homeless as well

 

[Decepticon]

Or perhaps we are talking about lots of conflicting programs, like:
Justice is how you want people to be treated if you could by chance have been anyone in society.
--> if I act according to this justice principle, I am a nice guy.
--> if I am a nice guy, people should like me.
--> so I have a need to treat anyone the way I would want myself to be treated in their positon.

But by doing so, you might put yourself in situations where you materially lose out.
--> helping someone whose car broke down, might ruin your new suit, and it will cost you valuable hours of sleep.
--> donating to any random bum on the street will cost you money you could have spent on hookers.
So you put a price on your conscience. I wanna be a nice guy, but it ain't THAT important.

The higher the proximity, the higher the importance of being nice. If a kid dies in Africa, I don't give a damn. If somebody on this board dies, I might give a damn, and even donate a few bucks. (or not) If I don't put myself in a position where my conscience is challenged, there is no problem, and then I don't need to care.

But how the conscience develops, might be caused by biological differences in playing games, or identifying games? Or isolating the dominant strategy?

Well, I can't say that I have a fully developed theory here, but perhaps some of you have more waterproof concepts? (That you ain't keeping secret till you have gathered enough to publish )

 

[erg923]

I think its intereting that you seem to be intellectualizing (in the psychodynamic sense of the word) everyones' points. Just a clinical observation.

 

[OldPsychDoc]

1. How many homeless people do I need to take home and feed, or how much do I need to donate in order not to be a "leech" on society, according to you?
2. Why should I not be a leech on society if I can? What is keeping me?

"Waterproof" arguments are for philosophy classes, not the real world. If you do any psychiatry, you'll see that every individual case has a unique spin to it. One homeless person may need resources which might be the wrong intervention for the next homeless patient.

My practical answers to your questions would be:
1) as many as it takes to convince yourself that they are real people, as worthy of treatment with human dignity as your own 1st degree relatives.
2) a) social shame/sanctions. Admittedly a bigger issue in other cultures than in the individualist West.
b) expectation of reciprocity--that someone will be there for you when you need help.
c) for the greater good of the society--quality of life for all rises when poverty is addressed.

 

[erg923]

"I don't know. I imagine a lot of judgemental, barking, authoritarian and intolerant doctors are pretty much able to live good lives with their attitudes. As long as they can pin the chain reaction results of their attitude on someone lower down in the hieararchy, why not be intimidating to patients. Saves you from a lot of trouble. People that have a high tolerance to what they accept from others, but are mild in return, might strike you as sympathetic, but are they employing a winning strategy?"

Im confused? Who is "winning?" You, or the patient? And winning at what?

Overall, this demonstrates an enormously poor understanding of the importance of Doctor-patient rapport/relationship and the emotional impact of medical illness on patients. Are you really this oblivious to the literature on Doctor-patient relationship and how this effects a patient's willingness to comply with treatment, willingness to change unhealthy behaviors, and overall patient outcome? Not to mention the psychological benefits this offers to patients due to the correlation between hope and quality of life when coping with illnesses. I'm sure you are are of the literature in this area, no? Did they really not cover this at your medical school? You're missing a HUGE piece of your job as a doctor with this attitude.

 

[Decepticon]

"I don't know. I imagine a lot of judgemental, barking, authoritarian and intolerant doctors are pretty much able to live good lives with their attitudes. As long as they can pin the chain reaction results of their attitude on someone lower down in the hieararchy, why not be intimidating to patients. Saves you from a lot of trouble. People that have a high tolerance to what they accept from others, but are mild in return, might strike you as sympathetic, but are they employing a winning strategy?"

Im confused? Who is "winning?" You, or the patient? And winning at what?

By winning, I meant employing a strategy that is most beneficial to you. I didn't really specify what I meant by beneficial, but if reproduction was the measurable unit, I could be a total a-hole towards patients, and still attract women like **** attracts flies, or if career advance was the unit, I am sure I could come far with antisocial traits, also in medicine.

Overall, this demonstrates an enormously poor understanding of the importance of Doctor-patient rapport/relationship and the emotional impact of medical illness on patients. Are you really this oblivious to the literature on Doctor-patient relationship and how this effects a patient's willingness to comply with treatment, willingness to change unhealthy behaviors, and overall patient outcome?

I guess I could be a lot better on doctor-patient relationships. I still have a lot to learn in medicine, and I will probably hit the wall pretty hard when I have to make decisions myself.

Well, from me back to topic; I understand that you can benefit from showing patients that you are understanding, non-judgemental and caring. I guess that is part of the reason why I strive towards seeing myself as a service-person and not the commander in chief of other people's health. But judging by how many doctors I have worked with, who psychodiagnose patients as difficult, or turn midly dysphoric as soon as the patients opens her/his mouth to do something different than just nod, I imagine one could come far, and make sh*tloads of money by being a regular authoritarian a-hole. So why not?

You’re missing a HUGE piece of your job as a doctor with this attitude.

What attitude? Analytical introspection?

 

[Decepticon]

"Waterproof" arguments are for philosophy classes, not the real world.

OK.

My practical answers to your questions would be:
1) as many as it takes to convince yourself that they are real people, as worthy of treatment with human dignity as your own 1st degree relatives.

They are real people, but my 1st degree relatives are worth more to me. Aren't your 1st degree relatives worth more to you, than random persons?

2) a) social shame/sanctions. Admittedly a bigger issue in other cultures than in the individualist West.

Agree.

b) expectation of reciprocity--that someone will be there for you when you need help.

Is this more like justifying to yourself and your conscious that you get help, if you need it? "I am a good person," so I should get help, and everyone should see that.

I honestly don't see how you could expect much reciprocity by donating cash to someone on the other side of the globe. And if nobody else is aware that you are donating, then this doesn't do anything to insure reciprocity, but perhaps it serves something else. What that something else is, is what I have been trying to aim at, the entire discussion. What is the base for this something else, when there is an extremely low chance for reciprocity?

c) for the greater good of the society--quality of life for all rises when poverty is addressed.

That is a good background for why it makes sense that humans act selflessly, but it doesn't explain why I would feel compelled to be one of the few donating to wikipedia, when I can leech. I am just one little person out of many. So my donations don't really do a difference. Accepting that premise, helping homeless and donating to wikipedia starts looking like the classical prisoner's dilemma.

If we both help each other, we are better off.
If I help you, but you don't help me, I get screwed.
If I don't help you, but you help me, I am much better off.

Seeing as my actions in the homeless case have no influence on how another completely different person might help me later, the dominant strategy should logically be to don't give a f*ck.

... so why do some of us still help... ?? (big mystery.)

 

[OldPsychDoc]

By winning, I meant employing a strategy that is most beneficial to you. I didn't really specify what I meant by beneficial, but if reproduction was the measurable unit, I could be a total a-hole towards patients, and still attract women like **** attracts flies, or if career advance was the unit, I am sure I could come far with antisocial traits, also in medicine. .[/COLOR]

Well, antisocial traits can also impair you in medicine--for example, one might note that an attending favors working with a somewhat altruistic, pleasant, but less bright medical student as opposed to the egotistical, argumentative obviously-intellectual one, thus advancing the educational fitness and future matching/job prospects for said pleasant medical student, whilst antisocial student is happily attempting to hook up with hot nurses (potentially further encumbering his future career prospects with angry in-laws and/or child support payments).

I guess I could be a lot better on doctor-patient relationships. I still have a lot to learn in medicine, and I will probably hit the wall pretty hard when I have to make decisions myself.

 

[michaelrack]

sss

 

[Doc Samson]

Seeing as my actions in the homeless case have no influence on how another completely different person might help me later, the dominant strategy should logically be to don't give a f*ck.

... so why do some of us still help... ?? (big mystery.)

Logic has ABSOLUTELY NOTHING to do with human behavior.

 

[OldPsychDoc]

Logic has ABSOLUTELY NOTHING to do with human behavior.

Now changing Doc Samson's alter ego to a different fictional super star...

 

[erg923]

By winning, I meant employing a strategy that is most beneficial to you.

Huh? Your kidding me right? Isn't your job the opposite of that? Would you want a doc who wants a stategy that is best the best for himself, or the best for patients? Be honest. I think I'd prefer the one who is looking for the best stategy for ME, the patient. Who would you chose?

The impression that I am getting is that you would like to be a Doctor. However, you dont seem to care about being a good doctor, as you seem about the percieved quality of your skills or the care you provide. Do you think that is fair to patients? And how would you maintain your referal base when your rep spreads around the local medical community?

"I imagine one could come far, and make sh*tloads of money by being a regular authoritarian a-hole. So why not?"

Perhaps our patients deserve better than this? Perhaps people coping with illness deserve to be treated better than any a-hole on the street? Perhaps being involved in someone's emotional experience and/or having them entrust their lives to you should be thought of as a humbling experience, rather than just a a way to exploit and "make money?" Would you honestly want to go to a physician with this kind of attitude? Did you really not learn bedside manner in your clinical skills didactics. Or was this something that was just difficult for you to pick up?

Your sociopathic traits and attitudes seem contraindicated for a career in medicine. Thoughts?

 

[Doc Samson]

Now changing Doc Samson's alter ego to a different fictional super star...

Aw, c'mon OPD. I was shooting for Bones McCoy.

 

[OldPsychDoc]

Aw, c'mon OPD. I was shooting for Bones McCoy.

OPD=McCoy (I claim this based on curmudgeonliness!)
Doc Samson=Spock
Sazi=Kirk, of course.

The rest of the regulars can fight it out over the second tier...

 

[HCE]

OK.

They are real people, but my 1st degree relatives are worth more to me. Aren't your 1st degree relatives worth more to you, than random persons?


What that something else is, is what I have been trying to aim at, the entire discussion. What is the base for this something else, when there is an extremely low chance for reciprocity?

If we both help each other, we are better off.
If I help you, but you don't help me, I get screwed.
If I don't help you, but you help me, I am much better off.


... so why do some of us still help... ?? (big mystery.)

I'm not understanding the logic of comparing 1st degree relatives with strangers, in this case homeless persons with mental illness. In terms of being a practicing psychiarist, you are free to set up a practice in which you serve only your 1st degree relatives. This would be as financially rewarding as a practice exclusively serving the homeless.

Looking at helping the mentally ill homeless from a non-altruistic perspective, particularly during residency (where I suspect psychiatrists see the largest number of homeless in their careers), I do think there is some reciprocity. Besides "allowing you" to hone your skills by treating them, I suspect (I'm no expert) that the homeless are exposing you to all kinds of pathologies that you would otherwise not be exposed to. "...so, why do some of us still help...?" Maybe because we actually do get something out of the relationship...we grow as a person (yeah, whatever that means), we learn to appreciate what we do have, we get to check off those religious check-boxes before we die....I do believe that every patient you see in any field of medicine can teach you something about medicine and life....maybe this is the ultimate reciprocity... Okay, I'm starting to sound Dr, Philish, so I'll stop now.

 

[Anasazi23]

OPD=McCoy (I claim this based on curmudgeonliness!)
Doc Samson=Spock
Sazi=Kirk, of course.

The rest of the regulars can fight it out over the second tier...

Hmm...I'm not sure if I'm flattered or flattened.

I find Decepticon's arguments quite Ayn Randish i.e. objectivism. She wouldn't, in common circumstances, endorse overt cruelty or this type of brashness I think, but I can see the parallels to the philosophy, which isn't all bad. In quite, I'm quite a fan of hers.

 

[Doc Samson]

OPD=McCoy (I claim this based on curmudgeonliness!)
Doc Samson=Spock
Sazi=Kirk, of course.

The rest of the regulars can fight it out over the second tier...

<pouting in a very un-vulcanlike manner>

 

[BabyPsychDoc]

At least from the psychiatry perpective, I'm not so sure you want to give mentally ill homeless and immigrant populations a few shots and send them on their way....things could get dangerous....and of course, then you have homeless and immigrant children....are they "on their own"?

(I'm expecting a post here from BabyPsychDoc )

Oops, have been busy - changed jobs last weeks and have a few things going on in my life.... Have to live down to HCE's expectations, though

Actually, I have nothing against mentally ill immigrant and homeless; neither do I think that you can just give them a few shots to fix their problems (I am not even going to go in to the logics - or lack thereof of this statement). Yes, they may be seen as a "drain on the society" by some - however, being mentally ill they cannot be held fully responsible for their actions and must be given help and support required. And I believe, it is our (ie, the society's) responsibility to provide such help.

I do have problems with multi-generation welfare parasites, but by definition parasites are subjects that can work but choose not to. Many mentally ill people would love to work (and quite a few I know actually do work, with appropriate support and supervision), so they do not qualify for the definition of parasite.

 

[BabyPsychDoc]

Looking at helping the mentally ill homeless from a non-altruistic perspective, particularly during residency (where I suspect psychiatrists see the largest number of homeless in their careers), I do think there is some reciprocity. Besides "allowing you" to hone your skills by treating them, I suspect (I'm no expert) that the homeless are exposing you to all kinds of pathologies that you would otherwise not be exposed to. "...so, why do some of us still help...?" Maybe because we actually do get something out of the relationship...we grow as a person (yeah, whatever that means), we learn to appreciate what we do have, we get to check off those religious check-boxes before we die....I do believe that every patient you see in any field of medicine can teach you something about medicine and life....maybe this is the ultimate reciprocity...

I wish I said that. Could not agree more.