Academic journal article Health and Social Work

Social Work Outreach to Homeless People and the Need to Address Issues of Self-Esteem

Academic journal article Health and Social Work

Social Work Outreach to Homeless People and the Need to Address Issues of Self-Esteem

Article excerpt

Studies of homeless people have noted the high incidence of mental illness (Ball & Havasy, 1984; Belcher & Toomey, 1988; Fischer & Breakey 1988; Lamb, 1984). However, less attention has been paid to the problem of low self-esteem, its incidence among the homeless population, and its consideration in the provision of mental health services. The sense of failure and stress caused by the inability to secure basic needs and sometimes safety and by the isolation and alienation of homelessness (Cohen, Putnam, & Sullivan, 1984) can lead to low self-esteem.

The feeling of worthlessness that low self-esteem generates can prevent individuals from successful functioning in their occupational, social, and leisure activities (Belcher & DiBlasio, 1990b). In homeless people, it can block motivation to find gainful employment, housing, and other essential needs. Failure to secure needs often leads to despair and worsens an already poor view of self.

Isolation, alienation, and deprivation create high levels of stress in homeless living. Foraging for food, having inadequate access to bathroom facilities, and lacking adequate social networks can lead to burnout and fatigue (Hatfield, 1989; Wrubel, Benner, & Lazarus, 1981). As homeless individuals succumb to burnout and fatigue, they accumulate more failures than successes in their lives, which in turn renders them less able to successfully integrate themselves into the community (Belcher, 1988).

As homeless people attempt to live out their daily lives, many of them encounter failures that further weaken already damaged egos. Chronic failure contributes to alcohol and drug problems (Segal, Baumohl, & Johnson, 1977) and involvement with the criminal justice system (Benda, 1987; Gelberg, Linn, & Leake, 1988). Self-esteem is undermined because homeless people often have difficulty formulating and achieving goals. Homeless people increasingly lose control over their reality, which then becomes a function of external forces.

Homeless people, like the rest of society, have goals that, if not met, can lead to feelings of loss. Even though homeless people may have some supports, their disconnection from society and inability to achieve basic goals may lead to low self-esteem. Particularly disturbing is the growing number of homeless people who work but who are unable to meet basic needs such as food, clothing, and shelter (Hopper, Susser, & Conover, 1985; Wilson, 1985). Other homeless people have experienced a lifetime of failures and have rarely been employed (Belcher & DiBlasio, 1990a). These factors can place homeless people at risk for developing mental health disorders or for exacerbating existing psychiatric conditions. Consequently, studies on self-esteem are important in generating prevention and treatment strategies.

Clinical practitioners often use the Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised (DSM-III-R) (American Psychiatric Association |APA~, 1987) to diagnose mental health disorders. In some cases low self-esteem may mimic disorders found in DSM-III-R that could result in confused diagnoses and misguided intervention. For example, a clinical depression such as dysthymia may be diagnosed in a homeless person with low self-esteem who presents with at least a two-year struggle with feelings of hopelessness and low energy or fatigue. In this situation the hopelessness may be connected with constant failure to meet needs and the low energy from food deprivation, lack of a safe and comfortable place for restful sleep, or possible health problems.

Confusion may also result in the diagnosis of personality disorders, which are disorders that reflect enduring patterns of inflexible and maladaptive personality traits. Some homeless people present with symptoms similar to personality disorders but actually are suffering from low self-esteem. For example, for a specific diagnosis for borderline personality disorder, clients must demonstrate five of the following eight criteria since early adulthood: (1) unstable and intense interpersonal relationships, (2) impulsiveness in at least two self-damaging behaviors, (3) affective instability, (4) inappropriate anger, (5) suicidal threats or self-mutilation, (6) identity disturbance, (7) feelings of emptiness or boredom, and (8) frantic efforts to avoid real or imagined abandonment. …

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