Will losing your home kill you?

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If you work in a homeless clinic, every so often you're going to see a Mike. He's easy to spot in the waiting room because his clothes are too business-y and nice. But there is always some detail that gives him away. This time, it's his hair that's mashed up in back and he doesn't seem to know it. Three months ago he went through a divorce and lost his house to the IRS. For two months, he's been living out of his car, wheeling and dealing, trying to put something together, sponge-bathing in public toilets. He came in because he's recently lost his car, and then his phone, and you get the feeling he waited two hours to be seen mostly hoping you'll let him use a clinic phone to make a bunch of calls. He can't really say why he's here, his speech is pressured and he's only got a roll of blankets to keep him warm and he's vibrating with stress, his hoarse voice rising as he describes his life, how his back is killing him, how he can't sleep, and you notice that his hands are shaking.

It's difficult to listen to him, and you realize that part of the reason is because maybe, his story is a little too close to home.

Is it the lost home? Or the loser?

Even if the death rates among the homeless are higher, isn't it just because the people we're talking about are deeply flawed to begin with? You've probably heard people say that the only reason someone is homeless (especially those chronically homeless) is because they're not like you and me. Hey, you're no Scrooge, and neither are your colleagues and friends, but dinner conversations on this topic still sound uncomfortably similar to when Scrooge says, "I help to support the establishments I have mentioned - they cost enough and those who are badly off must go there," adding, "If they would rather die, they had better do it, and decrease the surplus population."

If it's any consolation, the Scrooge response is pretty common. In the November-December Harvard magazine, there is an interview with social psychologist Ann Cuddy, who studies perceptions of social groups. She describes the "contempt" quadrant, which is populated by the homeless, welfare recipients, poor people. "They're blamed for their misfortune," Cuddy says. "They are both neglected and, at times, become the targets of active harm." Deep-seated cognitive patterns may prepare the way for maltreatment. "There's an area of the brain, the medial prefrontal cortex (mPFC), that is necessary for social perception," she explains. Recent imaging research showed no activation of the mPFC in response to pictures of homeless people. Cuddy points out: "People are not even recognizing them as human."

The numbers argue otherwise. A study from New York found that the reasons for homelessness, even before the downturn of the economy, did not significantly differ between those people who were mentally ill (either defined broadly or narrowly), and those who had no diagnosis of mental illness at all. Insufficient income, job loss and lack of suitable housing were the same for all groups.

And like a rising tide, home loss seems to be inching closer to all of us. One in 10 Bay Area homeowners is projected to be more than 60 days delinquent on their mortgage, a number that has soared up from 1 in 100 in 2007. Those numbers may already have worsened, and they don't reflect the renters who've lost or are threatened with the loss of their homes, or the people who have begun to "couch surf" after being unable to find a job.

But is "homelessness" different from home loss? Institutions like the foster system, the prisons, and the lack of mental health resources are all acknowledged contributors to homelessness. But both academic studies and homeless people themselves often report that the reason for their homelessness is more mundane than you might expect, even in countries with comprehensive social safety nets - eviction, divorce, domestic violence and job loss. Here, the 2009 San Francisco survey showed that a good 57.7% of people on the street self-reported reasons that may be closer to our own lives than many of us expect: things such as landlord sold home/stopped renting/raised rent (3.4%), or eviction (5.3%), or lost home to foreclosure (1.3%). Reasons of divorce, separation, domestic violence, death in the family, illness and hospitalization all added up to 11.9%. And then there's lost job (25.2%).

So, listening to Mike, the uncomfortable thought emerges - if you were put out there on Sixth and Mission for three months, no money, no family, no friends, how well would you do? And how much would you change before it was over?