João Gama Marques
Joana Henriques-Calado
Martin M. Schumacher- 1Consulta de Esquizofrenia Resistente, Hospital Júlio de Matos (HJM), Unidade Local de Saúde de São José (ULSSJ), Centro Clínico Académico de Lisboa (CCAL), Lisboa, Portugal
- 2Clínica Universitária de Psiquiatria e Psicologia Médica (CUPPM), Faculdade de Medicina Universidade de Lisboa (FMUL), Centro Académico de Medicina de Lisboa (CAML), Lisboa, Portugal
- 3Homeless Outreach Psychiatric Engagement for Lisboa (HOPE 4 Lisboa), Santé Mentale et Exclusion Sociale (SMES), Lisboa, Portugal
- 4Centro de Investigação em Ciência Psicológica (CICPSI), Faculdade de Psicologia, Universidade de Lisboa (FPUL), Lisboa, Portugal
- 5Faculdade de Psicologia, Universidade de Lisboa (FPUL), Lisboa, Portugal
- 6Independent Researcher, Sissach, Switzerland
Editorial on the Research Topic
Mental illness and neuropsychiatry of the homeless: psychosis, personality, drug abuse, and other brain disorders
The ailments of persons experiencing homelessness have been studied by clinicians, but also academics, from different backgrounds for many decades. A rapid search on PubMed, using the word homeless, revealed its first use by in 1888 (Henderson, 1888). Although the author might not have been the first one to use the concept, it seems that it was the first time the word appeared in this important database. Since then, many other works focused in the homeless. Today we celebrate three of those:
One hundred years of “the hobo: the sociology of the homeless man” by Nels Anderson
In November 2023 we celebrated the 100th anniversary of the seminal work “The hobo: the sociology off the homeless man” by Nels Anderson, a sociologist, that in 1923, Chicago, United States of America, distinguished hobos, tramps, bums and home guards (Anderson, 1923). In the following decades, countless authors realized the complexity of persons experiencing homelessness, exploring other concepts, such as vagrants (Kirchesch, 1950), skid rows (Myerson, 1953), runaways (Robins and O'Neal, 1959), urban nomads (Gropper, 1967), drifters (Bandler, 1967), squatters (Pataki-Schweizer, 1978), street people (Jones, 1983), throwaway people (Curtin, 1986), street youth (Côté, 1989), space cases (Fischer, 1992), gutter punks (Goetz, 2000), squeegees (Dachner and Tarasuk, 2002), etc.
Thirty years of “Santé Mentale et Exclusion Sociale” by Luigi Leonori
In December 2022 we celebrated, the 30th anniversary of the European organization Santé Mentale et Exclusion Sociale (SMES), created by Luigi Leonori, a professor of Psychology, in 1992, Rome, Italy. He and his colleagues were worried about the social exclusion (“Exclusion Sociale”), of persons with mental health (“Santé Mentale”) problems, experiencing homelessness (http://www.smes-europa.org/). Not only in Europe, persons experiencing homelessness have been labeled with a considerable number of different designations: pixote (Brazil), gamino (Colombia), itinérants (Canada), clochard (France), puliukko (Finland), sans-abri (France), pennebruder (Germany), barboni (Italy), tunawisma (Indonesia), furosha (Japan), sin techo (Mexico), khate (Nepal), desamparado (Peru), sem-abrigo (Portugal), or BOMZI, the acronym for Bez Opredilyonogo Mesta Zhitelstva (Russia), etc (Glasser, 1994).
Twenty years of “Sem-Amor Sem-Abrigo” by António Bento and Elias Barreto
In September 2022 we celebrated the 20th anniversary of “Sem-Amor Sem-Abrigo”, a book published in 2002, in Lisboa, Portugal, by the recently deceased António Bento (Gama Marques, 2024), a psychiatrist, and Elias Barreto, a psychologist. At the time, the authors interviewed a small sample of homeless men and found not a single case of secure attachment style, leading them to propose the loveless (sem-amor) hypothesis among the homeless (sem-abrigo) (Bento and Barreto, 2002). Interestingly, all around the world, many other authors also looked on persons experiencing homelessness, as human beings lacking other important things, besides love: jobless (Miller et al., 1970), rootless (Holden, 1975), houseless (Bailey, 1977), supportless (Lipton and Sabatini, 1984), defenseless (Farr, 1985), restless (McLaughlin and Pepper, 1990), familyless (Liebow, 1993), roofless (Newton et al., 1994), nameless (Gama Marques and Bento, 2020a,b), healthless (Yen et al., 2009), shelterless (Burton et al., 2020), etc.
Here in Portugal, we have been trying to follow charismatic leaders, inspired by true homelessness champions who brought people together and held on to a vision (Pannel and Parry, 1999), such as António Bento and Luigi Leonori in Southwestern Europe, or Mitch Snyder (Snyder and Hombs, 1986) and Edwin Fuller Torrey (Fuller Torrey, 1988) in Northeastern America.
We published papers revisiting theoretical concepts such as marontology, comorbidity (Gama Marques and Bento, 2020a,b), super-difficult patients (Gama Marques, 2021), mortification and shelterization (Gama Marques, 2022a,b). We did reviews on homelessness and epilepsy (Pontes Silva and Gama Marques, 2023), schizoaffective psychoses (Spranger Forte et al., 2023), and attachment disorders (Neves Horácio et al., 2023). And we spread case reports of homeless patients with conditions such as haltlose personality disorder (Gama Marques, 2019), treatment resistant schizophrenia, organic psychosis, pellagra, Capgras delusion (Gama Marques, 2022a,b), Huntington chorea, John Doe and Diogenes syndromes (Gama Marques, 2023).
We have been doing interstitial or street psychiatry, while leading the Homeless Outreach Psychiatric Engagement for Lisboa (HOPE 4 Lisboa) (Monteiro Fernandes et al., 2022; Gama Marques et al., 2023). Figure 1 represents just an example of our work: the sleeping ground of two of our psychotic patients, a middle age couple sharing, for more than a decade, a grandiose folie a deux with indescribable ruin and misery.
Figure 1. The sleeping ground of two of our psychotic patients, a middle age couple sharing, for more than a decade, a grandiose folie a deux with indescribable ruin and misery.
The present Research Topic on Mental Illness and Neuropsychiatry of the Homeless: Psychosis, Personality, Drug Abuse, and Other Brain Disorders, compiles ten articles from both sides of the Atlantic Ocean, on five different Frontiers journals.
Frontiers in Human Neuroscience: an Original Research manuscript, by Rangu et al. (Oklahoma), describes a relation between head concussions and medication non-adherence; and a Brief Research Report, by Pluck (Thailand) raises a pertinent question: is executive dysfunction among the homeless a true impairment or just another case of frontal lobology?
Frontiers in Artificial Intelligence: an Original Research article, by Chapman et al. (Utah), assesses the longitudinal housing status, of patients, using electronic health record data.
Frontiers in Psychiatry: one Opinion by Bravo et al. (Portugal); and one Brief Research Report, by Herrera-Imbroda et al. (Spain), both regarding the problem of readmissions in the homeless population; one Mini Review, by Henriques-Calado and Gama Marques (Portugal) dedicated to personality disorders; and a Systematic Review, by Hird et al. (New Haven), looking at the approaches to improve medication adherence in the homeless population.
Frontiers in Psychology: a Community Case Study by Gabrielian et al. (California), on the engagement of stakeholders in a homeless veterans' program; and one Original Research article, by Oliveira Azevedo et al. (Portugal), dedicated to a harm reduction intervention with homeless people struggling with alcoholism.
Frontiers in Public Health: one Brief Research Report, by Catthoor et al. (Belgium) looking at the housing problems in admitted psychiatric patients.
We regret not having more articles published in this topic. Nevertheless, we hope our Research Topic' articles will stimulate future discussion regarding persons living and dying with psychiatric disorders and neurologic diseases while experiencing homelessness.
Author contributions
JG: Conceptualization, Investigation, Writing – original draft, Writing – review & editing. JH-C: Supervision, Validation, Writing – review & editing. MS: Supervision, Validation, Writing – review & editing.
Funding
The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.
Acknowledgments
Dr. Philip Timms (London, England, United Kingdom), Dr. Pierre Ryckmans (Brussels, Belgium, European Union), and Dr. Victor Soto (Barcelona, Spain, European Union), all at Santé Mentale et Exclusion Sociale (SMES) in their respective countries.
In Memoriam
Dr. António Bento, 1954–2023 (Lisboa, Portugal, European Union).
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
Anderson, N. (1923). The Hobo: the Sociology of the Homeless Man. Chicago: The University of Chicago Press.
Bandler, L. S. (1967). The drifters. Children of disorganized lower-class families. Family functioning: a psychosocial perspective. Int. Psychiatry Clin. 4, 225–253.
Burton, D., Jones, S., Carlisle, T., and Holmes, A. (2020). Homeless men with psychosis are spending more time shelterless. Aust. Psychiat. 29, 145–148. doi: 10.1177/1039856220928860
Côté, M. M. (1989). Escape and survival strategies of homeless youth in Montréal. Sante Ment. Que. 14, 150–157. doi: 10.7202/031524ar
Dachner, N., and Tarasuk, V. (2002). Homeless “squeegee kids”: food insecurity and daily survival. Soc. Sci. Med. 54, 1039–1049. doi: 10.1016/S0277-9536(01)00079-X
Farr, R. K. (1985). The Homeless Mentally Ill and the Los Angeles Skid Row Mental Health Project. Los Angeles: Department of Mental Health.
Fischer, P. J. (1992). Victimization and homelessness: cause and effect. N. Engl. Public Policy 8, 229–246.
Fuller Torrey, E. (1988). Nowhere to Go: the Tragic Odyssey of the Homeless Mentally Ill. New York: Harper & Row.
Gama Marques, J. (2019). Pharmacogenetic testing for the guidance of psychiatric treatment of a schizoaffective patient with haltlose personality disorder. CNS Spectr. 24, 227−228. doi: 10.1017/S1092852917000669
Gama Marques, J. (2021). Super difficult patients with mental illness: homelessness, marontology and John Doe syndrome. Acta Med. Port. 34, 314. doi: 10.20344/amp.15868
Gama Marques, J. (2022a). Mortification and shelterization of homeless psychiatric patients in Portugal. Eur. Rev. Med. Pharmacol. Sci. 26, 1431−1432. doi: 10.26355/eurrev_202203_28204
Gama Marques, J. (2022b). Pellagra with Casal necklace causing secondary schizophrenia with Capgras syndrome in a homeless man. Prim. Care Companion CNS Disord. 24:21cr03014. doi: 10.4088/PCC.21cr03014
Gama Marques, J. (2023). Diogenes syndrome in a homeless man with the Westphal variant of Huntington's disease. Prim. Care Companion CNS Disord. 25:22cr03283. doi: 10.4088/PCC.22cr03283
Gama Marques, J. (2024). In memoriam António Bento (1954–2023): champion of the loveless homeless in Portugal, veteran member of Santé Mentale et Exclusion Sociale (SMES) in Europe. Int. J. Soc. Psychiat. doi: 10.1177/00207640241250309
Gama Marques, J., and Bento, A. (2020a). Homeless, nameless and helpless: John Doe syndrome in treatment resistant schizophrenia. Schizophr. Res. 224, 183–184. doi: 10.1016/j.schres.2020.08.027
Gama Marques, J., and Bento, A. (2020b). Marontology: comorbidities of homeless people living with schizophrenia. Acta Med. Port. 33, 292. doi: 10.20344/amp.13561
Gama Marques, J., Chesi, D., Coelho, R. O., Castanheira Costa, I., Santos Antão, C., Pedro, C. A., et al. (2023). Homeless outreach psychiatric engagement for Lisboa (HOPE 4 Lisboa): one year of marontology, and one John Doe living with Diogenes syndrome. Int. J. Soc. Psychiatry 22, 227–230. doi: 10.1177/00207640231179322
Gropper, R. C. (1967). Urban nomads–the Gypsies of New York City. Trans. N. Y. Acad. Sci. 29(8):1050–1056.
Holden, H. M. (1975). Medical care of homeless and rootless young people. Br. Med. J. 4, 446–448. doi: 10.1136/bmj.4.5994.446
Jones, R. E. (1983). Street people and psychiatry: an introduction. Hosp. Community Psychiatry. 34, 807–811. doi: 10.1176/ps.34.9.807
Lipton, F. R., and Sabatini, A.l. (1984). “Constructing support systems for homeless chronic patients,” in The Homeless Mentally Ill: A Task Force Report of the American Psychiatric Association, H. R. Lamb. Washington: American Psychiatric Association.
McLaughlin, M., and Pepper, B. (1990). “The young and the restless: programming for the crisis-ridden young adult patient,” in Psychiatry Takes to the Streets: Outreach and Crisis Intervention for the Mentally Ill, eds. N. L. Cohen. New York: Guilford Press.
Miller, B. A., Pokorny, A. D., and Kanas, T. E. (1970). Problems in treating homeless, jobless alcoholics. Hosp. Commun. Psychiat. 21, 98–99. doi: 10.1176/ps.21.3.98
Monteiro Fernandes, A., Gama Marques, J., Bento, A., and Telles-Correia, D. (2022). Mental illness among 500 people living homeless and referred for psychiatric evaluation in Lisbon, Portugal. CNS Spectr. 27, 699−708. doi: 10.1017/S1092852921000547
Myerson, D. J. (1953). An approach to the Skid Row problem in Boston. N. Engl. J. Med. 249, 646–649. doi: 10.1056/NEJM195310152491603
Neves Horácio, A., Bento, A., and Gama Marques, J. (2023). Personality and attachment in the homeless: a systematic review. Int. J. Soc. Psychiatry. 69, 1312−1326. doi: 10.1177/00207640231161201
Newton, J. R., Geddes, J. R., Bailey, S., Freeman, C. P., McAleavy, A., and Young, G. C. (1994). Mental health problems of the Edinburgh 'roofless'. Br. J. Psychiatry. 165, 537–540. doi: 10.1192/bjp.165.4.537
Pannel, J., and Parry, S. (1999). “Implementing ‘joined-up thinking': multiagency services for single homeless people in Bristol,” in Homelessness: Exploring the New Terrain, eds. P. Kennet, and A. Marsh. Bristol: Bristol University Press.
Pataki-Schweizer, K. J. (1978). Transcultural coping: psychiatric aspects in squatter settlements. P. N. G. Med. J. 21, 270–275.
Pontes Silva, R., and Gama Marques, J. (2023). The homeless, seizures, and epilepsy: a review. J. Neural. Transm. 130, 1281–1289. doi: 10.1007/s00702-023-02685-8
Robins, L. N., and O'Neal, P. (1959). The adult prognosis for runaway children. Am. J. Orthopsychiatry. 29:752–761.
Snyder, M., and Hombs, M. E. (1986). Homelessness in America: A Forced March to Nowhere. Washington: Community for Creative Non-Violence.
Spranger Forte, A., Bento, A., and Gama Marques, J. (2023). Schizoaffective disorder in homeless patients: a systematic review. Int. J. Soc. Psychiatry. 69, 243−252. doi: 10.1177/00207640221131247
Keywords: psychiatry, neuropsychiatry, psychology, neuropsychology, homeless
Citation: Gama Marques J, Henriques-Calado J and Schumacher MM (2024) Editorial: Mental illness and neuropsychiatry of the homeless: psychosis, personality, drug abuse, and other brain disorders. Front. Psychol. 15:1447883. doi: 10.3389/fpsyg.2024.1447883
Received: 12 June 2024; Accepted: 17 June 2024;
Published: 03 July 2024.
Edited and reviewed by: Antoine Bechara, University of Southern California, United States
Copyright © 2024 Gama Marques, Henriques-Calado and Schumacher. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: João Gama Marques, am9hb2dhbWFtYXJxdWVzJiN4MDAwNDA7Z21haWwuY29t