The Trauma Cycle: Homelessness and Stigma

Just before midnight, in Austin, Texas, a man cried into a camera as he faced his first night on the streets.

Mike Black, a millionaire just 24 hours prior, had relinquished his luxury apartment and all monetary assets to attempt to earn a million dollars in a year, starting from nothing. Implementing his personal growth mindset, Black endeavored to overcome homelessness and poverty with business savvy and optimism. Although Black chose homelessness, his peers on the streets did not share the same freedom.

Homelessness is a complex phenomenon that is both caused by trauma, mental illness, substance use, systemic racism, and poverty, while also precipitating these issues (Padgett et al., 2020). Material causes for homelessness such as low working class income, high rental rates, low housing availability, and historical gentrification of inner-city slums are direct and visible causes of homelessness (National Academies of Sciences, Engineering, and Medicine, 2018; Jones, 2015). However, the indirect and invisible causes for initial and continued homelessness are equally as powerful: stigma and trauma work silently to alienate vulnerable people from crucial resources and community. Stigma revives childhood trauma and creates tangible barriers to health, housing, and employment for people experiencing homelessness (PEH). Trauma and stigma cascade into one another, fueled by a dispositional view of people, a minimalist understanding of freedom and a refusal to acknowledge the material, social, and psychological prerequisites for membership in our society.

The ideological function of Negative Freedom creates a dispositional view of PEH so that they are viewed as responsible for their own subjugated position in society (Phelan et al., 1997; Johnstone et al., 2015). Believing in Negative Freedom means believing that everyone has the same shot at material success because freedom is based on the absence of external barriers. In other words: we are independent beings free to self-determine our position in society based on our innate work ethic, intelligence, and talent (Berlin, 1969; Carter, 2021). Positive Freedom conversely holds that situational factors allow or disallow access to success. This means we are interdependent beings requiring certain environmental nutrients to express our work ethic, intelligence, and talent; these environmental nutrients can be understood as Asset Citizenship.

To experience Asset Citizenship in our society, you need money, networks, and knowledge: money is capacity for change; networks are access points to resources; and knowledge is the ability to manage social and monetary assets. Mike Black, for example, had significantly more asset citizenship than other PEH as evidenced by his ability to quickly obtain shelter, feed himself, forge new relationships, and start a business. Without access to his fortune, Black used his manner of speaking, bachelor’s degree, pre-planned survival strategies, and emotional support from family and friends to maintain himself. Asset Citizenship therefore requires not just monetary, but social and epistemological resources. Because of this belief in Negative Freedom, though, Black omits his privileges from his explanation of success.

Stigma leaps from the gulf between optimism and reality. We can hear it hidden within Black’s logic at the end of his 19th installment in the series, shortly before he went home to live with his parents. He said:

“Set up the life that you want. Then it's a matter of how bad you want it.
Are you willing to put in the work? Most people aren’t.” (Black, 2020)

Unhoused people are consistently measured against this individualistic view of life, that associates a person's success or challenges with personal attributes—often work ethic. This view is called dispositionalism and it is not a universal human truth but rather a culture-specific tendency to draw causal lines to a person's character rather than their context (Lee et al., 1996). The view of Negative Freedom creates logical conditions for a dispositional mindset to arise. The thinking goes: if you are homeless, then it's probably your fault. For Black, PEH are tacitly the lazy, unmotivated foil for his material success. They are condemned as people not willing to put in the work (Phelan et al., 1997; Johnstone et al., 2015).

Research shows that stigma is a strong force for continued homelessness as it prevents the people experiencing it from seeking care from institutional sources, while reducing the quality of care provided (Reilly et al., 2022). Interpersonal stigma in the health care system emerges as discriminatory action by health care providers such as rushed discharge, mistrust of PEH, segregated appointment schedules and waiting rooms, and outright denial of care (Canham et al., 2024). Discrimination against PEH results in experiences of dehumanisation and power differentials. Unhoused patients report being treated as “subhuman” or “trash”, while anxiety about stigma leads to concealment of pregnancy, substance use, and other conditions from providers (Canham et al., 2024).

Outright denial of treatment and early discharge by health professionals harms PEH in the short term and long term. Abuse from health care professionals alienates PEH and results in substandard or nonexistent health care. Similar experiences of dehumanization and discrimination push PEH away from homeless shelters and care management. The weight of the homeless label often strips people of their identity, they often cite feelings of “just being a number” (Canham et al., 2024). Stigma persists even when PEH attempt to improve their circumstances. Discrimination by employers and landlords preferentially exclude homeless people with minimum income requirements, reliable references, and assumptions about drug use (Canham et al., 2024).

The cumulative experiences of these negative interactions are traumatic in their own right and actively keep PEH unhoused—drastically increasing likelihood of early death (O’Connell, 2005). But stigma also revives childhood traumas that precede and often cause homelessness.

According to one meta-analysis, almost 90 percent of PEH have experienced at least one Adverse Childhood Experiences (ACEs)—characterized by various forms of abuse, neglect, or family dysfunction experienced in early life (Liu et al., 2021). More than a third of PEH have experienced sexual or physical abuse in their lifetime (Liu et al., 2021). Given their prevalence, ACEs are understood as an indirect cause of homelessness, thus the invisible factors of trauma contribute heavily to the visible result of homelessness. Furthermore, parents that experience ACEs are very likely to pass them on to their children; trauma is intergenerational and thus cyclical (Narayan et al., 2017).

The trauma felt in childhood and revived in adulthood through structural, interpersonal and internalized stigma keeps individuals unhoused and predicts a similar fate for their children.

These revelations present us with two opportunities for breaking the cycle and address the invisible causes of homelessness. First, targeting stigma at its ideological root by acknowledging Asset Citizenship can foster whole person care solutions. Housing First and the Social Determinants of Health as concepts are manifestations of Positive Freedom in action. Second, to address trauma, prioritizing the mental health needs of PEH and children currently experiencing ACEs (Canham et al., 2024). This strategy highlights the importance of clinical social work, a specialty of Seattle University, as a vital care modality for PEH.

Housing First is a rehousing model that understands shelter as a foundation for human flourishing (National Alliance to End Homelessness, 2025). As a reaction against sobriety and employment requirements for housing, Housing First (HF) seeks to quickly and permanently place unhoused people into a residence while supporting their health care, recovery, and employment needs. Similarly, the Social Determinants of Health (SDH), recognize housing, along with liveable income, food security, and access to quality education as determinants of physical health (U.S. Department of Health and Human Services, n.d.).

However, structural stigma against PEH and other vulnerable communities hamstring efforts to implement HF and SDH. Lack of funding often leads to incomplete fulfillment of Housing First tenants, leaving out substance use or mental health support. Funding and lack of housing are consistent carriers for HF programs (Greenwood et al., 2013). In San Francisco, for example HF has not successfully reduced homelessness despite spending over 20 billion on the project (GrowSF, 2025). Lack of emphasis on recovery and mental health services to complement housing meant PEH weren’t supported adequately to achieve stable housing status.

California is applying SDH by using state Medicaid funds for whole-person care— including provision of housing (Schneidermann & Villegas, 2025). This effort is challenged by siloed care providers and differences in payment structures between community based organizations (CBOs) and Medicaid providers (Schneidermann & Villegas, 2025). In addressing trauma through clinical mental health support, interventions are most effective when timed with release from an institution and combined with active outreach, case management, and housing (Hwang et al., 2014). The effectiveness of whole person care and the challenges faced by HF also apply to this intervention point.

Although some obstacles to solutions are practical, many, such as lack of funding, are centered in structural stigma towards PEH and related communities. The source of stigma is our persistent tendency toward dispositionalism, and more abstractly our belief in Negative Freedom. Programs attempting to jump-start asset citizenship for PEH through institutional care are hopeful but the resistance is stiff. If we are to effectively combat homelessness, we need to address our beliefs and the cruelty they create.

References

Berlin, I. (1969). Two Concepts of Liberty. In Four Essays on Liberty, Oxford University Press. 

Black, M. (2020, July 23). This is Not a Good Start | Million Dollar Comeback Day 1. Mike Black. https://youtu.be/LJY9ruwZ8Jk?si=o0GgZKaHEoLB-k6G

Canham, S. L., Weldrick, R., Erisman, M., McNamara, A., Rose, J. N., Siantz, E., Casucci, T., & McFarland, M. M. (2024). A scoping review of the experiences and outcomes of stigma and discrimination towards persons experiencing homelessness. Health & Social Care in the Community, 2024(1). https://doi.org/10.1155/2024/2060619

Carter, I. (2021, November 19). Positive and negative liberty. Stanford Encyclopedia of Philosophy. https://plato.stanford.edu/entries/liberty-positive-negative/

Greenwood, R. M., Stefancic, A., Tsemberis, S., & Busch-Geertsema, V. (2013). Implementations of Housing First in Europe: Successes and challenges in maintaining model Fidelity. American Journal of Psychiatric Rehabilitation, 16(4), 290–312. https://doi.org/10.1080/15487768.2013.847764

GrowSF. (2025, April 15). How San Francisco built a homeless system that fails its most vulnerable. Research. https://growsf.org/research/2025-04-14-sf-homeless-system-fails-vulnerable/

Hwang, S. W., & Burns, T. (2014). Health interventions for people who are homeless. The Lancet, 384(9953), 1541–1547. https://doi.org/10.1016/s0140-6736(14)61133-8

Johnstone, M., Jetten, J., Dingle, G. A., Parsell, C., & Walter, Z. C. (2015). Discrimination and well-being amongst the homeless: The role of multiple group membership. Frontiers in Psychology, 6. https://doi.org/10.3389/fpsyg.2015.00739

Jones, M. M. (2015). Creating a science of homelessness during the Reagan era. The Milbank Quarterly, 93(1), 139–178. https://doi.org/10.1111/1468-0009.12108

Lee, F., Hallahan, M., & Herzog, T. (1996). Explaining real-life events: How culture and domain shape attributions. Personality and Social Psychology Bulletin, 22(7), 732–741. https://doi.org/10.1177/0146167296227007

Liu, M., Luong, L., Lachaud, J., Edalati, H., Reeves, A., & Hwang, S. W. (2021). Adverse childhood experiences and related outcomes among adults experiencing homelessness: A systematic review and meta-analysis. The Lancet Public Health, 6(11), 863–847. https://doi.org/10.1016/s2468-2667(21)00189-4

Narayan, A. J., Kalstabakken, A. W., Labella, M. H., Nerenberg, L. S., Monn, A. R., & Masten, A. S. (2017). Intergenerational continuity of adverse childhood experiences in homeless families: Unpacking exposure to maltreatment versus family dysfunction. American Journal of Orthopsychiatry, 87(1), 3–14. https://doi.org/10.1037/ort0000133

National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Population Health and Public Health Practice, Policy and Global Affairs, Science and Technology for Sustainability Program, & Committee on an Evaluation of Permanent Supportive Housing Programs for Homeless Individuals. (2018). Appendix B, The History of Homelessness in the United States. In Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. essay, National Academies Press (US).

National Alliance to End Homelessness. (2025, March 10). Housing first. Toolkits and Training. https://endhomelessness.org/resources/toolkits-and-training-materials/housing-first/

O’Connell, J. J. (2005). Premature Mortality in Homeless Populations: A Review of the Literature, 19.

Padgett, D. K. (2020). Homelessness, housing instability and Mental Health: Making The Connections. BJPsych Bulletin, 44(5), 197–201. https://doi.org/10.1192/bjb.2020.49

Phelan, J., Link, B. G., Moore, R. E., & Stueve, A. (1997). The stigma of homelessness: The impact of the label “Homeless” on attitudes toward poor persons. Social Psychology Quarterly, 60(4), 323. https://doi.org/10.2307/2787093 

Reilly, J., Ho, I., & Williamson, A. (2022). A systematic review of the effect of stigma on the health of people experiencing homelessness. Health & Social Care in the Community, 30(6), 2128–2141. https://doi.org/10.1111/hsc.13884

Schneidermann, M., & Villegas, J. L. (2025, October 6). How medi-cal is tackling homelessness through Innovative Housing Solutions. Behind the Headlines. https://www.chcf.org/resource/how-medi-cal-tackling-homelessness-innovative-housing-solutions/

U.S. Department of Health and Human Services. (n.d.). Social Determinants of Health. Healthy People 2030. https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health