Review of "Rough Sleepers"

Plus a review of a NYT Bestseller on homelessness

Today’s piece is specific, but important. It’s a book review about a very recent, popular title that overlaps significantly with my work. I think this review will be valuable even if you haven’t read the book as another example of things I talk a lot about.

Enjoy!

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Imagine my excitement to hear about the upcoming release of Rough Sleepers. The author, Tracy Kidder, is a NYT Bestseller multiple times over. His book Mountains Beyond Mountains about Paul Farmer was so inspirational when I first started in this field. And now he was writing about homelessness in America? When I wrote my book, there was little sense in the marketplace whether homelessness was a topic people wanted to read about. Now, there’s a guaranteed bestseller about it!

Having now read the book, I certainly retain some cause for celebration. Many people will undoubtedly walk away from this book with a better sense of homelessness and what causes it. Readers will fall in love with some of the characters, who are real people who have (and still do) experience homelessness, and perhaps look at their own unhoused neighbors differently because of it. In all, I think this book is a net good.

That being said, I had major concerns when reading this book—and I chose to write about them here because I think they really matter. The majority of them revolve around the book’s focus and ultimate fixation with the person of Dr. Jim O’Connell, the “hero” of the book. 

But before we get there, I want to say a quick word about how this book handled “housing first.” If you’ve read anything I’ve written, you know I support housing first whole-heartedly. When it is followed with fidelity, it is wildly effective at ending homelessness. However, the words “with fidelity” carry a lot of weight. Many cities and organizations claim they are “housing first,” but because of housing availability actually abandon the key components of it: that there be choice and agency, and no strings attached. In this book, author Tracy Kidder talks about the studies that show how housing first is effective, and then describes in detail how it was implemented (poorly!) in Boston, and ultimately concludes that the jury is still out. As if housing first didn’t have enough criticism from bad faith actors, Kidder should do more than shrug at this debate based on a notably poor implementation of it. One can’t declare, “I don’t like steak,” when all they’ve sampled is a McDonald’s hamburger patty.

In broad strokes, the book hinges its care and interest in homelessness on one man, Dr. Jim O’Connell. He is a typical Tracy Kidder hero, a (white) man who forgoes a traditional (and likely lucrative) career to provide services to people who lack traditional access to them; in this case, health care for the homeless. While Kidder is reluctant to call Dr. Jim a hero or saint, you will find the idea throughout the book: in the mouths of his patients and colleagues, and in Dr. Jim’s own resistance to accepting these labels (a sure-fire sign to many that he deserves them all the more.)

I have no beef with Dr. Jim. He seems like a wonderful, kind, and generous guy. I learned a lot from the wisdom he shares in the book. The world is likely a better place because of him. Nonetheless, I’m finding more and more that our instinct to associate systemic issues with the “heroes” that tackle them has three problematic consequences:

1. It overrides the voices of those who are actually experiencing the harm

2. It celebrates and standardizes unhealthy expectations in helping professions

3. It risks the possibility that if the “hero” is tainted, our support for the issue goes with them

To the first point, the book is ultimately about Dr. Jim, and I wish it were more about his patients. While there are lots of stories, and one particular individual that earns more of Kidder’s focus (more on this later), they largely take a backseat. And that’s a shame, because I think we have far more to learn from them; Dr. Jim could have been our entry point into that world, rather than its filter.

At several points throughout the book I had to stop and exclaim to the void, “Dr. Jim has terrible boundaries!” And this became a sticking point as I read—while Kidder doesn’t go so far as to celebrate Dr. Jim’s overworking, under-resting, and 24/7 availability, it is brushed over as a quirk, or even admired as what makes him special. As though it were an aside, the book mentions in parentheses that Dr. Jim’s first marriage ended, and that his work was likely to blame. 

The danger of this is the expectation it places on those in helping professions: that to do this work is to eschew relationships, hobbies, rest, and a full life. It declares, “This is what you signed up for,” to every person willing to enter into society’s brokenness. And that’s just a damn shame, because it doesn’t have to be that way. To paraphrase my friend KJ Ramsey, we can acknowledge and uplift one another’s belovedness without sacrificing our own. 

Dr. Jim does not have to answer his phone and pager at 2am. If the program determined that 24 hour access was a need, they could implement an on-call system where multiple physicians or responders take turns with the phone. When his entire staff complains about his tendency to give away money and the negative consequences it has on the Program, Dr. Jim (and Kidder) should take that more seriously. We have to keep boundaries if we’re going to do the work that needs to be done. If we don’t, we have little hope of reaching the finish-line, and even if we do, what will be left of us to enjoy it? (See my post from a few weeks ago on Spider-Man and boundaries.)

Why Spider-Man should go to therapy

The final danger of filtering homelessness through Jim’s heroism? If Jim loses our favor, our care for the unhoused may go down with the ship. I hope that Dr. Jim is everything that Kidder hopes he is. (Although the details of his second marriage raise red-flags: again breezed through, the author mentions that Jim marries Jill, who works in the program he oversees, and that they have a surprise child when Jim is in his 60’s, implying both a power and age differential.) Ultimately, if Dr. Jim gets canceled, his work can be dismissed accordingly. If this book were more interested in the work, in spending time with multiple people in the program or those doing similar work across the country or world, this risk would be diminished.

The longer I do this work, the more convinced I am that we don’t need heroes. We need lots of people who are skilled at entering brokenness, walking with people through difficult circumstances, and laying aside judgment for the sake of human flourishing. And we should celebrate these folks not by granting them sainthood or a generous “attaboy,” but by paying them well(!), giving them adequate time off, ensuring they have access to support for the vicarious trauma they accumulate, and by changing policies so that the weight they bear becomes lighter and the need for them lessens. People who work in these fields should not have to sacrifice themselves on the altar of our hero-complex while we continuously ignore their cries for systems-change. Instead, let’s make a world where Dr. Jim isn’t necessary; and in the meantime, let’s allow people like him the ability to love their neighbors and themselves. 

Lastly, I need to comment about the way Kidder chooses to write the book. And if you want to avoid “spoilers,” now may be a good time to stop reading. There is a “character” death that bothered me a great deal in this book–especially as someone who has written about this topic and told similar stories. 

You’ll notice my use of “spoilers” and “characters” are in quotation marks to highlight that this is, obviously, not a work of fiction, and the people in the book and the things that happened to them are real and true. All this being said, the way Kidder tells the story, who he chooses to focus on, and the order in which he presents information are choices made for literary reasons, which bear resemblance to the way fiction writers approach their stories. They are choices made ultimately to take the reader on a journey toward a catharsis. When this is done well, the reader feels like they are alongside the characters and feeling what they are feeling. When it is done poorly, a reader can feel like they are manipulated, or their emotions exploited.

The choice to focus on Tony as a secondary main character is troublesome for a few reasons, but the most disturbing to me is that he ultimately “dies at the end.” Again, Tony and his death are real and true—but the decision by Kidder to focus on Tony, to make him the only ambassador of our empathy, only to end the book in his death feels manipulative. It’s a twist of a knife that serves a literary purpose more than it serves Tony, or certainly the thousands of other Tony’s that don’t receive the same level of attention.

And in the end, I left this book feeling like Kidder never got it. He was so distracted by a “hero,” and fixated on one special case, that he missed the opportunity to truly see homelessness for what it is. Kidder’s thesis seems to be, “Look at this hero who somehow keeps on helping people even though they keep failing,” instead of recognizing the destruction in our systems; our white-knuckled obsession with “success” under capitalistic frameworks that disregards hundreds of thousands of people, while insisting we all agree it's “their own fault”. Kidder should know better, having spent years invested in this story. The myths are resilient though—and I’m all the more heartbroken that a book this popular and good cements more myths than it uproots.