The Second Edition contains an expanded discussion of the Causes and Solutions to the crisis of chronic homelessness.

We avert our eyes when we meet them on the street: homeless mentally ill people with their hand-scrawled signs, shopping carts, and cardboard boxes. Because of the fear and revulsion they arouse in us, or the guilty relief we feel at our own relative good fortune, we fail to see—no, insistently deny—any human connection with them.

Still, we’re curious: How do these people end up on the street and how do they survive the stress and privations of such a life? How do they brace themselves against the elements day after day? How do they cope with their frightening symptoms, their drug addictions, the paradoxical mix of extreme danger and mind-numbing boredom that characterizes their existence? What combination of biological vulnerabilities, traumatic childhoods, drugs, mental disorders, and financial devastation brought them down? And how do some manage, against all odds, to climb out of this desperate situation?

Practicing psychiatrist, professor, and former commissioner of mental health Robert Okin spent two years on the street, meeting and photographing homeless individuals with mental illness to find answers to these questions. Using his ability to connect with the people he met, Okin masterfully brings them to life through stories and images that are intimate and gritty. These accounts are not only intrinsically interesting, they help us reflect on why these troubled souls living on the periphery of society should matter to the rest of us: Because we share their humanity. Had things gone differently in our lives, their plight could have been our own.

How often have we looked back in history at instances of great human suffering and asked with outrage how they could have been allowed to happen? We are living in such a moment today. The phenomenon of homelessness is taking place in our time, on our streets, on our watch.