“This book is a treasure trove of keen insights into mental health policies over the past forty years and their impact upon vulnerable people who have ended up on the streets of America. It is a welcome counterpoint to the popular misconceptions about mental illness and violence. Dr. Okin has literally spent his time in the trenches to peel away the layers that make these human beings invisible and movingly exposes the triumphs and tragedies of navigating through life. Beyond the helping professions, this book should be required reading at every school of public policy, political science, and journalism.”

—Clarence J. Sundram, Special Master, United States District Court, and former Special Advisor on Vulnerable Persons to the Governor of New York

“It’s hard to know which is the most compelling part of Robert Okin’s Silent Voices: his eloquent introduction and history of homelessness, his vivid photographs, or his moving interviews with his subjects. The best means of overcoming stigma and shame is humanization, and Okin’s gritty, revealing book does just that—humanizes those individuals most of us would rather avoid, people with troubling mental disorders who traverse and live on our urban streets. Once you pick up Silent Voices, it’s nearly impossible to put down.”

—Stephen Hinshaw, Professor of Psychology, University of California, Berkeley, and author of The Mark of Shame

“You’ve captured people’s souls through your photographs… and are using that ability to raise awareness about a painful and sad topic… You also have an amazing ability to see the humanity in people and bring out the best in them. Silent Voices is a glimpse into a sad situation through a ray of light.”

—Priscilla Rodriguez, Program Director, Mexico office, Disability Rights International

Silent Voices is a book that gets you closer to two realities around us that we rarely get to see firsthand. On the one hand, the book makes us see in a different way how people live on the streets—the kind of people we know are there but we try not to see. On the other hand, the stories told by Robert L. Okin are so human that they resemble the realities of those who do not live on the streets. They make us think about our very own vulnerabilities about the possibility of perhaps someday ending up like the characters in this book—suffering unbeatable pain and loss that leads us ultimately to stay ‘in a vacuum of nothingness.’

“Besides what every person shared with the author, the beauty of the images provides us a more realistic and compelling side to all these stories. We can spend a long time looking at the photographs, which brilliantly captured so much sadness, loneliness, yet also hope. It was as if those faces being photographed thanked the author for sharing their stories—and that from now, they will no longer be silent voices.”

—Sofía Galván, Human Rights Specialist, Inter-American Commission on Human Rights, Organization of American States

“In Silent Voices, Robert L. Okin draws on his forty-year clinical and organizational experience working for and with seriously mentally ill individuals to provide an emotionally moving look at the lives of the homeless in our nation’s cities. The book pairs his stimulating, candid photographs of persons living on the streets of San Francisco with their own stories about their lives. Powerfully written, Dr. Okin’s integrating narrative helps the reader understand the social and economic context for homelessness in the mentally ill and face directly our national failure to provide humane care for our most vulnerable citizens.”

—Jonathan F. Borus, MD, Stanley Cobb Distinguished Professor of Psychiatry, Harvard Medical School

“With clarity and empathy, Dr. Okin reveals the life histories and thinking of homeless mentally ill people living on the street. His explanations of the personal, historical, political, and economic causes of mass homelessness—and his suggestions for what is needed to solve these issues—represent a call to action for all of us. Silent Voices is a very important book on a persistent problem in American society.”

—Lawrence Lurie, MD, Past President, Northern California Psychiatric Society

“This extraordinary book is truly a revelation, revealing the lives behind the faceless human beings who live on the streets. The photographs that tell their stories are deeply moving. Dr. Okin’s descriptions of his encounters are not only beautiful clinical vignettes but more importantly written with passion and humanity. A must-read for all of us who try to help and need to understand.”

—Steve Sharfstein, MD, Clinical Professor, University of Maryland, and former President, American Psychiatric Association

“From the very beginnings of photography, the camera has been used to bring into compassionate focus those we now call street people. In this 150-year-long history of finding beauty in the broken, no one has photographed with deeper understanding than Robert Okin, who alone has uncovered the personal stories of his subjects and given them a voice.”

—Elizabeth Marcus, author and contributor to the New York Times

“During his career as a public official, hospital administrator, and clinician, Dr. Robert Okin has persistently and courageously promoted the welfare of psychiatric patients. In Silent Voices, he presents informative, moving personal stories and gripping photographic images of the homeless mentally ill. He brings out of the shadows those who are routinely disregarded by their fellow citizens and shows us the devastating effects of homelessness on every aspect of their being. Silent Voices obliges the reader to consider how we as individuals and as a society can help the homeless mentally ill reclaim their lives and, in turn, make ours a better country. It is a book for all Americans.”

—Stephen A. Green, MD, MA, Clinical Professor of Psychiatry and coeditor of Psychiatric Ethics and An Anthology of Psychiatric Ethics

“The pictures and voices of this book are a powerful wake-up call for all of us to complete the task of creating community services so that mentally ill people are not forced to live in the streets, jails, or prisons. This book beautifully conveys the humanity of these people—their voices and pictures hopefully will not only motivate this country to want to help but make us realize that they deserve our help.”

—Richard Shadoan, Past President, Northern California Psychiatric Association; Past Governor, California Psychiatric Association; and Past Board Member, American Psychiatric Association

Silent Voices opens the readers’ eyes to what is often avoided by city dwellersCthe homeless mentally ill living on the streets of our cities. Dr. Okin, a highly regarded psychiatric expert on issues related to the severely mentally ill, here turns his attention, and ours, to a complex and troubling problem. Writing of his personal struggle around dealing with this issue helps the reader engage with the sensitively drawn portraits of the approximately forty homeless mentally ill people Dr. Okin met, interviewed to varying degrees of depth, and photographed. The book is testimony to his capacity to establish contact with this difficult-to-engage group of people and offers the reader a rare opportunity to share these encounters. Dr. Okin has bracketed these portraits with enough scholarly information to contextualize them, historically and from a public health perspective. The book should be read by both mental health professionals and laypersons with concerns about this important public health issue.”

—Stefan Stein, MD, Professor of Clinical Psychiatry, Weill Cornell Medical College

“What a powerful book… After reading it I feel an enormous sense of appreciation for Dr. Okin. His voice was such an important part of the experience for me as a reader. It felt like having a loving guide taking me on a journey into overwhelmingly dark and bleak places. The gentleness of his voice and the depth of his commitment encouraged me to read more when I felt flooded by sadness or fear. The enormity of his heart, his courage, and his compassion brought a warm light to the darkness of the stories. Having him by my side on the journey, knowing that he was sad and scared too, but much braver and more committed than I, was the difference that allowed me to hear these stories instead of just have them be told.”

—Margo Brockman, Partner, Interchange Counseling Institute

“Robert Okin touches the heart with unflinching honesty and compassion as he brings us along on his moving journey into a world of isolation, sadness, and stigma. With vivid and heartbreaking photographs, and with the words of the many homeless people he befriends along the way, he reveals just how close any one of us could be to living on the street. We have all taken part in isolating those who are different, whether they are labeled “mentally ill” or disabled in other ways. This book is a window into the importance of embracing our humanity, healing our differences, creating inclusive communities, and finding a kinder way to be with our fellow travelers on this earth.”

—Dorothy Dundas, survivor of forced combined electroconvulsive therapy and insulin shock and human rights activist

Silent Voices is a remarkably insightful, compelling, and vivid illustration of the daily challenges faced by the homeless mentally ill living on the streets of San Francisco. The book is authored by the dedicated and highly respected psychiatrist Robert Okin, former chief of psychiatry at San Francisco General. He has chronicled the stories of forty-two individuals whom he interviewed and photographed during his two-year journey throughout the neighborhoods of San Francisco. Silent Voices is wonderfully written and a must-read for all mental health professionals and advocates who wish to improve the lives of the homeless mentally ill. No book tells their story better.”

—Robert E. Hales, MD, MBA, Joe P. Tupin Endowed Chair and Distinguished Professor of Clinical Psychiatry, UC Davis School of Medicine; Editor-in-Chief, Books, American Psychiatric Publishing; and Medical Director, Mental Health Services, County of Sacramento

“The brilliant voices and deeply etched faces of the homeless people of San Francisco are luminously brought to life in Silent Voices by Dr. Robert Okin. We are compelled to look long and deep—no street aversion and ‘next time’ with this gorgeous, heartbreaking volume. These unmoored, homeless people can been seen and heard: their frank and mythical assessments of themselves; the brew of choice and chance that brought them here; their inventive, dogged adaption to sorrow and tragedy; bravado and resignation. “Nothing about us without us”—a stance of the mentally disabled movement (Hear us! See us! Have us at the table)—is creatively brought to life by Dr. Okin’s compassionate listening and his art.”

—Bernardine Dohrn, retired Clinical Associate Professor, Bluhm Legal Clinic, Northwestern University School of Law; Founding Director, Children and Family Justice Center; and coauthor or coeditor of Race CourseA Century of Juvenile Justice, and Zero Tolerance

Silent Voices creates for us intimate connections with a world most of us barely know. In public health, we carefully reduce the world to numbers; in medicine, to diagnoses. Dr. Okin brings us to people we all see on our streets—the homeless mentally ill. They talk to him. In their words, accompanied by his eloquent photographs, he tells their remarkable stories. No one who has wondered about street people, no one who has struggled to help these people as a population or as patients should miss Dr. Okin’s powerful insights.”

—Anthony Robbins, MD, MPA, Professor of Public Health, Tufts University School of Medicine, and coeditor of Journal of Public Health Policy

“‘I’m immune to pain in my body, but when someone hurts my feelings, it makes me feel real sad and I cry.'” So Erradyse, a woman living on the streets of San Francisco, describes her life to Dr. Robert Okin, author of Silent Voices: People with Mental Disorders on the Street. This powerful collection of personal stories and photographs by the author captures the heartbreaking challenges of people who got the short end of the stick throughout their lives. Almost every one of dozens of people interviewed tells of tragic losses in life: sexual or physical abuse, abandonment by a mother or father, nightmarish memories from the jungles of Vietnam that will not go away decades after they events took place. The stories tell of hopes and dreams shattered by unexpected twists and turns of life that led inexorably down the path to homelessness. Yet there is often just a glimmer of hope that shines through. Okin’s light touch and open-ended interviews allow people to explain not only what led them to homelessness but what keeps them waking up in the morning. There are a few heartwarming tales of men and women who find themselves or get just enough help from a social worker to come clean from drugs or get a job. But there are even more stories of those who don’t make it. And when that happens, Okin wisely sets aside his observer’s distance to open up about his own feelings. ‘Notwithstanding the brevity of our friendship,’ he says of Barbara after she passes, ‘her death has left a noticeable hole in my heart.’

“Based on a career pioneering the deinstitutionalization movement as commissioner of mental health in Massachusetts and Vermont, running the psychiatry department of San Francisco General Hospital, and volunteering for Disability Rights International in a dozen countries around the world, Okin brings a breadth of experience and insight to understanding the failures of our mental health system that fundamentally lets down so many people. He offers useful background but no easy answers. Most important, Okin provides a collection of painful but often beautiful personal stories that allow his subjects to explain their own lives according to their own internal logic. In so doing, he assures that the title of his book need not be true. Homeless and labelled with mental illness his subjects may be—but their voices are silent no more.”

—Eric Rosenthal, Executive Director, Disability Rights International

“Anyone who reads these lines has seen a lot of homeless people on the streets who look physically or mentally ill. A few of us occasionally stop to talk to such people or let them stop us to talk. But I know no one who has engaged as closely with as many of them as Robert Okin, who has not only recorded what they had to say but taken pictures to bring them alive on the page. Reading this book will change the way you see them. The troubled human beings are our neighbors. They are not easy to help, but as Okin makes clear, much more could be done if we really tried. Reading this book just might bring the day when we get closer to doing that.”

—Christopher Jencks, Malcolm Wiener Professor of Social Policy,
Kennedy School of Government, Harvard University

“Courageous, beautiful, heartrending. This indispensable book draws us into the lives of the homeless mentally ill, dispelling our preconceptions as they look at us from the page and tell us who they are in their own words. Dr. Okin gives us an unforgettable portrait of ourselves as he describes his moving encounters with people who are shunned and victimized but become compelling witnesses of our society when they are given the chance to be heard.”

—Alicia Liberman, PhD, Irving B. Harris Endowed Chair in Infant Mental Health and Vice Chair, Academic Affairs, Department of Psychiatry, UCSF School of Medicine, and Director, Child Trauma Research Program, San Francisco General Hospital

“Dr. Robert Okin’s hopeful, vivid, and care-filled display of the humanity, experiences, and uniqueness of some of the mentally ill homeless on our streets informs and reminds us these are our human brothers and sisters, more like us than unlike us. Dr. Okin’s lovely work here contributes greatly to the enterprise of a more humane and helpful approach to those among us afflicted with illnesses that obstruct their capacities to live with full dignity and humanness. He shows us with his fascinating intimate photographs, his sensitive interviews and his and his subjects’ own descriptive prose the needs, feelings, and longings we share with those we have regarded as alien, strange, and different. Perhaps our enhanced awareness through works such as this can lead to better chances for the lives of these fellow human persons.”

—Stephen J. Walsh, MD, Clinical Professor of Psychiatry, UCSF School of Medicine