Using Medicine to Help Heal: Dispelling Myths about Homelessness Using Stand-Up Comedy

“I hear a lot of myths about homelessness in San Francisco. Myth number one: homeless people want to be homeless. It’s true that some people find community in living outside in a tent, taking drugs, and paying hundreds of dollars to do so… Of course, I'm talking about Burning Man, not homeless people in San Francisco.”
 

I’m performing my stand-up comedy at Café International’s Open Mic night. The audience laughs and I sense it’s my chance to slip in some facts. 

“The truth is that people are homeless because there isn’t enough housing. California has gained roughly 900,000 new renters since 2005, but lost 1.7 billion in state and federal aid for affordable housing.”

For the last year and a half, I’ve worked in a homeless clinic in downtown San Francisco. This past summer, I joined a research group that studies housing strategies for older homeless adults.

Since beginning medical school in 2017, I wondered if stand-up comedy could be a way to dispel common misconceptions about homeless by bringing the facts to gatherings at which Bay Area residents socialize.  

As medical students enrolled in the Bridges Curriculum, we have ample opportunities to learn how to address the social determinants of health. Just as our curriculum has dedicated blocks for organ systems, we have two blocks—“Health and Society” and “Health and the Individual”— to critically analyze the social, economic, and political contexts that contribute to health. In addition, students have opportunities to actively address the political circumstances that contribute to poor health, by participating in advocacy groups such as White Coats for Black Lives and the Do No Harm Coalition.

“Myth number two:  homeless people come to San Francisco for the weather. Can you believe that? Who opens the weather app and decides to be evicted next time they are in San Francisco?”

“Dr. Kushel’s research group, which I joined last summer, found that 81% of the older homeless adults we surveyed became homeless in the Bay Area, consistent with the wider literature stating that most homeless people become homeless near their homes.”  

This joke gets fewer laughs than my quip about Burning Man. “Sorry this part of my piece isn’t as funny. I just think people need to know.”

Writer George Sanders defined humor as “what happens when we’re told the truth quicker and more directly than we’re used to.” And researchers have found in randomized experiments that humorous events are more likely to remembered.

Furthermore, comedy can be used for advocacy or therapy. Comedian John Oliver has mixed humor with investigative reporting to satirize political figures. Doctors have been known to use gallows humor to process difficult events.

“Being off-balance can make us laugh, and sometimes laughing is what keeps us from falling over,” writes bioethicist Katie Watson, an Assistant Professor in the medical humanities and bioethics program at Feinberg School of Medicine at Northwestern University, in a bioethics report released by the Hastings Foundation.

“Myth number three: we spend way too much money on homeless individuals. One journalist at the San Francisco Chronicle calculated our city spends about $10 per day on each homeless person. What can you buy for $10 a day in this city?  Here are some literal prices from items around the Bay.”

I squint at my notes: 

“Craigslist ad: parking spot only $200 per month… only fits BIRD scooters. 

Here’s another Craigslist ad: used tissue with a Patagonia logo stitched onto it: $95.

Whole Foods: Google employee’s backwash in an empty bottle of kombucha: $22 dollars. 

Folks, this is why we needed Prop C. Affordable housing is the best medicine.”

There are rules to comedy, writes Judy Carter in her book The Comedy Bible. You shouldn’t mock individuals who are more oppressed than you are. Men shouldn’t joke about women. Majorities shouldn’t joke about minorities. Blue humor, or off-color jokes about taboo topics such as sex or drugs, may shock audience members into laughing but usually aren’t cathartic or original. The best comedians elucidate unnoticed absurdities or injustices in our daily lives.

After I finished my routine, a man approached me. “I’ve been working in affordable housing for 20 years and wish more people knew about the work I did. Thank you for doing this!” Others told me they had learned something were entertained.

Lack of affordable housing, a broken criminal justice system, growing economic inequality and other social forces disproportionately affect the health of homeless individuals. Study after study concludes housing is the best medicine.

Yet, communicating these sobering realities to the public remains a challenge. 

“I was at the shelter the other night and met a patient with a T-shirt that read ‘VOTE YES ON PROP C. The homeless crisis hurts all of us,’” I say to the audience.

“I totally support Proposition C. Housing is medicine. But I’ve never been ‘hurt’ by a homeless person. So, I told my patient: ‘People like me moved to your neighborhood, gentrified it, then all the supermarkets left and were replaced with kombucha stores and barber shops that specialize in giving haircuts to white people with dreadlocks.

Prop C’s slogan should have been the other way around. All of us hurt homeless people.’”

To learn more about homelessness in the Bay Area and how students, faculty, and leadership at UCSF are helping bring more equitable care and resources to people challenged by the housing crisis and related issues that impact wellness, readers can follow Dr. Margot Kushel and Kelly Knight, PhD, Associate Professor of Medicine on Twitter.  

Note on sources used in this story:

To write my stand-up piece, I summarized two op-eds (Why there are so many homeless people on the West Coast; How the Homeless Population is Changing: it’s older and sicker) and a research article (Pathways to Homelessness among older homeless adults: Results from the HOPE HOME study) by Margot Kushel, MD, Professor of Medicine and Director of the UCSF Center for Vulnerable Populations (CVP) at Zuckerberg San Francisco General and Trauma Center (ZSFG), and her research group.