Undiagnosing Childhood As A Mental Disorder

You don’t have to read the article if you read the first, and at this point only, comment in response to it. The article is called It’s more than just a movie, and purported the subject of the article is–go figure–Reactive Attachment Disorder.

RAD children, according to the article, are apparently kind of like Stepford Wives, only they’re children.

“They’re like boarders in a boardinghouse. They sleep in your home and eat at your table, but you never really know who they are.”

From the article we also get this:

According to the American Academy of Child and Adolescent Psychiatry, RAD is a complex psychiatric illness characterized by difficulties in developing emotional attachments with others, including parents.

Enough nonsense, now let’s cut to the response.

From reading both of Jane Ryan’s books, it is my opinion that she is most likely a proponent of the scientifically-unvalidated pop psychotherapy called “Attachment Therapy” (which goes by several names, such as Holding Therapy, Rage Reduction, etc.). In 2006, a task force convened by the American Professional Society on the Abuse of Children published its report on Attachment Therapy, its parenting methods (aka Nancy Thomas parenting), and use of the unrecognized diagnosis “Attachment Disorder.” This task force condemned these practices as abusive and advised child welfare workers to investigate any of these practices as “suspected abuse.” The APSAC task force findings and recommendations were adopted by the American Psychological Association’s Division on Child Maltreatment.

Apparently the proponents of this Attachment Therapy are finding it convenient to blur the distinction between what the commenter sees as the “legitimate” DSM classification and their “bogus” “disorder”. Perhaps this kind of confusion will work to their advantage in the long run. How distant, after all, can any “reactive attachment disorder” be from an “attachment disorder”…linguistically speaking anyway?

“Attachment Disorder” (AD) is a bogus diagnosis ONLY used by Attachment Therapists, bears no resemblance to Reactive Attachment Disorder, as defined in the official DSM-IV. RAD is characterized by a child being either extremely withdrawn or overly friendly with unfamiliar persons. There are NO aggressive features associated with RAD. On the other hand, AD has a long laundry list of signs; it is a catch-all diagnosis, so that any child taken to an Attachment Therapist is likely to receive this “diagnosis.” (Even good behavior is interpreted as “stalking prey.”) It gets confusing because proponents of Attachment Therapy often conflate AD with RAD. The important point here is that an accurate diagnosis is needed to get effective and safe care. That isn’t possible with Attachment Therapists.

I wouldn’t say AD is a bogus diagnosis ONLY used by Attachment Therapists. I would think that many of the more nebulous and relatively minor “disorders” in the current DSM could be attributed to improper or incomplete weaning, and therefore, by extension anyway, are fundamentally attachment “disorders”.

Peggy Thatcher, the writer of the above comment, goes on to add.

Attachment Therapy and its parenting methods have been associated with numerous high-profile criminal child abuse and death cases.

Nanny state policies, and not necessarily pop nannies, are in large measure much of what lies behind the problem here. The future and adult independence of the child should be of foremost concern in child rearing. Children are very astute, and they can often detect when affection and caring in a family context is pretentious and unreal. I suggest that this—Jane Ryan might call it trauma—is what results in these Stepford children. These Stepford children in some ways are essientially, like children in foster care situations, throw away children. Child rearing should be managed by parents, and it should not be left up to mental health workers, pop or otherwise, if you don’t want situations to develop like the ones described.

Misdirections in Psychiatry

Dr. Steven Hyman, a former director of the NIMH, starts an article in Scientific American by giving us a history lesson. The title of this article is, oddly enough, Slipping the ‘Cognitive Straitjacket’ of Psychiatric Diagnosis. I guess he must be blaming straitjackets on Sigmund Freud, but only non-chemical straitjackets. It is subtitled, also oddly enough, Psychiatry’s diagnostic bible meets the awkward facts of genetics. I imagine he is thinking that graceful facts would be less subject to genetics, and more a matter of practice.

It can fairly be said that modern psychiatric diagnosis was “born” in a 1970 paper on schizophrenia.

Psychoanalysis was derailed and drug pushing biological medical model psychiatry started taking off.

The authors, Washington University psychiatry professors Eli Robins and Samuel B. Guze, rejected the murky psychoanalytic diagnostic formulations of their time. Instead, they embraced a medical model inspired by the careful 19th-century observational work of Emil Kraepelin, long overlooked during the mid-20th-century dominance of Freudian theory. Mental disorders were now to be seen as distinct categories, much as different bacterial and viral infections produce characteristic diseases that can be seen as distinct “natural kinds.”

As I’ve said before, the “mental illness” label is a physical disease when I can find it on a microscope slide. Despite attempts, such as E. Fuller Torrey’s harebrained cat flu theory, to make personal dilemmas biological in nature, as of yet, it’s a no show.

Four decades after their seminal paper, there are still no widely validated laboratory tests for any common mental illness. Worse, an enormous number of family and genetic studies have not only failed to validate the major DSM disorders as natural kinds, but instead have suggested that they are more akin to chimaeras. Unfortunately for the multitudes stricken with mental illness, the brain has not given up its secrets easily.

I will bet you that if we were to call what we now call “mental illnesses” chimaera, the name change alone would make them a lot more “cureable”.

Before turning to the scientific evidence of fundamental problems with the DSM, let’s first take note of an important problem that the classification has produced for clinicians and patients alike: An individual who receives a single DSM diagnosis very often meets criteria for multiple additional diagnoses (so-called co-occurrence or “comorbidity”), and the pattern of diagnoses often changes over the lifespan. Thus, for example, children and adolescents with a diagnosis of an anxiety disorder often manifest major depression in their later teens or twenties. Individuals with autism spectrum disorders often receive additional diagnoses of attention deficit hyperactivity disorder, obsessive-compulsive disorder, and tic disorders.

Now if you buy this explanation, you are awfully gullible. If truth be known, so called co-occurring disorders are an excuse to resort to polypharmacy. Polypharmacy is known to be good at producing very poor outcomes, but poor outcomes may be ignored if we blame them on the seriousness of the condition and, of course, two (or more) conditions must be more serious than one. Actually, this is merely a ploy to sell psychiatric drugs. Rather than put the patient on one drug, for one condition, we have an excuse to put the patient on more than one drug. When outcomes are poor, business is booming for drug companies and psychiatrists. Investors are pleased, market values rise, and the “patient” is a regular customer.

Once you’ve read the first four paragraphs of the article you’ve read the only important part of it. Either you’re on board with the author and other drug pushing shrinks, and you continue, or you have a different take on matters. If you have such a different take, as I do, then you have no reason to read the rest of the article. In the rest of the article, after a short ride abreast the wild mad gene chase, Dr. Hyman offers his two cent contribution to revising the DSM. I would strongly advise storing such revisions, together with previous and future editions of the DSM, safely in a trash can.

Dealing With An Infestation of Disability Workers

The APA’s task force revising the DSM is not the only group of people debating the definition of “mental illness”. The Bemidji Pioneer, a Minnesota newspaper, has an article by the director of a local mental health day care facility expressing her own views on the subject. The article in question bears the headline, Here’s to you–What is good mental health? In it she poses the following question:

Can someone who has a mental illness have good mental health?

Can a contradiction in terms be anything other than a contradiction in terms!?

If, as some people conjecture, “mental illness” is only a matter of degree, perhaps mental health must be only a matter of degree, too. This is to say that maybe one person is 95 % mentally healthy while another person is 95 % nuts, and if the one who is 95 % nuts was able to get matters under control, he or she would be a good deal of a percentage less nuts. The person who is 95 % “stable” could, of course, always lose 90 % of it, and therefore things have a way of equalling themselves out.

This, unfortunately, is not the direction our director is going in.

Can someone with mental illness have good mental health? Absolutely! Many of the healthiest people I know have a diagnosed mental illness. They have learned how to manage mental illness so that it doesn’t dominate their lives, just as diabetes can be managed. These individuals know and recognize stress triggers. They take care of themselves on a daily basis with good nutrition, sleep, exercise, structure/activity, medications if needed, and relaxation/peaceful times/spiritual support. They have also developed a strong support system – pets, family, friends, neighbors, business associates, spiritual leaders, professionals – who can help when they feel overwhelmed. As a result, people who have learned to manage mental illness can live like anyone else with good mental health.

Question: what does a person with a “serious mental illness” label have that the rest of the population doesn’t have?

Answer: A diagnostic label
A psychiatrist
Bottles of pills
A pact team
A case worker
A staffed day care facility
SSI disability payments
Subsidized housing
Voc Rehab education opportunities
Discrimination and prejudice

The paternalistic nature of social rehabilitation, that is, current mental health treatment practices, is debilitating in and of itself. Imagine being more or less “fucked” by all these people who are making a decent living off your theoretical “infirmity”? It’s hard to lose a “disability” that puts bread and butter on the plates of so many “worthies“. How are they to survive? Do something real about the matter, and disappointment of disappointments, a lot of people would be forced to make career changes.

A Critic of The DSM Revision Process

Allen Frances, one of the psychiatrists on the APA task force that drafted the DSM IV, has become one of fiercest critics of the secrecy surrounding the present task force’s effort to draft the future DSM V. An excellent article on this struggle to refashion what’s amounts to the shrinks’ Dead Sea scrolls into the next edition of the shrinks’ best selling bible of diagnosis can be found at Wired Magazines website, Inside the Battle to Define Mental Illness.

I’ve been amused in Dr. Frances to find myself agreeing with a psychiatrist who otherwise would have seemed, to my way of thinking, mainstream and medical model.

Frances, who claims he doesn’t care about the royalties (which amount, he says, to just 10 grand a year), also claims not to mind if the APA cites his faults. He just wishes they’d go after the right ones—the serious errors in the DSM-IV. “We made mistakes that had terrible consequences,” he says. Diagnoses of autism, attention-deficit hyperactivity disorder, and bipolar disorder skyrocketed, and Frances thinks his manual inadvertently facilitated these epidemics—and, in the bargain, fostered an increasing tendency to chalk up life’s difficulties to mental illness and then treat them with psychiatric drugs.

If you have heard anything about Dr. Joseph Biederman and his part in the recent childhood Bipolar epidemic. Dr. Allen Frances points out that this epidemic would not have taken place if the DSM IV had not opened to the door to diagnosing bipolar disorder in children in the first place, and therefore I imagine part of his motivation here may be a matter of penance for his own role in that epidemic. One of his concerns was that the present task force could be paving the way for another such epidemic with proposal of a pre-psychotic condition referred to as psychosis risk syndrome.

This new disease (psychosis risk syndrome) reminded Frances of one of his keenest regrets about the DSM-IV: its role, as he perceives it, in the epidemic of bipolar diagnoses in children over the past decade. Shortly after the book came out, doctors began to declare children bipolar even if they had never had a manic episode and were too young to have shown the pattern of mood change associated with the disease. Within a dozen years, bipolar diagnoses among children had increased 40-fold. Many of these kids were put on antipsychotic drugs, whose effects on the developing brain are poorly understood but which are known to cause obesity and diabetes. In 2007, a series of investigative reports revealed that an influential advocate for diagnosing bipolar disorder in kids, the Harvard psychiatrist Joseph Biederman, failed to disclose money he’d received from Johnson & Johnson, makers of the bipolar drug Risperdal, or risperidone. (The New York Times reported that Biederman told the company his proposed trial of Risperdal in young children “will support the safety and effectiveness of risperidone in this age group.”) Frances believes this bipolar “fad” would not have occurred had the DSM-IV committee not rejected a move to limit the diagnosis to adults.

Psychosis risk syndrome is no longer slated for the DSM V. Instead it has been replaced with something called attenuated psychotic symptoms syndrome.

When the rough draft of the DSM-5 was released, in February 2010, the diagnosis that had galvanized Frances—psychosis risk syndrome—wasn’t included. But another new proposed illness had taken its place: “attenuated psychotic symptoms syndrome,” which has essentially the same symptoms but with a name that no longer implies the patient will eventually develop a psychosis. In principle, Carpenter says, that change “eliminates the false-positive problem.” This is not as cynical as it might sound: Carpenter points out that a kid having even occasional hallucinations, especially one distressed enough to land in a psychiatrist’s office, is probably not entirely well, even if he doesn’t end up psychotic. Currently, a doctor confronted with such a patient has to resort to a diagnosis that doesn’t quite fit, often an anxiety or mood disorder.

Regardless of the label for it, I imagine they will have to come up with a drug treatment for it, and ultimately the course of this syndrome could be either to blossom into full blown psychosis, or to relapse into “normality”, the one “sickness” most doctors are unwilling to treat.

I had felt inclined to respond to a recent article in the New York Times about mental health conditions at Stony Brook University with a blog post about how, no, it isn’t that schools of higher education are getting “sicker” students than they used to be getting, it’s that there are more young people with psychiatric labels now, and a psychiatric label has never been something to prevent a person from going to college. Dr. Frances responded with his own letter to the New York Times in which he attributed this phenomenon, as do I, to over-diagnosis.

The exploding rate of “severe” psychiatric illness on campus is most likely caused by overdiagnosis — not by a decline in the mental health of college students. The people are the same, but the boundary of psychiatry has expanded at the expense of normality.

The childhood “mental illness” label was much less common, tended to be less severe, and was thought of as more treatable just a few years back. I, for one, don’t attribute our present epidemic to a sudden surge in genetic mutations, nor do I attribute it to a raging outbreak of pre-natal negligence.

Psychiatric diagnosis and treatment are enormously helpful for those with severe and persistent symptoms. By all means, let’s diagnose and medicate students who really need it. But the huge increases in the rate of mental illness almost surely represent a medicalization of the expectable difficulties many students have in adjusting to college life.

I doubt that the divide between those with, and those without, severe and persistent “symptoms” is nearly as large as Dr. Frances imagines it to be. I wouldn’t be in too much of a rush to “diagnose and medicate” students either, and certainly not without their consent. The advance of medicalization, on the other hand, is a problem that some of us would very much like to see reversed, as this advance spells absolute disaster and doom for large numbers of people. Reversing this advance is a matter of ending some of the practices that lead to, and sustain, our current epidemic in “mental illness” labeling.

Weight Gain Prevention Drug Fails In Trial

A story in the Globes just announced the failure of a drug being developed to prevent the weight gain associated with atypical neuroleptic drugs to do any better than a placebo, Obecure obesity drug fails trial.

Histalean was given in combination with Eli Lilly’s (NYSE: LLY) antipsychotic drug, Zyprexa, which is known to cause weight gain. In previous trials, Obecure was able to show that patients taking Zyprexa gained less weight when also taking Histalean than when taking Zyprexa alone.

Get that, gained less weight. Such was in the past, but more recently:

In the current trial using a higher dosage of Histalean, Obecure was unable to repeat the results.

Bio-light, the company developing Histalean, is repeating trials with a lower dosage to see if dosage might be at the root of this failure.

Eli Lilly, which partly financed the first trial of Histalean, on the grounds that ameliorating the side effects of Zyprexa would help product sales, is no longer involved in Histalean.

If you have any knowledge about this issue, you are probably aware that obesity is only one of a number of ill health conditions associated with a metabolic syndrome caused by the newer atypical neuroleptic drugs of which Zyprexa is an example. This metabolic syndrome has been credited with being the chief reason people in mental health treatment are dying on average 25 years earlier than the rest of the population.

Have we got a better argument for advancing methods of treatment that don’t involve the use of neuroleptic drugs, atypical or otherwise!? Well, actually, we do. Some studies have indicated that these drugs are at best ineffective, and at worst impeditive, if not preventive, to the process of complete recovery from serious life crises.

If there’s a lesson to be learned here it’s that health and fitness can’t be found in a pill bottle. Of course, this is a lesson some people are lax to pick up as it would jeopardize the enormous profit making power of pharmaceutical companies.

The market value of bullshit detectors down, way down

Ben Goldacre writes a series on Bad Science for the UK Guardian. In this series he just published a review of the Bad Science that occurred in 2010. Apparently it has been a bumper year for Bad Science. Much of the Bad Science this year concerned the mechanisms of the big pharmaceutical companies and the mental health industry. The heading alone gives you some idea as to the breadth of the problem, Dodgy dealings in tough year for whistleblowers.

It’s been a marvellous year for bullshit. We saw quantitative evidence showing that drug adverts aimed at doctors are routinely factually inaccurate, while pharmaceutical company ghostwriters were the secret hands behind letters to the Times, and a whole series of academic papers. We saw more drug companies and even regulators withholding evidence from doctors and patients that a drug was dangerous – the most important and neglected ethical issue in modern medicine — and that whistleblowers have a rubbish life.

Bullshit is thriving then while whistleblowers are not doing so well. I hesitate to say doomed. I kind of feel like our world needs more whistleblowers and less bullshit myself. Hmm. Is this the kind of legacy we want to leave with our children and grandchildren? It doesn’t exactly say great things for their future, does it?

Where science meets culture, we found the weirdly inverted solipsism of brain-imaging stories that claim pain is only real if you can see it in blood flow changes; while researchers claimed that attention deficit hyperactivity disorder (ADHD) is caused by genes, and that knowing this will reduce stigma, when the evidence overwhelmingly shows (to my surprise as much as yours) that believing a mental health problem has a biological cause increases stigma.

I saw that study, too, and funny thing, it seemed to have been swept under the rug almost as soon as it came out. Now you get the most recent study showing that “stigma” has not diminished one iota despite the rise in acceptance of the mental illness equals brain disease ideology. I happen, for good reasons, to subscribe to another theory. The mental illness equals brain disease ideology, by the way, subscribes to the biological cause view mentioned in the above snippet. Uh, and no wonder.

Evidence-based policy remains a distant dream. We saw politicians incompetently failing to produce evidence on whether their policy of compulsory drug treatment orders worked, and sacking David Nutt as chairman of the Advisory Council on the Misuse of Drugs when the evidence was available but the results unwelcome.

I should say that the evidense in support of forced drugging in this country, considering the sources behind it, has never been particularly reliable either. If anybody was paying attention to what was going on over there, David Nutt got sacked because he didn’t attribute the development of psychosis to the smoking of marijuana to any statistically significant degree. This was just not the sort of message some of the UK mental health treatment empresarios wanted to hear. All madness is reefer madness. Smoking marijuana causes people to go bonkers and we won’t hear of any other explanations. Smoking marijuana and heredity.

One might add to the above examples of Bad Science one thing that Mr. Goldacre didn’t touch upon, and that’s the ongoing attempt by some people in the mental health world to get electro-shock machines grandfathered in, despite all evidense to the contrary, as devices reclassified “safe” by the FDA. This would be a matter of going by “expert opinion” alone, and not conducting any research to test and verify the safety of these devices because such research would in all likelihood find the devices unsafe. This reclassification would also be a major slap in the face to shock survivors giving testimony on the damage done by these machines. No other procedures could be “approved” in such a fashion. Although it hasn’t happened yet, it remains a danger worthy of our vigilance. When it comes to bullshit, it is what it is, and (think conspiracy theories, crypto-beasts, ghosts and UFOs) it’s more popular than ever.

Nuts Is The New Cool

A study of 1,192 youths in the UK aged 12-17 was conducted by http://www.mentaline.com to find out about their opinions on mental health matters. Just over 1 in 10 young people, or 11%, in the UK think of “mental illness” as trendy according to this study. A press release in PRLog tells it all, 1 in 10 teens think mental illness is ‘fashionable’.

Regarding these youngsters who thought “mental illness” the thing:

34 % lied about having a “mental illness” in the past
32 % stated they knew somebody with a “real” mental health issue
49 % thought “mental illness” made you unique
16 % said celebrity sufferers gave “mental illness” it’s chic appeal
25 % just thought “mental illness” was cool
07 % thought they had a “mental illness”
61 % thought mental health should be taken very seriously

The 34% that admitted to pretending to have some kind of mental health problem in the past were asked to specify what the issue was. The top five problems were as follows:
1. Eating disorders – 22%
2. Self-harming – 17%
3. Addiction – 13%
4. Depression – 12%
5. Bipolar Disorder– 9%

And the winner is…Eating disorders by a length.

Given such statistics, I think maybe we need to reframe the way we look at emotional disturbances in order to lower rather than to raise the rates at which “mental disorders” develop.

Note: I’m not making an argument for excessive seriousness regarding either “mental illness” or mental health. Some people take their “mental illness” labels altogether too seriously. Some of those people are psychiatrists.

Completely Bonkers, The Bill of Goods

Mental Health Needs Growing in All Facets of American Life shrieks an article in World News Insight. The selling of “mental illness” must go on and the heartland of such selling has become the USA.

Mental Health issues seem to be more and more common everywhere you look. It seems that society is more accepting of the fact that Mental Illness is legitimate and not just ploys for attention or other foolish things that people come up with. However, even though we may be a bit more accepting the majority of us still have some growing up to do on the mental illness front.

Note: embracing “mental illness” is not the same thing as getting over it.

The good news is that we’re “embracing” it.

In good news, results showed a sizable jump in the acceptance of mental illness as a neurobiological disease, from 54 percent in 1996 to 67 percent in 2006 and with a 6 to 13 percent increase across all test indicators. Similarly, a majority of respondents endorsed care for mental illness, with 85 percent of respondents advocating care for those with major depression.

I would like to point out that not all “care” is actually care. One person’s idea of “care” might be another person’s idea of “harm”. Some of this “care” involves force. This is where “care” becomes imprisonment, torture, and poisoning. I don’t consider imprisonment, torture, and poisoning care.

The bad news is that we’re as prejudiced as we ever were. We haven’t made any progress on the community integration, or the end the stigma, front. This embrace is always at arms length, and in another end of town.

However, public stigma remained high in the 2006 study and relatively unchanged from numbers found in 1996. So while it’s good news that advances have been made to embrace a neurobiological understanding of mental illness and endorse psychiatric treatment, public acceptance rates of people with mental illness show little improvement.

The moral of this tale is that if you’re nuts, maybe you’d better just stick to your closet.

There is a recovery model of treatment for “mental illness” that this article doesn’t touch upon. Recovery is about getting over it. Recovery is where your “mental illness” has a beginning, a middle, and an end. You can’t sell “mental illness”, and get over it at the same time. Not unless it’s merely partial recovery you’re talking about, but there are some people who are in the partial recovery business, too.

Hmmm, maybe “mental illness” isn’t such a good thing after all. How many coo coos do we really need?

Selling “mental illness” is a ploy to sell psychiatric drugs. The drugs don’t actually help anyone get over their problems. Instead these drugs extend the “illness” through the managing of its “symptoms”. These psychiatric drugs work mainly by keeping psychiatrists and mental health workers in business. I tend to think people would be better off if they lost their “illnesses”. As far as love affairs go, I’ve known better.

Report On Employer Attitudes To Mental Health Issues Released

The Brits have released a report on employer attitudes toward mental health conditions. There is a story about this report in The Independent on Sunday, bearing the headline, Employers fail people with mental health problems.

The extent of stigma and discrimination is revealed today in a report on employers’ attitudes which found that half of business leaders would not hire people with mental health problems because of negative attitudes from co-workers.

“My co-workers made me do it!” Maybe so, and maybe not so. I don’t think the peer pressure excuse is any better than the “mental illness” excuse on the surface of the matter.

Four in 10 managers believe it is a “significant risk” to recruit people with mental health conditions to a job dealing with the public or clients, while nearly one in four are unable to name a single mental illness, the Shaw Trust survey of 500 business leaders found. This widespread ignorance exists despite the fact that one in six Britons are suffering from conditions such as depression, bipolar disorder, panic attacks, or anxiety at any given time, according to the charity Mind.

Nor is the ignorance excuse any better.

I notice that there is no mention is made of “schizophrenia” among the above “disorders”, and I’m wondering if there isn’t a bit of discrimination involved in the reporters neglect of the “disorder”, non-symptomatic, of course. Is “schizophrenia” somehow ‘beyond the pale’ of ordinary human “disturbed” experience?

The new poll, carried out by Trajectory, revealed that one in four companies believe people with mental health problems are less reliable than other employees. The research upon which the report is based also found that 78 per cent of employers think British industry loses talent because it does not know the best way to deal with mental health in the workplace. But Jacki Connor, director of colleague engagement at Sainsbury’s supermarket, said many of its store managers find people with mental health issues to be more reliable, and staff absence is lower among people with disabilities.

Change is in the air…

There are some signs of changing attitudes. About 21 per cent of companies now employ someone with a mental health condition, compared with 11 per cent in the 2006 survey.

Or is this increased percentage just an indication of the growing epidemic of “mental illness” drug companies, law enforcement officials, mental health industry professionals, advocacy groups, and the economic downturn have managed to stir up?

I don’t believe employers in the USA are any less prejudicial than employers in Great Britain, in fact I imagine them to be a good deal more discriminatory, and I think a report of this sort might do a world of good if conducted in the USA as well. Perhaps, given such a report, we could start to see a positive improvement in attitudes at the workplace as a result.

Ask a stupid question

In the What-Were-They-Thinking Department I’ve come across a headline fit for Jay Leno’s late night comedy routine. What do the homeless want for Christmas? I don’t know, but I’ll take a few wild guesses. Does it have windows and a chimney?

Actually the article is about a non-profit organization, Homeless Partners, that helps the homeless people draw up wish lists for Christmas and post their requests on line. On the more down to earth, meaning tent city, side of the matter, these lists are mainly of practical matters. (As if a house wasn’t practical.) The lists contain items such as “bus passes to get to work, grocery gift cards, personal hygiene items and clothing.”

While the lists contain practical items–shoes, backpacks, coats, etc.–in some of the letters to which the lists are attached these homeless men and women also ask for prayers, prayers for a job, prayers for an end to sadness, and prayers for a return of hope.