Difficulties Associated with a Clinical Psychiatric Study of a Transient Population

One of th e more interesting patients I eva luate d as a first year Child Psychi at ry fellow was a homosexual yout h who made cross -d ressing an d dan cing in the street a ll night with fri ends th e focu s of his life. H e had a diffi culty wit h mood control th at was com plica te d by multiple placem ent failures a nd runaway episodes . The qu estion put to m e was how to effectively intervene in this situation give n th e socia l inst ability. In order to understand th e patient better I had to learn more about his socia l group a nd th e various problems ass ocia te d with it. What I had just hea rd from th e pat ient was a glim pse of life in a little-known " underg round" subcultu re th a t was so fas cinat ing a nd worrisome th a t I was tempted to in it ia te a researc h proj ect based upon it. I found a collabora tor to la unch a research proj ect intended to study th e need s of this group of patients a t high-risk of mental health difficulties. In the next few months we em ba rked on a n exe rc ise in a clinica l research project in Psychi a t ry. T he main problems we faced were those of th e d ifficulty in access ing members of a trans ient population as well as legal a nd e thica l hurd les ass ocia te d with wor king with homeless youth. The population to whi ch my patient belonged was hom el ess inner-city "s ex ual minority" homosexu al adolescen t mal es a lleged ly livin g in abando ned hou ses under th e un officia l supe rvision of unrelated adults who were de f acto " parents." T his is termed th e "H ouse" subculture ( I). The you th in qu esti on were reportedly " refugees" fro m th e supe rvision of offic ia l agencies du e to di scri mi nat ion a nd abuse allegedly suffe re d in placements (2). Mor eover, th ey we re a lso su pposed ly a liena ted fro m th eir families du e to rejection as a result of th eir sexual ori entation and practi ces . Therefore th ey were often a lone in a big city, young, a nd at risk for sex ua l a nd fin ancial ex ploi tation. Rep orted pr obl ems in this popula tion include ph ysical illn ess suc h as sexually t ran smitted di sea ses a nd AIDS, menta l health problem s such as depression an d suicide attempts, d ru g abuse (incl ud ing hormo ne abuse ), crimina lity such as forgery a nd cre dit ca rd frau d to suppo rt th emselves, a nd prostitu t ion a long with it s associa ted probl ems (1,3,4). O ne of th e most fas cina ting aspec ts of this gro up was th e subcu lture th at th ey have create d for themselves , cross-d re ss ing in fairl y wellorganized fashi on shows termed " ba lls" in whi ch " house s" com pe te aga ins t ea ch othe r, a kin to team sports. Repor ted ly memb ers of " ho uses" eng age in crimina l ac t ivity to support th e cos t of wardrobe, makeup, a nd th e "ba ll" its elf ( I). In re turn for th eir particip ation members of " houses" receive shelter, emotiona l suppor t, ca mara de rie, a nd so me sen se of acceptance ( 1,5). Wh at was apparen tly before \I S was a support ive subcultu re that repl aced conventiona l society to suppo rt a vulnera ble