Homelessness and Psyche | The origin of suffering

Mental illness leads some sufferers onto the streets. Photo: dpa/Tobias Hase The number of mental sufferings is increasing. In public spaces it is visible that many “mentally abnormal” people live in Berlin. Their number is probably far higher than can be seen in the cityscape. There are significant social differences in mental illnesses. It is also a class issue: certain health problems are socially respected, others are not. Some of those affected live financially secure lives, others literally die on the streets.

Like Marco. Born in Brazil, he grew up as an adopted child in Luxembourg. He studied sound engineering abroad and became known in 2008 with a musical duo project in Luxembourg. In Paris he produced hip-hop and electronic music. In 2012 he was stranded in Berlin and from around 2016 he lived on the streets. Neighbors brought him mattresses, sofas and blankets. The street cleaners kept throwing away his things and neighbors kept helping.

Marco spoke with voices in his head. He only stayed in clinics for a short time. Marco lived so deeply in his delusion that he was unable to accept professional help for a long time. He remained stubborn. Low-threshold offers, treatment and an apartment could have helped him. Marco had been known to the social psychiatric service since November 2018. At the end of 2020, legal guardianship was applied for for him because he wanted to move into an apartment. But just a little later, on January 8, 2021, Marco was found at his sleeping place in Neukölln's Schillerkiez. He was 33 years old. The cause of death is “so far unclear,” wrote the “Tagesspiegel” recently.

The situation for mentally ill and poor people in Berlin is getting worse. Social cuts and a catastrophic housing market ensure this. The multiple crises stress many people. However, analyzes show "that socially disadvantaged people are more susceptible to a deterioration in mental health, even in times of crisis," writes the Paritätische Wohlfahrtsverband.

Whether long-term consequences of the corona crisis, refugees, wars, climate change, digitalization, the shift to the right or social inequality - these collective stressors have health effects. But the effects do not affect everyone equally, because wealthy people can afford the offers of the “mental health industry” in order to practice self-care and self-optimization. Psychological suffering is individualized and privatized, but its cause is structural. The social imbalance determines the individual's ability to overcome or at least alleviate psychological stress.

Why are there so many people in Berlin who are mentally ill? A common theory is that the anonymous big city attracts people who can live here the way they want. Berlin offers many cultural and social offerings and is therefore considered an attractive city of diversity and tolerance. But there are also risks lurking. People in big cities suffer from mental illness more often than in rural areas. Despite high population density, there is a risk of loneliness. The burdens of the big city such as noise and stress as well as the easier availability of alcohol and drugs can also make you sick.

This is why some end up on the streets in crisis situations. Studies show that up to 90 percent of homeless people suffer from addictions and mental illnesses. At times, many homeless people live in psychiatric hospitals, if they are admitted there at all. In the psychiatric ward at the Vivantes Clinic Neukölln, an average of 25 percent of patients are homeless, and in the winter months over 30 percent. »The lived reality is that Berlin hospitals submit job center applications for their patients, maintain contacts with foreigner advice centers and embassies and organize places in homeless facilities and warming rooms. None of these activities are the original task of a hospital," says the current health report on the care of homeless people in Berlin, which is published by Caritas and other organizations. This means they would not be refinanced.

Drugs fuel the problem. “Monkey Dust” is the name of a new drug that is entering the Berlin market. It is cheaper than heroin, more powerful than crack and very quickly addictive. Delusions are a common consequence of consumption. The city is also developing fentanyl emergency plans to prevent a fentanyl glut like the one in the USA from occurring in Berlin. Crack consumption in Berlin has increased sharply since 2017. Crack leads to a high level of addiction and makes addicts more aggressive. The current Berlin crack study states: "This form of consumption leads to rapid physical and psychological exhaustion, insomnia, psychotic symptoms and a drastic social decline." Interviewed professionals observed "an increase in psychotic/delusional symptoms and psychiatric crises."

Around 439,000 people live in Berlin with a diagnosis of depression

Staying silent about your own suffering is existential in the world of work and in your neighborhood. According to a study published in the “Bundesgesundheitsblatt” in 2023, almost a third of those surveyed reject people with schizophrenia as neighbors. “With increasing social proximity, rejection rates rise to up to 80 percent,” writes the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) on its website. Many of those affected are already excluded from the normal housing and labor market.

The fears of so-called normal people of becoming ill themselves also lead to resistance and prejudices that are age-old. The history of the exclusion of “madness” is a long one, it led from ships and towers of fools to workhouses, mental asylums and mass murder in the Nazi system. Anyone can become psychotic under great stress. Additional doses of predisposition and acute life events finish off some people. While those affected by such illnesses are confronted with increasing discrimination, a destigmatization of some mental illnesses can be observed, such as depression in the performance subjects (burnout) or neurodivergence (ADHD).

More and more people are being diagnosed, which is mainly due to exhaustion in a stressful working world. According to data analysis by AOK-Nordost, the number of sick notes due to psychological problems is increasing in Berlin: on average, they cause around 25 sick days per case. Around 439,000 people live in Berlin with a diagnosis of depression. There are different degrees of severity - from severe depression to mild depressive mood states. A diagnosis creates relief, deserves understanding and recognizes the state of inability to perform, "for which there is no legitimate place in neoliberal societies outside of pathologized categories," writes Laura Wiesböck in her book "Digital Diagnoses", published in 2025.

In addition, more and more people are diagnosing themselves and styling themselves on social media. ADHD is increasingly diagnosed when unproductive and distractible. According to data analysis by AOK-Nordost, ADHD diagnoses in Berlin have tripled since 2013, and the increase is particularly noticeable among women.

"Identifying yourself with ADHD may be a liberation in a world that declares idleness the enemy and demands constant discipline from individuals," is Theo Parker's convincing thesis from the book "Everything at once, now!", published last year. But the calculation doesn't add up; self-optimization and self-sabotage are ultimately two sides of the same coin. In the author's opinion, those affected should reconsider their performance expectations instead of "continually tweaking their own usability."

But it's hard to escape the general pressure to be productive. After all, the rent has to be paid. In Berlin you can always see the impoverishment on the streets. And that's scary.

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