When you walk into the Mission Neighborhood Resource Center, a space set up to help some of San Francisco’s 7,500 homeless people maintain their health and well-being, you are struck first by the colors: bright blue lockers, yellow and aqua walls, everything painted in toy-box hues. Men and women gather around plastic tables, joking, eating, waiting for their clothes to dry in the washing machines. The center often holds support groups and social events for their clients, including LGBT Saturdays and a weekly Ladies’ Night.
You sign in at a desk staffed by a cheerful, pleasant man. Your name goes on the second or third page; the space was designed to serve a few dozen people a day and instead serves hundreds. They form a line down the block before the doors even open. It’s two blocks from the heart of the Mission’s rapid gentrification, but worlds away.
The Resource Center also offers mental health services to its clients, many of whom are veterans, abuse survivors, and addicts. A number suffer from post-traumatic stress disorder, a psychological response to violence and other trauma that leads to flashbacks, nightmares, difficulty functioning and, too often, suicide.
Turn left and go up the stairs. Here you have a choice: straight will take you through a little nest of cubicles, walls dotted with family photos, and into the clinic, which is orderly and clean. It looks like a small neighborhood clinic anywhere in America: a tidy waiting area with a young receptionist behind a big desk, leading off to small, sterile exam rooms.
There, the neighborhood’s homeless people can access free preventative care, acute services like infection or fever treatment, and disease testing — people living on the street are eleven times more likely to suffer from tuberculosis, and between a third and a half of all those with HIV in the United States are either homeless or are at risk of losing their housing.
But if you turn left instead, you will enter one of two small, messy offices that, once a week, play host to a clinic run by the Homeopathy Institute of the Pacific, or HIP.
HIP is run by Wanda Smith-Schick, an intense, warm woman with hair that fans out from beneath a green headband like a cartoon sun. She is beautiful. When I visited the center she shook my hand, and I was struck with the feeling that this is a woman who gets shit done. “As homeopaths,” she tells me, “we are part of the cure. We listen like nobody else listens.”
The HIP clinic runs every Tuesday morning, staffed by three volunteers who each have their own private practices. Most of its patients are referred by the medical clinic or the mental health staff at Mission Neighborhood Resource Center, usually after the patients have expressed concern over seeing doctors and taking medication. HIP also operates two separate non-profit clinics, one elsewhere in San Francisco and one in Redwood City, California, specifically to treat veterans with PTSD and traumatic brain injuries.
“This room, I can’t see vets in. There are no windows, it’s like they’re trapped in a box,” Smith-Schick said, waving her hand around the small turquoise office. HIP started the veterans program because so many of the people they saw in the Mission were vets with PTSD. Those clinics mostly treat low-income vets, and occasionally their family members.
I asked her to tell me a story about someone she’d helped at the Resource Center.
“I had a patient with a history of violence. If someone blew their nose at him, he’d go into a rage,” she said. “When I treated him, things started to click back into balance. Months later, he got attacked by two guys at knife-point. He went back to where he was staying, got a knife, said he would get revenge. He tracked them down, found them—and then nothing. He told me, ‘I don’t know what happened, but I saw they were just kids. I don’t know what you’ve been giving me, but that wasn’t me.’”
“He’d always say, ‘Are you a witch?’ I’d say, nope, it’s a science.”
Homeopathy is not, in fact, science. It’s generally considered an alternative medicine, regulated by the FDA but not approved as a treatment. The core belief is “like treats like”; the patient is given a small dose of something that causes a reaction similar to the illness at hand. So for nausea, a homeopath might give a highly diluted amount of a treatment that causes nausea, on the principle that this will trigger the body to “correct the imbalance.”
Homeopaths call their work a holistic therapy, treating the whole person—mind, body, and soul. They spend time talking to their patients, finding out what hurts and what they’ve been through. Then they prescribe one of a few thousand “remedies,” generally in the form of a tablet. The pills contain mostly sugar and filler. The amount of active ingredient used in homeopathic treatments is vanishingly small.
In fact, in modern homeopathy the remedies are diluted to the point where they are unlikely to have a clinical effect. Often, the active ingredients are so diluted it would require absurd numbers of pills, statistically, to get even one molecule of treatment—in some cases, more tablets than there are molecules in the universe. Justifications from homeopaths vary, but usually focus on the idea that the tablets (or water, when the remedies are distributed as a liquid) in some way “remember” the active ingredients on a molecular level.
Many studies have shown that homeopathic remedies are no better than placebo. The studies that support homeopathy are often, as doctor and writer Ben Goldacre has pointed out repeatedly, plagued with scientific problems—for instance, patients may know that they’re getting a placebo drug, which taints the results. Goldacre is not alone in criticizing homeopathy. Practitioners are frequently accused of taking advantage of the gullible and desperate, and some people have become very sick and even died because they rejected modern medicine in favor of homeopathy.
Whatever success homeopathy has is probably due to the placebo effect. But the placebo effect is a genuinely amazing phenomenon. Scientists have discovered it can be helpful in treating chronic pain, gastroenterisis, and symptoms of Parkinson’s and depression. There’s value in thinking holistically: the mind has immense power over the body. That’s why doctors around the world are navigating the tricky moral waters of informed consent to utilize placebos in an ethical way. And though homeopathic remedies themselves may not have any scientific validity, here in the Mission they’re helping people turn their lives around.
Can sugar pills and empathy treat a deadly mental illness in an underserved population? And if they can—and it certainly looks like they can—does it matter that the pills aren’t really medicine?
“There’s tons of research that just contact alone is helpful for people. There’s a lot of spontaneous recovery among psychiatric patients—a lot of the time they feel much better after their first meeting,” said Jack Tsai, a Yale researcher who studies PTSD in homeless veterans. “If they’re getting benefits from homeopathy, it’s because of that hour of talking.”
I asked Bernardo Merizalde, a medical doctor and professor of psychiatry at Thomas Jefferson University, about homeopathy, which he uses on most of the patients in his private psychology practice. “I think homeopathic medicine is a very good, inexpensive treatment modality to help treat people with PTSD. I have used it in my practice with very good results, in combination with psychological therapies,” he emailed.
This combination is important. HIP doesn’t recommend homeopathic treatment as a replacement for therapy, or even a replacement for standard medication. The Institute works with medical professionals, including at the clinic in the Mission Neighborhood Resource Center. “I don’t ever tell anyone to go off their meds. I tell them to work with me and the doctor, and see their doctor regularly,” Smith-Schick said. “As long as we’re working together, it’s complementary.”
She also stresses that she’s not a trained therapist, and often convinces her patients to see one of the therapists on staff at the Resource Center.
The popularity of complementary medicine, says Tsai, is an indication that established medical practice isn’t cutting it with these patients. “If there’s been a rise in homeopathy, I think it actually points out the failure of the science community to come up with effective treatments,” Tsai said. “There’s a lot of vets turned off by medication, because of the side effects of antidepressants—impotence, daytime sleepiness, dry mouth. They may turn to homeopathy due to the failure of other treatments. It shows they’re looking for something, but there’s a lack of alternative treatments that are effective.”
Smith-Schick agrees. “Vets are coming to me because they don’t want to take drugs. We hear the effects [of going untreated]—more vets have killed themselves than have died on the front lines.”
The most effective treatments for PTSD aren’t drugs at all. They consist of different forms of forcing a patient to relive their trauma, and conditioning them to have a healthier response than full-body shakes and flashbacks. When patients who come in for homeopathic treatment spend an hour telling Smith-Schick about their trauma, it may have similar benefits to this type of therapy. And, when followed by pills and a promise they’ll heal, that might be exactly what HIP’s patients need.
There aren’t any records for how many veterans nationwide seek homeopathic remedies for PTSD, but HIP sees a few dozen a month. Smith-Schick showed me a video testimonial from one of her patients at the veteran’s clinic. He describes a dramatic change over six weeks, during which he took two doses of a remedy.
“I can honestly say I can’t recognize myself compared to the person I was when I came. I was suicidal, I was filled with rage,” the man in the video says.“I feel like, for the first time in my life, that I’m truly open to what God has offered me from the beginning, but you know, because of my circumstances, I’ve been distracted. I would suggest anyone who has any kind of traumatic history to fully take advantage of this wonderful, beneficial resource of homeopathy. And the compassionate listening skills of Wanda.”
Smith-Schick has always been a listener. “When I was in college, strangers on the street would come up to me and tell me their life stories. I must have a sign on my head that says, ‘Tell me more,’” she said. She came to homeopathy after working in an emergency room, and feeling uncomfortable seeing patients boomerang to the hospital with complications from their medication. Now, she finds her work with HIP to be the most rewarding part of her job.
“I say, I have to work my private practice around the clinic hours. My friends say, what’s wrong with you? It should be the other way around. But I just don’t think that way. If someone needs help, they should get it,” Smith-Schick told me.
Christina Garelli, another volunteer, was an architect before she was a homeopath. When her daughter was diagnosed with a genetic condition that caused a great deal of pain, doctors failed to treat it. Homeopathy, though, worked. So Garelli dropped everything to become a homeopath herself. Johanna Abate, the third homeopath at the clinic, attended a four-year program at the Institute of Classical Homeopathy, which as far as I can tell runs basically like a medical school, with several years of book training backed up by time spent in their free clinic.
Smith-Schick introduced me to Ricardo Newball, the services manager for the Resource Center. With a shaved head and hoop earings, he looks like a Hispanic Mr. Clean with a short beard. Behind his desk is a cork-board with photographs: before and after snapshots of clients who have gotten their lives together, a picture of Newball 100 pounds heavier than he is now. A shrine to hope, perhaps.
When I asked him about Smith-Schick, Newball exclaimed, “Wanda! The one and only!” He described her ability to spot emotional needs as almost super-human. “Wanda’s style is, love unconditionally,” he said. “But she’s also tough.” Initially he didn’t care enough about homeopathy to know if he believed or not. But after weeks of hearing him complain about his aching back, Wanda demanded he come in and take a remedy. It worked.
Now he goes to Wanda for pain, insomnia, and the stress of working an emotionally and physically exhausting job. “I make sure everything is ready so operations can run smoothly. When the director’s not here, I take over, and when the janitor’s not here I clean,” he said.
Having his fingers in everything means he sees the best and worst. Many days he sees both—he might get somebody he’s known for years homed in the morning, and then hours later get a call that another long-time client has died on the street. It takes its toll. Many of the other staff members go to the homeopaths to help with sleep problems and stress.
Smith-Schick, too, feels the strain of so much tragedy. “I hear horrifying stories. Every time I tell myself, now I’ve heard it all, there’s more. I think, oh my god, all these people are suffering,” she said. “It takes practice to detach and listen objectively. In training they say, leave yourself at the door. If you don’t, it’s more how you feel about what they’re telling you.”
I asked Smith-Schick what she’d say to those suggesting homeopathy is really an example of the placebo effect. “All I know is people who come to the clinic get better,” she said. “People get better, and some people leave and have peace.”