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Josephine Ensign, Skid Road: On The Frontier of Health and Homelessness in An American City

Marine Dassé
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Skid Road: On The Frontier of Health and Homelessness in An American City, Josephine Ensign, Baltimore: John Hopkins University Press, 2021, 288 pages, ISBN 13: 978-1-4214-4013-2, $27.95

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1Josephine Ensign recounts the history of the unfortunate souls of Seattle but also of their reputation: the poor seen as being lazy and vicious and how their treatment—or lack thereof—often through physical, sexual and emotional abuse relates to the boom and bust cycles of the city, its decision-making processes and most importantly: its system-level failures.

2Based on a wide variety of sources—ethnographic data gathered through full immersion and observation, historical archives, in-depth interviews—this is a work of narrative history where the rules of public policy, of healthcare, of solidarity and of lack of protective regulations are discussed thoroughly.

3This from-the-bottom-up story accurately depicts the life trajectories of the forgotten and voiceless of Seattle from the mid nineteenth century until today. It shows how, even if social origins shape, or even define, the trajectories of the homeless, the socio-economic system is equally, if not more, important. When dysfunctional—which it is to too many people—it often leads to disastrous consequences, for instance people committing suicide as their mental condition is left unaddressed.

4Josephine Ensign rightly questions political, social, and economic aspects of homelessness but maybe most importantly the moral quandary it raises. Indeed, whose responsibility is it and should it be to take care of the homeless? Their parents? Their siblings? Or the state? In her own words: “Am I my brother’s keeper? Are we our brothers and sisters’ keepers?” (9). These simple questions remain unanswered as they put forward the very definition of the family, the very definition of care, the very definition of human ethics and the very definition of solidarity.

5Every chapter opens with a detailed description of the urban atmosphere of a different era. The historical accounts also include many historic events, founding theories or powerful labor unions that have shaped the nation, the West, the city and its inhabitants’ lives, such as the Homestead Act of 1862, historian Frederick Jackson Turner’s Frontier thesis or the Wobblies. They provide a real added value to Ensign’s demonstration as they show how entrenched in the socio-historical context poor people’s lives were and still are. For the reader, this elucidates every era’s limitations, possibilities or prohibitions in terms of race, class, and gender, which allows a greater understanding of the aforementioned issues. In this respect, Ensign’s historical framing helps us understand the concrete impact a piece of federal legislation may have on one’s life.

6In the opening chapter, Ensign traces back the origins of the criminalization of poverty, and rightly points out that the Poor Laws already differentiated the deserving from the undeserving poor and did so since the latter were more vulnerable to exploitation. Indeed, the Elizabethan English Poor Laws, adopted by the early colonies, called for vagabonds and beggars to be “put in the stocks for three days and nights, given only bread and water, and then ‘warned out’—admonished to return to the ‘hundred’ where they were born or last lived” (15). This chapter focuses on the mid nineteenth century and therefore shows that the correlation between homelessness and its criminalization has existed for numerous decades, under different, more or less official forms. The author tells the story of Edward Moore, Seattle’s first homeless person, and his tragic death as he was left uncared for. Yet, at the same time, Dorothea Dix, a mental illness treatment reformer, advocated for “reasonable care” as she considered it was society’s duty to look after the mentally ill. In their own way, both questioned whose duty it is to look after those who cannot do it themselves.

7The second and third chapters both describe some of the most important protagonists of Seattle at the end of the nineteenth century, many of whom were mixed race Native Americans. We learn about the lives of quasi-homeless Seattleites Chief Seattle and his daughter Kikisoblu, also named “Princess Angeline,” who worked as a laundress and lived in a wooden shack on the shoreline. She became a symbol of a vanishing race of Native Americans in the American West. She represented the noble savage and suffered from domestic abuse as did her daughter, who committed suicide. Today, the YMCA women’s shelter near where she lived is named after her and is a safe house for women dealing with abuse and homelessness.

8In chapter 3, the author explains how three sisters became the first institutional providers for the paupers and the country poor. She also points out the high-class divisions and she denounces the sale and dissection of poor peoples’ bodies for medical purposes. She also analyzes how Poor Laws were put in place to punish the poor, as one of the first official and large-scale instances of the criminalization of poverty and pauperism.

9In chapter 4, she tackles the case of one of the first self-proclaimed physicians, who was forced to stop working by the municipality in the early 1900s: Alexander De Soto. The author qualifies his practice as reminiscent of Robin Hood since he charged high fees to the rich while providing free care to the very poor. He became well known for prescribing medicated gargles to a woman who had trouble eating but who later died of stomach cancer, after which he was accused of being a faith healer. The story sheds light on the lack of regular medical schools and on the existence of alternative health practitioners. Yet, along with others, De Soto founded the Seattle Benevolent Society and continued practicing on his waterfront floating mission. Ensign explains how the residents of Seattle confronted the harsh daily realities of homelessness through the Wayside Mission Hospital that cared for the homeless. Run thanks to volunteers and thanks to mainly private donations, the hospital took care of the ill paupers, and doctors there performed, among other things, the most unusual operations known to surgery (111). These small institutions lie at the center of the medical history of Seattle, which shows how unregulated and hazardous medical practice was, especially for the poor.

10In chapter 5, the author analyzes the racial and social divisions in the 1930s and 1940s and provides useful and necessary historical analysis of how structural crises impacted urban life. For instance, she establishes the link between the Great Depression and the development of Hooverville. We also learn that Washington became one of the first states to pass eugenics laws for the forced sterilizations of anyone accused of carnal abuse of a female person under 10 (135) and to provide an early version of mothers’ pensions: every woman with a child under 15 whose husband was dead, imprisoned, or insane could be allocated a small stipend. Local protagonists such as Hazel Wolf, who was particularly involved with Skid Road and Hooverville dwellers, defended them adamantly against evictions. Yet, the reform efforts were undermined by the labeling of the Progressives as “un American” as they were caught up in the first red scare at the end of World War I (132).

11Chapter 6 depicts Seattle’s homeless life in the 1980s and how businesses put a lot of pressure to revitalize the city, which resulted in a sharp reduction of Single Room Occupancy (SRO) units in Pioneer Square. Ensign also points out the general development of national enterprises, post-World War II highways for example, and more local decisions that affected racial minorities such as the expressway that was meant to ease white flight. The reader also learns that Seattle was part of the model cities program, aiming to revitalize the city, and how it entailed racial discrimination. The author then moves on to explore the radical changes in the 1970s, namely the feminization of poverty. Gender-based violence, especially within the African American community, coupled with drug addiction as well as the de-institutionalization of the mentally-ill, decimated inner-city communities. The efforts to improve the situation were all undermined by the consecutive Republican presidents who interpreted psychology as communism. The author describes street scenes and how traumatized youngsters, unable to seek help because of the lack of a well-functioning safety net, suffered sex abuse and were left with no choice but to turn to homelessness and prostitution in order to survive.

12The final chapter puts the emphasis on the multiple responsibilities of the city and the state and shows how spatial segregation reinforced differences and inequalities among communities. It deals with the beginning of Harborview Medical Center and the Western State Hospital. The author tackles research findings that show that breaking the intergenerational poverty cycle works best in high-opportunities areas that include better public schools, higher rates of two-parent households, higher civic engagement and community cohesion. Interestingly, these areas also tend to be more racially and socially diverse. The families are accompanied by housing navigators and the findings show that moving to these areas had long term benefits for the children.

13Seattle King County declared homelessness in a state of emergency and many regions launched a plan to end homelessness within ten years in the early 2000s. Even if the King County Committee to End Homelessness’ ten-year plan” was implemented, homelessness changed qualitatively as it became more visible and extended to an area called the Jungle. Unfortunately, this type of initiative had no substantive impact on policies or funding. At the beginning of the twenty-first century, efforts were made to provide more racially inclusive public housing but without addressing the specific housing needs of the very poor. Many homeless people were given bus tickets, notably by the Seattle Navigation Center, to supposedly reunite with family members when it was in fact a way to move poverty away from the city. In addition, they conducted encampment sweeps they considered as an extension of the broken window theory”, which considers incivilities like panhandling, graffiti and public inebriation as the first harbingers of more serious crime [representing] the first stop on the road to urban decline (205). Therefore, this chapter shows how the criminalization of poverty can take different forms. The book ends with the description of the promising initiative called the Block Project whose motto is yes in my backyard as it aims at reinserting homeless people in regular communities so that they can find the support they deserve.

14In this book, Ensign convincingly analyzes the dire unaddressed needs of the homeless to show that the cost of housing, mental illness, trauma, abuse, lack of stabilizing influence through family support, to name but a few, are all intrinsically linked. All these chapters demonstrate what can and surely will happen to the poor falling through the safety net. It shows that to allow for the resilience of the homeless, help needs to be given and problems addressed more extensively than they have been so far.

15The strength of the book is undoubtedly its realism, through the depictions of various and authentic life stories. Drawing on firsthand encounters, Ensign vividly relates homeless people’s trajectories with the utmost precision and details.

16Even if all chapters are extremely dense and well researched, the book is at its best in chapter 6 as Ensign mixes life stories, laws and history to provide an interdisciplinary approach to understanding and addressing homelessness.

17However, even if the constant reminders of the state and institutions’ failures prove useful in understanding the global situation, they might have been a little more detailed. Indeed, the political decisions could have been explored further as well as the influence of dominating ideologies (i.e. eugenics in the nineteenth century or neoliberalism in the 1980s) as they codify widespread beliefs and affect decision makers’ perceptions of their time and ultimately lead them to passing what can become life-changing legislation for the homeless. Although what is at stake is purposely not to focus on the different models or strategies to end homelessness, the book could have benefited from more enlightening insights of other models like Housing First for example. Also, a map of Seattle could have been of great use to readers unfamiliar with the city, especially one from the nineteenth century.

18All in all, this book rightly reminds the civic and moral duty of the city and of the state to fix its numerous failures thanks to a better child protection system, competent juvenile system, appropriate substance use counseling, addiction prevention. The author’s insights as a social worker provide the reader with a new perspective as she rightly questions whose responsibility it was and still is to look after the very poor. Skid Road offers extremely well documented research to better understand the urge to finally address inequalities, to respond to crises linked to socio-economic structural problems and systemic discrimination as the only way to eradicate homelessness.

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Marine Dassé, « Josephine Ensign, Skid Road: On The Frontier of Health and Homelessness in An American City »Transatlantica [En ligne], 1 | 2022, mis en ligne le 01 mai 2022, consulté le 16 avril 2024. URL : ; DOI :

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Marine Dassé

Université de Perpignan

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Le texte seul est utilisable sous licence CC BY-NC-ND 4.0. Les autres éléments (illustrations, fichiers annexes importés) sont « Tous droits réservés », sauf mention contraire.

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