The Elaboration of "Choice" in a Program for Homeless Persons Labeled Psychiatrically Disabled

In the United States, those street-dwelling homeless persons who suffer from serious psychiatric disabilities often reject the dependency generated by treatment modalities. Psychiatric and/or psychosocial rehabilitation, which emphasizes client choice, resonates with recent empowerment perspectives in community psychology, consumer-run mental health alternatives, and nontraditional homelessness programs. However, few of these approaches have been analyzed. This article examines critically how client choice, as a driving principle and idiographic concept, was constructed in a program for street-dwelling homeless persons labeled mentally ill by service providers. The cultural underpinnings of individualist choice are traced. This article analyzes the paradoxes of applying an idiographic framework, which favors case-by-case approaches over universally applicable rules, in a larger context of normatively oriented service organizations upon which the program depended for desired resources. Finally, it demonstrates how the emergence of a collectivity within the program redefined the outer limits of individual choice.