Winter is here, and the homeless will be dying in greater numbers than normal. Are they dying because of the callousness of urban life? Perhaps. They are certainly dying because of the blindness of current social policy.
Start at the beginning. Who are the homeless? A Boston study published in the current issue of the American Journal of Psychiatry attaches numbers to what most of us intuit from looking around: The homeless are drawn mostly from the mentally ill. The Boston study found 40 percent of the homeless to be psychotic, 30 percent chronic alcoholics, and 20 percent suffering from other very severe psychiatric disorders.
These numbers may be high. Healthy individuals driven to destitution by calamity -- sudden unemployment, family breakup or sheer bad luck -- probably account for more than one in 10 of the homeless. But not much more. Were our cities not overwhelmed by the mentally ill, the traditional safety nets of social welfare and voluntary charity would be adequate to handle the relatively small number of "new poor" cases.
They once were adequate. Twenty years ago there were no armies of grate dwellers. They dwelt elsewhere. Twenty years ago there were about 500,000 people in mental institutions. There are now 130,000. (The number of mental hospital employees, about 200,000, is essentially unchanged. But that, in other contexts known as waste and abuse, is another matter.)
The vast emptying of these institutions, begun in the Kennedy years, was undertaken in the name of the most humane ideals. One was liberty, the simple desire of an era steeped in civil rights to see personal freedom returned to thousands who had been locked away, many against their will.
The other ideal was community, a desire to restore to these people a sociality they had lost by virtue of their illness (and isolation) and that a caring community would help them regain. As President Kennedy said in his 1963 message to Congress that launched the community mental health revolution, "reliance on the cold mercy of custodial isolation will be supplanted by the open warmth of community concern."
It wasn't. Liberty proved a cruel gift for many with only the vaguest attachment to reality. And the idea of community proved simply a mirage. We do have our neighborhoods where people may exchange hellos, perhaps even know each other's names. But the turbulence of modern urban life does not permit anything so organic as the tightly knit community of generations ago. Certainly nothing so organic, it turns out, as to lend protection, let alone "open warmth," to the most difficult and alienated of citizens.
The Kennedy era reformers, of course, cannot be blamed for not seeing all this in advance. We, however, no longer have that excuse. We don't need foresight to see the results of the experiment. A newspaper will do. There now is empirical evidence, encamped on every Main Street from New York to San Francisco. Or in Lafayette Park, where Jesse Carpenter, World War II hero, recently froze to death.
What is to be done?
Revolving-door shelters are not the answer. The care they provide is haphazard. As a rule, they are open only at night. Their staffs are rarely trained to deal with severe, disabling illness. Medical, let alone psychiatric, problems go untended. And since the guests are free to drift in and out, no one can keep track of their care anyway.
Shelters, of course, are better than nothing, and in the absence of anything else they must be maintained. There is a better alternative, however, though no one dares speak its name. Asylum. A place where the homeless mentally ill are taken and given food, shelter, hygiene and a sense of order in their lives.
The word asylum, of course, conjures up the snake pit. The fact that the idea was corrupted by periods of pseudoscientific quackery makes for sad history, but it should not paralyze current social policy. The idea of asylum is to provide protection and care. In some historical periods (in the 19th century, in particular) the asylum offered just that. It cannot be beyond our wit to redesign humane custodial institutions.
The larger problem facing the idea of asylum, however, is not one of design, but of political will. Asylum means taking people away to be cared for, whether they like it or not. That means taking control, something we can barely bring ourselves to do with children, let alone with recalcitrant adults. (But then
again, children are not dying in
Lafayette Park.) And that means
violating their rights, as currently
The caveat is important.
There is nothing sacred (or, as
we Americans prefer to say, self-
evident) about current definitions. The law has long recognized the principle that people
may be committed against their
will. What has changed in recent
years is the standard justifying
commitment. The standard has
moved away from a mere incapacity to care for oneself and
toward actual dangerousness to
oneself and to others.
As the threshold for providing
people asylum, against their will
if necessary, has risen, so has the price to be paid. It amounts now to an army of broken souls foraging and freezing in the streets.
This is not the result of society's mean-spiritedness, though some advocates for the homeless would have us think so. It comes rather from a curious combination of fatalism, about the lot of the homeless, and sentimentality, about the freedom they are allegedly enjoying. In fact, the homeless mentally ill areabandoned, not free. Nor is their degraded condition at all inevitable. It is the result not of mysterious determining forces, but of a failed, though well-intended, social policy. And social policy can be changed. In this case, it will not be easy. There will be a lot of thundering from civil libertarians. But it certainly can be done.