Emptying the Mental Institutions

Not long after the shooting in Newtown, I happened to be reading a biography of Neal Cassady, who was muse to both Jack Kerouac in On the Road and Visions of Cody and several poems by Allen Ginsberg.

The book tells one story of Cassady and Ginsberg visiting writer William Burroughs at his ramshackle ranch in Texas. Burroughs was growing pot that he intended to sell in New York City. Present at the ranch was Burroughs’ wife Joan Vollmer.

When the crop was harvested, the group decamped for New York City, the men driving and Joan taking the train.

When Joan Vollmer arrived from Texas by train, her dazed and drugged condition got her promptly admitted to Bellevue.

I lived in New York City for twenty years and probably the last thing that got you admitted to Bellevue was being “dazed and drugged.” Any New Yorker can tell you the story of the crazy man they’ve seen every day for years on their block or on their way to work, the man babbling and sometimes frightening who nonetheless is always there, though perhaps with terribly brief institutional stays.

Melinda Henneberger captures this phenomenon well in today’s Washington Post about her time covering mental health issues in Texas. She says the mental health services were “reserved for dangerously ill, involved brief, groggy hospital stays followed up with a handshake, a script for enough pills to stun a moose and all the best wishes, see you soon!”

Phillip Terzian at the Weekly Standard reminds us that the emptying out of mental institutions starting in the 1960’s has wreaked havoc on our streets and has likely played a role in some of the mass killings since that time.

And yet, in the midst of our national hand wringing, one pertinent fact is persistently unmentioned. Since the passage of the Community Mental Health Act (1963) during the Kennedy administration, which mandated the closing of state mental institutions in favor of “community health centers” and outpatient care, and the massive and progressive “deinstitutionalization” of the mentally ill during the 1960s and ’70s, the residents of those old state hospitals have been transferred, almost totally, from the wards to the streets, and with predictable results.

Few “community health centers” were ever built, of course, and psychotics off their meds aren’t good outpatients. But the sudden emergence of mass populations of “homeless” people in cities during the 1970s and ’80s seems to have caught Americans off guard. It also afforded a political opportunity: The existence of homeless people—ordinary folks just a paycheck away from disaster—was conveniently blamed on the domestic policies of the Reagan (or any subsequent Republican) administration. No attention was paid, no attention was invited, to the mental health of those who lounge, sleep, urinate, defecate, scream, or beg for food on the nation’s sidewalks, stab the occasional passerby, or push bystanders onto subway tracks.

Putting aside the danger these people sometimes present, it does seem profoundly heartless to leave them on the streets to fend for themselves. I would think a great liberal initiative, one that would be applauded at least by some conservatives, would be to create new institutions, better than the ghastly places from mid-century, where these hopeless cases could be committed, yes committed, and find real help and maybe a little love.