Mental Illness and Homelessness

In a twist on identity politics (or diversity), this article describes a developing movement among the mentally ill to assert their right to be mad.  They call it “mad pride.”  As Newsweek reporter Alissa Quart puts it, these activists want to embrace their mental diversity by “refram[ing] their conditions and celebrat[ing] unusual (some call them ‘spectacular’) ways of processing information and emotion.”

Though not really a topic of the Newsweek article (which focused more upon madness as a sort of civil right), the story nonetheless reminded me of the continuing problem of the mentally ill homeless and two factors which have shaped the treatment of mental illness during my lifetime:  deinstitutionalization and the anti-psychiatry movement

In the years after the introduction of the antipsychotic drug thorazine in the 1950s, psychiatrists began warming to the idea that many if not most of the chronic mentally ill could be effectively treated with drugs, community mental health services, or some combination thereof.  As a consequence, many state mental hospitals were closed and dramatically fewer patients are hospitalized in these institutions today than was the case fifty years ago.*  This is known as deinstitutionalization.    

About the same time deinstitutionalization began gathering momentum, the anti-psychiatry movement led by figures such as Thomas Szasz and R.D. Laing also became influential.  Hostile to many of the assumptions of establishment psychiatry, the movement took the view that much of accepted psychiatric treatment was ineffective and even harmful.

The extent to which deinstitutionalization and the anti-psychiatry movement are associated with the problem of the homeless mentally ill is debatable.  Decline in the availability of affordable housing is also an important factor in the homelessness of the mentally ill; and anti-psychiatry is motivated by a humanistic perspective which seems at odds with disregard for the plight of the homeless.  Moreover, we would never wish to return to the snake pit mental hospitals of years past.  Yet, there can be little doubt that the anti-psychiatry movement helped to sustain deinsitutionalization; and that the latter has turned many thousands of the mentally ill out into the streets.      

In effect, states and communities have used deinstitutionalization to abdicate from much of their responsibility for the mentally ill.  Though this was undoubtedly an unintended consequence, the long ledger of tragic tales which have resulted — if it could be compiled — would surely astound us.     

I can speak from my own experience here, for I once had a friend named Jack who suffered from schizophrenia following a breakdown about 1970 — he was then in his twenties.  Though he was not homeless, and had access to treatment and medicine, left to his own devices he frequently attempted to self-medicate himself, experimenting with vitamins, alcohol, and who knows what.  I even remember he looked to the rebel anti-psychiatrist R.D. Laing as a sort of a hero for his analysis which implicated families and environmental factors in schizophrenia.  

But eventually, Jack’s self-medicating took a sad turn:  he poisoned himself with rubbing alcohol and died.  It is hard for me to imagine that this could have happened in a hospital; or that Jack’s death could not have been prevented in a community where there was adequate support for the mentally ill.      

I’m sure many of you could share similar stories of families and friends; I think especially of how destructive mental illnesses can be for families. 

At any rate, and getting back to the Newsweek article with which I began, before we follow the “prideful mad” down the road to their delusional rights (which sounds much like anti-psychiatry to me), should we not first focus upon building an infrastructure — both on the state and community level — which can adequately support quality care (whatever that may mean), both for the homeless mentally ill as well as the merely mentally ill?    

If you would like to learn more about the homeless and mental illness, probably the most prolific writer on the subject is the controversial E. Fuller Torrey.  Works of Torrey’s owned by Greensboro Public Library which are in whole or part concerned with this topic include:   Nowhere to Go:  The Tragic Odyssey of the Homeless Mentally Ill (1988); The Insanity Offense:  How America’s Failure to Treat the Seriously Mentally Ill Endangers Its Citizens (2008); and Out of the Shadows:  Confronting America’s Mental Illness Crisis (1997).

Some other recent books we have on homelessness and/or mental illness which may be of interest include:  Homelessness in the United States, edited by Jamshid A. Momeni; Land of the Lost Souls:  My Life on the Streets by Cadillac Man; The Soloist:  A Lost Dream, An Unlikely Friendship, and the Redemptive Power of Music by Steve Lopez; Breakfast at Sally’s:  One Homeless Man’s Inspirational Journey by Richard LeMieux; Scratch Beginnings:  Me, $25, and the Search for the American Dream by Adam Shepard; Have You Found Her:   A Memoir by Janice Erlbaum; Mad in America:  Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill by Robert Whitaker; Girlbomb:  A Halfway Homeless Memoir by Janice Erlbaum; The Glass Castle:  A Memoir by Jeannette Walls; and Without a Net:  Middle Class and Homeless (with Kids) in America:  My Story by Michelle Kennedy.

*According to E. Fuller Torrey, the population of public mental hospitals in the U.S. in 1955 was 558,000; by 2006, it was about 40,000 (The Insanity Offense, p.2).

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One Response

  1. Here its the same (UK), the mentally ill are abandoned to live in the community with help, but many struggle because what they need is a safer environment and more intensive talk therapies without interruptions from the outside world. I do feel that modern treatment of mentally ill is just as pitiful as shoving them into homes and forgetting about them. We are still forgetting about them, though they are just suffering in view this time. Is the new system really that much better?

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