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Shall we cart the homeless away? Sleeping on the sidewalk disturbs the neighborhood. It disturbs the universe. But reasons of tidiness or moral injury are simply not enough. In a free society, to deny freedom to people who have harmed no one, a better reason is needed.
There is one.
"We're talking not [about] people who by reason of choice want to be vagabonds or hobos, or some other romantic idea of homelessness," says Dr. John Talbott, former president of the American Psychiatric Association. "These people are in the streets because they cannot think straight, make decisions and organize their lives."
The mortality rate for the homeless mentally ill is three times the normal rate. They suffer enormous abuse, indignities, illness of all kinds. They continue to suffer in revolving-door shelters, the vast majority of which offer virtually no medical, let alone psychiatric, care. And no respite: shelters are routinely emptied every morning to keep the beds free for the coming night. That means a daytime of wandering, every day.
Last winter New York's Mayor Ed Koch decreed that when the windchill factor fell below 5°, the homeless would be taken to shelters whether they liked it or not. This winter the order goes into effect when the temperature merely falls below freezing.
Why not make compassion an all-weather policy? Danger should not be the only warrant for giving someone, even an unwilling someone, shelter and care. Degradation--a life of eating garbage, of sleeping on grates, of recurrent illness and oppressive hallucinations--should suffice.
There is a reason for forcibly removing the homeless mentally ill from the streets: not society's fear of what the homeless are doing to us, but concern about what they are doing, cannot help doing, to themselves. In a society that aspires to be not only free but humane, removing the homeless mentally ill should be an act not of self-defense but of compassion.
It is not enough to remove them from the streets just to an overnight shelter. And the community has demonstrably failed them. They need protection and care and order. They need asylum.
Asylum conjures up snake pits, lobotomies, a cuckoo's nest of horrors. But it need not be that way. Indeed, it has not always been that way. In psychiatry's prescientific era, mental hospitals were truly asylums. All that could be offered mental patients was an environment of safety, fresh air and vigorous activity. "Moral treatment" was the basis of the asylum movement of the 19th century. It was the 20th century and the first inklings--and misapplications--of an infant science of psychiatry that brought on the horrors of pseudo treatment and medical abuse.
Psychiatry is no longer in its infancy. Treatments are much more sophisticated, practitioners more discriminating. Good care can have remarkable effects. "Once people are given a minimum of security, regular food and clinical attention," says Medical Anthropologist Kim Hopper, "within a few weeks a remarkable alleviation of symptoms can eventuate." Moreover, the mentally ill get worse on the street. Think of what a life on Broadway would do to you.