On E. Fuller Torrey's Nowhere to Go: The Odyssey of the Homeless Mentally Ill, Jonathan Kozol's Rachel and Her Children: Homeless Families in America, and Richard H. Roper's The Invisible Homeless: A New Urban Ecology
Kasinitz, Philip
NOWHERE TO Go: THE ODYSSEY OF THE HOMELESS MENTALLY ILL, by E. Fuller Torrey. New York: Harper and Row, 1988. 256 pp. RACHEL AND HER CHILDREN: HOMELESS FAMILIES IN AMERICA, by Jonathan Kozol....
...The current shameful situation cannot be addressed without coming to grips with the problems of the poor as a whole...
...By presenting the homeless as people who are, above all, unlucky, he pushes the "but for the grace of God" button, and closes the distance between the reader and the families in Martinique...
...Some turn to drink and drugs...
...One recent attempt to understand this is E. Fuller Torrey's history of the deinstitutionalization movement in American mental health care, Nowhere to Go...
...This requires seeing the homeless for who they are: a heterogeneous group that includes many very troubled people with a host of special needs...
...the sincerity of his commitment to the poor is beyond question...
...Torrey is too quick to dismiss these alternative mental health agendas as frivolous...
...It suffers from the usual faults of works written for specialists...
...Of those on the streets (not in SROs or shelters) 78 percent had no health coverage of any sort...
...In light of Kozol's examples of slow mental deterioration and social disaffiliation, Torrey's cavalier dismissal of the idea that homelessness may cause mental illness seems simply ignorant...
...He points specifically to the growing economic isolation of the underclass, a chronic housing shortage, and Reaganera welfare cuts as among the causes of this crisis...
...He recommends political efforts, principally litigation and activism by the homeless themselves, as ways of pressuring society to recognize housing, as opposed to mere shelter, as a basic human right...
...It requires that the victims of injustice be seen as innocent, long suffering, and generally pitiful...
...Their appearance denotes widespread disorder and instability such as follows famines and civil wars...
...It is sobering to read the entry on "homelessness" in the 1968 edition of the International Encyclopedia of the Social Sciences, which declares that although wandering men can be found in many societies, "homeless women and children are relatively rare...
...There are ten times as many psychiatrists and psychologists in the United States today as in 1945 and twenty-seven times as many psychiatric social workers...
...It should be noted, however, that most of Ropers's data were gathered before the crack epidemic had peaked...
...The other problem with this moral approach is that by reducing the issue to society's cruelty, Kozol ends up asking us all to be kinder and gentler...
...Many found refuge in marginal neighborhoods and single room occupancy hotels (SROs...
...Clearly something of major consequence has happened during the intervening twenty years...
...To his credit, Kozol is also not afraid to present homelessness in starkly moral terms...
...It is there that most advances in housing rights have been made during the past decade...
...That is, they increasingly resemble the rest of the poor...
...That is unfortunate...
...At the same time we must insist that the problems of the homeless are to a large degree problems of poverty...
...Missing is the anger of the young men and women "aggressively panhandling" on the subway, the violence of the streets, the willingness of some victims to become victimizers...
...Thus although Kozol readily admits that many of the people he came to know at the Martinique displayed a variety of pathological traits, he believes that few had these problems "before the sledgehammer of dispossession knocked them flat...
...It makes no sense merely to treat these symptoms, Kozol maintains...
...This sheds light on a central weakness in Torrey's book: his dogmatic insistence that physiological causes and only physiological causes of mental illness are worth examining...
...The reason, I suspect, is that his analysis is oddly comforting...
...Their families...
...Thus, while everything Kozol tells us is true, it is not the whole truth...
...Absolute destitution," writes Kozol, "unlike most other aspects of life in America, is blind to color, race or place of birth...
...In reducing the story of New York's homeless to the compelling simplicity of a parable, Kozol seems to require that the downtrodden accept their lot with saintly forbearance, the better to shame the rest of us...
...Yet Torrey considers the changes in the housing market a secondary issue...
...Most activity on behalf of the homeless in the immediate future is likely to be centered in the courts...
...The lack of housing, he maintains, is only the most visible of the many cruelties suffered when these troubled people were dumped into unwilling communities...
...Their main problem now is homelessness, which, he insists, "makes healthy people ill, normal people FALL • 1989 • 567 clinically depressed and those who may be already unwell a great deal worse...
...He sees the homeless, or at least the one-third of the homeless he discusses, as sick...
...Ropers argues that while mental health factors are significant in creating and reinforcing the "disaffiliation" that leads some people to end up on the street, the primary causes of mass homelessness are economic...
...But when those families were themselves impoverished, it is no wonder that their least able members ended up on the streets...
...Small wonder then that the number of patients in state mental hospitals plummeted from over a half million in the mid-1950s to slightly over 100,000 today...
...As Torrey would predict, about a third of the Los Angeles sample had been hospitalized for a mental health problem (often related to substance abuse...
...Connections with kin and community are quickly severed...
...Ropers's research also calls attention to the fact that a growing number of people wander in and out of the shelter system...
...Not surprisingly, people who stay in the Martinique for any length of time often become depressed...
...As a physical entity the Martinique, with its maze of corridors, its rats and peeling paint, its thuggish security force, was depressing enough...
...While Torrey focuses on individuals, Kozol looks at the fastest growing segment of the homeless population: homeless families...
...The deinstitutionalization undertaken by the mental health establishment is a fascinating piece of history...
...These "rights" included the right to decline treatment and to refuse medication...
...While groups such as the Coalition for the Homeless have proved invaluable in the short term, going to court as a way to make social policy has a number of drawbacks, not least the fact that litigation, unlike legislation, does not build political coalitions that can protect gains once they are won...
...it's always cheaper to reduce the number of patients than to hire more staff...
...Against this background he draws a detailed demographic portrait of today's homeless based on both his own survey of over four hundred homeless people in Los Angeles and a review of other studies from around the country...
...And a grim story it is...
...True, The Invisible Homeless is not exactly a page turner...
...As such it is destined to have little policy impact...
...Originally published as articles in the New Yorker, Kozol's book consists largely of descriptions of people he met at New York's notorious Martinique Hotel...
...He does not believe that being homeless substantially worsened the condition of many of these people and he dismisses the idea that being out on the street may actually cause mental instability...
...But it also seems clear that many of the people Kozol describes need a good deal more than housing if they are to get back on their feet again...
...We see residents trying to fathom the fact that the city pays thousands of dollars a month to keep their families in the most crowded and dangerous settings, but will not (because of federal regulations) spend a few hundred dollars so they can live in decent apartments...
...Published by a tiny press, this work will not receive anything like the distribution of the Torrey or Kozol books...
...Yet for most, homelessness is a radically individualizing experience...
...It was only after these fell prey to gentrification in the late 1970s (long after deinstitutionalization had peaked) that large numbers started to appear on the streets...
...The number of these "hidden homeless," now doubling and tripling up in the nation's slums and public housing projects, probably dwarfs the numbers on the streets at any one time...
...THE INVISIBLE HOMELESS: A NEW URBAN ECOLOGY, by Richard H. Ropers...
...He also overrates the importance of doctors in creating public policy, paying a great deal of attention to disputes within the profession while barely touching on the host of political and economic obstacles faced by the community mental health movement as the 1960s waned...
...New York: Insight Books, 1988...
...Ultimately Nowhere to Go is an argument for reinstitutionalization...
...Physical illnesses are also extremely common...
...He reports that the homeless are increasingly members of minority groups and are younger and more often female than previously...
...And while he argues that these sick people have been barbarically treated, he lays the blame on a cadre of lazy professionals and their unwitting civil libertarian allies...
...q A LEGACY OF IDEAS A bequest of any size can be of lasting benefit to Dissent and help ensure that the ideas and beliefs you hold dear will continue to have a public forum...
...While his results do not differ drastically from the descriptions put forward by advocates for the homeless, Ropers provides a level of quantitative reliability missing in most accounts...
...The hospitals are what really do damage to people...
...Yet what Kozol has managed to capture, as few other writers have, is the despair which grows in such places...
...These sentiments were echoed in popular books like Ken Kesey's One Flew Over the Cuckoo's Nest and films like King of Hearts...
...The cause of homelessness," he insists, "is a lack of housing...
...Yet this approach has some severe limitations...
...Kozol is astute on how and why people distance themselves from the homeless—and he will not let us get away with it...
...It would have been useful, however, if Ropers had turned his analytical skills to the long-run utility of litigation as a tool for social change...
...261 pp...
...Torrey's medical approach stands in direct contrast to last year's big book on homelessness, Jonathan Kozol's chilling Rachel and Her Children...
...The hospitals were supposed to be replaced by "community-based" mental health facilities, a notion that epitomizes the confusion of the libertarian and communitarian ideals of the 1960s...
...Once the nation's largest "welfare hotel," the Martinique is now closed—no doubt Kozol's book had something to do with that—and the city is ostensibly phasing out hotels for homeless families in favor of semipermanent shelters...
...Our legal name is the Foundation for the Study of Independent Social Ideas...
...10017 (212) 595-3084...
...For more information, phone or write Dissent, 521 Fifth Avenue, New York, N.Y...
...Yet his insistence that privileged people should be nicer to those less fortunate may encourage precisely the sort of elite-sponsored volunteerism that Bush would pass off for social policy...
...In the resulting shuffle, the deinstitutionalized were often lost...
...By the late 1960s civil libertarians had taken up the defense of the rights of the mentally ill...
...As a lawyer from the Mental Health Law Project put it in 1974: "They are better off outside...
...Torrey's vitriolic attack on his more humanist colleagues (shameless hucksters whose assumptions are based on "no scientific evidence") dulls his otherwise astute discussion of the politics of deinstitutionalization...
...Despite its antiFreudianism, Nowhere to Go may serve a very therapeutic function for some readers, allowing them to look at the homeless without guilt...
...Yet there is little to suggest that the homeless are likely candidates for political mobilization...
...In sociology, labeling theorists argued against the stigmatization of deviant behavior and, in a classic case of an insight run amok, bureaucrats quickly jumped on the bandwagon, in part because minimal intervention strategies meant lighter work loads...
...What is missing in Rachel and Her Children is a systematic attempt to root the individual tragedies it documents in broader social dislocations...
...Ropers emphasizes the need to increase the 568 • DISSENT amount of emergency shelter space...
...So where did the impoverished mentally ill go...
...During the early 1960s psychiatrist Thomas Szaz gained a wide audience for the idea that mental illness was a "myth," while Erving Goffman's influential Asylums argued that the behavior of mental patients was often an adjustment to the conditions of the institution...
...After contemplating a host of such indignities, Kozol comes to the same conclusion they do: that the function of the Martinique is social "discipline," punishment for those who have ended up there, a warning to others...
...Yet he is right in stating that for the most part community mental health centers did not and could not meet the needs of the seriously 566 • DISSENT disabled...
...Despite his invocation of Piven and Cloward's arguments on the disruptive capacity of the poor, the reader remains unconvinced as to the efficacy of such strategies...
...The mentally ill were portrayed as free spirits resisting middle-class conformity, or as beautiful innocents with a simplicity too good for this world...
...At the same time mental hospitals have come under increasing attack...
...A nasty recurring theme in Nowhere to Go is a diatribe against Freudianism or anything else that suggests connections between environment and mental condition...
...Yet the seriously mentally ill, Torrey argues, receive less attention and treatment...
...Who after all were most affected by the release of mental patients from state institutions...
...In addition to families trapped semipermanently in shelters and welfare hotels, a large number of the poor are making occasional use of such facilities...
...Mental health professionals, he insists, have increasingly turned their backs on the seriously mentally disabled and instead sought to bring the benefits of psychotherapy to the mildly neurotic, those whom Torrey terms the "worried well...
...Even the significance of ethnicity begins to wane: white, black, and Hispanic families all seem remarkably similar...
...Hospitalization is now so expensive that, notwithstanding Mayor Koch's efforts to involuntarily hospitalize a handful of homeless people, mass institutionalization is today no longer an option...
...Often seen as a class apart, the homeless are here identified as part of a larger population of ill-housed poor people...
...Yet the conditions he describes remain common in New York and elsewhere...
...Towards this end, Kozol focuses much of his attention on children...
...Yet often this did not bother the advocates...
...Kozol is not George Bush...
...A book that does make this kind of connection is Richard Ropers's The Invisible Homeless...
...In estimating the potential clout of the homeless Ropers waxes a bit romantic...
...If we are to move beyond these "finger in the dike" strategies it is imperative that those of us on the left start to think about more long-term solutions...
...But community mental health facilities and the professionals who staffed them generally had other agendas, ranging from social change in the 1960s to self-awareness training in the 1970s...
...However, the real problem with releasing mental patients into the communities during the 1960s and 1970s was that in many poor neighborhoods "the community" itself was rapidly ceasing to exist...
...Even undeniably positive court rulings, such as those against overcrowding or understaffing, were subject to routine subversion...
...He also recognizes the limitations of such stopgaps and worries that such measures might signal a return to the poorhouse of old...
...Torrey ignores the relationship between deinstitutionalization, mental illness, and poverty...
...New York: Crown, 1988...
...Even the adults he presents, though often dazed and overwhelmed, are seldom bitter...
...Others become intensely religious...
...Still, Torrey's book is being widely read and discussed...
...True, the politically active among the homeless do help keep the problem in the public eye, and they remind us that homeless people are citizens, not merely clients...
...Yet the reader willing to slog through a bit of sociologese will be well rewarded...
...Ropers provides a useful overview of the history of homelessness in the United States since the Civil War, pointing out the similarities and differences between the new homeless and their predecessors...
...The mentally ill had rights as individuals, including the right to behave oddly —yet they were to become a community responsibility...
...This is not the sort of study that anyone is likely to dismiss as "anecdotal...
...Where these families were stable enough to create a structured environment and ensure proper medical care, deinstitutionalization had a chance of success...
...The intentions of these advocates were laudable and many of the abuses they sought to stem were real, yet their reliance on litigation as a tool of social policy had its pitfalls...
...Thus, as advances in tranquilizers and antipsychotic drugs made outpatient treatment more feasible, a variety of forces inside and outside the medical profession pushed toward deinstitutionalization...
...242 pp...
...Drug and alcohol use is widespread among them, but only in a minority of cases are these problems so severe that they might be considered a cause of homelessness...
...In examining postwar public policy towards the chronically mentally ill, who, he estimates, constitute about one-third of the homeless population, Torrey implicitly attacks the usefulness of talking about "homelessness" per se...
...A rare few manage to retain some perspective (and sanity) by becoming politically active...
...He argues that most homeless people, even after extensive time on the street, are primarily in need of housing and jobs, not therapy...
Vol. 36 • September 1989 • No. 4
