Monday, April 16, 2007

Preview Issue Polemic: Bob Darby

Asylum of the Streets
by Bob Darby

It's been fifty years since I was eleven and growing up in South Georgia. Sometimes when I said something an older male didn't like, he'd just laugh and say, "You're going to Milledgeville!" It was more than just a joke, because "Milledgeville" meant Georgia's notorious insane asylum. With more than ten thousand inmates, it was the largest mental institution in the entire United States and the only public facility for locking up crazy people in Georgia. People sent to Milledgeville didn't come back, and I never heard anybody in Toombs County call it a "hospital."

There was nothing scarier than the threat of being committed to Milledgeville. While most of the people committed to the asylum were mentally ill, the institution enforced social conformity and intimidated those who were conspicuously different. In 1956, the wages of sin were not just death, but being put away for insanity. Milledgeville was where Georgia dumped its "undesirables" instead of sending them to prison or burying them in a shallow grave or sinking them to the bottom of the river. Milledgeville was where a father put his promiscuous daughter and his disrespectful, drunkard son. And since the American Psychiatric Association classified homosexuality as a mental illness, Milledgeville was where gay men who got caught being gay got locked up. Since the concept of racial equality was legally defined as insane, civil rights workers faced the threat of being arrested and committed to the asylum. For undesirables and for the mentally ill alike, "therapy" at the largest mental institution in the country meant electroshock, lobotomy, and solitary confinement. Sane people who were sent to Milledgeville were unlikely to stay sane for very long.

there met him a man with an unclean spirit, who dwelled among the tombs; and no man could bind him, no not with chains. And always, he was crying, and cutting himself with stones. And he asked him, "What is thy name?" And he answered, "My name is Legion; for we are many."

Mark 5: 2-3; 5-9

Mental illness was no more curable in 1956 than it was in the first century, A.D. The man who called himself "Legion" in the Gospel of Mark would be called mentally ill today, but the town from which he came did not take his life, or let him starve or die of exposure, as we might imagine. Legion's illness may have made him unapproachable and even dangerous, but the people of his community took care of him the best they could. If this biblical story is any indication of the way things were two thousand years ago, the mentally ill of the ancient Levant were seen as suffering from afflictions beyond their own control. When efforts to subdue the man failed, the community not only allowed him to live, but to live on sacred ground in the village cemetery.

How a society treats its mentally ill has always been a barometer of moral character. In Colonial America, it was the legal and financial duty of every township to add an extra room to the house of the family where a mentally ill person lived, so that the sick person could be fed, clothed, and even confined for as long as necessary. In fifteenth century England, large asylums for "lunatics" were maintained by the Crown and staffed by the clergy. One memorable asylum is still remembered today as "Bedlam," although its actual name was "Bethlem." The conditions for Bethlems' inmates were unsanitary and harsh, but the Crown and the Church were probably doing the best they could, given their limited resources and primitive understanding of mental illness. Bedlam provided services for England's "lunatics" for more than five hundred years, and those services were probably not that much different from what inmates at Milledgeville received in 1956.

The original meaning of the word "asylum" signifies a place of protective and benign refuge. It has been unusual for even the poorest of societies to outright abandon their "insane" to roam the streets and to fall victim to hunger and exposure. While asylums like the one at Milledgeville have often been misused for political purposes, they still fed and housed large numbers of people who had diminished capacity to take care of themselves. The best that asylums could ever expect for their inmates was spontaneous remissions, which would warrant temporary discharges until symptoms returned and the individual had to be returned to the asylum. When the Dutch painter Vincent van Gogh was in remission from his affliction and out of the hospital he compensated for his mental illness brilliantly. But his remissions were never permanent, and in despair over his illness, he committed suicide. The prolific English novelist and essayist, Virginia Woolf, suffered the same fate. Suicide still ends the lives of almost twenty percent of today's mentally ill who are not treated. For Van Gogh and Woolf, the best that psychiatry could offer was asylum, patience, and the hope for spontaneous remission.

Then in the late nineteen-fifties a medical breakthrough changed everything. New drugs were introduced that brought about long remissions from the major symptoms of schizophrenia and manic depression. Soon thereafter, drugs were developed that successfully treated major depression. All over the world, mental institutions became hospitals instead of asylums. Effective treatments were available for many whose conditions had long been hopeless. With such high expectations, the state of Georgia built a network of regional mental hospitals in the early sixties, strategically located throughout the state. Milledgeville, re-named "Central State Hospital," ceased to be the largest "insane asylum" in the country. The new system called not only for better hospitals but for the establishment of "Group homes," reducing the need for hospital beds and providing transitional "half-way" facilities for successfully medicated patients poised for re-integration with the world they knew before they got sick. The plan would cost less than "warehousing" at Milledgeville, and no patient would leave a hospital or group home without outpatient care and a safe place to live. The stigma against the mentally ill would diminish as their afflictions would be recognized as manageable by the new medications. In the flush of such early optimism, the promise of successful treatment was almost as good as a cure. Born of science, kindness, and hope, the new plan for caring for the mentally ill was called de-institutionalization.

At first, the de-institutionalization was a great success. For the two to three percent of the American population suffering from severe mental illness, there was hope like there had never been before--a revolutionary breakthrough in a revolutionary decade. The sixties seemed to promise everything good. When the Civil Rights Movement triumphed over Jim Crow Segregation, the Nation--and most especially the South--was liberated from more than three centuries of institutionalized racism. President Lyndon Johnson declared his "War against Poverty" in 1965, when what we now call "homelessness" was unrecognizable in such an unprecedented era of liberal generosity and wealth. Medicare and Medicaid mandated health care for the old and poor, and it was likely that a National Health Service would become a reality for all Americans before the end of the decade. Equal rights were demanded by women, gays, and native Americans. An environmental movement to save the planet itself was launched, and millions of Americans took to the streets to protest the War in Vietnam.

But the War lasted far too long and cost far too much. Funding for Johnson's War on Poverty was forfeited to his War in Vietnam and the "military industrial complex" that President Eisenhower warned about in 1960 drained resources originally intended for public health. There was no "peace dividend" when the War in Vietnam ended in 1975; the military budget actually grew to pay for the "Cold War" with the Soviet Union. When Ronald Reagan became President in 1981, the ambitiously compassionate mental health programs initiated by Jimmy Carter were dismantled. Moving in lockstep with the "Reagan Revolution," state governments all over the country cut their budgets for helping the poor and sick to build jails and prisons, and poverty and suffering inevitably increased. De-institutionalization of the mentally ill degenerated to mean closing down hospitals and throwing the patients out on the street, typically with no more than a few pills and a list of shelters.

The unsmiling man in the business suit at the art opening was a lawyer with the Department of Human Resources. I told him about Food Not Bombs and our work with the homeless and asked about the 1998 closing of the Georgia Mental Health Institute and the simultaneous cutting of thirty million dollars out of the state's annual mental health budget. "Yeah," he said," that's called 'purposeful neglect.' You'll never see it in print, but everybody at the DHR knows what purposeful neglect means-it means saving the state money. Somebody has to lose, right?" Before I could reply, he turned his back and walked away.

I wanted to know how my famously outspoken progressive representative had voted on the 1998 legislation that closed GMHI and cut the mental health budget, so I wrote and asked her. She never replied. Later I found out that the provision for GMHI's closure was tucked away into the full annual budget proposal and that the only way for a member of the House to vote against the closure and the budget cut was to vote against the entire budget. The principle of purposeful neglect had been successfully inserted i and was unanimously approved. The hospital that had been called GMHI was closed, and the mental health budget was slashed as the DHR recommended.

In 1955, there were more than 500,000 Americans in public institutions for the mentally ill; by 2005, there were fewer than 100,000. The nationwide doctor- and lawyer-administered Treatment Advocacy Center estimates that there are 3.5 million homeless Americans, of which about thirty-five percent are mentally ill. This means that there are more than one million mentally ill people living and dying on America's streets; in Atlanta alone, there are at least several thousand. A recent PBS TV "Frontline" documentary called "The New Asylums" counted 300,000 mentally ill people locked up in state and federal prisons, the great majority of which are there not because of violent crime, but because they are a public nuisance and the government has nowhere else to put them. If the number of mentally ill in jails is added to those in prisons, the total comes to about 500,000. Of the approximately six million Americans with severe mental illness, about one and a half million of that number are either homeless or incarcerated.

The man at my door was running for a seat in the Georgia House. When I asked about his position on the homeless mentally ill, he looked surprised and said that he used to work for the Department of Human Resources at Milledgeville's Central State Hospital. He said he was required to fill out discharge forms saying that patients were leaving the hospital to group homes that didn't exist. I asked him to be more specific and to put his story in writing, but he evaded my request and said I should contact the National Association for the Mentally Ill.

The doctor said he admired my activism for the homeless mentally ill. He leaned back in his chair and said that when he was a resident at Grady he filled out discharge forms claiming that patients were leaving the ward for treatment and residential programs that didn't exist. To refuse to go along with that procedure of the Emory Medical School might have interfered with the completion of his residency. Later on, he resigned his membership in the American Psychiatric Association because of this and other such things. Twenty-five years later, the same doctor charges $200 an hour.

Georgia's DHR, the state legislature, and the federal government are all accomplices in wide-spread abandonment of the mentally ill and in the deaths of thousands of many who had been made homeless because of their actions. And while their scheme of "purposeful neglect" was once inflicted almost exclusively on the mentally ill, it is now being visited upon other helpless populations throughout the country. The Atlanta Journal-Constitution (7/506, p.A5) reports that nationally there are 200,000 homeless veterans, forty percent of them Vietnam vets. Soldiers returning from the Iraq War are already joining the homeless ranks in visible numbers. There are also at least 32,000 Americans with AIDS who are homeless, along with their dependent families; and there are many uncounted others who have been made homeless by chronic, disabling diseases like cancer and diabetes. We are no longer "taking caring of our own" because our government is spending our taxes on war, jails, and prisons. Three years into the fiasco in Iraq, American military spending is about equal to that of all the rest of the world combined, while we are only five percent of the world's population. The United States has the highest per-capita prison incarceration rate in the world. Georgia has more than eighty thousand people in jail and prison, which exceeds two percent of our state's entire adult population.

Every weekday I pass through Five Points on my way to work. In the little park between the MARTA station and Marietta Street, I witness firsthand Atlanta's Asylum of the Streets. In the midst of a heat wave, an elderly woman is wrapped in layers of clothes and her possessions are piled in a shopping card. She slouches motionless on a bench. A man walks by aimlessly, barefoot and mumbling. An old man in a black winter coat waves a bible and shouts unintelligibly.

With proper attention, sixty percent of schizophrenics and eighty percent of manic-depressives can be successfully treated and brought back into normal human society, and constant improvements in medication will continue to improve those percentages. Would America tolerate a million people on the street with Parkinson's Disease--instead of that same number who are now on the streets because of mental illness? After almost three decades of throwing the helplessly sick out on the streets, Mainstream America seems to notice this atrocity only to complain. When will the politicians, the preachers, and especially those who claim to be on the "Left" live up to their calling to stand up for the oppressed and rescue those on our streets who are truly the most oppressed of all?

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