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<\/p>\n\u201cOur once great cities,\u201d President Trump declared on his campaign trail, \u201chave become unlivable, unsanitary nightmares.\u201d He campaigned on a promise to \u201crelocate\u201d tent cities to large parcels of government land. At a time when nearly 10,000 unhoused adults and more than 2,000 unhoused children lived in Washington, DC, Trump ordered Mayor Muriel Bowser to remove homeless people from public sight. His order began with the removal of encampments and most recently included a 24-hour notice to remove all people living in tents near the State Department and the Capitol before the June 14, 2025, military parade on the President\u2019s birthday. Trump is not the first to order people who can\u2019t afford housing to be removed from public spaces. Indeed, it seems to have been a requisite action for cities hosting the Olympics and a core component of \u201curban renewal.\u201d<\/p>\n
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Society\u2019s practice of physically segregating privileged people from those they deem to be \u201cless than\u201d has deep roots. The deliberate practice of social segregation first seems to have come into use regarding issues of madness. \u201cIf someone should be mad,\u201d wrote Plato in The Laws, \u201che is not to appear openly in the city.\u201d The relatives were to guard the person in their homes. If no relatives or neighbors assumed responsibility, the individual with strange and erratic behavior would have to be kept in a hut on the town common at public expense.<\/p>\n
In 1811, when the wealthy gentlemen of Boston grew tired of stumbling over persons who were loitering or obstructing their errands, they collectively contributed private funds and built \u201cThe Asylum for the Insane\u201d across the Charles River. The Asylum opened in 1816 as part of Massachusetts General Hospital, and then was renamed after John McLean, a merchant and benefactor. By 1916 the Asylum had 8,000 public-funded patients. In 1844 Luther V. Bell, MD, McLean superintendent, and 12 other asylum superintendents from the eastern U.S., founded the Association of Medical Superintendents of American Institutions for the Insane\u2014now known as the American Psychiatric Association. The Institute of the Pennsylvania Hospital was placed out of sight across the river from the thriving city of Philadelphia. New York located the Bloomingdale Insane Asylum in Morningside Heights in upper Manhattan in 1816. Further segregation was accomplished by \u201cUgly Laws\u201d which were passed in the late 1800\u2019s in San Francisco, Reno, Portland, Chicago, New Orleans, New York, Denver, Columbus, Omaha. These \u201cunsightly beggar\u201d ordinances targeted the poor and disabled, with jail time and fines (See Susan M. Schweik, The Ugly Laws: Disability in Public.)<\/p>\n
In Raleigh, NC, six prominent families donated 2,354 acres in 1850 for Dorothea Dix Hospital (Dix Hill) specializing in the care of insanity. On a hill overlooking downtown Raleigh, the property encompassed an epileptic colony and 2200 acres for farms, dairies, and timber. Dix was inspired by the Moral Treatment ideas of Samuel Tuke, Philippe Pinel, and later, Benjamin Rush. Asylums were self-sufficient towns, not requiring interaction with the outside, featuring railroads, post offices, grounds for gardening, farming, outdoor sketching, swimming, and strolling. Residents contributed labor to their community in a well-ordered environment with exercise, quiet and safety. Above all, Dix insisted, residents must be treated with respect and dignity.<\/p>\n
The Georgia State Lunatic, Idiot, and Epileptic Asylum in Milledgeville, GA, which opened in 1842, became the largest mental asylum in the world. Operating on \u201cthe institution as family\u201d model, with a specification that no rope or chain restraints were allowed, by 1960 there were 12,000 patients on 1,750 acres in more than 200 buildings, one for sterilization.<\/p>\n
In 1854 Dix campaigned for Congress to pass the Bill for the Benefit of the Indigent Insane. The bill proposed to sell over 12 million acres of federal land and use the proceeds to build asylums all over the country. President Franklin Pierce vetoed the bill on the grounds that caring for the poor and mentally ill was the responsibility of individual states. Dix argued that the way the states were treating their most vulnerable was a sure sign of their moral failure.<\/p>\n
By the 1870\u2019s almost all states had asylums for the insane funded by state dollars, supplemented by some private revenues. By 1900 the public asylums occupied 300,000 acres. The establishment of asylums coincided with a eugenics movement and infamously warehoused people deemed to be intellectually, morally or physically undesirable. By contrast, the affluent paid to stay in a private home with a noted physician where servants ministered to all their needs.<\/p>\n
Doctors of Psychiatry, called Alienists, attacked Dix\u2019s moral treatments as unscientific; other more respected physicians could remove the infected tissue. Even the Greek Democritus was praised by Hippocrates for cutting open animals looking for madness and melancholy. Alienists, therefore, turned their attention from the mind to the body. Believing that the mentally ill, like those with black bodies, had a diminished sense of pain, psychiatrists enacted harsh treatments on them: chilling, burning, bleeding, shocking, twirling, purging, and lobotomizing. But their methods were not curative, and the growing populations of patients resulted in crowded custodial institutions and fear of treatments.<\/p>\n
Although Ronald Reagan is usually credited or blamed with deinstitutionalization, 20 years earlier John F. Kennedy had signed the Community Mental Health Act of 1963 (CMHA), calling for a national network of 1500 community mental health centers (CMHCs) to treat those discharged from state hospitals. Less than half the community centers were ever built. The community did not welcome released patients near their suburbs, gated communities, shopping malls, schools, or in their physicians\u2019 waiting rooms.<\/p>\n
California led the way in establishing the legal basis for forcing mental health treatment on members of the public. In 1967 Governor Reagan signed the LPS Act establishing \u201cDanger to Self\u201d or \u201cDanger to Others\u201d as grounds for an involuntary 72-hour hold and evaluation, but it was Governor Gavin Newsom who signed an amended SB 43 to make it possible to also pick individuals up for being \u201cGravely Disabled.\u201d Human Rights Watch posted a letter in opposition, saying \u201cthis bill expands the circumstances under which the State can deprive people of their autonomy and liberty, making it easier to remove both housed and unhoused people from society.\u201d Being \u201cGravely Disabled\u201d means not only the inability to provide food, clothing, and shelter for oneself, but also the inability to provide personal safety and medical care due to a mental health or substance use disorder, or both.<\/p>\n
Dej\u00e0 Vu<\/p>\n
Removing people loitering and sleeping on public property from public view has a long history. What is unique in 2025 is a brutally transparent for-profit motive. First, the majority of the \u201chomeless\u201d are characterized as mentally ill\u2014 not as people who can\u2019t afford housing. In the context of these policies aimed at erasing and containing unwanted populations, it is especially important to note that many people who can\u2019t afford housing are full-time workers. In an article for The New York Times, April 8, 2025, Eliza Shapiro described 22 shelters on the outskirts of NYC for people who go to work every day. These Employment Shelters house librarians, Uber drivers, Amazon delivery staff, mental health counselors, home health aides, construction workers, line cooks, graduate student assistants, exterminators, police officers, cleaners, elementary teachers in public school.<\/p>\n
Second, efforts to corral unhoused persons into forced treatment have been dramatically sharpened by weaponizing a diagnosis of anosognosia. The Treatment Advocacy Center defines Anosognosia, also called \u201clack of insight,\u201d as \u201ca biological condition that prevents some people with severe mental illness (SMI) from knowing they are experiencing symptoms of a brain disorder.\u201d (In general medicine, being unaware of deficits is seen in hemiplegia after strokes, Alzheimer\u2019s disease, cerebral palsy, and other motor impairments, all evident as brain lesions on neuroimaging.) If those living on the streets won\u2019t accept treatment, a diagnosis of anosognosia enables states to arrest them for their own good. The primary disease the chronically homeless are unaware they have is Schizophrenia. NAMI\u2019s spokesperson Dr. Xavier Amador claims that up to 98% of folks with true schizophrenia have anosognosia which could be called a \u201creality denial syndrome.\u201d There is a potentially expansive market for treating schizophrenia. According to Mindsite News April 2024, research spending was $239 per person with Alzheimer\u2019s, $109 for Autism, but only $64 for Schizophrenia.<\/p>\n
In a similar drive to enforce medicalization of the houseless, California enacted the Community Assistance, Recovery & Empowerment (CARE) Act in 2022 to be phased in by all counties by December 2024. Under the CARE Act, the number of people forced into taking medication has been \u201cmassive\u201d according to Conor Gallagher .(See www.nakedcapitalism.com\/2023\/01\/californias-plan-to-disappear-the-homeless.html<\/a>) While those who voted for the CARE Act might have pictured nice social workers and certified peer support staff offering pills, juice, resource lists, and a smile to outpatients, what is actually delivered can be long-term decanoate injections of anti-psychotics that last up to 40 days.<\/p>\n