Psychiatry, Violence, and the State: California’s Systematic Failure of Its Unhoused Population

Upon the catastrophic failure of its economic policies, California has decided to systematically restrain, incarcerate, forcibly strip, and drug its now sizable unhoused population.

Rent control, out of control zoning laws, and other red tape have plagued California’s housing economy for years, limiting housing supply despite high demand. The most vulnerable citizens have been pushed onto the streets, unable to find long-term housing options where they feel safe. Advocates push for “housing first” as a solution for the homeless to solve their problems, which allows unconditional housing as a right regardless of mental health or addiction status.

The hopelessness, isolation, paranoia, and mental breaks which often (understandably) characterize the unhoused experience are interpreted by many in the public as symptoms of “unsound mind” rather than failures of social policy. The abuse and neglect the homeless have suffered at the hands of the state and society being ignored has had a devastating impact on the social policy surrounding those affected.

Despite being a cheaper alternative to forced institutionalization, housing first doesn’t have quite the same political backing. Providing long-term shelter without strings attached does not pay dividends to Governor Newsom’s healthcare industry donors. Unfortunately for the unhoused population under his rule, their needs, as well as those of the California taxpayer, are deemed irrational.

In fact, beyond just being cheaper than forced institutionalization, housing first saves the public substantial amounts of money. Rather than allowing the homeless to descend into mental anguish, drug abuse, and occasionally crime, places that cure the issue at the source save money by reducing the need for services addressing the symptoms of the problem. Providing for the basic needs of the unhoused reduces the need for services of all kinds and promotes public safety.

However, these facts are as irrelevant to the state of California as those exposing their policies which created the homelessness crisis in the first place. The government would rather deem those most hurt by their policies as being of “unsound mind.” Thus, they can void their victims of standard inalienable rights and themselves of all responsibility.

The consequences of the concept of “unsound mind” have been harrowing, leading to innumerable human rights abuses. Historically, and currently, many psychiatrists have insinuated that no one free from the grips of “schizophrenia” could prefer to be homeless rather than incarcerated in a mental institution and put on antipsychotic drugs. This claim has been made and published in The Lancet, a well-respected journal, despite no factual basis or reasoning provided. It shows just how powerful the bias of invoking a psychiatric diagnosis to discredit critics can be.

This places psychiatry in a unique position among medical specialties in that the responsibility for unappealing services is completely displaced onto the intended target demographic, often to the point where the target demographic is forced to engage with the specialty. Then, when the long-term outcomes are predictably worse, psychiatrists then claim “services” are more needed than ever. They will then pile on more drugs and shocks, sometimes without consent, and rarely with fully informed consent. All trauma is dismissed as more disease progression and more reason to force additional “help.” (This happens across all social strata, as it so famously happened to Britney Spears. If a world-famous pop star could not defend herself from psychiatry, how could destitute outcasts possibly stand a chance?)

Furthermore, one must look at the symptoms of “schizophrenia,” the archetypal diagnostic label deeming someone of “unsound mind”: delusions, hallucinations, disorganized speech, catatonic or disorganized behavior, and diminished emotional expression. You only have to be impaired for six months and have a couple of the aforementioned symptoms for one month to get a diagnosis. Several of these are signs of fear (such as speaking unclearly and not showing emotion), and all of them make sense in the context of the mind-breakingly harsh unhoused experience, exposed constantly to hunger, irregular sleep, little support, and a potentially violent police state. Attacking their liberty would just create even more trauma than they already have.

A few months ago, I had a discussion with an unhoused man at a bus stop in California. He seemed surprised I even bothered talking to him and almost cried. He asked if I was a psychiatrist, and I said no. (I wonder now if he was afraid I was going to commit him.) We talked for hours. When the topic of psych wards came up, he believed it was inhumane to be sent against one’s will. He also told me in detail about why so many unhoused individuals were not currently sheltered, with reasons ranging from strict rules to poor conditions to only allowing short stays. In essence, the unhoused homeless are in the situation that they are because, between several unsavory options, the freedom of the street seemed best to them. (That, or they had exhausted their options.)

Investigative reporting shows the homeless are fleeing forced treatment. Given the option, I would prefer to be on the street too; there is at least more freedom there. I would be surprised if anyone who has researched, investigated, or been to most of these places from the viewpoint of the user disagreed. Having lived in California myself, and known plenty of people who went to the wards or were committed to them, I’ve never heard a single positive experience. Their mental health unanimously either remained unimproved or got worse. (Of course, there are nice treatment centers; but the homeless and most of those in crisis don’t have access to those kinds of facilities. That’s a large part of why they aren’t going voluntarily.)

The paranoia characterizing many of those labeled with “unsound mind” can, and has been, addressed with great success by addressing the root causes, like housing and employment. Furthermore, more consensual services minimizing drug use while maximizing human connection could vastly improve outcomes. Forcing hospitalization on those who don’t want it is more expensive, more traumatizing, and creates worse outcomes than housing first, in addition to potentially increasing the risk of suicide. It goes against the principle to do no harm for professionals to advocate such invasive, inhumane, drastic measures, especially when the bare minimum has not even been tried.

Another issue in forced hospitalization is that resources are diverted from voluntary patients, straining the staff and creating a worse scenario for everyone involved except those profiting at the top. I once had a conversation with a woman who recounted her depths of despair wherein she was turned away because the beds were full. She told me she almost committed suicide that night because she felt so emotionally out of control. She had already had multiple suicide attempts on her record, and the doctor did not care. With estimates showing that many if not most patients experience coercion in admission, and that this worsens outcomes, it is a miscarriage of justice that she was not allowed a bed in favor of locking up people who likely didn’t even want to be there.

Everyone in crisis deserves an environment where they feel safe. California has not been providing this, from the policies targeting the most vulnerable to the notoriously corrupt Los Angeles Police Department. Resources are diverted away from policies that are free to enact, save tax money, reduce crime, and create a more compassionate society, and into more incarceration, whether in jails or in mental institutions. The result is less of everything to go around and a crueler, harsher world for those most affected.

What the state of California is doing is a form of DARVO. The state denies its wrongdoing towards its people and then institutionalizes them, framing the ones suffering the most at their hands as a root cause of social ills. With the recent legislation, psychiatry has gotten its big win by being handed an even bigger role in coercive social control than it already had. It is becoming further cemented in its historical and current role as an arm of the state, exploiting its power over the most disempowered people in society. (While they claim to be well-regulated, the insides of these institutions tell a different story entirely; the letter of the law doesn’t apply when those being abused are disempowered in every possible way from fighting back.)

The most logical, cheapest, and most humane solutions are being ignored by legislators in favor of a violent gaslighting of the state’s most economically vulnerable. Despite having produced this crisis, California politicians walk free while tossing their victims into asylums.