“Our once great cities,” President Trump declared on his campaign trail, “have become unlivable, unsanitary nightmares.” He campaigned on a promise to “relocate” 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’s birthday. Trump is not the first to order people who can’t 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 “urban renewal.”
Society’s practice of physically segregating privileged people from those they deem to be “less than” has deep roots. The deliberate practice of social segregation first seems to have come into use regarding issues of madness. “If someone should be mad,” wrote Plato in The Laws, “he is not to appear openly in the city.” 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.
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 “The Asylum for the Insane” 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—now 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 “Ugly Laws” which were passed in the late 1800’s in San Francisco, Reno, Portland, Chicago, New Orleans, New York, Denver, Columbus, Omaha. These “unsightly beggar” ordinances targeted the poor and disabled, with jail time and fines (See Susan M. Schweik, The Ugly Laws: Disability in Public.)
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.
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 “the institution as family” 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.
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.
By the 1870’s 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.
Doctors of Psychiatry, called Alienists, attacked Dix’s 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.
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’ waiting rooms.
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 “Danger to Self” or “Danger to Others” 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 “Gravely Disabled.” Human Rights Watch posted a letter in opposition, saying “this 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.” Being “Gravely Disabled” 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.
Dejà Vu
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 “homeless” are characterized as mentally ill— not as people who can’t 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’t 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.
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 “lack of insight,” as “a biological condition that prevents some people with severe mental illness (SMI) from knowing they are experiencing symptoms of a brain disorder.” (In general medicine, being unaware of deficits is seen in hemiplegia after strokes, Alzheimer’s disease, cerebral palsy, and other motor impairments, all evident as brain lesions on neuroimaging.) If those living on the streets won’t 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’s spokesperson Dr. Xavier Amador claims that up to 98% of folks with true schizophrenia have anosognosia which could be called a “reality denial syndrome.” There is a potentially expansive market for treating schizophrenia. According to Mindsite News April 2024, research spending was $239 per person with Alzheimer’s, $109 for Autism, but only $64 for Schizophrenia.
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 “massive” according to Conor Gallagher .(See www.nakedcapitalism.com/2023/01/californias-plan-to-disappear-the-homeless.html) 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.
The pharmaceutical industry continues to reap profits not only from the forced medication of poor people, but also from the development of expensive drugs and personalized care for the wealthy with addiction and mental health diagnoses. For example, Privé-Swiss on the Connecticut shore costs 20 thousand a week. In the same league are the Sylvia Brafman Mental Health Center and Tikvah Lake for executives in FL. While North Carolina’s public behavioral health program under Managed Care in the mid 2000’s tried to limit psychiatric hospital stays to three days, private residential time in luxury centers is frequently 365 days or longer.
Big Pharma is fast-tracking expensive drugs for treatment of the seriously mentally ill and all those who do not admit they are SMI. Bristol Myers Squibb’s KAR XT is projected to earn 7 billion by 2028. (KAR XT for schizophrenia had the highest patient discontinuation rate in clinical trials.) By successfully lobbying to remove so-called red tape from the approval process, Big Pharma has made it easier to obtain expensive psychiatric drugs. As of February 24, 2025 prescribers, pharmacies, and patients are not required to report weekly absolute neutrophil (white blood cell) count before dispensing Clozapine, thus increasing access and billing. New Jersey is leading the way in eliminating prior authorizations for the latest medicines, before trying older, cheaper ones.
As the federal government defunds suicide prevention at least 300 new drugs for depression are being developed with 163 in phase 1 trials, according to Datamonitor and Biomedtracker. The market is only expanding; there was already a 64% increase in use of anti-depressants since 2020 by adolescents and young adults according to Kao Chua, MD, PhD at the University of Michigan, reported by Institute for Healthcare Policy and Innovation, November 21, 2024. Pfizer who makes the two most prescribed drugs for depression, bankrolled the PHQ9 used by Primary Care physicians as a depression scale. (See Dr. James Davies’ You Tube “Ethical Matters: Mental Health, Capitalism and the Sedation of a Nation.”)
MAGA Ethics for “Those Who Matter”
On June 13, 2025, RFK. Jr. announced the appointment of Jim O’Neil, CEO of the Thiel Foundation, as Deputy Secretary of Health and Human Services. Peter Andras Thiel, born in West Germany in 1967, who put the first outside money into Facebook, then PayPal, is now the chairman of Palantir with ICE and IRS contracts to perform data analytics and automate decisions. In his CS 183 class at Stanford on Startups, back in 2012, kept alive by the posting of student notes, Thiel divided humanity into those who are Outsiders (weak, disagreeable, dumb, and poor) and the Insiders (having strength, charisma, beauty, high intelligence, and wealth.) Thiel is said to have inspired J. D. Vance with a university lecture and then bankrolled Vance’s senate race. While the new administration signed orders, bills, and filed lawsuits, Elon Musk used chainsaw tactics on government agencies. He referred to faith leaders from Bishop Mariann Budde and Rev. Dr. William Barber to Popes Francis and Leo, who criticized DOGE’s abrupt cuts of people and safety net programs, as mere “NPC’s” or Non-Playing Characters. They do not interfere, he said, with “Those Who Matter.”
Profitable corporations matter. According to a report from JAMA-health-forum Network, more than three-fourths of physicians in 2024 were already employed by for profit health systems such as:
Acadia Healthcare Company, the leading for-profit provider in the US, operates 258 facilities in 38 states and Puerto Rico, headquartered in Franklin, Tennessee. Acadia Pharmaceuticals prompts consumers to “Elevate Life.”
UnitedHealth Group, whose CEO was assassinated in December 2024, by L.M., instantly becoming a folk hero, uses algorithms to cut off patient care. UnitedHealth has nationwide bought up surgery centers and specialty pharmacies and offered private for-profit Advantage Plans, heavily touted by the AARP which claims a membership of 110 million. Headquartered in Wisconsin, United Healthcare keeps exceeding Wall St. profit estimates.
Hospital Corporation of America (HCA) turned non-profit Mission Hospital in Asheville, NC, into a for-profit business largely by cutting staff, supplies, and services like delivering babies and wound care. Mission joined almost 300 HCA for profit hospitals around the country.
Can profits be generated from encampments on federal land? Robert F. Kennedy, Jr., director of Health and Human Services, has said that he will open “Wellness Farms” with proper diet and exercise where the “damaged” will be put to full time work growing organic food. As we witness the development of internment camps for farmworkers and immigrants, it is important to ask if Wellness Farms of the urban houseless will be part of a forced labor project. The polio vaccine was tested at Letchworth Villages in NY (1911-1996). Certainly, private prison systems today regularly induce inmates to participate in drug trials. Might the internment camps beta-test Elon Musk’s products for brain injuries? Tesla’s innovative wheelchair? Could those cleared out to make America’s cities look more beautiful and prosperous be trained as servants for the tech innovators in the ten Freedom Cities? Without transparency and accountability for those “out of sight,” the possibilities are as terrifying as they are limitless.
The Age of Avarice and Acquisition, not Aquarius
While society has long been deeply flawed, it has been flawed despite collective efforts to care for and about each other. What would a government be like with freedom from all civic responsibility? The MAGA idea of monarchy is only big because there are billions of dollars behind it. “Might makes right” is an aphorism which asserts that those who hold power are the origin of morality; they control a society’s view of right and wrong. The Book of Wisdom (Apocrypha) written around the first century BC, describes the reasoning of the wicked: “Let us oppress the righteous poor man; let us not spare the widow nor regard the gray hairs of the aged. But let our might be our law of right, for what is weak proves itself to be useless.” Rooting out “weak members of society,” according to Sally Edelstein in “Down on the Farm,” February 2025, fascists and oligarchs usually target “minorities, queer people, feminists, liberals, and people with disabilities.”
“Might makes right” is the credo of totalitarianism. Back in May 2015, Pope Francis’ Encyclical letter said that “immense inequality, injustice and acts of violence” have arisen from adoption of the principle of “might is right.” He spoke about it again days before his death. Abraham Lincoln in his Cooper Union campaign address in 1860 addressed the Southern Democrats who wanted to preserve the economy of enslaving people: “Your purpose, then, plainly stated, is that you will destroy the Government, unless you be allowed to construe and enforce the Constitution as you please.…” Lincoln accused them of wanting to “rule or ruin” the government. He then reversed the phrase: “Let us have faith that right makes might, and in that faith, let us, to the end, dare to do our duty as we understand it.” America will never be Healthy—or Great Again—without Caring Again.
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Disclaimer
To former colleagues and those I know from social media who have labored long as activists to get attention for the intersection of “the homeless” and the “mentally ill”: I acknowledge that a small percentage of those counted as “the homeless” choose a lifestyle without rules or financial burdens. And I have known homeless veterans who could not tolerate being enclosed in a room after they were imprisoned in cages in Cambodia or Vietnam. I also acknowledge the tragic cases of teens, adults and elderly refusing attention to their mental health who then kill themselves or inflict violence on others.
Regrettably, there is no social media list as large as NAMI’s or TAC’s to tell the equally tragic stories of mental health patients whose bodies became completely rigid, whose tongues involuntarily, constantly circled their lips, who could never have an erection, who could not remember their children’s names, whose faces lost all expression, who couldn’t get out of bed for water, who had metabolic syndrome, who became morbidly obese, who were unable to sit still day and night, disturbing others, in shelters and jails, being evicted from programs, dorms, and family homes. There is no sympathy list for those who have trusted mental health providers, only to receive a diagnosis, a label, that destroyed their lives by denying their credibility, their prospects of a future, and invalidating their personal and social relationships.
I grew up in Atlanta where “bad” children did not go to hell, but to Milledgeville. I was involved with the consumer/survivor/ex-patient movement in both California and North Carolina. I have been a beneficiary of SAMHSA opportunities and grants. I have been certified as a Psycho-Social Rehabilitation Practitioner by Boston University and a Certified Peer Support Specialist. I persist in believing in human rights, mutuality, non-coercion, non-violence, and choice. I persist in this belief because I know how it feels to be treated with dignity and respect, to live with hope and purpose, for myself and others, and to find community in safe spaces created by others deemed maladjusted.
Bonnie J. Henderson Schell
July 16, 2025
Though this piece contains a lot of history, I take it basically as an opinion piece.
This problem has been with us for a very long time and is in fact the reason that Earth exists in its current form.
Here the homeless are characterized as “people who cannot afford housing.” Though that may be technically correct, it does not exactly represent the reality on the ground. Studies have shown that many if not most of these people are drug addicts or have similar problems. The expense of their addictions, as well as the effects the drugs have on them, are the reasons they cannot afford, or perhaps tolerate, to have a roof over their heads.
The real problem is the way modern life can break people, with no effective methods for putting them back together. Modern society tends to be careless about people; its willingness or responsibility to see to the general happiness and welfare of its members tends to be weak or absent. Everything is handled through bureaucratic systems that never seem to work well. A true sense of community has been lost.
The “mental health system,” if it existed in fact and not just in name, could be a major driver in correcting this problem. Its clients would include many leaders and members of “the elite,” as many of them are demonstrably emotionally or mentally disturbed and unable or unwilling to do their jobs. It would pass many “poor people” (victims of society’s lack of responsibility) over to a welfare system which would ideally actually take care of them properly. And we can imagine that these problems would eventually recede and become quite manageable.
Except for a few of us who live in Fairy Land, we all know that this in not how things are right now. But I don’t see complaining about it as all that helpful. The elites have reasons for behaving as they do; some might even be good reasons. They don’t share those with us, as they have a tradition of acting privately, if not secretly. Attempts to tear down that privacy – as evidenced by the recent Epstein affair – are usually successfully resisted. The elites have a lot of power, and they use it to protect themselves. They also use it – presumably – to protect us. They just can’t tell us about all that.
The ultimate resolution would be better mental health for all involved. And that’s what this website is all about. We all already know that our political and social systems are basically insane. The “mental health system” should be working to fix that, but it isn’t. That is our challenge.
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“The elites have a lot of power, and they use it to protect themselves.” And they utilize today’s “mental health” industries to do this for them.
“We all already know that our political and social systems are basically insane. The ‘mental health system’ should be working to fix that, but it isn’t. That is our challenge.”
I agree, we need to get rid of Western civilization’s “insane” “political and social systems” … today’s “insane” societal problems are basically the same problematic industries, as Jesus spoke out against over 2000 years ago … +psychiatry and psychology, et al.
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Great documentation! I may have missed the reference! Where or when did you begin to think of yourself as a citizen? To the extent you were able to realize the legal to assist with the challenge? I tracked in a similar way, though the experience through Voc Rehab became an issue. To really understand the South or North, East or West, seems as if a whole bunch of people are enslaved. Having said this, am reminded of the song Glen Campbell would sing about Arkansas, the Land of Opportunity until the name was tagline was changed to “The Natural State”!!!
And in our age, recall how Faubus would meet Eisenhower and built the next generation of mental hospital, that emerged from Kennedy. When I would start the city planning program at OU in Norman, the social worker Wayne Chess would be having lunch with President Carter to expand the community mental health program. But I had yet to understand the nature of being labelled or accepting the aggregate name, “The Mentally Ill”. One has to travel into Hell and back and then explain many times the problems. Somehow, though in traveling back to Arkansas and advocating for Justice, there seems to be an expression from business and all levels of governance, of people as well as organizaitonal behavior to run away from the word and label imparted. We might take a bit longer or shorter, depending on what technologies we have experimented with or on! But as my 11 grade Teacher conveyed, perhaps the South will Rise Again, about like biscuits and gravey! When folks get the facts, the road and path will turn to hum like a bird and sting like a bee! Understand the conditions that made the South Mad, hot enough to fry the egg on the car seat!
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