On an all-American road trip this summer, I arrived in San Francisco, a city of bright lights, trendy hippies, shopping malls that sell jumbo jets and streets peopled by the homeless. A breed of homeless completely unlike any I had seen before. Walking through the wealthy gay district I received cheeky smiles from tramps with signs saying ‘I’m sexy and I’m homeless’, ‘Kisses for a $’, and my personal favourite, ‘My wife had a better lawyer’. These people weren’t apologetic for begging, didn’t seem hopeless, nor to have been living this way for long. Many of them were happy, even.
But then I hit downtown. Now the homeless I saw were more decrepit, and there was no sense that their lives might ever change. On closer inspection, I realised I was looking at an entire population of the mentally ill, with illnesses like I had never seen before – people babbling to themselves, crying, obsessively tapping every fourth paving stone, a man in a wheelchair which was older than me with a sticker on the back of it which said ‘Not to be removed from St. Francis Memorial Hospital’. A couple lay down and embraced in the street; one of them had no arms. As I walked down an incredibly long straight street, a man, roughly in his 30s, had been loudly talking to himself beside me in what sounded, with its scatterings of trendy slang, like the voice of someone who used to have a whole bunch of friends. He turned around ahead of me and started screaming right at me. At first I was terrified, but then I realised he didn’t even see me. I stole round a corner and took a breather. Where was I? Apparently in a caricature of a mental asylum. Where had America gone? And how had this happened in the land of the free?
I later discovered that what I had witnessed was in part due to America’s ‘deinstitutionalisation’ – a policy that began in 1955, of closing down long-stay psychiatric hospitals, with the (unfulfilled) intention of treating people in community mental health services. The objective, as defined by President Carter’s Commision on Mental Health, was ‘to maintain the greatest degree of freedom, self-determination, autonomy, dignity, and integrity of body, mind, and spirit for the individual while he or she participates in treatment’. Instead, many severely ill schizophrenics, manic-depressives and others with major, incurable dysfunctions were discharged without ensuring that they had any long-term form of help. As a result, much of the severely mentally ill population has simply been relocated to the streets and jails, where ‘self-determination’ amounts to a choice of soup kitchens, and any so-called ‘dignity’ or ‘integrity of body, mind and spirit’ is long gone.
America seems to be conducting not so much a war on poverty as a war on the poor. New Orleans, for example, is known to do clean-up acts, in which police take all the homeless off the street and dump them in jail – an ill-conceived pretence which merely sweeps the problem under the rug. There seems to be a misguided attitude to these people – as though the country believes it has no responsibilities.
Homelessness is often considered as a problem of the 80s, since the media is now looking elsewhere, but the effects of deinstitutionalisation are still very apparent. Council housing does not exist in the way that we know it in the UK. Instead there are ‘the projects’ in some cities, often referred to as ‘the housing of last resort’ because of endemic problems of ostracisation and violence, and there are also homeless shelters, avoided by many who would rather be out on the streets because of the extreme violence, rape, theft and murder that haunt these places. For the disabled homeless there are highly unlikely ways to claim money, involving lawyers and large amounts of paperwork. Without benefits, mentally ill children are known to have been left out on the streets by parents who cannot care for them. With almost no safety net to catch the fallen, these vulnerable people are in an abyss out of which they can never climb.
I thought about getting on a bus, before somebody noticed me as the odd (sane) one out, and after a brief moment considering whether the people on the street or on the bus looked the least distant from my level of reality, I hopped on. The bus driver, perhaps sensing my wide-eyed shock, began to speak about what I had witnessed, from his perspective: ‘I have seen the worst of what can happen to a man pass in front of my bus. If I had known what I would have seen I never would have taken this job.’ The insane-o next to him nodded knowingly.