THROUGH THE WORMHOLE TO 1972 – THE STATE HOSPITAL IS BACK! by Art Smukler MD, author & psychiatrist

My morning bike ride, on the bike path between Santa Monica and Venice, CA, was especially poignant, but not for the obvious reasons.

Interspersed among fellow bike riders, hardy girls in bikinis (It was a nippy 62), hardcore volleyballers, walkers and joggers, surfers, riders of the Bird (the new rage electric scooter) and philosophers — strolling with their cups of coffee and addressing the human condition, were hundreds (YES HUNDREDS) of Street People — arranging their numerous bags filled with gathered treasures, curled up on the sand under dirty blankets, screaming obscenities easily heard from blocks away, taking care of swollen bladders against the walls of buildings, wild-eyed and staring into oblivion, making comments (Thinks he’s so hot! Asshole! You won’t put poison in my body! Come near me and the devil will finish you off!), wrapped in sheets and blankets.

The Street People, of which at least 1/3 are psychotic, were my constant companions as a young psychiatric resident in Philadelphia. The training ground was PGH (Philadelphia General Hospital), founded in 1729 and closed in 1977. Now these unfortunates, who used to fill the beds of hundreds of state hospitals, roam the streets all over the United States. Back in the seventies Community Mental Health was the new rage. It would solve the problem of housing thousands of psychiatrically ill people and save us billions of dollars.

Initially it all worked quite well. There were numerous mental health facilities, psychiatrists, psychologists, social workers and mental health workers. Then the federal and state money dissolved into other programs and the mentally ill followed their illnesses into the streets.

Do-gooders support the rights of the homeless, but they ignore the fact that these people need food and a safe place to deposit their bodily waste. Fouling the streets is more of a problem than just aesthetics. There is truly the potential to infect many people with bacteria that can easily be picked up by rodents and other disease-carrying-animals and birds. Also, a paranoid person really believes he is being attacked. The streets can be dangerous!

So here I am, remembering “The good old days” when I was a young psychiatrist. In just a few minutes I’ll be having my morning cup of coffee at one of my favorite cafes and reading all about the economy, Trump’s latest brag, a new movie or TV series to see, a great book to read, and how we need to do something about the problem of the homeless. Well, it’s not just a problem; it’s an epidemic!

Luckily a lot has been accomplished since the seventies — new meds, new approaches to mental illness, and a significant reduction in the stigma of mental illness. Taking care of the mentally ill on our streets is also taking care of ourselves. Even selfish people can get behind making changes and investing in the mentally ill and ourselves. Housing, hospitals, medication and mental health workers are expensive. Who better to spend it on than ourselves. Improving the condition of millions of street people will “Make America Great”. Even narcissists sometimes come up with a good tagline.

If you enjoyed reading, Inside the Mind of a Psychiatrist, you might also enjoy Dr. Smukler’s novels, Chasing Backwards, a psychological murder mystery, Skin Dance, a mystery, and The Man with a Microphone in his Ear. All are available as paperbacks and eBooks.