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.

PARANOID KILLERS AMONG US? by Art Smukler, author & psychiatrist

Back in the flush sixties, the federal government provided millions of dollars to support community mental health programs. The eerie, dark, cavernous hospitals for the insane were bulldozed or turned into condos, and the care of thousands of mentally ill patients was shifted to local community mental health centers. Graphic visions of schizophrenics chained and screaming was now going to be a thing of the past.

Since Hahnemann (now Drexel University School of Medicine) had a terrific, community-based program and psychiatric residents had the opportunity to treat all forms of mental illness, I decided to do my residency there. My first six months were spent at Philadelphia General Hospital (PGH), an ancient psychiatric fortress with a unique treatment program. During the morning meetings everyone had a vote. Doctors, nurses, art therapists, psych techs and patients would vote on all sorts of things, including discharges. No chains, no demonic ECT toting psychiatrists, just young enthusiastic psychiatric residents wearing bell bottoms and colorful shirts.

It all sounded great except for one “little” problem; most of these patients were psychotic! They heard voices (auditory hallucinations), thought people were after them (paranoid delusions), and without medication were impossible to reason with. Some even became violent and very dangerous. Not a fun experience for a clueless 1st year psychiatric resident who was assigned to treat a violent paranoid man — but more about that in my novella, The Man with a Microphone in his Ear.

Fast forward fifty years to 2013. The government’s money stream has diminished from a mighty river to a trickling creek. Thousands of mentally ill patients have chosen to wander the streets of our cities begging for food, mumbling aloud to themselves, and pushing all their worldly belongings in a battered food cart. Like the patients I treated at PGH, they refuse medication and refuse help.

Most are just hungry and needy and mean no harm, but some believe, really believe, that they are under attack, and without provocation will attack first. They aren’t in psychiatric hospitals, but still suffer from a profound psychiatric illness. Now their illness is simply visible to anyone who takes the time to look.

Should the state hospitals be reopened?

I think so.

Very sick people need structure and treatment. Their impulses to attack, because they feel under attack, need to be treated. If they are too sick or too dangerous to be among us, they will at least have a safe, comfortable environment in which to live until they get better. It doesn’t have to be like in the primitive days of the screams and chains. New therapies, new medications, and an enlightened approach to mental illness is needed. Just because people have rights, doesn’t mean that mental illness will just disappear.

How many Cruise missiles will it take to rebuild our hospitals and care for our mentally ill street people? Would it really cost more to have this sick population in a hospital rather than all the money we spend on police work, social services, cleaning crews and a flawed community mental health concept?

Art Smukler MD is the author of Skin Dance, a mystery, Chasing Backwards, a psychological murder mystery, The Man with a Microphone in his Ear, and the blog, Inside the Mind of a Psychiatrist.