De-institutionalization just shuffles the institutions

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Christopher F. Rufo writes,

The question now is not, “What happened to the asylums?” but “What replaced them?” Following the mass closure of state hospitals and the establishment of a legal regime that dramatically restricted involuntary commitments, we have created an “invisible asylum” composed of three primary institutions: the street, the jail, and the emergency room.

Here is an issue that is better framed by conservatives than by progressives or libertarians, no?

16 thoughts on “De-institutionalization just shuffles the institutions”

  1. American libertarians function as a linear combination between conservatives and progressives. On this issue they are progressive.

    Proggies wanted crazies out of the asylums so they could vote blue properly.
    The con side wanted crazies off the streets, because they vote blue. Coincidentally their argument was less wrong, but that doesn’t mean it was sincere.

    Possibly it’s also about pure sadism. The DNC hates normal, healthy folk and wants them to suffer. (Not as much as it hates blacks, though.) Perhaps the effect on the vote is fully negligible, but they continue to support the policy due to the undeniable damage caused to life satisfaction.

    • Lots of people are wrong. Heck, I’m the only person who’s right about everything. But few people are pure sadists. Almost nobody “hates normal, healthy folk and wants them to suffer.” That includes the DNC.

      • Okay. Inform them of their error. See how they react.

        Are they curious? Do they try to ensure they aren’t causing vast harm?

        E.g. black fatherlessness, 50s: 20%. Black fatherlessness, present: 75%. Do blacks not deserve to have fathers? When this level of negligence is found elsewhere, it is called criminal negligence and draws jail sentences. Given that the effects were predicted in advance, they could have known in advance. They do not retract. Either they’re brain-tumour level stupid or they’re doing it on purpose. Either way, trying to rule with this attitude would, in a just country, draw jail sentences.

        You’re making excuses for them. Good boy. Very good boy.

        • I am saying that one should respond to their arguments and battle them with facts rather than making insults. You are doing the same sort of thing that woke people do by calling anyone who disagrees with them a racist.

  2. Derbyshire has a Homelessness mnemonic, he got from a NYC social worker, “CATO-4321”, and which matches my own experience.

    The first part, the “CATO,” gives the four categories of homeless people; the second part, “4-3-2-1,” gives their relative proportions. I’ll take the four categories in turn.

    “C” stands for “Crazy.” I apologize for that: It’s not a very sympathetic way to speak about people with mental-health issues. This was forty years ago, when we spoke more bluntly. The “C” of “CATO” goes with the “4” of “4321”: Forty percent of the homeless are afflicted with mental-health issues.

    Next, “A.” That stands for “Addicts,” and it goes with the “3.” Thirty percent of homeless people are drug addicts. Alcoholics may be in there, too — I forget.

    Next after “C” and “A” comes “T.” That stands for “Tramps.” This word isn’t much used in American English; my friend and I were living in England. I think the nearest equivalent here is “hobos.”

    This population of homeless, the “T’s” — who of course are twenty percent — these are people who like living on the streets. They’re not crazy and they’re not drug addicts. Homelessness is their chosen lifestyle. They’re the happy homeless.

    Finally the “O’s” at ten percent. “O” stands for “Out of luck.” These street people are not crazy, they’re not addicts, and they don’t want to live on the streets. They just have no choice.

    These are people you or I would recognize as normal, but they’ve had some terrible reversal of fortune. Lost their job, lost their house, wife left them and took the kids, no family to fall back on for support. It happens. There but for the grace of God …

    After he’d explained his little mnemonic to me, my 1979 friend added the following. Quote from memory. “Of all those four groups, the only one that Social Services can do much for in a permanent way is the “O’s.” They want to be helped; and when you try to help them, they co-operate. The Crazies and the Addicts mostly won’t co-operate, because they mostly can’t; the Tramps won’t co-operate because they don’t want to.”

  3. Rufo doesn’t address the Housing First model (https://en.m.wikipedia.org/wiki/Housing_First ) to addressing homeless Ness for which there is some supporting evidence including RCT studies published as recently as this year per Google Scholar. Washington state has such programs.
    Homes First for example which has an office in Olympia, appears to be slowly but steadily making an impact: https://issuu.com/44984/docs/homes_first_annual_report_2019_-_final
    Housing First is probably widely overlooked because it supports the populist goal of individual autonomy through home ownership which is opposed by progressives, libertarians, and conservative s alike: progressives opposing because private housing is structurally racist, libertarians because private homes slow the global movement of cheap labor resources that could more cheaply be housed in Singapore-style guest worker dormitories, and conservatives out of fear of the lower castes and under classes attaining autonomy.

  4. Libertarian arguments had a big role in dismantling the old system of mental asylums.

    Most of them were dismal places where patients were far too often mistreated or drugged up. Even the best ones had depressingly little success in treating the mental illnesses that put patients there in the first place. In such situations it is hard to overcome libertarian objections to depriving people who have not committed crimes of their freedom.

    I would like to hear more on why the conservative framing of this issue would be better and what that framing would mean for policy.

    • I suppose it depends on how accurate the notion of the invisible asylum is.

      Asylums were probably dismal places, but so the street and prisons are quite dismal too.

      I knew a man who begged in my city, even when it was cold and miserable. He would likely have fit into the C category. He had little connection to reality and I recall seeing him stagger around in pants which he had soiled. I gave him help when I saw him, but there was little I could reasonably do besides buying food or giving him a few bucks. I suppose that and some acknowledgement that he existed, which many did not give him. After having not seen him for sometime, I suspected that he died.

      He was free in the sense that he wasn’t stuck in some building against his will, though in fairness I’d rather be under house arrest for the rest of my life than to have traded places with him.

    • Right. Can we force people to take their medication? Can we institionalize someone because they choose alcohol above all else? We cant even restrict them from buying weaponry.

  5. I would be interested in hearing some options for a better solution. The current system certainly doesn’t work.

    • There’s no way to answer that if you don’t define ‘better’ first. It’s hardly a new problem, and different cultures dealt with the matter in various ways, which sometimes depended on the overall level of wealth.

      One reason to be against involuntary commitment even in pretty obvious cases of mental illness comes back to the same issue of trust in institutions. If you trust judges and doctors to be make decisions in a consistently professional, rational, fair, and humane manner, then some non-prison commitment for some people some of the time makes sense.

      If you are worried about biased members of corrupt institutions and the Political abuse of Psychiatry then you might be willing to accept the conquences of having no asylums as a price one is willing to pay to keep inconvenient dissidents from getting locked up in those facilities.

      The is the general argument in favor of “unreasonably strict rights”. If you could trust people, you could tolerate a few reasonable and rare exceptions in extreme cases. If you can’t trust people, the zero-trust solution is to take away their opportunity to abuse power by taking away the power altogether.

  6. This is all schizophrenia in its polygenetic glory. This is an incredibly common disease with a 1% worldwide prevalence without substantial environmental contribution. Formal DSM criteria only capture a portion of its complexity.

    Very dangerous to “solve” this problem with top-down theories and ideology. Most of the underlying suppositions with these solutions have nothing to do with the underlying biology.

    Tough problem. Suspect our children will still be struggling with it to some degree. Then again, we cured HIV and Hepatitis C and likely soon, COVID.

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