Locking up the mentally ill has a long history in the U.S.


Just when the United States started to make some progress reversing decades of mass incarceration, Democrats want to lock up people with mental illness in the name of compassion and care.

New York Mayor Eric Adams called it a “moral obligation” to hospitalize people against their will if they are a danger to themselves. His proposal has police officers assessing whether a person is mentally ill.

In Portland, Ore., Mayor Ted Wheeler recently told a roomful of business leaders that he wanted to lower the threshold for involuntary commitment of people who are both mentally ill and homeless, declaring: “They need help, and they need compassion.” The outgoing director of the Oregon Health Authority echoed Wheeler, calling for expanding the capacity of the Oregon State Hospital, the site of the 1975 film “One Flew Over the Cuckoo’s Nest.”

In California, Gov. Gavin Newsom has signed legislation that would allow family members and first responders to mandate treatment or involuntary commitment.

Incarcerating those perceived as mentally ill is not a new idea. In the 19th century and the first half of the 20th, hundreds of thousands of people were forced into mental institutions and hospitals. Many of them were immigrants deemed a danger to the broader society. Then and now, removing people from our communities to be put in institutions has been a project of social control.

In the 19th century, asylums, charitable hospitals and almshouses emerged as part of a reform movement to provide “moral treatment” to the poor and the ill. The very meaning of the word “asylum” — sanctuary or retreat — suggested a “therapeutic landscape.”

Then, in the Progressive Era that began in the late 1800s, eugenics — the science of improving humanity by “breeding out” disease and undesirable races — gave these institutions a new mandate: to protect healthy and “well-born” citizens from the biological dangers of mixing with people labeled “feebleminded,” “mental defectives” and “lunatics.”

By the turn of the 20th century, asylums became prisons where people could be warehoused out of sight and mind. Although citizens were among those stashed in asylums, immigrants were even more likely to be caught in the web of carceral hospitalization. At the time, more than three-quarters of people in New York City’s “lunatic” hospitals were foreign-born. In the West, immigrants made up more than half of all patients in mental institutions.

The arrival of millions of immigrants at the end of the 19th century and in the early 20th century led eugenics-inspired public health professionals to act as front-line guards, protecting the country from supposedly dangerous foreigners who threatened to “pollute” the nation, to use their racist lexicon.

The assistant surgeon at Ellis Island, Howard Knox, a member of the Eugenics Research Association, wrote with alarm in a medical journal about the danger to the country of “unfit” immigrants. As he put it, “A drop of ink in a barrel of water does not make ink, but the greater the number of drops of ink in that barrel of water the more inky it becomes.” Knox was particularly worried that immigrant inspectors would not detect “morons,” who, he warned, “will immediately start a line of defectives whose progeny, like the brook, will go on forever.”

In 1912, the New York Lunacy Commission found that one-third of the entire state budget was spent locking up and caring for the mentally ill, and half of the people incarcerated were foreign-born. New York’s Mental Hygiene Law that today governs involuntary commitment eerily invokes the name of the eugenicist 1926 Office of Mental Hygiene. The language of “lunacy” and “mental defects” is long gone, but the notion of mental hygiene binds us to a dark eugenicist past.

Much like Adams’s proposal to deputize nonmedical professionals such as police officers to evaluate mental disorders, the surgeon of the Public Health Service, E.H. Mullan, in 1917 published guidelines to help immigrant inspectors at Ellis Island detect mental “defects.” Inspectors were expected to make a diagnosis in a matter of seconds through rudimentary questions and observation.

The characteristics Mullan suggested to diagnose “maniacal psychosis” were extremely vague, including “striking peculiarities in dress, talkativeness, witticism, facetiousness … excitement … [and] laughing.” Inspectors were told that depression was evidenced if the immigrant had “slow speech, low voice, trembling articulation, sad facies, [and] tearful eyes.” So, whether they were talkative or responded slowly, laughed or cried, or were excited or sad, all could be proof of mental illness and subject them to detention and deportation.

At the same time, Mullan cautioned inspectors to be attentive to cultural differences in making their assessments. If an “Englishman reacts to questions in the manner of an Irishman, his lack of mental balance would be suspected.” Or, Mullan explained, “if the Italian responded to questions as the Russian Finn responds, the former would in all probability be suffering with a depressive psychosis.” Eugenicist doctors propagated cultural stereotypes and categories of mental illness, like “feebleminded” and “moron,” to justify their forcible incarceration of people from backgrounds they deemed “unfit.”

The ideas of eugenics soon informed federal legislation curtailing the immigration of those from undesirable countries in Southern and Eastern Europe, and virtually banning all Asian and Black entry. A system of national-origins quotas was in place from the 1920s until the 1960s, when Congress rejected the openly racist and eugenicist framework that had choked off immigration.

Just as eugenics fell out of favor in formal immigration policy, reformers challenged ideas about mental illness that had justified the existence of asylums and many psychiatric hospitals. In 1960, an astounding 630,000 people were locked up in mental hospitals across the country. But the last bill signed by President John F. Kennedy in 1963, a few weeks before his assassination, was the Community Mental Health Act. In signing the bill, Kennedy declared that the “cold mercy of custodial care would be replaced by the open warmth of community.”

But community-based resources rarely materialized. Instead of “care,” in the 1980s and 1990s, presidents from Ronald Reagan through Bill Clinton pushed policies that punished the poor, curtailed access to health care and welfare, and promoted incarceration.

By then, the kinds of institutions where people were locked up had shifted. Psychiatric facilities closed, while jails and prisons proliferated. Although these institutions had different stated purposes, people without financial resources who experienced mental illness frequently became enmeshed in the criminal legal system. In 2008, the United States hit a record 2.3 million people caged in jails and prisons.

Reform efforts since then have led to reductions in the number of people locked up. But the trend toward decarceration has proved fragile. Following the summer 2020 protests against police brutality, a rise of homelessness and a perception of spiking crime, there has been a sea change.

What is perhaps unexpected is that the latest calls for caging the mentally ill come not only from Donald Trump but from Democratic politicians in the bluest of cities. And like their Progressive Era predecessors, they speak of therapeutics to mask a politics of social control. If they succeed, we are likely to see the reversal of a decade of decarceration as mentally ill and other marginalized people are plucked from our streets and locked away in asylums. All in the name of compassion.