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ARLINE MATHIEU
Anthropology Department
Hunter College, The City University of New York

The Medicalizationof Homelessnessand the

Theaterof Repression

As a result of changes in the economy and attendant government policy

decisions, the United States is experiencing a crisis in homelessness
unprecedented since the Great Depression. While some homeless people
are mentally disabled, the majority are not-they are homeless because
they lack sufficiently well-paying jobs and because of a lack of adequate,
affordable housing. This article examines how, during the 1980s, the New
York City government publicly and politically linked homelessness with
mental illness, a linkage frequently reinforced by the press. This medicali-
zation was used to divert attention from the socioeconomic roots of the
problem and to justify the removal of homeless people from public spaces.
The author examines changes in government policies and responses of
activists, the public, and the press in several different phases over the
decade. [homelessness, medicalization, poverty, mental illness]

uring the late 20th century, economic shifts and policy decisions in the
United States have led to a level of poverty and homelessness that has been
unprecedented since the Great Depression. This article focuses on the case
of New York City during the 1980s, where the politicians and the press consistently
linked homelessness with mental illness, thus medicalizing a socioeconomic prob-
lem. Although some homeless people were also mentally ill, most people were not
and had become homeless because of decreased low-income housing, declining
real wages, unemployment, and cuts in government benefits. Broadly speaking, the
city government's medicalization of homelessness was an attempt to delegitimate
the plight of homeless people as victims of national political and economic shifts
and to divert attention from the structural causes of growing poverty. The charac-
terization of homeless people as mentally ill undercut their credibility in the drama
played out in the media, where government officials assumed the roles of defining
homelessness and dealing with it. This analysis shows that the New York City
government's policies, touted as protecting mentally ill people living on the street,
were in fact a form of medicalization initiated by the administration to justify the
removal of homeless people from public spaces.

Medical AnthropologyQuarterly7(2): 170-184. Copyright? 1993, AmericanAnthropologicalAsso-

ciation.

170
THE MEDICALIZATION OF HOMELESSNESS 171

This articledrawsfrom my fieldworkin New York City, from 1984 to 1990,

and from press reports of the period. The information was collected through
interviews and visits with families and individuals living in hotels and shelters,
participationin meetings and otheractivitiesof organizationsof homeless people
andof advocates,andattendanceat governmentmeetingsandhearings.An archive
of press reports was also developed, which provided a chronicle of the city
government'spolicies and the responsesof advocatesand activists,the public, and
the press.

Structural Causes of Homelessness

Since the mid-18th century,homelessness in the United States has occurred
as a resultof shifts in the economy (EricksonandWilhelm 1986; Hoch 1987). The
rise of homelessness duringthe 1980s is no exception. The recent crisis occurred
in the context of a changing global economy in which the United States is in a
position of declining internationalhegemonyandin the process of deindustrializa-
tion thathas affected the labormarketandleft millions of people withoutadequate
wages. Scholarsidentify economic conditionsof the 1970s-high unemployment
levels, rising inflation, and decliningreal wages-as precipitatingthe crisis of the
1980s (Hopperand Hamberg1984:21). The Reagan administration'spolicy deci-
sions and the concomitantredistributionof income upward,however, are more
immediatelyresponsible for the dramaticincrease in the numberof people who
became homeless during the past decade (Blau 1992; Hope and Young 1986a,
1986b; Marcuse 1988).
At a time when workers'realwages weredeclining,theReaganadministration
tightenedeligibility requirementsfor governmentassistance and cut the benefits
derived from federalprograms,includingunemploymentinsurance,Social Secu-
rity, and public assistance for families. During the first two years of the Reagan
administration(1981-82), the governmentcut federal income maintenancepro-
grams by more than $20 billion (Scott 1984:21). At a time when the stock of
low-income housinghad decreaseddramatically,the administrationreducedfund-
ing for subsidized housing. From 1981 to 1989, HUD's (the federal agency for
Housing and UrbanDevelopment)budgetfor low-income housing programswas
cut by almost 80% (Coalitionfor the Homeless 1989:2).
While many people in the United States, regardlessof geographicregion or
of urbanor ruraldomicile, foundtheirday-to-daylives increasinglyimpoverished,
the people of New YorkCity were doublyaffected.In responseto a mid-1970s city
fiscal crisis, the municipalgovernmentinitiatedpolicies to shore up the financial
and corporateinterestsof the city. At the same time, the governmentignored the
needs of low- and moderate-incomepeople and withdrew services from their
neighborhoods.'Massive displacementoccurredas a result of housing abandon-
ment and demolition, arson,eviction, andgentrification.Between 1978 and 1987,
the numberof vacantapartmentsrentingfor $300 a monthor less droppedby 72%;
by contrast,the numberof those rentingfor $500 or more (in constant dollars)
increasedby 112%(Weitzman1989).
From the mid-1970s throughthe 1980s, New Yorkerswho had alreadybeen
economically disenfranchised,includingmany people of color, found themselves
in the throesof an upwardredistributionof wealth,orchestratedbothnationallyand
172 MEDICALANTHROPOLOGY
QUARTERLY

locally. In 1984, the Coalition for the Homeless (1984:5-6) estimated that there
were 35,000 homeless people in New YorkCity. By 1989, the estimatednumbers
of homeless people had reached70,000 to 90,000 (Blau 1992:220).The numberof
homeless families in New York City sheltersalone rose from 500 in January1981
(New York Times 1987b), to 1,400 in January1983, 2,400 in January1984, and
3,300 in December1984, representing"astaggeringannualrateof increaseof more
than67%in the numberof homelessfamiliesbeing served"(EricksonandWilhelm
1986:xxvi). The dramaticincreasein the numberof homeless families continued
into the second half of the 1980s, so thatby 1988, New York City was providing
temporaryshelterto 5,200 families (Blau 1992:157).2

Medicalization of Homelessness and Government Responsibility

The personal characteristicsof poor people have often been cited as an
explanationfor poverty and homelessness in the United States. Kim Hopper, a
prolificwriteron homelessnessas it has occurredhistoricallyandas it occurstoday,
has examined earlier portrayalsof homeless people to understandhow these
portrayalsarereplicatedin currentperceptions.Writingof New York's attemptsto
deal with homeless people, he argues:"Persistenteffortshave been made to reduce
the problemof homelessness to the problemsof the homeless poor themselves-
variouslyconstruedas defects, vices, or ailments"(Hopper 1991:123). In official
discourse, Hopper argues, "repeatedly,the language of pathology and images of
the grotesquehave been resortedto in orderto explain distressedcircumstances"
(127).

Voices in the Theaterof Repression

During the 1980s, some government officials denied that a problem of

homelessnessexisted. PhilipAbramsfromHUD claimedin 1982:"No one is living
in the streets"(Hope andYoung 1986a:248).Othergovernmentofficials attempted
to delegitimatehomeless people as victims of economic shifts and as playerswith
voices worthyof being heard.PresidentReaganandothermembersof his admini-
strationarguedthat people who were homeless, hungry,or unemployed,were so
by choice (Guardian1989;New YorkTimes 1988d).Koch, the mayorof New York
City, claimed that "families were voluntarilybecoming homeless and taking 'the
welfarehotelroute' in orderto get betterapartments"(New YorkTimes 1986b:30).
A response by the mayorto questionsfrom the audienceat the AmericanInstitute
of Architects' 120th nationalconventionwas a particularlycruel attemptat stig-
matization.The mayor instructedthe audienceon differentiatingpeople in public
spaces: "'These homeless people, you can tell who they are', he said. 'They're
sitting on the floor, occasionally defecating, urinating,talking to themselves-
many, not all, but many-or panhandling"'(New York Times 1988c:B4).
Throughthe 1980s, the mainstreammedia remainedequivocal in its charac-
terizationsof homeless people, alternatingbetweenportrayalsthatdemeanedand
degradedandthose thatattemptedto elicit sympathyfromreadersor viewers. Some
of the extremeportrayalsearlierin thedecadewere especiallyvicious. Descriptions
became elaborationsof earlier skid row stereotypes:people forced to ride the
subway at night for lack of shelterwere portrayedas "theworst of life ... drunks,
THE MEDICALIZATION OF HOMELESSNESS 173

vagrants,prostitutes,wild-eyed men with mattedhairand beardwho may well be

insane"(New York Times April9, 1980, cited in Baxter and Hopper 1981:13). A
1989 cartoonin a Brooklynpaperdepictinghomeless people as humanrefuse was
hardlyless vicious.
Activists challenged the negative characterizationsof official and media
discourse and campaignedto alter the public image of homeless people. Ruth
Young, who was homeless for a yearanda half and who was the executive director
of Parentson the Move, an organizationof homeless families, told a reporter:"We
have to do a lot of education.We have to deal with the stigma of homelessness.
Many people in the communitythinkhomeless people are two-headedmonsters.
Orjust lazy people on welfare ... [e]ducationis very important"(Unity 1989:6).
Young and otherhomeless activists workedby word and example to alterthe
negative stereotypes.They testifiedat public hearings,lobbied local and national
elected officials, participatedin communityand civic activities in local churches
and schools, and spoke at university and other public conferences. Young, an
African-Americanwoman, speakingat an educationalforum to a predominantly
white, middle-classgroup,told them:
Thestereotypingthatgoesalongwithhomelessfolkshastobechanged.Youhave
to talkaboutattitudesandperceptions-youknow,if I touchyou andyou are
homeless,I mightcatchit too.4Theysayhomelessfolkareon drugs,arelazyand
docile and uneducated.We have to change thatperception.People also may say
we'rehomelessbecausewe'vebeenevicted.Butwe haveto look at the whole
cycle;we haveto talkabouteconomicandsocialjusticeandaboutpeopletaking
their communitiesback. We have to talk about racismand about apartheidright
here....You have to talkaboutthe whole thing.5

Homelessnessand MentalIllness
In his essay, "The Emergenceof the Homeless as a Public Problem,"Stem
(1986) arguesthattheproblem"emerged"in the public's consciousnessin the early
1980s as a resultof legal actionrequiringNew York City to provideclean and safe
shelter for people who sought it, political action through demonstrations,and
reportsrevealingthe living conditionsof people withouthomes.An advocacystudy
by Baxter and Hopper (1981) portrayedthe dangers faced by mentally ill adults
living on the streets,and furtherfocused the public's attentionon the issue.
During this period, the medicalizationof homelessness was most prominent
in portrayalsof homeless people as severely disturbedindividuals who had lost
theirhousing when statementalinstitutionswere closed ("deinstitutionalization").
The struggleby New York's city andstategovernmentsin 1980 to shirkresponsi-
bility for people without housing was a preview of the city administration'slater
attempt to create a drama that would rationalize measures of confinement and
control.
As earlyas 1980 . . . New YorkCityMayorEdwardKochwas resistingstate
pressureto openmoreshelters,whilein turnthegovernorof New Yorkreacted
angrily to city officials' attemptsto link the homeless to the state's release of
psychiatricpatients.... If the homeless were considereda welfare problem,the
city had ultimateresponsibility.If they were considereda mentalhealthproblem,
the stateneeded to act. The deinstitutionalizationtheorywas again voiced repeat-
174 MEDICALANTHROPOLOGY
QUARTERLY

edlybytheKochadministration,
leadingtothemayor'scallforlegislationtoallow
thecityto involuntarily
committhehomeless.[Stem1986:116]
The argument that deinstitutionalizationwas the cause of homelessness,
however, does not hold. The period of deinstitutionalizationoccurredprimarily
duringthe 1960s andearly 1970s. In a letterto the Guardian,Hopperstated:"Over
half the totaldecline in inpatientsfrom 1965 to 1985 took place by 1971"(Hopper
1987a:19). Evidenceof increasingnumbersof people withoutshelter,however,did
not appear until the late 1970s, when deinstitutionalizationwas ending. The
numbersof homeless people burgeonedeven later,in the 1980s.6
Young childrenand theirmothers,furthermore,constitutedthe largest, fast-
est-growing segment of the homeless population. In 1986, "New York City
reportedthat66 percentof its homeless were families with children"(New York
Times, 1986a:1B). The overwhelming majorityhad no contact with a mental
institutionandshowedno signs of mentalillness. The linkingof homelessnesswith
mentalillness by some politiciansand in news reportscontinued,however.
Certainly some of the more visible victims of homelessness had suffered
mental illness and were on the street because no community care facilities or
low-cost housing existed to providea refugefor them.Otherswho occupiedpublic
spaceshad moved into a mentalnetherworldas a resultof pain, loneliness, and the
disorientationof having no base from which to engage in the most minimal
activities and social relationshipsby which people assume their humanity. By
comparisonwith the haunting visibility and disturbingpresence of mentally ill
people living in the streets, many others who had become homeless were living
doubled or tripledup with relatives or friends and had thus become the "hidden
homeless."7Others managed to sustain a normal appearanceand, consequently,
blended in with the common passerby in the street and were not identified as
"homeless."Thus,people with themost alarmingappearancefrequentlyinfluenced
whatmany of the public came to consideras "thehomeless."
Ster contendsthatthe recession thatoccurredduringthe winterof 1982 and
1983 changedthe frameworkof legislationgearedat the theoryof deinstitutionali-
zation. "Moreand more news reportsand 'experts'linked the homeless explicitly
to unemploymentandforeclosures.Thus, as the economicsituationof the 'normal'
population declined, the homeless were portrayed as more normal" (Ster
1986:116). In New York City, however, the mayorcontinuedto link the problem
of homelessness with mental illness and frequentlywas well served by the press,
for instance,the New YorkTimes,in perpetuatingthis linkage into the second half
of the 1980s.

Medicalization and the Confinement of Homeless People

GovernmentPolicy: Benevolenceor Control?

An overview of the city's administrationpolicies from 1984 to 1989 indicates
that officials were more concerned with removing homeless people from the
public's view thanassuringthathomeless individuals-mentally ill or not-would
receive adequatehousing and social services.
 OF HOMELESSNESS
THE MEDICALIZATION 175

During the winter of 1984 and 1985, record numbers of people sought
emergency shelterfrom the cold, at times strainingthe shelter system beyond its
capacity.In a New YorkTimesarticle,"Policeto Roundup Homeless when a Cold
Wave Grips City," the mayor announced:"the police would remove homeless
people from the streetsduringperiods of severe cold and take them to municipal
hospitals whetherthey were willing to go or not" (New York Times, 1985a:B1).
The new policy not only overrodethe requirementof psychiatricdiagnosis before
unconsentinghospitalizationbut also emphasizedthe issue as one of homelessness,
not mental illness.
Furthermore,the shelter system was severely inadequatefor the people who
did seek protection.The city governmenthad only consentedto provide shelterto
homeless people when forced by a State SupremeCourt decision (Callahanvs.
Carey 1981). Inadequatein number,the shelterssoon were overcrowded-some
of the barrack-typeshelters housed up to one thousandmen at a time-and the
conditions were wretched. Repeated court orders were issued to force the city
administrationto comply with the minimalstandardsof the originalconsent decree
(Hopper 1987b:94). Repeatedlythroughthe decade, homeless people, organiza-
tions of homeless activists such as HomewardBound CommunityServices, the
Homeless Clients Advisory Committee, and Parents on the Move, as well as
advocates, including those from the Coalition for the Homeless, the Citizens
Committeefor Childrenof New York, and the New York Civil LibertiesUnion,
decriedthe scandalousconditionsin the sheltersandhotels wherehomeless people
lived.
In a telling example of poor standardsin the shelters,the State Commission
of Correctionsrejecteda buildingas a proposedjail where a city agency had been
housing 280 homeless men. The building failed to meet fire safety codes (New
York Times 1989a). Public assistance for people who were mentally ill and
homeless also was far from adequate,as evidenced in the shortage of resident
mental-healthfacilities and programsprovidingoutpatientor long-term mental-
health care. Thus, when the city governmentannouncedits policy of removing
people from the streets, homeless men and women and advocates argued that if
facilities were available and in adequateand safe condition, force would not be
necessary.
The following winter,the governmentrespondedto the first blast of freezing
temperaturesand icy winds with a policy similar to that of the previous year. It
announced that it was directing police and authorizingdoctors, nurses, social
workers, and mental-healthworkers to forcibly hospitalize people living in the
streetswhen the temperaturefell below freezing.The city administrationportrayed
itself as concernedand humane.This policy, it maintained,was createdto protect
mentallyill people from freezing to deathby getting them to sheltersandhospitals
(New York Times 1985c, 1985d).
To what degree was the city government's policy in fact motivated by
benevolenceandcaring?First,as I have noted,in New YorkCity therewas a dearth
of adequateand humane temporaryshelters or mental-healthfacilities. Second,
police, ratherthan health workers, had been designated to identify and pick up
people, andpsychiatrists,social workers,and nurseswere not at handwhen people
were takenfromGrandCentralTerminalandothergatheringplaces. If people were
in fact mentallytroubled,help was not forthcoming!
176 MEDICAL
ANTHROPOLOGY
QUARTERLY

The policy in partmay have been an attemptto force the stategovernmentto

assumeresponsibilityfor mentallyill patients(as implied in the New York Times
1985b).ButI believetherewas a moreimmediatestrategybehindthesemeasures.That
is, the city administration's
moves were not simplykind effortsto keep mentallyill
peoplefromthecold;rather,they wereattemptsto keephomelesspeopleout of sight.
In fact,muchof the "roundingup"of people was not fromfreezingstreets,but from
interiorspaces, such as GrandCentralTerminal,PortAuthorityBus Terminal,and
PennsylvaniaStation,wherepeoplehadgone to keep out of the cold;thesewere also
public places,wherethe visibilityof homelessnesswas bringingincreasingshameto
the city. At the publictransportationterminals,commutersand out-of-townvisitors
were constantlyconfrontedwith the evidencethatNew YorkCity was notproviding
adequatehousingfor its people,not even in the cruelestwinterweather.
The government'sattemptto keep destitutepeople out of publicview became
even moreevidentlaterthatyearwhen the administrationannouncedit haddecided
to extend this program,which had been instituted as a "cold weatherpolicy,"
through the summer;and even more so in the later years of the 1980s as the
administrationattemptedsystematicallyto removepeople who werehomelessfrom
otherpublic spaces, such as the parksand subways.

TheRole of the Press

Over the next year and a half, the public debateregardinghomelessnessand
mentalillness continued.For instance,afterthe New YorkTimesprintedan article
on the psychiatriccare system, which linked homelessness to mentalillness (New
YorkTimes 1986c), a teamof epidemiologistswrotea letterto theNew YorkTimes
to argueagainstthe article:
The exaggeratedestimate("theproportionof those in shelterswith serious
psychiatricproblemshasbeenestimatedat morethan70 percent") is grosslyat
oddswithourrecentresearch,whichfindsindicationsof seriousmentalillness
(excludingthosewithdrugor alcoholproblemsonly)among258percent of users
of NewYork'ssingle-adult shelters.[Strueninget al. 1986:A34]
The Mayor'spress releases and the newspaperscontinuedto conflatehome-
lessness andmentalillness. Articles aboutthe Mayor'spolicy-which, in fact, was
a policy applicableto mentally ill people who were withouthomes-were head-
lined "Koch'sHomeless Plan"(New York Times 1987d, 1987e), or "KochPolicy
for Homeless"(New York Times 1987f) (emphases added).These three articles,
in fact, respectivelydiscussedpsychiatrists'andsocial workers'assessmentsof the
policy in relationto psychiatricfacilities, a psychiatricwardat Bellevue Hospital,
andchangesin the behaviorof people who arebothmentallyill andwithouthomes,
and the extent to which these changes are broughton by fears of hospitalization.
The articlesthusconcernedpeople who were bothmentallyill andhomeless,rather
thanhomeless people in general.

The Case of Billy Boggs: "Iwas not insane when theypicked me up-I was
homeless"
In August 1987, the mayor expanded the criteriaregardingwho in the city
could be given treatmentagainsttheirwill. Beginningin October,"homelesspeople
 OFHOMELESSNESS
THE MEDICALIZATION 177

'in dangerof serious harm within the reasonablyforeseeable future"'would be

takento Bellevue Hospital for a 15-dayexamination(New York Times 1987c:1).
During the year, the administration'slinking of homelessness to mental illness
made the headlines repeatedly and with some notoriety. The first person the
administrationchose to "roundup" in its 1987 "campaign"of institutionalization
turnedout to be an articulatewoman-Billy Boggs, nee Joyce Brown-who, with
the help of the New York Civil Liberties Union, challenged the government's
attemptto hospitalize and medicate a homeless person.The State SupremeCourt
judge hearingthecase ruledthatthecity hadfailed to provethatBoggs was mentally
ill or unableto carefor herself. Furthermore,the judge wrote in his decision:
It cannotbe reasonedthatbecauseJoyceBrownis homelessshe is mentallyill.
Whatmustbe provedis thatbecauseshe is mentallyill she is incapableof
providingherselfwith food, clothingandshelter.Yet,thoughhomeless, she copes,
she is fit, she survives.
She refuses to be housed in a shelter.That may reveal more aboutconditions in
sheltersthanaboutJoyce Brown's mental state. It might, in fact, prove that she's
quite sane. [New YorkTimes 1987h:B2]
The city administrationpersisted and appealed the ruling. Consequently,a
state appellatecourtbarredBoggs's release and ruled she be held for at least two
weeks for psychiatrictreatment.A little more thana monthlater,in a three-to-two
decision, the AppellateDivision of the State SupremeCourtruledthatBoggs was
"mentallyill anda dangerto herself andothers."TheNew YorkTimesreportedthis
decision under the headline of the "Koch Homeless Plan" (New York Times
1987i:1).
Yet anothermonthlater,city doctorsdischargedBoggs fromthehospitalwhen
a statejudge barreddoctorsfrom treatingher with antipsychoticdrugs againsther
will. In an interview,Boggs declaredshe hoped "to get a job as a secretaryand put
her life back together.... 'I wasted 12 weeks of my life in the hospital ... I was
not insane when they picked me up-I was homeless"' (New York Times
1988a:A1).
By April of 1988, the New YorkTimesreportedthat the mayor's policy had
been impededby courthearings,overcrowding,andplacementproblemsin mental
healthfacilities,as well as by bureaucraticsquabbles.Also, city workershadpicked
up far fewer people thanofficials had predicted(New York Times 1988b).

Government Policy: From Medicalization to Criminalization

The promotional image of Koch's New York-a thriving, swirling mass of
economic recoveryand investmentopportunities-was destroyedby the ubiqui-
tous sightof public-spacehomeless. Now thattheirpresenceis beginningto affect
commerce,transportationofficials are worried.What if, as LynnTierney of the
PortAuthority,which now houses up to 500 people daily, asks, "peopleget off a
planefromJapanandaregreetedwith the sightof 200 homelessin theinterational
arrivals
buildingatKennedyAirport?"
Badforbusiness.[VillageVoice1989:35]
In the late 1980s, with declininglow-cost housing, increasingviolence in city
shelters, and growing threatsfrom TB and AIDS, greaternumbersof homeless
people soughtrefugein public places. They soughtprotectionfromthe wintercold
178 MEDICALANTHROPOLOGY
QUARTERLY

in indoorbus andtrainterminalsand subways;they congregatedandslept in parks

in the warmermonths.
The press during this time featured articles highlighting the presence of
homeless peoplein publicspacesandthe effect of such visible miseryon thepublic.
A New YorkTimesheadline read:"A First Look at Homeless Is Raw Sight for
Tourists"(New YorkTimes 1987g). The articledescribedhomelesspeople in lurid
terms-"bloated women with ulcerated legs and hollow-eyed men who shout
obscenities,"andmeasureswere takento protecttourists-signs stating"Peoplein
uniformare here to help you; people not in uniformcould hurtyou" (New York
Times 1987g:B1-2). Upon interviewingvisitors,however,thereporterfoundsome
who did not judge homeless people harshly."The saddestthing is the contrast,"a
school psychologist from Massachusettstold the reporter."Thata society should
be so incrediblywealthy at one end and so desperateat the other!The bag ladies
and the Gucci bags, if you will." But it was not only touristswho felt something
was awry, the reporteraverred."[O]verwhelmingly,it is not the out-of-towners
who feel most threatenedor inconvenienced by the homeless, but rather the
commutersand suburbaniteswho are weary of the pervasivemiseryin theirmidst
andunsettledby feelings of guilt or helplessness"(New YorkTimes 1987g:B1-2).
After the city's policy failed to institutionalizepeople againsttheir will, the
administrationtook on an overtly repressivepostureduringthe last two years of
the decade. During this period, it became increasingly apparentthat city policy
aimed to rid public spaces of visibly homeless people. In March 1987, the mayor
"declaredhis supportfor a driveto keep the homeless fromsleepingin city bus and
traindepots"andrailroadpolice at GrandCentralTerminalarrested24 people who
"appearedhomeless," six times the average daily numberof arreststhere (New
York Times 1987a:B6). Those arrestedwere charged with criminaltrespass, a
tactic,civil libertieslawyerscontended,thatcircumventedthe previousday's State
SupremeCourtrulingthatbarredarrestingpeople for loiteringin suchplaces (New
York Times 1987a). Reportingon the arrests,the New YorkTimescommented:
Their[referringto peoplewhowerehomeless]presencein a magnificentBeaux-
Artsmonument somehowseemsmoreof anissue,andtosome,moreof anaffront.
Perhapsit is thecontrastbetweenarchitecture
thatso well embodiesa society's
aspirationsandlivingevidenceof thewretchedness
of someof itsmembers[New
YorkTimes1987a:B6]
By the 1989 mayoralelection, homelessness had become one of the prime
concernsof voters, and the mayor increasinglyhad come underattack.The issue
of homelessnesswas repeatedlyposed in mayoraldebates.ANew YorkTimes-CBS
poll in New York City found thatfour out of five registeredvoters routinelysaw
homeless peoplein theirneighborhoodsor on theirway to work.The accompanying
New YorkTimesheadlineread, "Poll Shows New YorkersFault City Efforts for
the Homeless"(New YorkTimes 1989b). In 1989, precedingthe election,govern-
ment officials made a majoreffort to sweep the problemfrom view.
Early in the year, the mayor had announcedas top prioritythe removal of
homeless people from parks,subways, transportationterminals,and streets.The
administrationincreasedthe police force in the terminals,and severalmonthslater
createda pilot programwhereby a charitableagency would encouragepeople to
move to shelters(thoughthey repeatedlyhad refusedto go to city sheltersbecause
THE MEDICALIZATION
OFHOMELESSNESS 179

of the level of violence, infectious diseases, and prison-like regulationsthere).

Othercity strategiesfor "removal"includedclosing off spaces thathad been used
as gatheringplaces by homeless people (for instance, at GrandCentral)or, alter-
natively, opening the "doors of GrandCentralStation to be sure that the winds
would blow upon its sleep-ins as fiercely as on the streetsoutside,"and spreading
ammoniaon terminalfloors to discouragepeople from sleeping there(New York
Newsday 1989a:6).
In the autumn of 1989, the city administrationalso instituted"codes of
conduct,"manyof which"appearedaimedat the homeless,"andwhich"advocates
for the homeless and civil rights lawyers immediatelydenounced... as illogical
and mean-spirited[andwhich] appearedto be partof barely disguisedeffort [sic]
to displace the homeless through police harassment" (New York Times
1989c:B11). The New York City MetropolitanTransitAuthorityannouncedthis
effortin postersdisplayedin subwaystationsandtrainsandin brochuresdistributed
to riders.The postersandbrochureslisted the codes of conductandidentifiedthem
as part of the city's "OperationEnforcement."The natureof the operationwas
graphicallyhighlightedin the postersand literaturewith the image of an oversized
police badge.
The City ParksDepartmentsimilarlydeveloped parkrules to clearpoor and
dispossessed persons from view. Press headlines announcedthe administration's
planin whichpolice would"SweepHomeless"fromthe parks(New YorkNewsday
1989b).
Advocatesandhomelesspeople attackedthe inhumanityandinjustice,as well
as the "sweep mentality,"of the city goverment's response to homelessness. A
homeless mantold film directorBill Brand:"Theylook at us like we're germs,like
we're dirt"(in thefilm HomeLess Home).A formerlyhomeless mother,expressing
dismay and abhorrenceat the government's measures and identifying with the
people who were targetted,remarkedto me, "We're today's outcastsof society."
Organizationsof homeless people who had become activists,such as the Homeless
Clients Advisory Committee, Homeward Bound Community Services, United
Homeless Organization,Parentson the Move, and others,publicly denouncedthe
policies. Homeless people camped in Tompkins SquareParkand protestedtheir
removalfrom the public space with militance.9

Conclusion
Althoughperceptionsof poor and homeless people in the UnitedStateshave
variedover time, the primarycharacterizationhas been one thatattributedcause or
blame to the individual(Blau 1988; Bremner 1972; Hoch 1987; Hopper 1991).
Solutions to the problemsof poverty and homelessness also have varied,ranging
from the more severe systems of compulsory labor, indenture,imprisonment,
banishment,and even torture,to the more humane-though not necessarilyade-
quateor unstigmatized-programs of the New Deal and the GreatSociety (Abra-
movitz 1988; Blau 1988;Ericksonand Wilhelm 1986; Hoch 1987;Trattner1974).
In the 1980s, when the numbersof homeless people rose at a staggeringrate,
some governmentofficials resortedto earliernegative stereotypesand attempted
to delegitimatethe plight of homeless people. In New York City, wherethe rateof
homelessness was amongthe highest in the nation,the city governmentattempted
180 MEDICAL
ANTHROPOLOGY
QUARTERLY

to createa dramain which it would appearthatthe personalflaws and disabilities

of people withouthousing had broughton the crisis of homelessness. The mayor
deprecatedhomeless people andcharacterizedthem as mentallyill. The linkingof
homelessness to mental illness set the stage for governmentmeasuresthatwould
confine and controlhomeless people.
The medicalizationof homelessnessby attributingit to the closing of mental-
healthfacilities appearsinitiallyto have been an attemptby the mayorto force the
stategovernmentto takeon theresponsibilityfor shelteringhomeless people.Even
when it became clear that young children and their mothers constituteda large
segment of the homeless population,the mayor continued to link homelessness
with mentalillness. Broadlyspeaking,the administration'scontinuedidentification
of homelessnessas a medicalproblemof individualsservedto divertattentionfrom
homelessness as a systemic economic andhousing problem.Close examinationof
the city administration'spolicies between 1984 and 1989 reveals yet anotheruse
of the medicalizationof a socioeconomicproblem.It was used to justify theremoval
of homeless personsfrom public spaces and from the view of the public.
The administrationof MayorKoch was cited repeatedlyfor failing to provide
safe and adequateshelterto homeless personswho in many instanceshad refused
to go to sheltersbecause of the unhealthyand violent conditions there.In fact, an
official had admittedthatthe administrationdeliberatelyprovidedminimumserv-
ices to deter people from using the shelter system (Ferrer,Golden, and Shulman
1987). While facilities for homeless people were abysmally inadequateand fre-
quently dangerous,provisionsfor mentallyill people were no better.Community
mentalhealthresidencefacilities,treatmentprograms,andoutpatientandlong-term
care programswere inadequate.
Despite these conditionsof scarcityandneglect, officials continuedto portray
city governmentas concernedandhumane.From 1984 to 1988, officials claimed
that the policy of forcing people into hospitals and shelterswas createdto protect
them. Homeless people and advocatesarguedthatforced institutionalizationwas
a violationof legal rightsandthatif thecity provideddecentandsafe shelter,people
withouthomes would use it. Furthermore,whathomeless people reallyneededwas
affordablehousing.
In the second year of the city's forced hospitalizationpolicy, the administra-
tion emphasizedthatit was a wintertimeeffort to preventmentallyill people from
freezingto death.However,thegovernment'sactionsindicatedotherwise.Police-
ratherthan medicalpractitioners-picked up homeless people, and beds for men-
tally disabled people were not availablein the municipalhospitals, in any case.
Furthermore,duringthe winter,officials removedpeople from indoorpublicplaces
wheretheyhadgone to protectthemselvesfromthe cold; alternatively,they treated
the indoorspaces to preventhomeless people from using them. Finally, when the
wintercold ended, the administrationextendedits policy into the summer.
In the late 1980s, challengesto the legality of the government'sinstitutional-
izing people against their will; administrationfailures in carryingout the policy;
andincreasingnumbersof homelesspeoplein publicspacespushedthegovernment
into a more confrontationalandrepressiveposture.By 1987, the city government
discontinuedphrasingits policies of containmentof homeless people in medical
terms.In 1989, when homelessnesswas an election year issue, the mayorinstituted
police measuresto "sweep"homeless people-and the issue-from view. Earlier
THE MEDICALIZATION OF HOMELESSNESS 181

policies that attemptedto medicalize homelessness were abandonedfor policies

thatcriminalizedhomelessness.
What was absent from these responses to homelessness were policies that
effectively dealtwith the actualthreatsto homeless people's healthandwell-being,
as well as to the rootcauses of homelessness itself, thatis, the lack of decent wages
andlow-cost housing.Overthe courseof the decade,few homelesspeople received
adequate,permanenthousing.The lives of homeless people in shelters,hotels, and
in the streetcontinuedto be particularlyendangeredby malnutrition,disease, and
violence. Actualhealththreats,such as tuberculosis,spreadamongshelterresidents
and homeless people living on the streets. And mentally ill people who were
homeless continuedto be without the appropriatemedical care or the apartments
or residentfacilities they required.

NOTES

Acknowledgments.I am especially indebted to the women, men, and children who

allowed me intothe improvised"homes"of theirhotel andshelterquartersandwho accepted
and trusted me to attend their meetings. This essay is adapted from a chapter of my
dissertation,Parents on the Move: Families Resist, The GraduateFaculty of Political and
Social Science of the New School For Social Research,March 1991. I thankmy commit-
tee-Shirley Lindenbaum,RaynaRapp,Kim Hopper,andLouiseTilly-for theirperceptive
critiquesof thatdocument.
Correspondencemay be addressedto the authorat the Departmentof Anthropology,
HunterCollege, 695 ParkAvenue,New York,NY 10021.
1. Alcaly and Mermelstein (1977), Castells (1977), and Tabb (1984) provide an
analysis of the causes and consequences of the New York City fiscal crisis. Blau (1992)
examines the way in which decisions made in response to the fiscal crisis by the mayoral
administrationsof AbrahamBeame and EdwardKoch (spanningthe years from 1975 to
1989) contributedto the proliferationof homelessness in New YorkCity.
2. It is not possibleto calculatetheexact numbersof people who are,or were, homeless
for the obvious reasons that many are so difficult to reach. For example, people living in
abandonedbuildingsor cars, moving throughoutstreets,parks,subways,or otherspaces,or
living doubled up with families or friends because they lack housing are not included in
these figures. Precise numbersare not the point, however, estimates serve to illustratethe
magnitudeof the crisis.
3. In his examinationof the shapingof public and official views of poverty,Bremner
notes the mid- to late-19thcentury-when the United Stateswas rapidlyindustrializingand
requiredincreasing numbers of industrialworkers-as a critical juncture. A prevailing
attitudewas thatpovertywas "anindividualmatter"and"theobvious consequenceof sloth
and sinfulness"(Bremner1972:16, 17). Even duringsevere economic depressions,such as
thatof 1873-79, portrayalsof poorpeople were renderedin imageryof personalflaws, vice,
and even evil. FrancisWayland,a Yale professor,speakingto an audienceat a Conference
of State Charitiesequated "tramps"-people without permanentjobs or homes-with
professionalthieves and describedthem as criminalspronetowardthe unspeakable:people
who would "roba defenseless child ... murdera cripple"(Blau 1988:7).
4. At times,homeless activistsalso used the languageof pathologyandcontagion,but
they used it to expose and condemn the way in which homeless people were stigmatized.
Describing the harmfuland persisting nature of the "homeless"label, Ruth Young said:
"Onceyou are 'homeless', you are no longer a memberof the society you were partof. You
are a leper and will carry that with you the rest of your life." Young's image of leprosy
emphasizes the pariahstatushomeless people experience and echoes official discourse of
182 MEDICAL
ANTHROPOLOGY
QUARTERLY

the 1960s when poormen andwomenliving on the Bowery's"skidrow"were also described

as "lepers"[Hopper1991:122].
5. Privateand governmentalagency reportsfrom 1986 and 1988 show that slightly
more thanhalf of the populationof people who were homeless in the United Stateswere of
color, primarilyblackandLatino(Blau 1992:26).A 1987 studyof the New YorkCity shelter
system found 72% of residents were black non-Hispanic, 17% were Hispanic (Struening
1987).
6. Blau (1992) examines the relationshipbetween homelessness and the release of
patients from mental institutions.For a detailed discussion of deinstitutionalization,see
Johnson(1990).
7. In 1987, the city releaseda reportestimatingthe numberof doubledup families-the
"hiddenhomeless"-was as high as 100,000familiesin HousingAuthorityapartmentsalone
(Citizens Committeefor Childrenof New York,Inc. 1988:6).
8. For a discussion the ways in which figures indicatingthe percentageof mentallyill
people in the homelesspopulationbecomeinflated,see Blau (1988). Lovell (1992) examines
the extent to which psychiatricclassification in public policy researchcontributesto the
conflationof homelessness and mentalillness.
9. David Dinkins defeatedEdwardKoch in the 1989 mayoralelection. Homelessness
as an issue in theelection was raisedrepeatedlyby thepublicandthemediaandin preelection
debates;homeless advocatesand activistsenergeticallyregisteredhomeless people to vote
and campaignfor Mr.Dinkins.

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