You Call That Compassion?

a stock photo

I live close to Yale University and sometimes I take my morning walks around there. The campus is beautiful and walkable, and I badly miss academia; as uncool as it sounds, I’m afraid I’m a sucker for the pageantry and sense of self-importance. There’s also a lot of great restaurants in the neighborhood, as well as Yale’s impressive museums, so I’m around there at least once a week or so.

Most days that I pass through I walk by a particular storefront, where a homeless woman lives in a doorway. I guess she must go somewhere else some of the time, but in the last several dozen times I’ve been on that block, she’s been there, no matter the time of day. She’s young, though it’s hard to say exactly how young, given the way that homelessness ages you. She can’t be much older than 30, though, if she’s that. She’s obviously afflicted by mental illness, drug abuse, or both. And she’s clearly dying. She’s emaciated, she’s jaundiced, her stomach is distended, her skin hangs off of her in spots, she’s got open sores, sometimes her breathing is labored. She appears permanently disoriented, moving slowly and unnaturally, often seeming ready to collapse. She lives like that so close to a university with a $40 billion dollar endowment that you could throw a rock from her spot and hit the walls of one of the tasteful gothic buildings. And there’s every chance she’s going to stay there until they find her dead in that doorway. Because, you see, here in maybe the most progressive city in true blue bleeding heart liberal Connecticut, we really care about the homeless.

I asked about this woman with a friend of mine who works for a local nonprofit that frequently interacts with local government agencies. She told me that the homeless woman I’m talking about is well known in the system, that many people reach out about her because she’s so visible in a major thoroughfare. The trouble, or so I’ve been told, is that like so many of the homeless she refuses help when offered, and both the policy and the culture of institutionalized do-gooding prevent the people who might save her life from doing anything about it. To force help on dying people must not be considered. And for the current generation of said do-gooders, that’s the end of the story. Nothing to be done. For reasons that I find impossible to understand, just utterly senseless, many progressives have decided that forcing help on the homeless and the sick is a worse outcome than simply letting them die. And letting them die is exactly what we’re doing.

The New Yorker recently took a break from its primary function, hosting ideas festivals for people who subscribe to the Criterion Channel, to rail against Gavin Newsom’s order to start dismantling homeless encampments. The piece dismisses any notion that coercion is ever necessary to rescue homeless people from suffering and death. And I do mean dismisses! Nathan Heller, celebrated for writing profiles of Haim or whatever it is writers like him do, has no time at all for the notion that perhaps there are people who are incapable of saving themselves even when given ample resources. There’s no “to be sure” paragraph in Heller’s piece, no concession. He allows that these things take time, I guess? That’s all I’ve got. And this is indicative of the default liberal attitude towards this issue, that there is no other side worth considering. The need for coercive efforts to save addicts is not to be considered. The need for involuntary commitment is not to be considered. The need for legal and governmental structures that address the simple fact that our conscious minds can be taken over by neurochemical forces we can’t control is not to be considered. They can’t just take a stance on a contentious and emotional issue; they have to assume out of hand that there is no serious opposition to their position.

Which is utterly bizarre when you consider the sheer number of people who die on the streets in this country every year, despite having had the opportunity to access voluntary services. Even if I were to find myself on Heller’s side of this divide, I would recognize that the costs of opposing involuntary care for the homeless and mentally ill has immense human consequences. Sometimes - lots of times - “honoring” the “autonomy” of the most vulnerable means simply letting them die in plain view of our busy little society. Many many times, it means ignoring their daily suffering under the aegis of feel-good progressive antipathy towards government action, which is really weird when you consider that belief in good government is core to left philosophy. And the suffering is extreme. After all, the encampments Heller defends are sites of terrible violence, by their nature actively promote the use of dangerous drugs, are filled with endemic sexual assault, act as incubators of horrific diseases, dramatically contribute to the spread of parasites and rats, and in general amount to conditions that no human beings should have to live in. And yet Heller devotes himself instead to attacking shelters and how unpleasant they are, as if it’s better to live under the freeway with no drinking water, exposure to shigellosis, and predatory neighbors.

Lest I be accused of the same failing: I am well aware of the personal and emotional costs that come with involuntary care, for mental illness and more broadly. You might even say that I have personal experience! And I don’t, for a moment, underestimate what a serious thing it is to take away someone’s right to make personal decisions in that way. Nor do I doubt that the provisioning of this kind of care can come packaged with neglect and abuse, even though I think the communal insistence that psychiatric hospitals are universally places of abuse is based on fantasy. I take all of this very seriously. But to take it seriously requires looking at the reality of people like the woman in the doorway near Yale, who is dying in slow motion in view of thousands of people in a site of tremendous elite success and material opulence. The consequences of involuntarily treating people can be severe; the consequences of not doing so, far too often, is permanent suffering and death. I am utterly unable to occupy the mindset that insists on ignoring that fact. If Jordan Neely’s court-ordered treatment - that is, his involuntary care - had entailed being in a locked ward, as it would have been in an earlier era of psychiatric care, he would likely be alive today. But the culture and policy that has sprung up due to constant demonizing of involuntary care has led to many programs with this exact weakness, a lack of any ability to physical ensure compliance with treatment. Is that not in and of itself a very powerful argument, that society had already insisted that Jordan Neely get help, but was too squeamish to ensure that he did?

Says Heller, “The basic wish of the program—like many in America right now—is Please, Just Make These People Disappear.”

Really? That’s the wish of the people who favor involuntary treatment and a more forceful effort to get help for the homeless? Because to me, that perfectly describes the desire of people like Heller, to make the problem disappear. It’s just that, where he accuses others of wanting the homeless to disappear physically, Heller wants them to disappear morally, to leave no stain on his conscience. Coercion is icky; it’s not something groovy educated people want to associate themselves with. If our society takes affirmative efforts to solve problems that appear intractable, efforts which aren’t always pleasant and which require us to balance legitimate competing definitions of the best interest of the most vulnerable, well, that might implicate them, might implicate Heller. If government acts coercively in an effort to save lives, then that might make the good liberals like they have dirty hands. (These people almost always are the same that favored mask mandates and usually vaccine mandates, to save lives, but never mind.) But if we never act coercively, and instead continue to make the same tired and empty demand for more of the voluntary services that have never ended homelessness anywhere, well, that’s a safer emotional place to stay. Who wants to deal with all that unpleasant business? Stay pure. Do nothing.

I find several things funny about all this. One, that the benign neglect that liberals happily bestow on the homeless is indistinguishable in effect and action from the approach of “tough love” conservatives, those who insist that God helps those who help themselves. The latter believe that, when given no help, people will pull themselves up by their own bootstraps; the former don’t think that the homeless should feel any pressure to be pulled up, at all. Hey, live in squalor thanks to the ferocious paranoia and intense delusions that prevent you from having a job or healthy relationships! You do you! March to the beat of your own drum! What those groups share, “anti-carceral” liberals and anti-government conservatives, is a policy response to intractable homelessness that amounts to throwing up their hands and doing a shruggie. I’ve asked again and again and again: what do you do, as was the case with people like Jordan Neely and Rebecca Smith and Joyce Brown, when someone who lives on the streets has access to housing and mental health treatment but refuses it? What do you do when someone is clearly going to die but is incapable of accepting help? No one can give me an answer. Not a plausible answer or a convincing answer or a thought-provoking answer, mind you, but any answer. They just say the same thing over and over again: we need more funding and voluntary programs. What do you do when addiction and mental illness have hijacked someone’s mind to the point that they’ll refuse antibiotics when they have a dangerous infection, something that actually routinely happens? I have no idea. And neither does Heller.

Second, consider the headline of Heller’s piece, “It’s Too Early to Give Up on Homelessness in America.” What does that mean? Trying to force vulnerable, addicted, and psychotic people to clear out of horrifically unhealthy and dangerous camps and into support services is giving up on them, but saying “well, we need more funding” before playing Wordle in the Conde Nast break room somehow is not? It’s such profound argumentative arrogance, to insist that because you don’t agree with the methods that your opponents want to use to save lives, your opponents are therefore giving up on those lives. I find it quite vulgar, and quite ugly. I hear all the time from people who work in various support services and first responder jobs and nonprofit organizations who feel very strongly that my position is correct, that the only way to save many people is by temporarily overriding their conscious decisions until they’re well enough to make them with a clear mind. They’re all just giving up on the homeless? They spend their whole lives trying to save these people, but they don’t care about them? Please. Save me the sanctimony. I would say not that it’s too early but that it’s too late - too late in the day, after decades of evidence, to go on pretending that voluntary programs and funding are sufficient to save desperate people.

Unfortunately, there’s an elite position on this, and it’s the one Heller voices. Many of our society’s tastemakers would simply prefer not to get involved in this issue, even as they steel themselves to walk past someone screaming to himself on their way to work. Those that do engage just keep muttering empty nostrums about increasing access to voluntary programs. It’s appropriate that the piece ran in The New Yorker, which appears to revel in its status as the voice of a certain type of urbane liberal - the kind of urbane liberal that believes in just this sort of hands-off approach to social policy, a feel-good embrace of libertarianism in all but name. (Opponents of involuntary commitment will often cite Thomas Szasz, the godfather of anti-psychiatry, who explicitly rejected the concept of psychiatric medicine because it conflicted with his right-wing libertarian views, a man who said in an interview “I'm as far right as you can go.” Cool hero!) At some point, it’s got to end, this endless dance of shaking your head and lamenting the lack of good programs while sick people turn down programs that already exist and the human devastation grows. At some point you have to admit that your preference for altruistic neglect is still just a preference for neglect.

Heller mocks Newsom’s pieties. Well, Gavin Newsom certainly is given to piety. But what could be a better example of an empty piety, a vacant platitude, than saying over and over again “We need more funding and voluntary services!” while human beings rot to death at your feet?