June 27, 1994

Let’s Not ‘Treat’ the Problem of Homelessness With Drugs

The New York Times, June 27, 1994, page 16.

To the Editor:

Your June 17 article reporting growing support in New York State for involuntary commitment to mental hospitals describes “a bill that would place those released from mental hospitals under court order to take medication and get counseling.”

A major aim is to force treatment on street people, and in almost all cases, that means drugs without counseling. In my interviews with street people at drop-in centers, I have found nearly all of them would rather endure the risks of homelessness — including starvation and physical abuse — than subject themselves to psychiatric drug treatment. Is their viewpoint entirely irrational, as the proposed laws would suggest?

In most cases, the drugs forced on street people are categorized as neuroleptics or antipsychotics. These drugs cause a neurological disorder, tardive dyskinesia, which is usually untreatable and irreversible. It involves involuntary movements that can be disfiguring, disabling and sometimes painful. Conservative estimates indicate tardive dyskinesia strikes 25 percent or more of drug-treated patients. Among the homeless, who are likely to be exposed for longer periods, the prevalence can exceed 50 percent.

As I document in “Toxic Psychiatry” (1991) and elsewhere, proof is growing that many of these patients will also undergo drug-induced permanent damage to their mental processes, tardive dementia. Beyond that, the neuroleptics do not “tranquilize,” as some other medications do. They typically produce painful and sometimes agonizing physical and emotional reactions, including akathisia, which can drive the victim to move compulsively in a vain attempt to alleviate the inner agitation.

While the neuroleptics do cause lobotomy-like apathy and docility, this serves the interests of institutional care more than the patient’s needs.

Even if, by a seemingly objective standard, drug treatment might “help” some of these people, should we force it on them? In addition to the civil liberties issues, there are social and economic ones. The problems of homelessness should not be “treated” psychiatrically. Homelessness escalated under 12 years of economic policies that reduced the income of the poor and produced unemployment, while raising housing’s cost.

Instead of psychiatrically sweeping the streets, let us increase the opportunities for America’s poorer and less able citizens. As a group, they are most in need of unskilled or entry-level jobs and affordable housing. And those few who are too disabled to work need our sympathy and support, not involuntary drugs and giant lockups.

Executive Director, Center for the Study of Psychiatry Bethesda, Md., June 17, 1994