I was used to seeing homeless people while growing up in San Francisco — a city that, according to the 2015 “San Francisco Point-In-Time Homeless Count & Survey Report,” has a homeless population of 6,686 (including both in shelters and on the streets). The increase of homelessness in San Francisco is tied to a history of deinstitutionalization of mental patients and a shortage of affordable housing, as well as to public service cutbacks. This issue cuts close to home for me because my mother was institutionalized in Napa State Hospital during the 1950s, was released during the period of deinstitutionalization, and moved into public housing in the 1970s, where she experienced another form of institutionalization via the welfare system.
During the 1950s, an era of strict gender roles, women could be committed to a mental hospital simply for deviating from the norm. For example, Carol Warren’s 1987 book Madwives: Schizophrenic Women in the 1950s studied middle-class white women who were committed to Napa State Mental Hospital. Warren found that their husbands had committed them for disobedience or for not being good mothers. She also found that some women viewed their institutionalization as a welcome break from the demands of home and family.
The history of black women’s institutionalization in mental hospitals is quite different, however. Black women have long been targets of state violence, including during the period of slavery, of course, but also via forms of medical abuse during the past centuries. For instance, James Marion Sims, considered the father of modern gynecology, used black women in medical experiments while searching for a cure for vesicovaginal fistula. During slavery, black people were also classified as having a mental illness called drapetomania merely for wanting to run away from their masters. During the era of legal segregation, black and white patients were placed in different wards due to concerns that the presence of blacks would hinder the recovery of white patients. When blacks were committed to mental institutions, they were disproportionally sent to public hospitals, where treatment options were less robust than in private institutions. Black patients suffered from more diseases than whites (such as tuberculosis), received poor diets, and lacked medical care.
My mother was a product of the Great Migration, moving in the late 1940s from Louisiana to San Francisco with my aunt, who had gotten a job at the Hunter’s Point shipyard. While a teenager in San Francisco, my mother became pregnant out of wedlock and was sent back to Louisiana to have my sister, although she returned after the birth. My aunt, who was married and had little contact with my mother, raised my sister.
In 1955 my mother became pregnant again. This time my aunt and uncle had left California for Hawaii where my uncle had a military job. The details of what happened to my mother are sketchy, but they go something like this: she had a “nervous breakdown” and was committed to Napa State Hospital, while my sister became a ward of the court. My mother started talking to herself and hearing voices. It turned out she had schizophrenia. A few years later, my sister died of pneumonia, and my mother remained at Napa for eight more years.
While at Napa, my mother, like the other women there, was completely controlled by the state. In Napa Hospital, women had limited access to cash, which was often held by family members or hospital staff. Patients going to the bathroom were monitored since it was feared they might harm themselves if left alone. Women experienced forms of abuse such as electroshock therapy, overmedication, forced sterilization, and sexual assault. The widespread abuse of mental patients prompted the shift towards deinstitutionalization, as part of a civil rights movement concerning mental health.
During World War II, research and funding programs for psychologically traumatized soldiers increased the number of professionals in the mental health field. In 1946, Congress passed the National Mental Health Act, creating the National Institute of Mental Health, which applied traditional public health approaches. However, these advances in research and clinical practice did not improve hospital facilities, and federal aid to mental hospitals decreased. In 1955, Congress passed the Mental Health Study Act, which made recommendations on mental health policy. This eventually led to the Community Mental Health Centers Construction Act of 1963, which resulted in many state hospitals closing.
Mental health clinics and community care centers began taking in the ex-patients. The cost of caring for people with mental illnesses in hospitals could now be transferred from the state to federally subsidized programs, such as Medicaid and welfare. However, the closing of state hospitals and the birth of community care models did not create the results activists had hoped for. Many former mental patients were placed in ill-equipped nursing homes; some were placed in shelters, welfare hotels, or group homes. Many became homeless, like the people beside the 91 freeway begging for money.
Meanwhile, public housing was increasing across the nation as new immigrants, along with blacks and Latinos, moved into urban areas while whites moved to the suburbs. In Los Angeles, freeways made it easier for suburban whites to commute in and out of the city for jobs, but they displaced families of color. So-called “urban renewal” was a disaster in terms of creating viable new housing for the poor; instead, it subsidized suburban housing and underfunded public housing.
When my mother was released from Napa State Hospital during the period of deinstitutionalization, she was faced with the decision of where to live. Until I was two years old, she lived in the Haight-Ashbury district of San Francisco, but as rents rose in the area, she had to leave. The only alternative she could find was the projects, which she avoided for as long as she could before surrendering and moving into the notorious Sunnydale Housing Project. Sunnydale was built as military housing for white families during the war, but after the postwar suburbs were created, these families left, to be replaced by blacks and Latinos. Sunnydale once had white picket fences surrounding neat yards; it was clean and safe. As it became defunded with “urban renewal,” however, it became a neglected haven of crime, hopelessness, and despair.
I remember my mother would tell me news stories she had heard that Sunnydale was one of the worst housing projects in the city. As a child I recall frightening incidents that supported her fear of the projects. When I was six, a young black man snatched my mother’s purse; seeing she had only a welfare check, he handed her purse back to her. Twice our apartment was broken into; once we came home to find items missing and spots of blood on our bedroom sheets. Numerous times we heard gunshots, and one of my earliest memories was of a man who had been stabbed banging on people’s windows in the middle of the night begging for help. Our worst fear was not of being a victim of violence, however, but of welfare officials discovering that my mother had a mental illness, which could lead to my removal and placement in foster care.
My mother was essentially reinstitutionalized via the welfare system, which mirrored how she was treated in Napa. She could not work after her release from the hospital and had to apply for state assistance under the Aid to Families with Dependent Children program (AFDC). As in Napa Hospital, the welfare state controlled many aspects of our private lives. For example, social workers documented what was in the home to ensure we were not lying about what we could afford. Fathers could not live at home because it would be assumed the women therefore did not need aid, so single mothers dominated Sunnydale.
Similar to the movement for deinstitutionalization, the National Welfare Rights Organization developed to improve the lives of women on welfare, especially women of color. As noted, government control experienced by black women on federal assistance during the 1960s and 1970s was not unlike the forms of control experienced under state psychiatric care in the 1950s. For example, both regimes discouraged poor women of color from becoming mothers, either via sterilization or financial abuse. Even today, women receiving assistance under the California Work Opportunity and Responsibility to Kids program (CalWORKs) are restricted to family caps; if they have an additional child after they sign up for CalWORKs, that child may not receive aid. Women of color on welfare who had additional children were accused by caseworkers of just wanting more aid, even though the money was never enough to live on. In the early 1990s, when I was filling out the financial aid papers to apply to San Francisco State University, I learned that my mother survived on $9,000 a year.
During this time, Ronald Reagan’s infamous “Welfare Queen” stereotype conditioned how caseworkers behaved towards poor black women on welfare. I remember once, when my mother had forgotten to fill out one of the many necessary forms, the caseworker curtly told her that she could get “cut off” for a mistake like that. My mother lived in constant fear of having her mental illness discovered. She also feared the rampant crime in Sunnydale, as well as the rumors of “development” that could lead to us being relocated and potentially homeless while they remodeled the dilapidated housing units. She thought she would be free after being released from Napa, only to learn that she had exchanged one form of incarceration for another.
Currently, as Northern California prisons become overcrowded, Napa Hospital has taken in more of the criminally insane. Meanwhile, many people with mental illness remain in the prison system, where they are not getting the treatment they need. In California’s carceral state, the twin institutions of welfare and public housing are the new punishment industry for poor women of color.
Read more LARB pieces related to mental health and illness here.