Freddie deBoer: Blue Cities Progressives Need to Get Real on Involuntary Commitment

[00:00:11] Hello and welcome to Blue City Blues. I'm David Hyde with Sandeep Kaushik. And today's topic is involuntary commitment for people suffering from severe untreated mental illness, which is one of the first topics that Sandeep and I talked about when we're thinking about doing this podcast in part because it's such an important topic, but also because it's been such a third rail in Blue City politics that conversations just don't seem to even get going about this issue.

[00:00:39] And that perhaps illustrates something about how Blue Cities work or don't work. Our guest today, Freddie DeBoer is a writer and a blogger who is currently working on a book about mental illness and has already written a lot about involuntary commitment. And if you're wondering where he's coming from, his New York magazine piece is titled The Case for Forcing the Mentally Ill into Treatment. Freddie DeBoer, thanks so much for joining us. Freddie DeBoer, thanks for having me. Did you approve that headline? I don't. I did not. Yeah. And in general, I've had almost no control over

[00:01:09] headlines throughout my 15 years of freelancing, which is the number one thing that people refuse to accept. And people just never learn that, you know, you can yell at the writer about most everything, but not the headline and not the art. But you own that one to some extent.

[00:01:25] Yeah, I don't care. That one's perfect. That one. Yeah. I didn't like one that I did years ago, and I can't remember who ran it, but they kind of scrambled like my suggestion. And so that I mean, they fixed it, but it was instead of people of color, somehow it ended up as colored. I had nothing to do with that, but of course the burden.

[00:01:53] You racist Freddie DeBoer. And racist in a weird way too, going anachronistically racist. Yeah. Yeah. Yeah. Freddie, hey, thank you so much for coming on, man. I've been a huge fan of your work for a while now.

[00:02:08] You know, but both as a kind of, you know, person and commentator on the left, but also as somebody who's been a pretty vocal critic of current practice of progressive politics and particularly its identitarian turn and, you know, or whatever we want to call it, the era of the greater opening or what have you. But I'm really happy to get a chance to talk to you about this particular topic and voluntary commitment because it's something, as David was saying, and I agree, I've long felt is one of the most profound failures of blue city government.

[00:02:38] And just to, you know, I've been, I recently finished a two-year stint as the board chair of the largest shelter, housing, and behavioral health homelessness services provider in Washington state.

[00:02:52] So I know something about these issues and nothing cuts me more in all of the flaws and failures of our homelessness response system than when I see a clearly mentally ill person out on the streets of Seattle, like yelling at passers-by as I'm walking down the street. And I and everybody else kind of make a, make a, make a, make a detour around them and just go on our way.

[00:03:19] Middle of winter, they're half naked, barefoot, it's cold and wet, and there's just no response. We all just treat it as part of the background noise of living in a place like Seattle, a blue city. And man, that cuts me to the core. Like why can't we address this manifest problem of this person suffering too impaired to make a rational judgment about their own well-being?

[00:03:49] Yeah, I mean, it's, as you mentioned, I'm in the midst of writing this book. My first two books were about 250 pages and this one is looking like it's going to be like 450 plus. And the reason for that is there's just no way to tell this story in a way that's not very complicated. You have to understand it sort of by like the path dependency of liberal culture, but also of the law.

[00:04:14] So I think what may be most useful for your listeners is to start with a little bit with the policy, with the legality of these sort of things. So, you know, for a long period of time, people deemed mentally ill had very little rights at all. And they were often warehoused in large asylums that really were pretty awful places. The sick and the wealthy had access to private facilities. Then, as they do today, that were very opulent and nice.

[00:04:43] But most mentally ill people ended up in these large asylums. The conditions in them were genuinely deplorable. You have, first of all, the first thing that people have to understand is the deinstitutionalization movement, which was a long-running movement that had gathered steam over a long period of time to seeking to move the mentally ill out of these warehouses, out of asylums, and into what is often called community-based or family-based care.

[00:05:12] A huge portion of that is just the birth of modern psychopharmacology in the 1950s. So in the 1950s, you have the first wave of antipsychotics that are developed, so primarily Thorazine. And I can tell you as someone who's been on antipsychotics for a long part of my life, they are unpleasant medicines, but they are very effective at what they do. The first modern antidepressants are born in the 1950s. It's the first modern anxiolytics, so anti-anxiety drugs, et cetera.

[00:05:42] Lithium has been used as a mood regulator for centuries, but the sort of scientific understanding of it sort of grows a lot in the 1950s. So the first step of this process is just you have the birth of these drugs, which enable more people to live outside of restrictive psychiatric settings. And that's sort of like the first mover. And then in 1963, you have what's called the Community Mental Health Care Act. It's the last bill ever signed by John F. Kennedy but for his assassination.

[00:06:11] And it's an absolutely classic example of sort of liberal good intentions leading to bad law. So the idea was that, again, like a lot of these asylums really were deplorable places. And so there's an effort to get people into what they call community care. And so the Community Mental Health Care Act pushed states and created a lot of levers within states

[00:06:39] that states would generally maintain some institutions primarily for the criminally insane, so for people who were deemed to be ineligible to return to society because of criminal acts, but to gradually close all these institutions and to replace them with a series of community mental health care centers. Unfortunately, that part never really came to fruition because that was an unfunded mandate.

[00:07:03] The bill just didn't provide anything like the funds necessarily to build these community mental health care centers. And, you know, state politics are always budget first, right? Budget is always the first most powerful priority in state politics. And this bill gave state government said, hey, you want to find some money for the budget? Well, those asylums are quite expensive overall. They're large institutions with a lot of costs. And so it gave them the opportunity to sort of cut those things.

[00:07:33] They never came up with the sort of community mental health care system that was supposed to replace it. And so people started to get moved out of the asylums. And what happens practically is that most of those people end up on the streets. Many or most of those people. In 1975, there's a major Supreme Court case. There was a guy, this is the case O'Connor v. Donaldson.

[00:07:54] This guy Donaldson was a guy who had been diagnosed with schizophrenia and he had been confined to a mental institution in Florida for 15 years under at least disputed circumstances. And he sued for his freedom. As part of that finding, the Supreme Court says, and this is like the height of sort of liberal jurisprudence in the Supreme Court. They say you can't let someone's actual mental illness be a determining factor in whether or not you can involuntarily commit them.

[00:08:24] The only thing that matters is their propensity for violence. So the new standard after – and states sort of instantiate this in different ways. But the overriding federal standard is that you can only involuntarily commit someone if they are a danger to themselves, an immediate danger to themselves or to others. And in the sort of immediate offing of that, this tended to be interpreted quite strictly so that a lot of people who previously would have been involuntarily committed were not.

[00:08:55] This is a kind of a perverse situation I think even on its face because you're removing the sort of – a doctor's ability to ascertain the psychiatric health of someone from a psychiatric evaluation. Doctors will tell you all the time. An ER shrink will tell you that they're not really practicing psychiatric medicine when they make this determination. What they're doing is trying to play like soothsayer. They're trying to predict the future in ways that they can't possibly.

[00:09:24] But that's another blow sort of to getting people into these – out of the – off the streets. And then finally, you know, the Americans with Disabilities Act, which I think is a great law in general but has had a lot of sort of unfortunate outcomes as well. You know, that just gives patients a dramatic new set of tools legally to challenge their treatment in psychiatric facilities.

[00:09:49] And pragmatically, that not only gives them the ability to sue for release in ways that they couldn't before, but it also creates generations of young doctors who have a risk averse – and by risk averse, I mean legal risk averse sort of approach to these sort of things. So anyway, over the years, you just have a series of these legal and policy changes that sort of chip away at voluntary treatment standards, making it harder and harder.

[00:10:16] And then you also have a long-run, you know, particularly post-financial crisis scenario where states are just looking to slash funding wherever they can. And a lot of that stuff comes out of the state mental health systems. And so you get a situation like we are now where you have an incredible number of homeless people with serious psychiatric illness. And you have a set of laws and policies that make it very difficult to fix that problem.

[00:10:44] It's a complicated history and a story, and I was thinking as you were describing it, I mean, even people who are old enough to remember Geraldo Rivera and, you know, some of his exposés of institutions in New York back in the day. That's how he made his mark. They don't know it or they don't know it well. But I was really struck if we take it to the present by something that you wrote on Substack. I never think of myself as a contrarian or try to be divisive for divisiveness's sake.

[00:11:12] But I have a lot of positions on which I'm on a lonely hill. And somehow, though, no corner is lonelier than this one. I was thinking about that in the context of just some of my own reporting here in Seattle. I was interviewing a politician back in 2023 who is now Seattle City Council president. And in this interview, she told me that involuntary commitment could be on the table the following year, which was a surprise because it's something that kind of had been the third rail of Seattle politics, you know, in recent years.

[00:11:38] When it came up, if a politician would have brought that up, they'd be called a fascist or a Nazi or something similar to that. And this woman not only told me she was thinking it should come up, but behind the scenes, Seattle's progressives, Seattle's homeless advocates, people in the medical profession were all agreeing with her that there needed to be at least a conversation about this.

[00:12:00] So the next thing I know, the story comes out and I'm getting chewed out for writing it, not because it was inaccurate, but she's, you know, why are you doing a story about this? That's not my priority. So clearly, you know, even in 2023, late 2023, she's still worried about blowback. That seems to be changing now in 2025. But what can you tell us about your experience writing about this and kind of just the state, the poor state of conversation about this topic in Blue Cities?

[00:12:29] I would first start by sort of saying that it is an interesting sort of set of issues because on the one hand, you do have a lot of natural allies in the sense that many, many people experience their regular sense of danger and discomfort that comes from interacting with severely mentally ill people in urban spaces.

[00:12:48] It is not possible to be a commuter in New York City and use the subway on the long term without coming into contact with people who are clearly unsafe to themselves and to others in that space. And even when those don't sort of prompt big national controversies, they're very unpleasant.

[00:13:06] And so one of the things that I'm always telling people is, you know, don't let the sort of liberal parody of tolerance keep you from saying, I don't want to be trapped in a metal tube underground with somebody who was muttering to himself and, you know, punching into his fist, you know, in that sort of way. Don't let yourself be pushed off of your spot in that way.

[00:13:29] I mean, I think a really big thing here is in the Internet era, a particular version of like academic leftist politics has dramatically grown in its influence. That coming out of cultural studies departments and other sort of humanities departments in elite universities is a version of politics that has really deepened and intensified a version of disability politics,

[00:13:56] which holds that any coercive effort with any patient in any circumstances is inherently unjust, right? The people that I run into in terms of like fighting with people about this, very rarely are people who are involved in on the ground sort of administrating social services to the homeless.

[00:14:18] It's almost always people who are sort of at a remove and operating again now very often on social media online, but also in direct academic settings where the issue is never sort of like the brick and mortar of what's happening to somebody on the streets in reality. It's not just a reality, but it's these abstract rights that if you are abridging them, then you are guilty of ableism.

[00:14:41] I can tell you that like as someone who has fought with sort of all sort of elements of the academic life for a long, long time, there is no group that is more aggressive than the disability rights activists. And they're the people I argue with the most now. I, you know, I have a friend that I when I lived in New York, she had moved to New York after frustrating years working in disability services in the Twin Cities area in Minneapolis and St. Paul,

[00:15:11] where, for example, you know, she was she was a social worker. So she was an actual state employee and she went to meet a homeless man who had a gangrenous wound on his arm and was in severe danger of losing that arm and also in danger of losing his life.

[00:15:30] And while she approached him to talk to him, a group of activists who had been sort of set up this like action campaign or whatever for that area showed up and physically intervened and got in between her and a homeless schizophrenic man with a gangrenous wound. Right. Because they told her that as because she was a state employee, her work was fundamentally carceral, even though she wasn't saying anything about putting him in jail. Right. So I think that that is like a big part of this.

[00:15:58] Gangrene is the ultimate expression of the ultimate expression of freedom. Right. I mean, there's a story that I think is is appropriate here, which is this is this is before everything got as crazy as it got now. But, you know, in the 1990s, there was this black homeless woman who had schizophrenia in New York City named Joyce Brown. And Joyce Brown was someone who, you know, was periodically addicted to heroin, who would engage in minor sex work in order to get money for food.

[00:16:26] She was profound schizophrenic delusions about what was happening about her. She had an intense rage against black men, which would often compel her to physically assault them, even though she'd never met them before. And she often one of the expressions of her schizophrenia was that she thought that any black man who came near her was a particular black man against which she had great enmity. So she eventually gets forced into involuntary commitment.

[00:16:53] And the New York Civil Liberties Union springs into action to save her because they argue that she is not a danger as dictated by the O'Connor B. Donaldson standard. And they have a big public campaign. It became sort of a local, like liberal, like sort of, you know, controversy. And they got in front of a sympathetic judge and the NYCLU got her sprung.

[00:17:19] And they went to Harvard Law and they brought Joyce Brown with them to give a speech about like getting people out of unfair or unjust involuntary commitment. But there was three women who were very opposed to all of this. And those were Joyce Brown sisters. So this is an – these are the three adult sisters of this black woman who had been fighting for their whole life to keep her in treatment.

[00:17:46] And they said – not only did they not want her sprung because they said we know what's going to happen to her. She is going to die on the streets if she's not forced into treatment. But they specifically said that it was – that what was happening was racist. And their argument was that the white lawyers at the NYCLU and the white judge who gave that verdict would never allow their white family members to live in the conditions. I mean living in squalor. I mean she would – she was known to constantly soil herself, for example.

[00:18:16] That they would never allow that in their own – in their own family members. And it turns out that they were more right than the NYCLU was because two weeks after giving a speech at Harvard, two weeks after participating in that, Joyce Brown was back off her meds and schizophrenics on the street of New York where she was sort of – spent the rest of her life sort of in and out of treatment, periodically addicted to crack cocaine, and died in her early 50s.

[00:18:45] Because that's what happens when you live on the streets for that long. And this is the sort of thing where it's all defined by the constant retreat into abstraction by the people who are opposed to this stuff. The NYCLU could say, oh, we're upholding a particular abstract right while her sisters say, hey, we're the person who's kept her alive for decades and we know what's going to happen. So it's a collision of the actual versus the theoretical.

[00:19:14] And I think that that sort of defines the current situation, which is that like every argument that I have about people who are actually dying on the streets ends up being bogged down in a question like of, you know, what do disabled people really want and what do we owe them in an abstract sense?

[00:20:02] Abe single-handedly drove all sorts of federal legislation. The safety caps on pill bottles, that was Abe Bergman, right? The National Indian Health Service sending doctors and nurses. It was created in the 70s. That was Abe Bergman to reservations. That was Abe Bergman. Banning flammable materials in children's clothing. That was an Abe Bergman legislation, right? Like, so Abe reaches out to me. I'm a known quantity.

[00:20:30] I'm a political, you know, consultant and figure in Seattle. And he's like, I have a political question for you. Can we get on a call? I get on a call with this guy. Abe's 95 years old. And he tells me, you know, when I was in my 60s, I adopted three kids from Russia. One of them had fetal alcohol syndrome, was a very troubled kid from the get-go. And his whole adult life, he's in his 30s now, his son.

[00:20:57] He's been severely mentally ill, addicted, homeless, living on the streets of Seattle. And his question to me is, Sandeep, why can't we help my son? Why can't we? He said the one good year my son had was when he got convicted of something. They sent him to Western State Hospital. He spent a year there. He stabilized. He built some relationships with people, the staff there at Western State.

[00:21:27] And then, of course, a year later, they replaced him. He's right back on the streets. And he's like, look, my son's too far gone. He's not going to survive much longer out there. But there's so many other people. Why can't we fix this problem? And he's like, I'm 95 years old. I'm too old to do this. Why aren't people like you who are involved in politics? Fixing this problem. And he died about six months later. And this has been bugging me ever since. Like, you know, when I talked to Abe, I tried to start a – I told him, the politics of this are really, really hard, Abe.

[00:21:56] I really – I've been trying. I've been trying to have a conversation about this, and I'm not getting anywhere. And I'm going to try again now that you've said this to me. But the politics of this are really freaking hard because of some of the things, Freddie, that you're talking about. So there's the piece of this when you actually talk to family members of these people. Like, I think it becomes a lot more real. But for a lot of people, this is an abstraction, right?

[00:22:21] We're having a conversation about philosophical principles of individual autonomy and not a conversation about human suffering. Yeah. I mean, I always have to sort of fight to sort of define a – this sort of – I mean, I fight to insist that my position here is a left position, which is that – I mean, look. In the most basic way possible, I am talking about the government provisioning of essential medical services, right?

[00:22:51] I – as part of the left, I believe in good government and I believe in the necessary role that government has to play in providing services to people who can't or won't access them when they need to, right? And it's – I mean, a really big part of this is always to say people in their right minds don't live the way that the severely mentally ill live on the streets, right? They don't make those choices.

[00:23:21] So if you look at Jordan Neely, who was the black man who was homeless man who was choked to death on a subway in New York a couple years ago, it just drives me nuts how people only sort of have one way to sort of address these issues. And immediately what a ton of people on the political left were saying is, oh, we need more programs. We need more funding. We need more programs. Which is just sort of always the sort of response to these sort of things.

[00:23:45] To which I would say, like, look, Jordan Neely was in a program and he walked away from it because he was too sick to do otherwise, right? People say, oh, he didn't have access to mental health care. Not only did he have access, he was – he had a court order requiring him to access those mental health services. He had punched somebody, completely randomly punched a senior citizen in the face.

[00:24:10] And as part of avoiding a long prison sentence for that, he was diverted out by a judge who said, you have to go to this program and you have to work the program or else we're going to put you in jail. But because the ward was not locked, because for whatever weird reason, you know, those sort of city-designed programs for severe mental health treatment had adopted this ethos that you never lock the door. He walked away and never came back and he was dead within a few months of that, right?

[00:24:39] He had access. But he was not in a right state of mind to be able to compel himself to do it. Like I, you know, I wrote a piece for City Journal late last year where I told – I talked about this issue and I talked about a woman named Rebecca Smith. This is another New York City-based homeless person. This time she was in the early 1980s and she was a woman who lived in the financial district and who was – she literally slept in a cardboard box. And she was known as like a city fixture.

[00:25:05] Like she was sort of like a personality and everybody liked her and they'd give her food and she would sort of tell jokes to the Wall Street guys as they walked by. But then, you know, one winter they knew that a particularly cold winter was coming, a very brutal winter was coming. And they said, Rebecca, you're going to die if you stay out here. But she refused to go to take advantage of any of the programs that were offered to her and a bunch of stuff was offered to her.

[00:25:28] And people said, well, you know, this is probably a real threat to her life because this winter is really going to be brutal. So they moved to involuntarily commit her. But because in New York especially, you know, the activist class had built so many different challenges to involuntary commitment, it took several weeks for them to get the process of securing an involuntary commitment.

[00:25:54] And when they went to go serve it, they found that she was frozen to death in her box, like literally frozen stiff, right? A person who was not suffering from severe mental illness would not make the choice to sleep in a cardboard box in the financial district when the temperatures were dropping to negative five below, right? And so you have to always bake in here.

[00:26:18] It's not sufficient just to say that, like, these people are choosing not to take advantage of these services. The fact of the matter is that the kind of illnesses that they have are overwhelming sort of their mind's ability to make a rational choice, right? Which is precisely what sort of these standards exist to do or they have traditionally existed to do.

[00:26:42] When you have someone whose rational ability to choose has been completely overridden, we feel as a society that we have a responsibility to choose for them. I think you're answering these questions that I'm about to ask, but Sandeep and I in our other podcast about Seattle and just, you know, being around town, I've heard a lot of the same things that you've heard on this and other kinds of topics. One of which is just why would we do this?

[00:27:08] Why would we consider changing laws to expand involuntary commitment in blue cities and states when there's a severe lack of treatment capacity as it is? You know, why aren't we doing this before creating the housing that people need? Why aren't we doing this before we do all of these other things? I think you're you are kind of answering that. But when somebody asks you that directly, what do you say? Yeah, I would say housing doesn't solve doesn't fix schizophrenia, right?

[00:27:35] Like I this is a big sort of in another little weird wing of sort of interleft argument. It was sort of the Yimby movement is often talking about how we don't, you know, our homelessness problem is fundamentally a housing problem. But again, Rebecca Smith was offered multiple places to ride out the winter. And, you know, initially somebody offered a shelter and she turned on the shelter. I think for obvious reasons, people don't want to go to a shelter. But she was also offered the ability to have a private room in a particular place, et cetera.

[00:28:05] But she wanted to sleep on the street because she was incapable of understanding what the risk was to her. Right. And of course, we need to build more housing. And of course, we need to build better community mental health services. The problem fundamentally is there is a unique issue with compliance to treatment that arises from mental health.

[00:28:24] That means that it doesn't matter how many structures or hospitals or whatever you build if the people don't come to them because the voices in their head that they are telling them that if they go to the community mental health center, someone's going to kill them. Right. That they're going to implant bugs in their teeth that broadcast to the CIA. Right. It is a particularly poignant and difficult problem in a culture that in a society that really praises and prizes sort of individual autonomy.

[00:28:54] But Jordan Neely doesn't matter how many services or hospitals you put together. It doesn't matter sort of how much you built out the housing stock. Right. He slept in on the subway when he had better places to sleep. He did not take his pills even when those pills were provided to him totally free of charge. He didn't take advantage of a multitude of services that were offered to him throughout his life to find a job and to get better stability because his illness just hurt him too badly to do that.

[00:29:24] I mean one of the things I tell people all the time is that most people have a mental block against really understanding the depths of really deep mental illness because that reality is so unpleasant. Right. The notion that your will can be completely hijacked by disease is so difficult for people to contemplate that they often just won't really understand just how bad this stuff is. You know.

[00:29:51] I was in a – forgive me for saying something unpleasant but this is an example I've used before because I think it's important to use this kind of example. I was in a support group with a guy once who told me that he had been inpatient in a state facility.

[00:30:06] I think he had been sectioned and he was in the calf eating and all of a sudden a bunch of orderlies and nurses and doctors rush in and sort of get everybody out of the cafeteria because another patient there while he was in an inpatient setting, while he was on powerful drugs, he had somehow gotten his hand on a piece of sharpened metal and he had attempted to circumcise himself in the cafeteria. Right.

[00:30:35] And I don't like – you know, I don't enjoy sort of sharing those kind of stories but there is a constant need to remind people that like the Hollywood idea of beautiful madness is just not what this is. Right. That you have schizophrenic mothers who kill their children because they think it's the only way to save their souls. Right. And you have people who commit horrific self-injury and you have people who freeze to death on the streets of New York. Right.

[00:31:03] And all that – you know, of course we need to build all of that stuff. But until and unless there is a mechanism in place that can force the people who need to be forced, you're going to have this large transient population of people who are not going to get treatment. And they're going to make the urban environment much more unpleasant for a lot of us.

[00:31:24] I was just going to say on the question of housing, I actually have somebody in my extended family who suffers from untreated mental illness but has an apartment. And even with a loving family who loves and supports them and everything else, it's very difficult for them to get that person the help that they need. And they're housed but, you know, they clearly need help in many, many ways.

[00:31:51] And even in that situation, it's really difficult because of the laws that are currently on the books that are in some ways there for good reasons. But what's really been frustrating, you know, is just to have the height of that at a time where people are like, no, we can't even have a conversation about this. You know, it's just to see that person suffering and it's like, no, we can't even have a policy discussion about it. If you bring this up, you're a fascist. Just like that piece of it, the sort of enforced silence. I mean, this isn't the only topic, but that's just been incredibly frustrating to me.

[00:32:21] But, Sandeep. Yeah, just to build on David on the anecdote you just told about your family member because I think, Freddie, you were hinting at this. I do wonder whether there is a kind of class dimension to this, right? In that, David, your family has the wherewithal to do something on the private level to deal with your relative, right? It may be inadequate. Maybe it's hard. It's whatever. But they can get him or her housed and, you know, kind of get you. I mean, it's complicated.

[00:32:51] Like, you know, if the person gets violent, you could call the cops. But then what happens then? Do the cops shoot them? I mean, these are real types of questions. But this is something we've talked about a lot on this podcast that, you know, there is a class dimension to latter-day progressivism, right?

[00:33:08] It is the sort of the worldview of an educated, you know, elite, you know, and that they're sort of insulated on lots of different issues from the downstream implications of sort of pushing some ideological commitments to extremes. And, you know, and so I don't know, Freddie, am I off base here?

[00:33:34] Or is there something to the fact that, as you said earlier, we're talking about, in many cases, poor people of color, right, who have no resources. And we wouldn't let wealthy white people live in that kind of squalor and degradation. Yeah, so there's, I mean, a lot of our sort of instincts about this stuff can sort of be scrambled. It's very complicated. There's a great book that came out, I think, last year by a guy named Neil Gong, who's a sociologist.

[00:34:04] It is called Sons, Daughters, and Sidewalk Schizophrenics. And that book is about this weird, bifurcated sort of approach to mental illness where it can actually pay to be the poorer person when it comes to getting mental health care because you're more likely to be perceived to be unpleasant and a problem for society.

[00:34:27] Whereas a lot of sort of richer families have the ability to hide their mentally ill patients away and keep them from that sort of problem until it explodes into something that's violent, right? So that, you know, one of the things he talks about is like, you know, I mean, there are, I don't think people understand this. There are private mental health facilities in the United States that are like exclusive resorts plus like Thorazine, right?

[00:34:55] Like it's, it's their, they, you know, they, I mean, they, there's some of the charge in like the thousands of dollars a day and they don't take insurance, right? Like, but in like those places, like you're, you tend to get more of a sort of like loosey goosey sort of vaguely spiritual approach to mental health care. Whereas if you are someone who is unfortunate enough to be like to do something or be perceived to be a problem enough that they'll forcibly treat you, then that can actually save your life. And so this is one of the ironies with Jordan Neely.

[00:35:26] It turned out even not to be enough here, but when he punched that person, committed felony assault and almost went to jail for a long time, he put himself into a pathway that sort of insisted on treating him in a serious way and that he be medicated, right? In other words, his chance for survival actually probably increased because he, he did something bad enough, right? When he hit someone.

[00:35:55] And so there's this weird sort of scenario where the people who are saved sometimes are the people who do a bad enough thing early on that they get forced into the treatment pathway. So a pathway. So it's a couple of years ago in Indiana, there's this guy, Bailey Hamor, who was in his early twenties and obviously schizophrenic. He had told doctors that there was demons crawling around in his walls, et cetera.

[00:36:20] His parents had struggled for years trying to get someone to commit him, but nobody would. And then finally he stabbed another guy to death and now he's going to spend the rest of his life in a psychiatric hospital. And I can't remember if it was one of the parents or somebody else from the family, but they gave an interview afterwards where it's like, we were hoping he would do something criminal, but not this criminal so that he would be forced into treatment, right?

[00:36:46] Which is obviously a deeply sort of disordered situation that we're in. I think it's really important to say, you sometimes hear people say or claim that because the Supreme Court, because O'Connor v. Donaldson is a Supreme Court decision, the only thing that's going to change that standard is a constitutional amendment. But that's not true, right?

[00:37:10] The Supreme Court has the ability to interpret a prior Supreme Court decision. There are some very smart people who think that if you actually read the O'Connor v. Donaldson decision, it has a broader definition of the patient's well-being than has traditionally been interpreted as, which would then give doctors greater latitude to be able to hospitalize people who needed it. We just sort of, everyone's sort of waiting for the right legal case.

[00:37:39] So, you know, the Adams, the Adams administration, Eric Adams administration in New York came in and one of the things they talked about because the issue has become inescapable is, you know, people in public spaces who are clearly deeply mentally ill that make other people feel unsafe. And they sort of, and they've said that they're going to more aggressively pursue involuntary commitment. And a lot of people are sort of waiting for the other shoe to drop,

[00:38:06] for somebody to sue over that more aggressive pursuit, because that could finally spark the legal case that could end up in the Supreme Court, which could result in reinterpretation. And I would suggest that the Roberts Court right now would probably be very amenable to a more expansive definition of involuntary commitment. They've certainly not been afraid of revisiting other precedents, as we know.

[00:38:33] I mean, I do hear this a lot, Freddie. Like when I tweet and say, you know, what the fuck? Why aren't we, you know, involuntary commitment? We got to do something about this. I almost invariably, some lefty tweets back at me about how I don't understand the Constitution and what I'm talking about is unconstitutional and we can't, you know, it's in the Constitution. You can't commit somebody. And what you're saying is, no, there's a problematic Supreme Court interpretation that's ripe for revisits. Right.

[00:39:03] And you have to understand, like, the actual expression of this stuff, even though we're all supposedly sort of operating under the same precedent from that case, from state to state, the actual sort of, like, how this works as expressed in state law and in state practice and how the different courts have acted there, it really matters.

[00:39:29] Like if, you know, long-term patients will talk about, like, you know, like getting sectioned in New York or in California is way harder than it is in some other places. Right. So it's not like there actually is, like, some bright shining, you know, sort of black and white lie. And it's just – and again, it's like, you know, even if you're someone who is from the sort of libertarian hippie wing of the left, right,

[00:39:56] and your real interest is in, like, individual liberty, again, I do not understand how you can see it as liberty if someone is living under the influence of an illness that is compelling them to do things that they wouldn't ordinarily want to do. Right. It's – I mean it's a cliche. It's the same thing everybody says when they get to a psychiatric hospital and they get medicated. But it's true. I would never have done this thing were I of right mind.

[00:40:25] Well, if that's true, then, like, that's not actually an expression of your liberty. Right. Like, those things are not actual expressions of liberty because they are not actually chosen. I mean the sort of, like, thought experiment I always tell people is, like, if I give you a drug, right, that I know changes your mindset and then I ask you to sign a contract with me, right, a bad contract, a contract that benefits me. And then after the fact, you know, you look at the contract and say, oh, this contract is awful.

[00:40:53] Would society permit that contract and treat it as lawful? The answer is no, right? Like, a judge is not going to say, oh, yeah, that's cool. The judge is going to say, you were not of your right mind because you were drugged. And I would just sort of say the same exact thing about mental illness, right? If we know that mental illness can have effects on the mind that are similar to the use of mind-altering drugs and we know that that's true, why would we see that as an expression of liberty?

[00:41:18] Like, if you went down into the subway and you saw a friend of yours and you knew he had been drugged with something and you saw that he was sleeping on the floors and sleeping in his own excrement, etc., you wouldn't say, oh, this is an expression of his liberty, right? Well, you shouldn't do that with mental illness either. You mentioned the state of the conversation in New York with your mayor of New York City and the governor wanting to expand voluntary commitment.

[00:41:44] And this year, the city of Seattle is asking the state to make changes to expand involuntary commitment. But it's not the more progressive Democrats in those cases, is it, who might be more likely to want to do things like raise progressive taxes to help pay for some of the costs that are going to be associated with this stuff. So it's sort of like another situation where we have the progressive left taking kind of what it sees as a principled stand, but ultimately could end up, if things are headed in this direction, almost like sitting it out

[00:42:14] and letting more conservative Democrats or a Republican-appointed Supreme Court kind of make the decisions for them. I don't think they'll sit it out. I think they're going to fight it. But anyway, Freddie, yeah, yeah, yeah. Yeah, they'll fight. But I mean, I bet it but Luke's. Yeah, maybe. So ultimately, yeah, well, who knows? I mean, look, like there's a reason it was the Eric Adams administration and not the de Blasio administration that went forward with this thing. I mean, look, like it is, I mean, I think in, I mean, I can only, you know, I live in New York for eight years

[00:42:43] and until fairly recently. I'm sure it's true other places, but in New York, it is sort of just becoming a matter of sort of like realpolitik that you have to do something because the experience of being frightened of a severely mentally ill person in a public space has become so constant and so universal in New York that even a lot of lefty people are sort of starting to get religion on this.

[00:43:09] I mean, you know, I've always had this sort of index in my head of like of all the different things that I write about politically, right? How much people are sort of the parts that people are willing to publicly be on my side with and the parts where people sort of say, well, I can never say this publicly, but right. It's like sort of what sort of portion of the people who are supporting me are doing so knowing that they couldn't say so in front of, you know, in certain environments.

[00:43:35] And this is a big one where it's just like, there's a lot of people who have the right politics on this explicitly, but they have to go into the subway, right? They have to be in a narrow metal tube with strangers who are seriously dangerous to themselves and others. And eventually that kind of overwhelms the more sort of romantic inklings. I mean, I said, you know, look, I said at the beginning of this thing, you have to understand the policy, but you also have to understand the culture, right?

[00:44:03] And I think like as much as the policy problems are real, it's just, it is a, really is like a very direct line from the 1960s and one flew over the cuckoo's nest sort of to this sort of liberal sort of perception of madness as being like telling the real truth or whatever, that it's all like everybody in a psychiatric hospital is a, like a freedom fighter. And that- A seer, a seer. A seer, yeah.

[00:44:33] He seems to pierce the veil of society or whatever. And that's such a huge problem, right? I, you know, I say to people all the time, like, look, like, I've been in five different psychiatric hospitals in my life. None of them were pleasant. My first trip was in a forensic ward, which I certainly don't recommend. But look, like, they were mostly just sort of boring, drab places. They were not hideously cruel places.

[00:44:58] And there really has been a lot of reform in the last, you know, 30 or so years because people knew that these places were ugly and they needed to do better. They can always do a better job, but, like, they have improved a lot. And it's just so many people. It is just literally, I mean, their entire vision of these places comes from movies. And so they just don't have any evidentiary basis to understand them, right?

[00:45:23] And just really quickly, just to be fair, because when you do look at the footage from the 60s or 70s, Willowbrook, the Geraldo Rivera expose from 1972, the conditions of those places were truly horrific, right, at the time, right? So that's sort of the sort of image imprint I think people still have in their minds of people being abused in these horrible…

[00:45:47] My spouse grew up on the Upper West Side, and her mom worked in Willowbrook, and she went there as a little kid. She brought her to work. She didn't have anywhere for her to go. And she's still scarred by the experience because she was so freaked out by it. But anyway, sorry. That's kind of a silly anecdote. There was a lot of reluctance in those places.

[00:46:06] But again, the comparison is not to an imaginary life where you bust all the patients out and they go and wander America as truth-tellers. The comparison is to the person who is sleeping in their own excrement on a train who is using dangerous synthetic marijuana and has a number of infections that are slowly killing him, right? Like, that is the comparison that matters.

[00:46:34] And for the record, like, with the… I just really hate… One Flew Over the Cuckoo's Nest. Like, I have a real personal… Like, as a film, you don't like it? I love that movie. As a film, it's whatever. I mean, the film is fine. I will… I mean, like, as a social symbol, I guess. I mean, the thing is, like, the first thing is just that, like, you know, I guess this is probably explained better in the book than the movie, but he is very expressly not actually mentally ill.

[00:47:04] Like, the whole premise is that he is… Faking it. He is pretending, faking it in order to avoid prison, right? So, like, that in and of itself is not, like, a great sort of model. But also, like, you know, I tell people, like, the character Randall McMurphy, he's been sort of elevated as, like, this countercultural hero figure. I tell them, you know, the reason that he's going to prison and so that he wants to get out. He's going to this hospital because he wants to get out of prison.

[00:47:32] The reason he's going to prison explicitly is for raping a 15-year-old. So, maybe that's not, like, the best hero for the counterpulture. It was a simpler time. And, yeah, yeah, yeah. I actually, I have a fondness for that movie. And I do think Jack Nicholson's character in that movie is sort of the, maybe the iconic early 70s antihero. Like, you know, I mean, it's sort of quintessential in some ways.

[00:47:58] But I take your point that it's not a very good exemplar for us to be basing our policy decisions about how to handle mental illness in 2025 based on, like, you know, Nurse Ratched and One Flew Over the Cuckoo's Nest, right? Freddie, you were just talking about New York City and that it's now, I mean, obviously, there have been, it's not just Jordan McNeely, but a series of kind of pretty spectacular incidents, right?

[00:48:25] You know, and maybe they're outliers, but you don't need too many of these things like the woman that just got immolated on a subway train or what have you. Homeless woman who was lit on fire by another person. And this is every, this is almost every blue city right now has reached this point of, whatever you want to call it, recognition.

[00:48:45] But to Freddie's point, like, they're now including progressive politicians in New York City who are like, oh shit, we got to do something about this because people are clamoring for some action here after these, after this stuff. I don't think the conversation in Seattle has progressed nearly to that extent, though I do think the vibe is shifting perhaps on some of this stuff.

[00:49:06] And just a conversation I've been having recently, a person here by the name of Lisa Dugard, she's the creator of Law Enforcement Assisted Diversion, which is a national model. She's a MacArthur Genius Award winner because she created this national model for how you marry a kind of social service response to law enforcement, right? And she, anyway, and it goes to a point you were making earlier, Freddie.

[00:49:31] And Lisa Dugard is on the front lines of service delivery in dealing with populations of the sort that we're talking about, both with severe addiction and severe mental illness. And Lisa Dugard is a really good lefty, right? And Lisa will tell me, and does tell me, look, Sandeep, I don't know what the percent, 95, 97% of this problem, like, give me the resources to house and to case manage and to work with people.

[00:49:58] And they will come inside and I will take a hotel and we will figure out their problems and we will work to get them permanent housing. You know, that's the core of the problem. That is a core issue. But she will also admit, because she sees it every day, whatever it is, 3%, 5% of people, they won't come inside or we can't bring them inside because it's too dangerous to our staff or to our other clients.

[00:50:23] And some of these people, some of them need to be in jail and some of them need to be committed. And we don't have the tools to do that, right? And that's the kind of pragmatism from somebody at the front lines of this who's like, I'm not just saying let's do involuntary commitment. I need the resources too to help all these other people, but let's figure something out, right? And that's where I would love to see this conversation go. Look, you've got to build a better infrastructure for these things than you currently have.

[00:50:52] It's hard to sort of see in the United States in 2025 as it exists where that money comes from. I mean, I just – I don't know. You have places like California where the state taxes are already quite punitive and then you have other – and there's like not a lot of overhead. And then there's other places where it's just a complete political nonstarter to sort of do that. But like the problem with just saying you need more programs and facilities – excuse me – and money is that money has got to come from somewhere.

[00:51:22] And states just don't have the wherewithal to do that, which is why you would love to have a presidential administration that wanted to take a two sort of pronged approach to this, which argued forcefully for a loosened standard for involuntary commitment and also led the way in providing more federal funds for addressing these problems.

[00:51:46] The problem is that like that sort of splits the coalitions in half, right? So in other words, the right is going to be eager to say – talk about involuntary commitment and the left is going to be eager to talk about more funding. But you're not going to get both from hardly anyone, certainly not from the Trump administration.

[00:52:06] But look, like in the short term, there's tremendous space to meaningfully expand the involuntary commitment standard in a way that you don't have to have the very specific sort of requirements about the immediate threat to oneself and to others.

[00:52:27] While also building in a greater sort of amount of due process so that people have the means to be able to get out if they don't belong there, right? Like I mean part of the problem is that when you do get people in, it can be the case that you can often be held for a long time in a kind of Kafka situation where your specific rights are not particularly clear.

[00:52:52] I was involuntarily committed in 2002 and I could tell you at no point that I have the slightest idea, you know, do I have a lawyer? Like how do I get out? When do I get out, et cetera? I just know that they put me down in the step-down facility at one point. They just decided I was going to be there. I was there for a few days and then they let me go.

[00:53:12] So like more due process for people who have been involuntarily committed but a sort of more latitude to involuntarily commit people I think would be a great start. And, you know, I think that there's also a fairly likely outcome where if the right case comes before the Supreme Court, their decision is to turn the standard back over to the states to a greater degree than it is right now.

[00:53:40] To say, oh, the states should be the ones who make the decisions about what the involuntary commitment standard will be. And it's likely that red states will be will have a more expansive involuntary commitment and blue states will have less. But like something to sort of change the current status quo is necessary. And look, I tell people this all the time.

[00:54:02] If the left doesn't provide basic law and order, then the fascists will do it for them. Right. Like if the left do not have a vision for how to solve these problems, then the people will elect the strongmen who will come in and will do it in a worse way. Eric Adams won the he was a Democrat. He is a Democrat. But still, I mean, he was the right wing candidate in the Democratic primary.

[00:54:31] And he won because New Yorkers were just tired of this and felt that it couldn't go on. And so like we need to have better alternatives. And you just you cannot address these problems by telling people, oh, what are you worried about? Oh, you're racist if you notice this. It's just that that dog does not walk anymore. And I think it really is going to become a matter of political life and death for local Democratic parties. I really do. Freddie DeBoer, thanks so much for joining us. Thanks for having me.

[00:55:01] That's it for another edition of Blue City Blues. I'm David Hyde with Sandeep Kashuk. Our editor is Quinn Waller. And if you like this podcast and you want it to grow, tell your friends about it. Tell your family about it. Tell anybody who might be interested in the future of Blue Cities about it. And please give us a five star review on Apple or wherever you get your podcasts. And we'll see you next time. Bye. Bye.