From the time I entered medical school at NYU in 1978 until the 1990's, New York was in visible decline. There was never enough money for the city to do what it wanted to help people, the crime often seemed out of control, various drug epidemics ravaged whole neighborhoods, and the price of real estate continually escalated, yet with all that, the single greatest sign of decline was visible on the streets. Everyday I would walk from my apartment to the medical school, later to the hospitals where I did my residency (NYU, Bellevue) and would have to walk around or over 1, 2, later 3 or 4, homeless people living on the streets. I "knew" via the New York Times, my primary source of information through much of this time, that homelessness was caused by the uncaring, offhand cruelty of the typical New Yorker who didn't "see" the homeless and fought to keep public housing "somewhere else." As a Psychiatrist, I recognized that the homeless in my neighborhood, who I often saw in the Bellevue Hospital Psychiatric Emergency Room, were all suffering from drug and/or alcohol abuse or severe Psychiatric disorders often exacerbated by drug and alcohol abuse. We could tell when the patients had been hospitalized; after anywhere from a week to a few months without seeing them, they would reappear on the street, with new, clean clothes, haircuts, shaves for the men, more in touch with reality. They would then deteriorate over the course of the next few weeks to months until the next cycle started. The Supreme Court had ruled that Psychiatric patients could not be treated against their will (even if psychotic and paranoid, they were allowed to be "crazy") and had to be held in the least restrictive environment possible; the civil liberties lawyers made sure these damaged people were able to exercise their rights tot he fullest. The politicians leaped at the chance to empty the large Psychiatric hospitals (the money saved was supposed to be spent on community mental health but somehow the politicians forgot that part of the equation) and thousands of extremely disturbed, poorly functioning people were taken from protected environments where they could have a bed and three meals a day, to life on the he streets. (Most preferred the streets to the homeless shelters because they felt safer from the predators who roamed the shelter system.) In the late 80's, early 90's, Crack cocaine hit the city; it had the perverse effect of addicting many more women, including mothers, than previous drug epidemics, and the city further deteriorated, now with whole, single-mother, families living on the streets. Life in the Big Apple seemed hopeless. The city was universally taken to be ungovernable; Mayor Dinkins was a nice man who was out of his element, but couldn't be held responsible for not being able to reverse the downhill course the city was taking.
Rudolph Giuliani was elected Mayor in 1993 and took office on January 1, 1994. He immediately instituted the "broken windows" policing policy and also exerted his powerful personality on he tools of government. Within a year or two, the "squeegee men", who typically menaced drivers into the city in herds at most intersections, were off the streets. The homeless population dropped dramatically. It is hard to describe to someone who has never experienced these things what a remarkable change this represented. The city once again was a place where life was vibrant and exciting, where walking the streets of the city was as entertaining as any Broadway play. Of course, the New York Times, which had supported Dinkins in his ineffectual attempts to (mis)rule the city, did everything to undermine Giuliani. He was all but called a fascist, under the sway of the moneyed, conservative, landlord class, racist, bigoted, homophobic, and a prude. He was taken to task for trying to clean up Times Square, where the XXX movies and clubs were so much a part of the vibrancy of New York (notwithstanding that no one in their right mind would want to spend much time there among the hookers and the dealers and the pimps). Despite the Times dong their best to demonize Giuliani, even those of us New Yorkers who thought his methods were a bit too authoritarian had to admit he was doing a great job in New York even before his heroic performance on 9/11.
What brings these thoughts to mind are my experiences of the last two days in San Francisco. Prior to arriving in San Francisco, all I knew about the city was that it is exceptionally liberal, has the lowest percentage of school age children within the city limits of any American city, had lots of hills, trolleys, Chinatown, the fisherman's wharf, and real estate prices among the highest in the country. The reality has been mixed. The city strikes me as extremely livable. It is a big city without being overwhelming, like New York often can be. Neighborhoods are distinctive and close together so that one can walk through a fascinating mix of architecture and ethnic ambiance. We haven't yet seen the Wharf or Alcatraz (that is for later today) but Chinatown was a treat, Union Square is a match for Fifth Avenue, and Haight-Ashbury is a mini-Greenwich Village, slowly giving way to American marketing and capitalist excess. You know the Hippie counterculture is over when there is a GAP at the corner of Haight and Ashbury Streets.
However, we ended up in a hotel about 5 or 6 blocks from Union Square and the walk between the hotel and the Square is illustrative. Apparently, all the homeless drug and alcohol addled men from New York have moved to San Francisco. In the late afternoon, drunk and/or stoned men, often with glazed eyes, lurching or swaying back and forth on the sidewalk, set up their small coops and condominiums on the street corners. There are only a small number of XXX movie theaters and adult stores on a two block stretch of Market Street that we had to traverse form our hotel to the Square, but there is a palpable sense of menace and dissolution on the streets. I have to add that no one bothered us but the aura of cultural rot and deterioration cast a pall over the area and had an impact on my family's reaction to the city.
I do not know why there is so much, a disproportionate amount to my eyes, of such homelessness in this area of San Francisco. I do suspect that liberal Judges have much to do with limiting the ability of cities to police themselves. I also imagine having a very liberal Mayor who is more concerned with performing Gay marriages than managing his city could be a contributing factor. No liberal Mayor wants to be attacked as insensitive to poverty and homelessness by trying to actually get people to move off the streets. In the end, the "why" of the situation doesn't really concern me. If the people of San Francisco are happy with their environment, good for them. I am not raising my family here and am only a visitor. New York has plenty of problems still and the constant promises by Democratic Mayoral candidates to raise taxes have made me look longingly at other states to move and start a practice. However, I would submit that homelessness such as is seen in this otherwise lovely city, is a reflection of an underlying cancer that is threatening to destroy our civilization from the core. This homelessness is a celebration of Rights without responsibility, a measure of solipsistic hedonism; the triumph of the individual over the family and over the shared culture. It is interesting that the left, with its historical collectivist ideology, should now support such atomized tribalism, but I suppose that is an inevitable outgrowth of their philosophical outlook. If all of reality is a construct and any construct supported by the power structure is a priori oppressive, eventually true individual freedom will be achieved when we are all free to be homeless and substance addicted.
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