Reviewed by David Brizer
Exiles in New York City: Warehousing the Marginalized on Ward’s Island
by Philip T. Yanos
Columbia University Press
April 2025, 192 pages, Paperback, ISBN-13: 978-0231212373176
Just to your right, driving over the Triboro (now RFK, may he rest in peace) Bridge, there is a Soviet bunker-style group of buildings, monolithic and institutional to the extreme. This is Manhattan Psychiatric Center, including the Dunlap, Meyer, and Kirby Forensic buildings, grand barracks in concrete and brick, built in the 1950s.
Many New Yorkers are in the dark when it comes to Ward’s Island. Some confuse it with a potter’s field, or with Randall’s Island, a place with a stadium for concertgoer’s connected to Ward’s by landfill. Others have never heard of it all. Few are aware that these grim mausoleum house hundreds – historically, thousands – of state mental patients. The sickest of the sick, the hollow-eyed ghouls staring at you from the other side of the cordon sanitaire.
We know these places mostly from our reading. As baby boomers, and then some, we followed the plight of these castaways from afar, in the pages of Michel Foucault, R.D. Laing, in the receding hoofbeats of the so-called anti-psychiatry movement.
I actually worked there, as an idealistic research psychiatrist, between 1989 – 1981. We believed we were getting a handle on violent behavior flashed daily among these, the sickest of the sick. Most patients came from the inner city; neither East Harlem nor Riverside Drive could hold them. These were the true desperadoes, the true damned of the earth: laden with three or four simultaneous diagnoses, drug addicted, missing teeth, broken brains…we recorded their kicks punches and harsh words on close circuit television cameras, for later review and analysis. We gave them tryptophan-loaded Nestlé bars to see if the serotonin boost would make a difference. (It didn’t, but they gained an amazing amount of weight. Chocolate bars every morning, day in day out, will do that.)
Idealistic, indeed. I recall peering at the Manhattan skyline from Ward’s Island with unbelievable sadness and frustration. My naive hope – every newbie psychiatrist’s hope – that I would identify misdiagnosed, wrongly institutionalized patients fell flat on its face. Most patients visibly shrank at the suggestion they could leave the place: where else could they so reliably count on–three hots and a cot?
Philip T. Yanos was there too, as a child growing up with his doting parents and brother on Ward’s Island. Not as patients, but as the family of Dr. Yanos, a psychiatrist in residence at the place. Yanos’ memories were not as stark as mine: he remembers a well-groomed lawn, the occasional sight of state hospital patients through the gauze of metal fences.
My memories were more stark, graphic. I walked among the hoi polloi of the warehoused, every day encountering one example after another of the fallout of chronic, severe mental illness. Patients with grounds privileges walked in that sloping belly-out posture peculiar to takers of large doses of anti-psychotic meds like Haldol and Thorazine. Their tongues and cheeks shimmied and quaked. Sometimes they would ask if I was a lawyer (i.e., someone who could set them free from the shackles of involuntary commitment.) Often one or another would nosedive at the sidewalk at the sight of an extant cigarette butt. A New York Times article from 1974, p 61 described how in state hospital day rooms the television was always on, the patients curled up and sleeping in chairs. (This was still true in 1990, when I was there.)
Differing perspectives aside, Yanos provides a detailed and learned examination of the politics, social realities, and possible alternate futures of Ward’s Island.
Interesting — and a source of endless contention between blues and reds — that taking care of those in need (mental health services, homelessness, food stamps , welfare, SSI) might well be within the compass of society, where it need for an astronomical defense bud and untaxed corporate greed.
Daniel Paul Schreber, whose description of the agonies of schizophrenia in Memoirs of My Nervous Illness is a core text in psychiatry (inspiring further works by Freud, among others) wrote of “…the sensation of a thousand voices…the belief that the world’s crisis and [his] personal illness were connected.”
He wasn’t far off.
Yanos’ Exiles in New York City picks up the thread and weaves it some more. Yanos was there between 1970-1980, a youngster living in professional residence on the island where his dad worked as a doctor. His encounters with the grotesque and sometimes repugnant behavior of the denizens of that odd place were few and far between.
The history of the institution is ably limned in these pages. At one time, Manhattan State Hospital (currently, Manhattan Psychiatric Center, MPC) was the largest psychiatric hospital in the United States. Formerly many thousands of patients were housed there; MPC’s census at the time of this writing is 240 and possibly going down. Municipal facilities on the island also include a shelter for men, another for women and children (under the aegis of Odyssey House, a recovery program for addicts and their families), and two congregate housing facilities. (Up for discussion at the present time is a possible 2,000 bed shelter for immigrants. Preferable, one would think, to a tent and federal armed guards in South Sudan, or Guantanamo Bay.)
The history of the faceless and nameless is inexorably parallel with society’s level of abhorrence for these. Ward’s Island is the cordon sanitaire for gentrified Manhattan:
…the use of a remote urban area as a “dumping ground” for socially marginalized persons is consistent …with the [earlier] development of “madhouses” in England and France…Keeping people away in a place like Ward’s Island …can serve a number of functions in society: keep them away to protect to protect worthier members of society from contagion; keep them away to protect “good people” in society from whatever dangers they are assumed to pose; keep them away so an not to be reminded of uncomfortable truths…All of these functions are clearly present in the minds of policymakers, who dread community opposition and bad publicity. (15)
Or, as the acronym goes, ‘NIMBY’: not in my backyard.
Yanos expands, social cartographer who has been there, expands on his theme:
The story of Ward’s Island…is a case study of the U.S. mental health system, encompassing the start of the asylum movement, the rapid degradation of its lofty goals, the optimism of the early deinstiutionalization movement, the disappointments that quickly followed…all within an overriding context of oppressive social systems, scarces resources, and public stigma. (16)
It is illegal to discharge someone from a state hospital to the streets or a shelter. (NYC, incidentally, is the only city in the country that mandates offering shelter to those requesting it.)
Yet deinstitutionalization looked good on paper — It drastically reduced the size of state hospital populations. But where do these people go?
From the earliest days of the city, Ward’s Island was a place for immigrants. By 1866, the city authorized the construction of an Inebriate Asylum for drunkards there. The institution that ultimately defined the island, the forerunner of Manhattan Psychiatric Center, was a branch of the NYC Asylum for the Insane, which opened in 1871.
The earliest approach to the severe mentally ill was custodial; up to and including ropes and chains. Warehousing, repugnant to many, was superceded by ‘moral treatment’, with social work, live conversation with other human beings, interest and where possible intercession in the dsyfunctional life styles of wardees.
Then came somatic treatments, many of them harsh and unreasonable, including both warm and ice baths, meds (Metrazole, barbiturates) as were available, then demon lobotomy, electroshock. Reform and scientific progress led to replacement of these with today’s evidence-based treatments, targeted medication strategies, coupled with community treatment. In 2022, Blacks and Hispanics made up over 60% of the overall homeless population.
People of color and immigrants, Yanos notes, have been and still are overrepresented among the mentally ill, particularly those diagnosed with schizophrenia: psychiatric diagnosis as the handmaiden of societal labels and prejudice.
Everyone benefits when mentally ill persons can return in one form or another to society.
Community placement costs at least 70% less than inpatient hospitalization.
Yanos documents an on-going struggle between socially-minded city planners and affluent interest groups, viz. private school parents in Manhattan wanting more recreational sports areas for their kids – the so-called ‘contested spaces’ in gentrified cities.
City planning Fuhrer Robert Moses, as was his habit, got involved, usually on the side of ‘benign neglect’ of the poor, that is, favoring utilization of public spaces for auto traffic and thoroughfares, at the expense of displaced former residents. Yanos’ sweep is near-magisterial, he explains how the single room occupancy hotels on NYC’s Bowery were satellite community placements for those who might otherwise have found a berth on Ward’s Island – people with grave mental illness are consistently overrepresented among the homeless. Further, the War on Drugs, initiated by then President Nixon, was a contributing factor in the overrepresentation of people of color among people experiencing homelessness. Antipathy toward the homeless mentally ill is absolutely encouraged by interest groups like the NRA.
On Halloween night, 1990, a dozen or more youths wearing masks walked over the footbridge connecting East 103rd street in Manhattan to Ward’s Island and attacked men sleeping in the shelter with meat cleavers and bats. Isolated incident, or the pointing of an abscess otherwise known as ‘Law and Order, safety first’?
Ward’s Island has served historically as a home for society’s most disadvantaged. Today the residents of the hospitals and shelters there are mostly Black and Latino men. It is also now serves as home to a large number of asylum seekers from West Africa and South America.
Some feel state hospitals should be closed outright – witness the Trieste Model, advanced by Franco Basaglia in Italy, where state psychiatric institutions have been replaced with community-based services, and considered by some to be a success.
Yanos, in this contemporary Baedeker’s guide to Ward’s Island, overlooked one attraction, a metaphor for the island (and for society’s handling of the chronic mentally ill) if ever there was one: the NYC Fire Academy, where trainees set model buildings on fire, practice extinguishing the blaze, then burn them down again.
One thing is clear: deep journalistic inquiry, such as Yanos’ Exiles in New York City, sheds much-needed light on a social morass that has been with us far too long. His reportorial zest, coupled with an inspiring sense of humanity and deep inquiry, is present on every page of this eye-opening book. This is a book about how we choose to live now, even when some of our lives are sequestered, shaded from prying eyes behind a meshwork of barbed wire fence.
About the reviewer: David Brizer is a Bronx-based book critic and author, His most recent novel, The Secret Doctrine of V.H. Rand, was published by Fomite in 2024.