Should We Bring Back Asylums? A Deep Dive Into Executive Order 14321

I have lived in Philadelphia and Washington DC, and I will be going to grad school in New York City. Just like any other experienced city dweller, I have had a few… interesting things happen to me.

I will never forget a man I still refer to as Metro Shrek. Soon, that name will make a lot of sense. I went to GWU in Washington DC and lived very close to the metro. Unlike most subways, the metro is relatively clean and usually affordable, so my college friends and I would travel the whole city whenever we wanted. The point is, I felt very comfortable.

So comfortable, in fact, that I felt perfectly fine walking without looking where I was going. While messing around on Instagram and/or Tinder, I smelled something strong. I turned off my phone. I looked up. And when I looked up, I saw a massive, 6’7 man who was completely naked. I literally jumped back, fell, and hit my head. Fortunately, 19-year-olds have a way of staying uninjured despite their occasional impulsiveness. That being said, I was extremely unhappy, as one would imagine.

Unfortunately, that’s not the last time I had an experience like that, and every urbanite on the planet Earth has gone through this at some point. Many women, my girlfriend included, have mentioned how unsafe the city can be, partly because of the homelessness epidemic that has struck many major cities in recent years.

First, let me clear up a few misconceptions. Despite popular opinion saying otherwise, the vast majority of the homeless, even those with mental problems, do not victimize or harass others. In fact, they are more likely to be the victim of a crime than a perpetrator. According to the Centers for Disease Control and Prevention, only around 40% of people experiencing homelessness stay in unsheltered locations, such as in a car or outside; the rest primarily stay in emergency shelters and transitional housing.

The person you see in your mind’s eye when you think about homelessness is usually not the result of being unhoused alone. What you physically see on the street is not representative of most of the unhoused population. The wild things we see and hear in the city are often caused by a combination of a lack of housing, combined with either a drug addiction or a severe mental disorder like bipolar disorder, schizophrenia, or other hallucinatory disorders.

So it is not surprising that many people support Donald Trump’s newest executive order: Executive Order 14321. The administration unironically gave it a vague title that almost seems satirical: Ending Crime and Disorder on America’s Streets. Despite the menacing name, this legislation is something that many people, some disability activists included, have been wishing for.

So what does it do? Simply put, it reverses America’s policy since the 90s of little to no involuntary hospitalization. Put simply, people with severe mental illnesses can be sent to a mental hospital — even if they don’t want to go. But before we can truly explore the implications, we need a brief history lesson about the Olmstead v. LC Supreme Court decision.

Before Olmstead

For most of American history, involuntary commitment was very easy. This wasn’t always at the hands of the state. Up until the rise of state hospitals in the Industrial Revolution, most people who had “gone mad” were either shunned from society, sent off to an exorcist, or simply kept under the close watch of their family. For the most part, local communities dealt with those suffering from mental illness however they saw fit.

At the time, mental illnesses were misunderstood. Until the Renaissance, it was believed that all humans had four humors (liquids within the body) that determined not only their physical health but also their mental health. That’s where the term humorous comes from; it moves your emotions and impacts your “humors”. These included blood, phlegm, yellow bile, and black bile. Having too much of one or too little of the other could cause problems; they had to be balanced.

Therefore, it was obvious that all you had to do was just drain out some fluids (usually blood) to fix most ailments! Unfortunately, this was wrong. So wrong in fact that it resulted in the death of America’s first president.

This changed in the 19th century. State-operated mental institutions became common in most developed nations, where those with mental disorders could be treated. That’s when we saw the emergence of dedicated "asylums" and "training schools." Initially conceived with some philanthropic intent, often believing that a rural, moral environment could "cure" mental illness or train individuals with intellectual disabilities, these facilities quickly transformed.  

The first public psychiatric hospital in America, Eastern State Hospital, opened in Virginia in 1773. The first dedicated facility for persons with developmental disabilities opened in Massachusetts in 1848. These institutions, despite their initial educational or therapeutic aims, rapidly became overcrowded and underfunded. They housed a wide range of individuals, including those with mental illnesses, developmental disabilities, physical disabilities, and even criminals, often without proper separation or individualized care.

The early 20th century saw the rise of the horrific eugenics movement, which significantly fueled institutionalization. The belief that "undesirable" traits should be eliminated from the gene pool led to widespread forced sterilization of people with disabilities. In 1927, the Supreme Court, in Buck v. Bell, upheld the constitutionality of mandatory sterilization, a ruling that stands as a shameful stain on American jurisprudence. This era cemented the idea that people with disabilities were a societal burden, best segregated and prevented from reproducing.  

As time went on, these institutions became more and more crowded. By the mid-20th century, particularly after World War II, the institutional system exploded. Facilities became massive "human warehouses," often housing thousands of residents. These institutions were typically isolated from communities, out of public view, and largely unregulated.  

This resulted in copious amounts of abuse up and down the chain of command. Patients with disorders that made them yell or lash out were often put in a straitjacket and thrown into a padded cell for days on end. Solitary confinement, physical abuse, and even sexual abuse were common inside these institutions. Few strong regulations existed, and the few that existed went unenforced. Even worse, many people were locked in an asylum unfairly. For example, women who were viewed as promiscuous could be said to be insane and thrown into the asylum. Therefore, it can be said that many of the people thrown into these places were simply those who went against the norms of society.

Sanitation was often deplorable. Residents lived in unsanitary conditions, often naked or in rags, covered in their own waste. There was a severe lack of adequate clothing, hygiene supplies, and personal care. Even worse, severe underfunding and staff shortages made it almost impossible to provide every patient with even minimal care. One attendant might be responsible for dozens of residents, making individualized attention impossible. Basic needs often went unmet.

Over time, public opinion shifted. Early advocacy efforts included parents organizing for their children's rights (e.g., The Arc, founded in 1950 by parents of children with intellectual disabilities), and disabled veterans advocating for accessibility. Inspired by the African American Civil Rights Movement of the 1960s, people with disabilities began to demand their own civil rights, asserting that disability was a matter of civil rights and discrimination, not just a medical issue.