A wavy bench on the train platform offers seating but no place to lie down

Keep It Moving: Transience, Debility and the Management of Homelessness

Public transportation areas have increasingly incorporated principles of “defensive urban architecture.” But such locations have long been part of the infrastructure of homeless services. What is the effect on people who are homeless, inquires Terrance Wooten, when the environment itself is hostile to them?

I woke up on January 10 to six unread text messages from six different people, a personal record. All of them were virtually the same: “Have you seen this?!” Attached was a link to a video originally posted on Facebook by a passerby in Baltimore, Maryland. The video, which has now sparked national controversy, was of a 22-year-old black woman who had just been discharged from a “local hospital” onto the streets.

Dressed in only a thin hospital gown and socks, the woman can be seen at various moments hunched over, slowly walking back and forth at a bus stop, disoriented and struggling to speak. She is unable to respond to questions but is trying; guttural moans and wailing escape her lips. A knot is on her forehead and gauze taped to her right hand. It is clear she is in no shape to be outside, let alone outside in 37-degree weather at midnight.

She eventually sits on the bus stop bench, which had been partitioned with armrests and constrains her mobility. Her belongings, which had been placed in plastic bags and left with her, lie at her feet. The man making the recording narrates the event for the viewer: He had just gotten off work when he witnessed security guards at the hospital wheeling the woman to the bus stop with her belongings and dropping her off. Concerned, he asked about her safety, but when he realized she was in duress and could not respond, he called 911. An ambulance picked the woman up and took her back into the hospital. 

The video immediately went viral, and it was through its virility that the woman was identified. While scrolling through Facebook, the woman’s mother recognized her daughter and reached out to the staff at the hospital. She discovered her daughter had since been discharged and sent in a taxi to a shelter in the city. There, the mother was able to locate and reunite with her daughter, who was reported to suffer from serious mental illness. She had been living in a residential youth program since she was 18 due to her challenges.

Since the video posted, the hospital has come under fire for carrying out yet another example of “patient dumping,” wherein vulnerable patients, usually people who are homeless or transient, often those with serious mental illnesses, are discharged to the streets or a shelter. They are “dumped” because they have no other place to go and do not have the financial means to remain in care or pay room and board somewhere else.

In 2007, CBS’ 60 Minutes did a segment on patient dumping in Los Angeles, finding that it was becoming a standard practice to discharge patients to Skid Row, an area known for containing one of the largest populations of homeless people in the U.S., particularly but not exclusively those with severe mental illnesses. Rapid deinstitutionalization of state hospitals in the 1960s and 1970s led to an increase in individuals diagnosed with a mental illness not having anywhere to go, many of whom found themselves homeless. Inadequate funding for community mental health centers coupled with increasing costs of housing and medical care as well as a lack of family support left many people down and out on the streets, as Peter Rossi documented in his seminal text.

While many news sources have reported on the problem of patient dumping, the burden that deinstitutionalization has placed on hospitals and shelters, the growing collusion of capitalist interests with health care provision, and the lack of support services for individuals with mental health issues, two things about this story immediately caught my eye: 1) the young black woman was left at a bus stop; and 2) she was eventually sent to a shelter, despite it later being discovered that she actually had a place to live.

These were not accidental or happenstance decisions. Rather, in discharging her, the assumption was that she was stable enough to go to the streets. In dropping her off at the bus stop, the idea was that she would then use the bus to go a shelter. That she was eventually sent to the shelter via taxi corroborates this reading. She was not intended to stay at the bus stop; this is especially true given the weather outside. Here, we see how the city’s public transportation and infrastructure functions as integral parts of homeless services. But where was she supposed to go, and what does it take to get there?

The nearest searchable women’s shelter is approximately one-half mile away from the hospital by bus, which runs in 20-minute to 1-hour intervals after 9 p.m., depending on one’s location. After being dropped off at the closest stop to the shelter, she would have had to walk roughly five minutes the rest of the way. If the shelter could not take her or had no room, she would have had to go back to the bus stop, wait and head to another shelter. This process of constant movement and potential uncertainty — as well as the expectation that individuals without a place to call or claim as home undergo this process — is debilitating. It literally wears on the body, as indicated by the moans of the woman and her shivering flesh. Covered only in socks, her feet were supposed to do the labor of carrying her around the city in the cold. The bus was her assistant, albeit one that did not operate as quickly as her shivers, an all too common narrative.

During my two years of fieldwork in a suburban county south of Baltimore, I regularly witnessed people being shuffled from one shelter to another, bags like this woman’s — sometimes bigger and heavier — over their shoulders, the cold biting their skin as they waited on buses or trains or walked from buses to trains. Often, they would arrive at one location just to find out they had to go to another due to a lack of room. When they would drop into gas stations or late-night fast-food restaurants to get warm or rest their bodies, they would be rushed out for loitering — or worse, accused of theft, sometimes having the police called on them. Some of them had severe mental illnesses or medical conditions like the woman in the video. Others of them were just down on their luck. All of them were trying to find a place to rest.

Mobility is integral to the city and city life. Increasingly, communities have been demanding forms of transportation that make urban (and suburban) spaces more accessible and environmentally friendly. New bike lanes, trolleys, bus routes and walking trails have emerged across various landscapes to help people experience urbanity in exciting and equitable ways. At the same time, we have seen the ever-constant privatization of public spaces and the rise in “defensive urban architecture” used to deter transient populations from lingering in certain areas of cities and suburbs, painting them as a threat to the order and movement of space. As such, they are forced to keep on moving, not staying too long in one place, even when that place is the hospital.

As scholars and activists continue to think about how to best serve, support and intervene in the lives of those experiencing homelessness as well as how to make more accessible landscapes, it is critical that we be attentive to how processes of debilitation — the slow wearing, tearing and tiring of the body — shapes the experiences of navigating both the city and homeless services. Transience is exhausting, and that exhaustion is debilitating; it can also be deadly. What this suggests is that homeless-service providers, urban designers and planners, and government authorities all have to be integrated agents in the fight to end homelessness, with an eye toward making movement across urban landscapes less debilitating.