I had a short-term job some years ago working at a home for dual-diagnosis adults. The best thing about that job was each night, on my way home, heading out of the driveway past some of the men’s group homes where, in all but the harshest weather, the guys would all be gathered on the porch. So the last thing I would see and hear each night before leaving was a half-dozen beaming faces and waving hands as they wished me good night and told me they’d see me tomorrow. Best perk I’ve ever had.
The worst thing about that job was the paperwork, especially the paperwork for the dozen or so individuals in our care who were former residents of the Pennhurst State School. That paperwork was a difficult chore, but a worthy one.
You may have heard of Pennhurst. If not, picture the hospital in One Flew Over the Cuckoo’s Nest, only worse. More than 2,500 mentally retarded Pennsylvanians were warehoused and neglected there in 1968 when WCAU reporter Bill Baldini arrived with a camera crew. Philadelphia’s Channel 10 News is still proud of this Pennhurst Special Report, calling it “perhaps the most important news report” in the station’s history. That pride is well deserved. This is what good journalism can do — speaking up on behalf of people with no voice, shining a light into dark corners and provoking change.
That report helped to prompt a class-action lawsuit on behalf of the residents of Pennhurst — a case that wound up going all the way to the Supreme Court of the U.S. three times, where it became a landmark decision regarding the care of the mentally ill. Eventually, nearly 20 years later, Pennhurst was closed and the Commonwealth of Pennsylvania promised that its residents would never again suffer from the kind of conditions they suffered there. That promise involved, as I said, a great deal of paperwork to ensure that it was being kept, but we were glad to be keeping that promise and glad, even, of the burden of documenting it.
I’ve been thinking about the Pennhurst case lately due to a series of reports in the paper by Lee Williams documenting “Trouble at Delaware Psychiatric Center.” The scope of this trouble is nowhere near the scale of the Pennhurst scandal, but it arises from many of the same underlying dynamics. Caring for those suffering from mental illness is not easy and it is not cheap and it never stops. This is even more true for dual diagnosis individuals (those with some combination of mental illness and mental retardation).
Deciding what our obligation is for such care and how we should go about providing it is a challenge made all the more confusing by the many different and undifferentiated competing notions of what we mean by “we” and “our.”
Here is another instance in which the principle of subsidiarity is not only helpful, but necessary.
We are poorly served by the widespread belief that our society involves two, and only two, kinds of political actors: individuals and the state. Subsidiarity, by contrast, recognizes the existence of a host of other actors and agents: families, neighborhoods, civic groups, schools, universities, businesses, churches, religious congregations, nonprofits, etc. Refusing to acknowledge the existence of such actors means refusing to acknowledge the relationships and responsibilities that individuals and the state have to them, which leads in turn to a distorted, Hobbesian, understanding of both individuals and the state. Individuals become viewed as detached, solipsistic atoms engaged in a war of all against all. The state becomes viewed as a monolithic, gargantuan Leviathan — a threat to, rather than the created servant of, the individuals. They are viewed as binary opposites, a view that allows in turn only the binary possibilities of socialism/totalitarianism or anarcho-libertarian/social Darwinism.
(It’s worth noting that the American Constitution rejects this binary view with its distorted understanding both of individuals and of the state, and it does so in its first three words.)
This binary outlook cannot accommodate the mentally disabled. They are, like all children, dependent, and thus incapable of surviving in a Hobbesian jungle. They are dependent, first and foremost, on their families. Acknowledging the reality of such dependence, and of the reality of the existence and obligations of families, shatters the illusions of the binary outlook and forces us to consider the wide world that exists beyond its artificial walls.
The mentally disabled are like all children, only more so. They will never grow out of it. Raising a 4-year-old is a challenge. Caring for a 4-year-old who will always be a 4-year-old, even as his body becomes the body of a 24-year-old, and a 34-year-old, can be overwhelming. Families facing such overwhelming dependence tend to become, themselves, dependent on outside help.
Those who can’t imagine any actors other than individuals or the (federal) state cannot imagine any sources for such outside help other than some kind of federal response — whether institutional or a cash transfer, paid for with tax revenue that they view, by definition, as confiscatory. Here in the real world, however, that help can come in a variety of forms from a variety of different sources: from extended family, neighbors, community groups, schools, businesses and charities (faith-based or otherwise), and from multiple levels of government — municipal, county and state as well as federal.
The idea of subsidiarity is that all of these different actors have different and complementary responsibilities in society. Each has a particular role to play, and the most just and most efficient scenario is one in which each plays its appropriate role and meets its appropriate responsibilities. The presence in our society of intensely dependent mentally disabled people is similar to the the presence in our society of orphans — the situation we looked at earlier as an illustration of the importance of subsidiarity. These individuals’ families hold the primary responsibility for caring for them, but when the family is unable to do so all of these other actors have a role to play.
Ideally, these other actors will be able to support the family, strengthening its ability to care for its members in need. Such support may be financial, or in kind, or in assistance with providing care. But the individuals may still require more specialized, professional care. We could walk through numerous best-case, and next-best-case, and next-to-next-best-case scenarios here, as we did in looking at the foster care system, seeing how in each scenario the failure of any of the various actors to play its appropriate role will result in slightly worse, slightly less effective care. Ultimately, if all the actors from the family on down the line fail to fulfill their responsibilities, then all that will be left is the state — the actor furthest removed and therefore least likely to provide efficient, quality care. Again, this does not result from nefarious government seeking to amass power to itself by usurping the role of these other actors, but rather from these other actors abdicating their responsibilities so that only the state remains as the provider of last resort. The end result of such a situation tends to look like the Pennhurst State School.
Judge Broderick’s decision to close down Pennhurst and to recommit to the mentally disabled, whenever possible, living in the community was a reaffirmation of subsidiarity. It requires a vigorous, but appropriate, role for all levels of government. The state’s role in all this is, foremost, to empower and enable all the other actors to meet their appropriate responsibilities as well. That involves both incentives and regulations, both tax deductions and funding that comes from tax revenue.
The taxes that provide such revenue are legitimate because they arise from the decision by “we, the people” that we do not wish to live in a society in which our most vulnerable and dependent are locked away in houses of horror like Pennhurst, because we have decided that these perpetual children ought not to have to fend for themselves on the street and that their families ought not to be crushed by the responsibilities they may not be financially or technically capable of fulfilling.
You anarcho-libertarians are free, of course, to disagree with this decision. You can complain that any taxation, even the negligible amounts required here, constitutes the theft of money that belongs to solipsistic, atomistic, individual you. But please recognize that in doing so — in abdicating your membership in “we, the people,” and refusing to participate in meeting any responsibilities that entails — you are contributing to the growth of the very government you supposedly dread, forcing it to expand to fill the vacuum left by your refusal to be a citizen, neighbor, parent, cousin, parishioner, executive, volunteer or taxpayer.
But in any case, don’t complain to me about it. I really had nothing to do with making humans social animals who live in differentiated, mutually dependent societies far more complex than your cramped, binary scheme. That just happens to be the way it is, whether you like it or not.
(Pennhurst photo from this site.)