Figure 1: St. Elizabeth’s Hospital in Washington D.C., one of only two mental asylums ever operated by the U.S. federal government (Courtesy of the Library of Congress) By Jeremy Peschard
In recent years, politicians in the United States have paid significant attention to two major political issues: firstly, the increased number of asylum-seekers at the U.S.-Mexico border, and secondly, the perceived dangers of homeless individuals with severe mental illness. At first glance, these might appear to be separate political and humanitarian crises; however, major U.S. politicians, such as Donald Trump, have connected them, echoing rhetoric from deep in U.S. history. Re-examining the history of psychiatry and immigration in the U.S. is a crucial exercise, as it reveals the complex and often unseen intersections between these two critical concerns.
As homelessness has risen in the country’s largest urban areas, both Democrats and Republicans have sought ways to address conditions that homeless advocates say is being treated more like urban blight than a public health or humanitarian crisis. In California and New York City, liberal politicians such as Eric Adams and Gavin Newsom have sought to resurrect involuntary psychiatric hospitalization as a way to reduce homelessness and provide “relief” to the homeless. The preferred mechanism in this case is to designate first responders with the responsibility of deciding when individuals meet a new lower threshold for an involuntary hold.
Republicans, meanwhile, are advocating for the return of large psychiatric asylums. From the mid-19th century to mid-20th century, state-run insane asylums were the most common form of mental healthcare in the United States. Their dismantling — part of a process known as deinstitutionalization — is commonly (mis)attributed as the primary factor in the increase of unhoused people who suffer from psychiatric illnesses. On the 2024 presidential campaign trail, presumptive Republican nominee and former-President Donald Trump proposed bringing back “mental institutions” during his second term. This, he argues, is the best way to remove homeless people from the streets and get them psychiatric help. Florida governor Ron DeSantis made similar promises during his presidential run, likewise calling for federally-funded psychiatric institutions.
The country’s second perceived social catastrophe is the nation’s “migrant” crisis. As refugees and asylum-seekers have sought safety in the United States in the largest numbers in twenty years, states and the federal government have failed to provide them with adequate shelter. This has left migrants to rely on non-profits and shelters for temporary housing. Fear-mongering rhetoric about vast numbers of unhoused asylum-seekers and “open borders” has sparked a backlash against migrants across the country.
These two seemingly disparate crises were connected by Donald Trump, who in December 2023, stated, “Illegal immigration is poisoning the blood of our nation. They’re coming from prisons, from mental institutions — from all over the world.” On a separate occasion later that same month, Trump again claimed undocumented immigrants from “mental institutions and centers” were “poisoning the blood” of the country and bringing disease along with them. Making no distinction between immigrants and asylum-seekers, he stated shortly thereafter that “millions” of people were illegally entering the country, and that some of these migrants were animals, rather than humans. Trump’s statements received widespread coverage and condemnation, primarily for their Hitlerian echoes. What remained largely unaddressed, however, was that his comments were rooted in a deeply American rhetorical and political tradition.
In the late-19th and early-20th centuries, politicians from New York to California believed that the large number of immigrants entering the country — Latin Americans, Asians, Italians, and Jews — represented a threat to the wellbeing of the “national stock.” In this era of eugenics, politicians, intellectuals, and medical professionals alike believed that unchecked migration from undesirable countries would lead to the “mongrelization” of the country and the rapid spread of diseases. Violent crime, insanity, and immigration were rhetorically connected by nativists who sought to severely curtail the number of immigrants from the “lower races” to enter the country.
Politicians and journalists sharpened these fears by suggesting “insane” and “criminal” migrants were intentionally being brought to the United States. As the Los Angeles Times claimed in 1905, “In many instances insane Mexicans [are] smuggled” across the border to receive psychiatric care in the US. Similar fears were prevalent for Chinese, Japanese, and Southern and Eastern European migrants. They became the targets of unfounded political theories, suggesting that foreign governments were deliberately sending their insane to the United States. Immigrants were, in fact, disproportionately institutionalized in the United States’ psychiatric facilities. This, however, was more likely attributable to societal biases regarding the health and wellness of immigrants — which has been detailed by historians such as John McKiernan-Gonzalez, Miroslava Chavez-Garcia, and Natalia Molina — than to any truth within such conspiracy theories.
Rhetoric suggesting ties between disease, insanity, and immigration had material repercussions on the lives of migrants. Over the course of the late-nineteenth and early twentieth-centuries, Congress passed increasingly stringent immigration policies. In 1882, the United States passed one of its first ever pieces of federal immigration legislation, barring those with physical or mental illness from entering the country. After that, the country’s immigration architecture expanded dramatically, adding requirements for medical examinations, legal provisions for deportation, and personnel for enforcement. The government of California even created its own statewide office dedicated to deporting any “insane alien” who was hospitalized in the state.
The result was that immigrants diagnosed with mental illness were physically removed from psychiatric hospitals by immigration agents, placed aboard trains, ships, and automobiles, and deported to their countries of origin. Recent works by historians Ethan Blue and Elliot Young have detailed the deportation process in these early years of federal U.S. immigration enforcement, suggesting that the institutionalization and deportation of insane aliens set the foundation for the country’s present deportation regime. The legal justification for deportation was that these individuals were “public charges,” unjust burdens upon the nation’s taxpayers.
In the 1930s, local states and municipalities used these claims about “public charges” —individuals who either relied on government assistance or were institutionalized in public facilities — to embark on one of the largest repatriation and deportation campaigns in U.S. history. The Mexican Repatriation, as it is now known, led to the expulsion of an estimated 400,000 Mexicans and Mexican Americans from the United States to Mexico. Due process and civil rights were trampled upon in these years, as governments sought to remove unwanted Mexicans, claiming they were drains on the economy and reliant on public assistance.
Accusations that immigrants are welfare abusers are not relics of the distant past. During his first term in office, Donald Trump sought to expand public charge regulations, making permanent residency much more difficult for individuals who had received public assistance. In 2024, Trump has not yet promised the return of additional public charge restrictions, yet his campaign rhetoric — accusing immigrants of coming from “mental institutions” and promisingthe “largest deportation effort in the history of our country” — does not augur well for the Latino community, people with mental illness, or those who are homeless.
Today, there are eight million Latinos in the United States with a mental illness, including 1.9 million with a serious mental illness. Latinos represent a disproportionate amount of the country’s homeless population and are the face of the migrant crisis at the southern border. As the United States faces the re-election of a man promising mass deportation campaigns and the formation of federally funded psychiatric hospitals, a reexamination of Latino American history is an important and instructive exercise. It reveals that claims about psychiatric disability, welfare, and unwanted migration have long been used to justify mass deportations and civil rights violations. As the 2024 presidential election moves forward, claims about homelessness, mental illness, and immigrants may be used toward disturbing and un-democratic ends. This is dangerous rhetoric which the country has seen before, and we should all be paying close attention.
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Jeremy Peschard is a history PhD candidate at Cornell University. His research examines medical exclusions and deportations in the late-nineteenth and early-twentieth century United States, focusing on public charge policy and psychiatric institutionalization in California and the U.S. Southwest. He can be found on social media on X @jeremypeschard and on TikTok @jeremypeschard.