Two-Step is a tall, skinny black man who has lived at the Nashville Union Rescue Mission for seven years. In nice weather he can be seen standing beside the Mission holding his pajama bottom up with one hand and doing a slow, rhythmical shuffle, hour after hour. He has been doing this since he was brought to the front of the Mission seven years ago from Central State, the mental hospital where he had spent all his adult life. Two-Step would like this book. It would explain important things to him, such as why he is now out on the street, doing a two-step in the sunshine, struggling to survive in a chaotic world he doesn’t understand.

But Two-Step doesn’t understand why, nor do the other mentally ill among the half million or more homeless persons lining the nation’s streets or adding to the hopelessly overburdened jails and prisons. Dr. Torrey documents with precision and clarity the process by which Two-Step came to shuffle in the sunshine by the Mission, and it is a story that every legislator should know.

Freud is part of the tragic tale, and so are the dreamy political tinkerings of the Camelot era. But the broom that was to sweep the mental hospitals clean was made; in the busy Social Planning Workshops of the Great Society of President Lyndon Johnson. From the early postwar years a movement led by “politically sensitive” psychiatrists had actively opposed the large state mental hospital structure. This movement sprung in large part from the orchestrated “outrage” of the “conchies” (conscientious objectors) who were allowed to work as attendants in mental hospitals in place of serving in combat units. And by the late 50’s a group at the National Institute of Mental Health (NIMH) had begun discussing “mental health” as a solution to the growing ills of the cities, especially poverty. Dr. Leonard Duhl, then chief of planning at NIMH, said that mental disease was a “socially defined condition” and that mental health “must be conceived as a social problem.”

The problem then was no longer the care of mentally ill patients; it was now to minister to a “mentally ill society.” Duhl had argued earlier that nothing would be accomplished if a patient from a low-income background was cured in the hospital and then returned to the poverty community. “It is therefore the total society,” Duhl had said, “that needs a mental health treatment program.” No one questioned how removing the mentally ill from the hospitals to the community would serve as a “mental health treatment program” for the community. (Actually, it did. But it wasn’t the kind of treatment program Duhl and the others had in mind.)

By the summer of 1963 the struggle of the activists to replace mental hospitals with community mental health centers (CMHC) was nearing an end. Substituting CMHC’s, not-yet built and only vaguely developed, for inpatient mental hospitals was the first domino. The political groundwork was done by Duhl, Dumont, and other like-minded psychiatrists at NIMH. Social education was accomplished by a then-rising guru of psychedelic drugs. Ken Kesey, with his One Flew Over the Cuckoo’s Nest. (The movie version has been required viewing for five generations of college students.) In college, students read Szasz’s The Myth of Mental Illness and Goffman’s Asylums. The first vows that mental diseases do not actually exist but are merely labels; the second asserts that “if somebody would just open the gates and let, these people out, the patients would not have to behave strangely anymore.”

All that was needed now to accomplish the long-awaited task of “returning the mentally ill to the community” was somebody with the key to the gate. Just 22 days before he was assassinated. President Kennedy signed the legislation creating community mental health centers. But those who believed that the patients no longer “would have to behave strangely” or that they would be cared for in the community mental health centers were going to beshocked.

There were about one-half million patients in public mental hospitals in the early 60’s. During the next decade, four of every five would be released. This is what that word is all about. “Deinstitutionalization,” says Torrey, “which originally implied services, follow-up, and aftercare, has instead been an act of dumping unprepared patients into unwilling and unready communities.” The community health centers, rather than attempting to care for the depressing, seriously ill ex-patients, turned instead to schools for drunken drivers and to fawning over the “worried well.” As a consequence, upwards of 200,000 mentally ill are now left with “Nowhere To Go” but to wander the streets of every large city in the nation. The drain on the already strained budgets and energy resources of large cities—for police, indigent health care, and public assistance—has been enormous. Lack of aftercare for the mentally ill has produced economic and political aftershocks that have shaken city governments.

Torrey provides us with good news and bad news. The bad news is that we have learned so little from the tragedy. The issue continues to be dominated by those public officials, many of whom maintain that the homeless mentally ill are individuals without homes who became mentally ill because they were homeless. Remember that was the argument of those who emptied the mental hospitals in the first place: these people behave strangely because they are locked up in mental hospitals. Thus, the victims cannot be returned to the hospitals nor be treated for their illness before they are “decently housed” which, in effect, dooms them to remain mentally ill on the streets.

There are two pieces of good news. First, Torrey says that there is sufficient money available to provide excellent care for the mentally ill—$17 billion in 1985. (Isn’t it refreshing to hear someone say that money is not the problem?) That is encouraging and half the battle. And then, there is this book. Reading the account of how a few highly motivated visionaries were able to change the entire structure of care for the mentally ill in a decade is a testament to perseverance. What is needed now—and desperately so by the suffering mentally ill on the sidewalks—is a group of highly motivated visionaries dedicated to changing the entire structure again, this time in the best interest of the mentally ill who have been made homeless. If there is not a group of men and women so dedicated already in place, then it is up to the next administration to put them there.

[Nowhere To Go: The Tragic Odyssey of the Homeless Mentally Ill, by E. Fuller Torrey (New York: Harper & Row) 256 pp. $18.95]