Lost but not Found: A Review of Philip Yanos’ Exiles in New York City
Introduction: The mental hospital at the heart of the matter
Philip Yanos, PhD, a psychology professor at John Jay College, who is also secretary of the City Voices board of directors, has written Exiles in New York City: Warehousing the Marginalized on Ward’s Island (Columbia University Press, 2025).
It is a scholarly (24 pages of footnotes) yet easy to read (137 pages of text) examination of how different forms of stigma are transformed into social ostracism. Whether you experienced mental illness, addiction, intellectual disability, dementia, poverty, homelessness, criminal conviction, or lacked status as an immigrant, chances were you ended up on Ward’s Island in the East River between 1847 and the present day.
This mixture of “mis-fits” was overseen by a jumble of managers, whether city and state governments or independent authorities and non-profit agencies, who believed that they knew what was best for their charges. But the heart of Yanos’ history is the evolution of the NYC Asylum for the Insane into Manhattan State Hospital, with 8000 troubled souls in 1930, the most in the nation, renamed the “Manhattan Psychiatric Center” by 1980 after deinstitutionalization reduced the census to some 1300 residents.
The costs and benefits of isolation
Parallel to building and filling institutions with the city’s dispossessed was the struggle for control of the rest of the island’s land use, including its eventual physical connection to adjacent Randall’s Island and the city proper via an assortment of bridges (including the Triborough, now the Robert F Kennedy.)
Thus, the initial isolation of the island as a “dumping ground” immune from the opposition of neighbors to “misfits in their midst” led to Ward’s becoming not only the site of the city’s first sewage treatment plant but also development and preservation of parkland that threatened the very existence of the previously built environment.
Much as these and the other institutions serving the island’s dispossessed were perennially under budgeted and falling into disrepair, Yanos, who has championed the psychiatric survivor and peer support movements, surprisingly finds that, over the years, the hospital’s staff did its best to help patients.
This conclusion is based on the major limitation of his study, namely its lack of testimony by the “inmates” themselves. Instead, he relies mainly on the superintendents’ annual reports for insights into how well the hospital functioned. (Opened In 1871, the initial Asylum for the Insane’s inhumane conditions were indirectly profiled in Ten Days in a Madhouse by the journalist Nellie Bly, who impersonated a patient at the women’s version on Blackwell Island.)
An island oasis in the making?
As early as the 1930’s, urban development czar, Robert Moses, has designs on Ward’s Island as a park that would require the closing and demolition of its domiciles. Even as this demise was delayed over subsequent decades, the island’s open space was little used until the 1980’s when private schools began appropriating if for ballfields, first on their own and then under the auspices of the Randall’s Island Sports Federation, later incorporated as the Randall Island Park Alliance (RIPA).
After years of being a dumping ground for the disposed, Ward’s, now subsumed under the new identity of Randall’s Island, was “invaded” by the very working- and middle-class people who had previously shunned the island’s inhabitants. This irony is writ large as the history of gentrification in New York City. Although Yanos decries it, especially the fences erected to separate the hospitals’ and shelters’ residents from the park’s users, RIPA’s success suggests that his plan for redevelopment of the Ward’s section into supportive and low-income housing for the previously marginalized is also possible.
Rather than abandoning the site and integrating everyone into community-based programs elsewhere in the city, Yanos claims that brief interviews in 2023, with just 30 residents and staff of the hundreds still living and working there, convinced him otherwise. I am skeptical that someone who has based his career on rigorous scientific proof would be so easily swayed.
In fact, his design, dreamed up with the help of his son, Theo, an urban planning student, is just that—a pipe dream—even if with the noble goal of transforming “a place of urban exile” into “a place of urban sanctuary” (page 137). With all due respect, what his plan needs for fruition, given the City’s current fiscal crisis and the continuing austerity of the Trump administration, is the deep pockets of an organization like RIPA that he views as a nemesis.
To further bring in from the cold Dr. Yanos’ urban exiles, I asked him the following questions:
1.You grew up on Ward’s Island when your father worked as a psychiatrist at Manhattan State. Then, your volunteering as a college student at the renamed psychiatric center convinced you to become a psychologist. How much did these experiences influence your decision to write the book? Was this the logical next step after your previous work, Written Off: Mental Health Stigma and the Loss of Human Potential (Cambridge University Press, 2017), about (self-) stigma or did you consider other possibilities?
Thanks for asking about this. These experiences greatly influenced my decision to write the book. I don’t know if it was the next logical step, but it was what I felt driven to do.
2.Having spent your career counseling clients, researching therapeutic techniques, and teaching students, you delved into dusty archives for “Exiles.” Why was it worth turning yourself into a historian when you could have written about the stories of participants in the “narrative enhancement” groups that are your principal contribution to the fields of psych rehab and peer support?
I guess I felt called to write the book because no one else had done it, thought that it was worthy of it, and I felt that my upbringing and experience as a mental health worker and stigma researcher put me in a unique position to do it.
3.The most informative part of the book is the reports of the hospital’s superintendents that were lost after 1970. Your speculations about what happened on the island from the 1970’s through the 1990’s mirrored the rest of the city’s history but are more complicated and harder to follow. How can you simplify your findings for this period?
I apologize if I have not written the book clearly- I did the best that I could.
4.This reliance on management’s and a few staff members’ perspectives short-change patients’ views, even though you briefly describe the experience there of Carlos, one of your former clients. In his New York Times article of December 24, 2025, Andy Newman’s interviews of Lamar Brown, a patient at Manhattan Psych, and of staff members, were more in depth than your whole book. Why were you apparently unable to find first-hand reports by any of the thousands of patients there during its century and a half of its existence?
Requesting archival patient records from the State Archives is quite a complicated process which I considered, but decided not to pursue for time constraint reasons. Instead I reached out through my networks (including City Voices) to try to conduct interviews with former patients, but I unfortunately did not received any responses. I do discuss what is in the public record about some specific patients (such as the late Linda Andre) over the years but was not able to get anything in depth. I did the best that I could within the time that I had available, and concede that the book would have been better if it included such stories (I’m not a professional journalist like the New York Times writer who you mention, but a public university professor, and am expected to balance writing a book with my other duties such as teaching, research and program administration).
5.When the hospital’s population declined to just 300 currently, those housed in other programs, such as (migrant) shelters, addiction rehab, and transitional living, remained steady at (a/several) thousand. Why didn’t you devote more analysis to these other services?
I did discuss those setting using as much information as I was able to find, but there was less information available.
6.You claim that Manhattan Psych’s care, though not cutting edge, was up to speed for the remaining long-term residents. Was this true for the Kirby Forensic Psych treating justice-involved individuals? To what degree did both offer revolving doors for patients who couldn’t maintain themselves in the community after discharge? Can you summarize the sources of the information about best practices?
I try not to claim anything- I discuss what is most supported based on the sources of information that are available. Regarding MPC’s practices, there was a convergence between what the former staff told me and what the hospital’s publicly available records indicated, which included research reports in scholarly journals. These sources indicated that they used evidence-based approaches as a matter of policy, in contrast between what was done in the 1980’s (based on what site visitors found and what I observed as a volunteer). I can’t confirm if Kirby Forensic Psychiatric Center’s practices are evidence-based because there was a lot less information available about it, but one of the former staff members stated that their treatment approach used evidence- based methods. So, less is known about what goes on in Kirby.
7.Given the almost 25 pages of footnotes, how did you determine what information went into the text for “lay” readers and what was reserved for your “scholarly” peers who delved deeper?
I tried to write the book for the “educated general interest reader” which is a type of reader that the publishing world talks about. It’s a person who reads non-fiction books on different topics. The goal was to have it be understandable by anyone regardless of their familiarity with a specialized topic. When writing in this style, I try to imagine that I’m talking to explain something.
8.You cite that visitors to Randall’s and Ward’s islands now number two million per year, while cynically noting that parkland expansion and gentrification in neighborhood go hand in glove. Given the benefits of open space for physical and mental health, shouldn’t you cultivate RIPA’s patrons and beneficiaries as constituencies to help realize your vision for the future, or, at least, to empathize with Ward’s residents who are currently shut out of such amenities? To what degree have you, your family, and associates benefited from what the greening of the islands offers?
I did reach out to RIPA while I was working on the book and they didn’t respond to my inquiry. It would be great if they were open to talking. I want to emphasize that I think that the work that they’ve done to improve the quality of the parkland on Ward’s Island is great, and my proposal wouldn’t take away any park space that currently exists- the area that would be used to create affordable housing would be in the area where the hospital currently is, which is currently zoned as residential (I’m not proposing to do away with the hospital either, just that the census could be consolidated into one building). I have personally benefitted from going on the bike path that was created as part of RIPA’s initiatives and wish that the island’s residents could also be able to enjoy it.
9.What is the website for comments about your plan and what kind of advice or support have you received there and elsewhere? Have you made any revisions as a result and how close are you to implementation?
The website which describes the proposal in more detail can be found here: https://www.wardsislanddesigns.org/ I’m just a college professor and advocate and don’t have the ability to implement anything policy-wise; I’m just trying to get the idea out to people who might be able to consider carrying some of it out. People who are interested can also listen to episodes of the podcast that I’ve been doing where some of these ideas are discussed: https://rss.com/podcasts/exiles-in-the-city/ In episode 1, I talk to someone who was a patient in the hospital in the early 1970’s, and, in episode 7, I talk to an urban studies professor who studied the redevelopment of Blackwell’s Island (now Roosevelt Island) and offered an interesting perspective on it. Anyone who wants to comment on any of my ideas can email me at pyanos@jjay.cuny.edu
10.Anything important that I missed?
Thanks again for your close reading of the book.
