Her first book reached out to mothers of afflicted and lost children, making common cause with their plight and her own. (And why is it, I ask again, that mothers seem always to be the point-parents in dialogues about m.i.? Where are the fathers?!) This second work is even more ambitious. It’s a compendium of stories that Ms. Ranahan has exhaustively retrieved from mothers in similar straits. It brings to mind the protean books of Studs Terkel more than a generation ago. Ms. Ranahan writes that she chose this interview-and-transcribe approach in lieu of “an extended rant,” and she has been forthright about the psychic weariness this journey has cost her. If you are lucky enough not to have lived in this horrific “sub-nation,” with its attendant catastrophes of diagnosis, effective treatment, ruinous healthcare costs, courtroom and criminal justice, effective political leadership, and awareness in the culture at large, please read Ms. Ranahan. And then get busy. You could help change the world. And DeDe Ranahan is now enshrined in the literature of enlightenment.
In the tradition of the late D.J. Jaffe, but with a psychiatrist’s grounding in nosology and a journalist’s zeal for social and civic truths, Insel explores the strange disconnect between stunning advances in the understanding of why and how the human brain can run amok, and the infuriating stagnation of actual reclamation for the mentally ill. He writes with laser-like clarity and the assurance of a master in his field.
I can’t recommend this book with any more persuasion than that of the great advocate Pete Earley, who writes on the back cover:
“’Healing’ is truly one of the best books ever written about mental illness, and I think I’ve read them all. Dr. Insel speaks as a parent, scientist, doctor . . . defining what’s wrong and offering clear-headed solutions—all the while guiding us forward with compassion, goodness, and hope in this juggernaut wake-up call.”
I am wearily–yes, wearily–posting links to two recent pieces by the peerless mental-healthcare blogger Pete Earley. Below them I’m linking to an archive within the blog you are reading now.
Their common denominator: they are about young brain-damaged men enduring Hell-on-earth lives on the streets of America as those who love them–mothers, sisters–trudge on through the years, and decades, trying vainly to awaken the conscience of the–the what? The whom? The withered, laughably misnamed “mental health” systems in their states that are restricted by outdated boneheaded rules and by the soul-deadened payrollers who run them. By the distracted politicians who appoint those payrollers and promptly forget them. By the oblivious electorate that will never form a constituency to keep the politicians on the case.
After his barbershop was vandalized by a mentally disturbed white man in Atlanta, Run The Jewels group member Killer Mike offered to help the man if anyone could identify him.
Killer Mike, a recording artist who is very vocal about supporting and enhancing Black entrepreneurship, posted a message on his Instagram account. He described his place of business being vandalized but used the moment to encourage others to “check on your mentally ill loved ones.”
The film version of NO ONE CARES ABOUT CRAZY PEOPLE, the documentary-in-progress, has a website as of Monday, December 27. Congratulations to producer Gail Freedman for achieving one more big step in getting this project to completion! https://noonecaresfilm.com
School shootings have haunted our collective consciousness for decades—a hoary specter that still grips us with dread—but this case brings new horrors to consider. It was not just any old spree of classroom murders carried out by a mid-adolescent with a semiautomatic handgun bought for him as a Christmas present by his Dad on Black Friday. This one dropped some new elements on us—and managed to bypass an element of omission. Advocates and all people of conscience must grapple with them, no matter the tedium and the elusiveness of solutions. Our sanity as a nation is at stake.
So, what must we grapple with?
First, a recap: the 15-year-old shooter, Ethan Crumbley, faces 24 felony charges for slaughtering four classmates and wounding seven other people with that semiautomatic handgun lying around in his parents’ bedroom. The charges include first-degree murder and terrorism. Ethan was captured before he could turn his Christmas present on himself. This is relatively rare, as is the high count of charges. The terrorism count may be unprecedented, and might set a legal precedent. Or it might set a legal obfuscation: The Oakland County Prosecutor Karen McDonald told CNN, last week:
“There is no playbook about how to prosecute a school shooting and candidly, I wish . . . it didn’t occur so I wouldn’t have to consider it, but when we sat down, I wanted to make sure all of the victims were represented in the charges that we filed against this individual . . . If that’s not terrorism, I don’t know what is.”
Well, with all respect, Ms. McDonald, it might be mental illness. More on that in a moment.
Here the “element of omission” takes center stage. Are the Crumbleys psychotic? Is Ethan psychotic? What is “psychotic”? How do we identify psychosis, and what do we do about it when we think we’ve seen it at work? Is this case an example of “shared psychosis,” in which some of the victims do not show clinical symptoms? What are the responsibilities—and the risks—of intervening in the actions of one who might be in a psychotic state?
These are old, wearying questions. They have been charged with fresh urgency by the bloody Oxford affair. Or should have been. After days of online searching, I have not been able to find an indication that any of the Crumbleys has received psychiatric diagnosis. I’ve found nothing but the most glancing speculation that serious mental illness—genetically inherited brain disease—was present in any of these people. And I certainly have found no serious, informed discussion about this possibility. And so the Crumbley story remains a missed opportunity at least as a “teachable moment,” a broad, ongoing national discussion on the nature of this beast. And on the policies—judicial/legal, educational, budgetary, and ethical—that scream out for rapid and thoroughgoing reform.
I am going to offer an example of policy dysfunction that I published in my previous blog. It was articulated by D.J. Jaffee, a disciple of the pioneering E. Fuller Torrey, who founded the invaluable Treatment Advocacy Center. Shortly before his death last year, Jaffe restated an observation he’d made many times in his talks and writings. It bears strongly on the Crumbley case:
“The law says we can’t do anything until after the psychotic victim becomes dangerous to self or others. As ludicrous as it sounds, the law requires dangerous behavior rather than prevents it.”
I cannot say whether Ethan Crumbley or his parents are mentally ill. A competent psychiatrist should and must make that call. I will say that telltale signs are blinking red.
There are Ethan’s notebook jottings, noticed by teachers: “The thoughts won’t stop. Help me,” and “Blood everywhere,” and “my life is useless,” and “the world is dead.” There are his sketches depicting a bullet and a bullet-riddled body.
There is the now-infamous message texted by Jennifer Crumbley to her son the day before he shot up Oxford High School, after a teacher told her that Ethan was searching for ammunition online in class: “LOL I’m not mad at you. You have to learn not to get caught.” And of course there is the fact of James buying that hideous weapon for his young son in the first place.
And there is the widely accepted thesis that if the rare onset of schizophrenia is going to occur, it typically occurs in mid-adolescence, Ethan’s period of life. This is the stage in which the prefrontal cortex is pruning itself of outworn synapses and generating new ones. If a genetic disorder produces over-pruning, an oversupply of normally essential chemicals such as dopamine can rush in and produce an imbalance that permanently damages the brain. (No thesis is yet seen as conclusive in the study of this affliction.)
The social effects of serious mental illness spread out in a widening cone from the victim through the family, the community, our schools, our political life, and the health of the nation. Mass shootings continue to be rare, but the debilitating dread of mass shootings is nearly pandemic. The cumulative costs are as under-appreciated by the populace as the nature of the disease itself. Ignorance, apathy, and fear continue to rule.
I have called in the past for creation of a federal cabinet-level department that would unify, critique, and extend policymaking in all these problem areas as well as others. Foundational reform of our disgraceful jails and prison systems, de facto catch-basins for the insane, for instance. Solitary confinement, that turns sane prisoners into madpeople and the mad into vegetables, must be abolished.
D.J. Jaffe disagreed with me about this. He felt that such a department would only add another layer of bureaucracy.
All right. Let’s add another layer of bureaucracy.
Mental-health reform is borne on the backs, overwhelmingly, of women: mothers of victims, mostly. Their advocacy work in the past twenty years alone has been heroic and sporadically effective. But these “secular nuns”—the phrase just came to me—are largely worn out and disillusioned. They carry on, but we must not depend on them to keep doing the trench-work that the problem demands. Our advocates need reinforcement—collective national reinforcement. Society must be made safe from our Ethan Crumbleys. Yet we must not let things rest at primitive blame and punishment. Humanity and moral justice call us to protect the mentally ill and to reclaim them if we can. This would be the most honorable means of protecting ourselves, and reclaiming our own souls.
The mass shooting in Michigan compels us to look again at psychosis, mayhem, and the enormous difficulties in warding off this witch’s brew.
The Crumbley family of Oxford, Michigan, and the victims of Ethan Crumbley’s early semiautomatic Christmas present purchased by Dad on the well named Black Friday, have been on my mind for the past week. I wish they would go away, and I wish It would go away. But they won’t go away, and It won’t go away. “It” being nightmarish gun violence in America.
In writing about annihilations such as this one, I would normally (strange word, that—“normally”)—I would normally jump astride one of my hobbyhorses as a mental-health reform advocate: I would renew my call for early intervention—diagnosing—as a means of thwarting people in the throes of psychosis before they act out their fantasies.
After Oxford and all its complexities, I realize that this “solution” is not enough. It may not even be attainable. Yet we have to try. We can’t go on. We’ll go on.
Instead of dashing off on the hobbyhorse, I have spent the week studying the case and renewing my layman’s education in mental illness. Here’s what has popped up:
It seems clear that the teachers and staff at Oxford High School went nearly as far down the road as humanly possible in reacting to the red alerts in Ethan Crumbley’s pre-shooting behavior. Nearly. On the day before the gunfire that left four students dead and seven wounded, a teacher spotted the 15-year-old Ethan looking at iPhone images of bullets in class. The next morning—D-Day—a teacher noticed Ethan at work on some deeply ominous sketches and writings: “The thoughts won’t stop. Help me,” and “Blood everywhere,” and “my life is useless,” and “the world is dead.” The sketches depicted a bullet and a bullet-riddled body.
The teacher reported these to a school counselor. Rushed to the counselor’s office, Ethan dismissed the materials as plans for a video game he was working on. (Police later found two videos that the 15-year-old had recorded on the Monday night before the slaughter. They showed him predicting what he was to do the following day.) The superintendent of schools called James and Jennifer Crumbley, Ethan’s now-infamous parents. In the 90 minutes it took them to arrive, school staff members observed and talked to Ethan as he sat in the office. His Christmas present lay unsuspected in his backpack. On arrival, Crumbleys were told that Ethan needed counseling. James and Jennifer shrugged it off and left. The school administration let the boy return to class. It was better, they figured, than letting him go home to an empty house.
At around 1 p.m., Ethan Crumbley began visiting classrooms.
I wrote above that the teachers and staff at Oxford High School had done “nearly” everything possible to prevent a young person in psychosis from a murderous rampage. What else might they have done? Here we enter the realm of the conjectural, and clarity is essential.
Those staff members acted—at least on the early evidence—with exceptional initiative and responsibility. Should they have gone further and called police? Perhaps. Michigan law permits protective custody and transport to a hospital by police if an officer observes behavior that suggests “a serious danger to self or others.” Would Ethan have sat and waited for the police to arrive at the school, and then thoughtfully exhibited his psychotic symptoms? Not likely, even should the officers have been trained to handle the situation, far from a foregone conclusion. As for these parents giving their permission . . . well . . .
The great, recently deceased advocate D. J. Jaffe best summed up this perverse tic of social policy:
“The law says we can’t do anything until after the psychotic victim becomes dangerous to self or others. As ludicrous as it sounds, the law requires dangerous behavior rather than prevents it.”
So there we are. And here we don’t go again.
Related to the subject of psychosis and mayhem, my week of re-education led me to an essay that merits reading by anyone interested in this issue. It has prompted me to re-think some facile assumptions I’ve let myself slip into. More on it tomorrow.
Among the most infuriating barriers to mental healthcare reform is the indifference of policymakers. The mentally ill don’t form a significant constituency, in voting or in contributions. Thus, you know, nobody cares.
State Senator Cindy Friedman, a Massachusetts Democrat, has burst through this complacency. Working with some colleagues mentioned below, Senator Friedman has crafted an important new bill and shepherded it through the Senate. It is on its way to the state’s House of Representatives for enactment into law.
The ABC Act, as it is called, should be a model for every state in the nation. And it signals to reform advocates that they have a new champion. Kudos to Senator Friedman. And thanks to my fellow advocate Donna Erickson for the heads-up!
Here is a glimpse inside the soul of an activist. Leslie Carpenter of Iowa City, Iowa, is among the very best we have. She has connected, and deeply, with people at all levels of public service to implant her passionate agenda of mental healthcare reform.
She also immerses herself in the lives, the despair, the desperate pleas for reclamation, from ordinary people who see their loved ones in agony. She embraces their anguished stories and does what she can to aid and comfort them. Often, her efforts fall short, as most of such efforts must. And when fatigue and frustration overtake her, she confesses it, eloquently, as in this Facebook post. Read it, please, and absorb a hero’s account of how god damned hard it is for all of us.
Sometimes in the life of being a very public serious brain illness advocate, I have people reach out to me for suggestions for loved ones, resources, etc. I try to respond to all of them and at least make an effort to reach them, give them all of my contact information, and let them get back into contact with me. Not all do, but when they do, I try to listen with a caring heart and share information that might be helpful.
Recently, I was asked to meet with someone who has worked within the system who wanted to share information with me of several cases and system failures they felt I needed to know since I work at the local, state and federal level to improve mental health care.I just left that 2.5 hour meeting feeling filled up with the poison of knowledge of so many cases with adverse outcomes, due to not just gaps in the system, but active choices of key people in the system.I have known there were problems, gaps, and challenges. I now know some of the people who specifically have caused harm, and my soul is feeling overwhelmed with sadness and disappointment.I need to move forward with solving some of this mess, and I will. But for now, I am sitting in a random parking lot crying and processing and figuring out the best next steps.For now, let me say this:We need more people to go public with this humanitarian crisis of not treating people with serious brain illnesses and not paying for them to be housed in the best level of care where they can be the healthiest and most stable.We need to care. We need to act, no matter how terrifying it might be to bring this information forward.#WeCanDoSoMuchBetterThanThis
The documentary-in-progress inspired by my book No One Cares About Crazy People rolls along. Here is an updated promo reel created by the producer, Gail Freedman.
Gail Freedman, the gifted and tireless producer of the documentary arising from my book No One Cares About Crazy People, has just revised and expanded the promo reel for the docu-in-progress. The new, riveting interviews show that Gail has traveled the United States on limited resources, eliciting personal stories from a range of afflicted people and their loved ones. She has also homed in on the unthinkable tragedy of the Rippee family of Vacaville, CA, giving us raw access to the ravaged Mark Rippee. Brava, Gail!
A personal note: the film now opens with my late son Kevin belting out “One More Saturday Night,” accompanying himself on an acoustic guitar, at age 7. Kevin was en route to becoming one of the premier guitar artists in the nation when he took his life in 2005 on the eve of his 21st birthday. Schizoaffective disorder.
I gave this tape to Gail early in the process. But I had not then listened to it myself–couldn’t. This morning was the first time I had heard Kevin’s child-voice in about 30 years.
No, seriously–and props, and godspeed to her! Her piece in the October 19 Washington Post turns a rare spotlight on one of the many under-explored areas of corrupt and viperish traps for mentally disturbed children.
Like solitary confinement–into which Ms. Hilton was dumped for a while, even though the foul world of “parent-approved kidnapping” has no law-enforcement authority–these predatory outfits are barbaric relics of the notorious “Bedlam” asyum, founded nearly eight centuries ago. Justice and human decency cry out for their abolishment, yet they and similar atrocities remain in business.
Paris Hilton’s bold denunciation has helped me to understand her for the first time, and to welcome her into the lists of reform advocacy. We need many more like her: public figures (all right, dammit, celebrities) who speak out from raw, often psychically crippling personal experience, to help us end the long sordid reign of abuse toward the mentally ill.
From the Washington Post:
Opinion: America’s ‘troubled teen industry’ needs reform so kids can avoid the abuse I endured
When I was 16 years old, I was awakened one night by two men with handcuffs. They asked if I wanted to go “the easy way or the hard way” before carrying me from my home as I screamed for help. I had no idea why or where I was being taken against my will. I soon learned I was being sent to hell.