Another Solitary Confinement Atrocity

This horrific story, originally reported by the excellent Milwaukee Journal-Sentinel and picked up by Slate a couple days ago, is yet another demonstration of my assertion in NO ONE CARES ABOUT CRAZY PEOPLE that “too many of the mentally ill in our country live under conditions of atrocity.” Terrill Thomas’s death by slow, deliberate, guard-induced dehydration while in solitary confinement at a Milwaukee County jail is an abomination, and a part of a larger national abomination. Our society must demand an end to solitary confinement!

Via Slate.com

Guards Who Left a Prisoner to Die of Dehydration, After Water Was Cut for Seven Days, Could Face Charges

Read the full story here: http://www.slate.com/blogs/the_slatest/2017/04/24/guards_who_left_milwaukee_prisoner_to_die_of_dehydration_in_cell_could_face.html

Voices From the Sub-Universe

Today I introduce a new, occasional feature to my blog. Please see below:

Ron Powers

Voices from the Mental Illness Sub-Nation

Near the beginning of my recently published book about mental illness, “No One Cares About Crazy People,” I write: Too many of the mentally ill in our country live under conditions of atrocity.

I grew convinced of this over the three years of my research into schizophrenia and its related brain afflictions that include schizoaffective disorder and extreme bipolarity. My examples in the book cover the spectrum of atrocity: mis-diagnoses (often “drug overdose”) by doctors; judges who order young victims into jail instead of treatment centers; beatings, deprivation of medications, and the torture of solitary confinement behind bars; death on the streets from bullets fired by untrained police; the daily fog and helplessness of the untreated insane.

These and some other areas—arenas—pretty much covered it, I was convinced. The spectrum of atrocity suffered by the mentally ill in America.

I was wrong.

I had limited my investigations to the barbarities visited on the “crazy people” themselves. Only after the book’s publication in March did a companion realm swim into focus for me: the realm of ordinary people whose lot is to care for the afflicted. These include mothers, fathers, siblings and friends of the helplessly impaired thousands whom our social bureaucracies have neglected and rejected and crushed. In many ways, these family members are damaged and abject as the loved ones they seek in vain to rescue.

No one cares, to coin a phrase, about those who care about crazy people.

This realm rushed at me in emails to my Facebook page and to the blog I created that related to the book. It swelled up within certain websites that I, as a writer about mental illness, was invited to join. These sites are closed off to anyone but relatives of madpeople; an enforced set of agreements keeps their conversations private unless they grant specific permission.

The writers on these sites are almost exclusively mothers—a fact that in itself merits contemplation. Mostly middle-class, they span several income, educational and racial categories. They are seldom “natural” writers, yet no one could mistake what they have to say. They write with the rare pitch of truth-telling passion that James Agee memorably described as “the cruel radiance of what is.”

What they have in common is a collective story more urgent, more morally devastating, more viscerally real, than be expressed by the modes by which outsiders receive information about mental healthcare: statistics and news items and policy statements and political press releases, delivered in detached, passionless prose.

Today, this blog commences an occasional compilation of these mothers’ voices (and those of other relatives as they are available). I have obtained permission from each source quoted, and have withheld identities, although some gave permission for that as well.

My hope here is twofold. One is that the reader will feel the same emotions as I have: shock and indignation that such chaos and neglect exist in America’s mental health-care systems, causing such a vast archipelago of misery and terror. The other is that these voices will encourage others to throw off fears of stigma and shame and begin hurling their own voices, their own testimonies, into the world. Only by putting human faces and voices upon the statistical morass of this ongoing atrocity can we hope to begin decisive, lasting reform.

 

We will begin with an example of the commonplace indifference and buck-passing at the community level that makes a mockery of the very phrase “mental healthcare system.”

 

“I have only enough strength this morning for a few lines. [My daughter] was discharged in 2011 with no psychiatric follow up appt. We scrambled to find someone, but before we could, she was readmitted to a second hospitalization. She had to drop out of school for a second time. She was too far behind. The [caregiver] had put her on a drug that literally made her bang her head on the wall. Then she was hospitalized another two weeks, and upon discharge the social worker made no referrals or linkages for her in the community, and would not respond to my inquiry about her diagnosis. I asked and her response was, ‘What does that matter?’

“She came home with us, and for the next two months, it was awful. In February, she was psychotic again, and ran out of the emergency room when I tried to get an evaluation. She was noncompliant with meds, and thought she was pregnant. She spent two weeks in one hospital and I threw a fit about her being sent home to us again because I had a 14-year-old at home to protect. She had become physically aggressive as well. They sent her to a state hospital after my totally pissing them off, and she stayed there for two months.

“My biggest frustration is no linkages, no follow-up, no support, etc. We were treated like nosy people wanting to meddle in our child’s life but, she was sent home to me to deal with every time. And, each and every time, I felt more inadequate to help her and to protect my other child. [Her sister] was terrorized and slept with her bedroom door locked. She also became angry with me, her mom, for not being able to protect her from her sister.”

 

 

Sometimes the afflicted family member is not a child, but a parent. Whether or not that parent has consented to treatment—and often they have not—the strain suffered by the spouse and children can be overwhelming. This eloquently written post offers an example:

 

“I must say that helping my kids to navigate their life in relation to their Daddy’s serious mental illness is serious emotional work. Tonight I held my 10 year old ‘Baby’ girl as she opened up and told me that sometimes she just starts feeling sad and then ALL of her sadness comes over her at once. I held her as she sobbed and sobbed. ‘Why can’t we have a normal family?’ ‘Why can’t we live in our own house where I could have my own room?’ ‘Why did my Daddy have to get sick?’ ‘Will it ever be okay?’ ‘Why can’t the doctors just fix this?”

“I want to know too.

“She voiced the little girl version of the questions that claw at my own heart and mind. The grief and loss come at us in waves. Tonight we sat and cried together. Her tears streaming down my chest and mine in her hair. . .”

 

 

 

The mother below and her son are casualties of grotesque, yet pervasive laws that place the “civil rights” interests of a person in psychosis above the right of a doctor or psychiatrist to order antipsychotic medication and/or involuntary commitment to a center for treatment. In most states, such a patient may be treated against his will only if he “demonstrates a danger to himself or others.” Given that virtually the only way to “demonstrate” such a danger is to enact it, this misbegotten law often has the effect of pushing psychotic young people into criminality.

 

“When my grandson was 11, we begged for help to keep him safe and out of trouble. Several psychiatrists later and many tears and meds for him, we were told: wait till he gets in trouble with the law. Then he will get help. His school told us the same thing. No one understood that what they were telling us was our fear!! We didn’t want this sweet soul of a kid getting into trouble with the police! We were not that kind of family, he was not that kind of kid! We were not going to let that happen! We would fight, pray, restrict him, take him to every doctor we could find. . .

“When mental illness takes hold of our kids we have no control. Mental illness wins over and over again. He is now 20 and hanging with some more worldly friends, friends whose families must have said and fought for the very same things. We must fight and tell the world how our kids didn’t have a chance. They did not pray for mental illness any more than one would pray for cancer. We need to fight for hospital beds in which to keep our kids safe. Our kids need to be able to have safe places to live, affordable meds, support and understanding of their illness. God hear my prayer!!!”

 

 

 

From this message, and others, it is clear that not even psychiatric doctors can be automatically trusted to have the competence and temperament necessary to help their patients.

 

“A bad day at the doctors. Our city had to basically shut down [its psychiatric care center] because of diverted funds, but after waiting a year, my loved one got an appointment, which was today. In the past year, we had seen a private psychiatrist who didn’t [ participate in my state’s Medicaid program], but would prescribe anti-anxiety meds to help [forestall involuntary confinement]. But she would no longer see him.

“The appointment started off badly as this new doctor called for security before my son even went into the office—possibly because of [troubling] paperwork he had filled out or because of his unusual look. In any case, the security thing set him off more than usual and the doctor made him leave and he is not allowed to return. I listened to the usual four-letter tirade all the way home, my son saying he would never go to another doctor again and don’t ever ask him to. He got out of the car before I came to a full stop at the house. I am so not looking forward to what will happen tonight. De-escalation armor on.”

 

 

 

And then there is the judicial system. As with psychiatrists and doctors, judges are commonly assumed (by outsiders and families of the afflicted alike) to be specifically educated in the neuroscience of chronic mental illness. They are assumed to recognize their moral duty to proceed with exceptional care and knowledge in adjudicating the fate of the most helpless people on earth. Doctors and jailers, of course, are bound by the same expectations.

 

A special test of that duty is their understanding—or lack of it—of the fact that the single most destructive action against a mentally ill inmate (in fact, against any inmate) solitary confinement, which quickly trigger and/or deepen psychosis.

 

Judging by the content of this mother’s message, her schizophrenic son has been failed by everyone in this chain. Both he and his mother have paid the price.

 

“My son’s court case is tomorrow. What’s tragic is the fact I begged for help since November 1. I faxed over a Do Not Release letter stating he was a serious harm to himself and me. Now, my son has spent three months in jail and has been allowed to deny all medications. My son suffers from anosognosia [a clinical term meaning “lack of insight into one’s mental illness”]. So, tomorrow, he learns the painful truth that his competency evaluation came back not competent to proceed.

“My son believes he aced [his mental competency test] and is coming home to me. But the doctor found him incompetent. No shocker there! If they had only listened to me back on November 1, he wouldn’t have had to spend three months and counting in jail! Plus, I wouldn’t have been severely beaten and cornered in my own bathroom [by him] for a second time. Now, my severely delusional child has been off all medication for a month. Talk about starting from ground zero!

“What he will experience tomorrow will be criminal. He will learn he’s incompetent, while wearing shackles and handcuffs. I fucking hate our system!!! He doesn’t understand his illness. His rights will be taken away. He will suffer from the phases of grief even though it is he who is lost to us. He will be left in a jail cell awaiting placement in the state hospital, which could take one to three months because the waiting list is so long.

“I begged with my son to call Disability Rights to represent him but he said he didn’t have a disability even though he’s received Disability for 5 years! What’s even more fucked up is that Disability Rights said they could only talk to my seriously delusional child. That is why he had to call! What a joke! I know so many parents who have lost their children with a serious mental illness in jail. So, please pray and send out positive messages into the universe that he makes it through, and finally receives the help he deserves!

 

This mother’s son was a small and thin 17-year-old, when local police arrested him for trespassing. The mother writes that, in a psychotic state, he had wandered into a neighbor’s house and fell asleep on a couch. The neighbors called police, and who, instead of taking him to a care facility, put him in jail. The mother has repeatedly called for compassion and treatment for him; so far, her calls have been ignored.

 

“Today is another day. It’s so hard to move forward with my life. We are stuck in this insane limbo. My son called today [from jail], and says mommy, ‘the inmates that hand out the trays they took most of the food off my tray. The guards were standing there. They said I have to pay a debt. They say I have to pay them if I want to eat. Put money in [X]’s commissary Account so I can eat.’ Over the past month, our son was in solitary confinement for almost two weeks. They stopped his antipsychotics cold for four days. He has psychosis, and is hearing voices. After the assault [by inmates] two weeks ago, he has a concussion.

“He’s been denied an MRI, or an emergency-room visit, despite my pleas. His vision is blurry, headaches, and nausea. He is emotional from the head injury. They will not wake him for his morning antidepressants. Now tonight he has informed us they are trying to extort money by starving him. So he was crying again tonight. We hope next month he sees the forensic psychiatrist.

“[The jailers] extort money for visits, commissary, basic necessities, phone calls, fees, per-day jail incarceration fees, fines, restitution, medicines, doctor fees, etc. Our son was charged as an adult at 17. The boy who dances like Michael Jackson, and plays 5 instruments. He hears voices. He has auditory hallucinations, and Asperger’s. Fifteen times, I tried to hospitalize him. Instead He went to jail where he spent weeks at a time in solitary confinement. He was beat up, his vision is still affected. He still had not had an mri.,. Tonight he sits in jail at just 18. He is not a hardened criminal. He’s a good, sweet kid, he wouldn’t hurt a fly. Every day I pray he will come out of this alive. My heart is shattered!

 

 

Here is another example of solitary confinement used as a blunt instrument—to effectively punish the victim of a jail beating.

 

“I just got off the phone with my son. He was beaten up two weeks ago [by inmates], and the jail’s answer was to put him in lockdown [solitary confinement] for 23 hours a day by himself. I had him agreeing to meds but they gave him the wrong meds and now he won’t trust them. He has been in the county jail for six months, and finally saw a judge for the first time last week. Now they need six weeks’ revaluation. Meanwhile, they keep him alone in lock up. He can call me on his hour out. He just called screaming and crying to get him out. I can only tell him he needs to hang in there and we are doing the best we can. But he’s slipping more. And nobody in the courts seems to care. My heart is breaking. His birthday is Wednesday. I am a single parent, and he’s my youngest.” 

 

And here is another example of the foolish inadequacy of “danger to himself or others.” Given that virtually the only way to “demonstrate” such a danger is to enact it, the law generally does more harm than good.

 

“The doctor told me, “‘Wait, N—, he’s not bad enough yet, he hasn’t committed a crime!’ [And then he said], ‘Your son is an adult. He has the right to be crazy if he chooses.’ 

My son has slipped through the cracks in every instance. There’s no consideration for families living with an untreated psychotic person except when it’s too late. We live in fear of our own son.”

TRUMP’S SHADOW FALLS UPON “CRAZY PEOPLE”

The president’s likely choice for a new fox to watch over the mentally ill henhouse summons the sardonic old joke: “‘Cheer up,’ I was told. ‘Things could be worse.’ So I cheered up, and sure enough. . .”

via The Wall Street Journal

The Trump administration is struggling to fill a top mental-health post, a job created last year to coordinate the efforts of far-flung federal agencies.

https://www.wsj.com/articles/trumps-latest-pick-for-mental-health-post-has-helped-prosecutors-secure-convictions-1492554280

 

PRINCE WILLIAM AND LADY GAGA DISCUSS MENTAL ILLNESS

ANOTHER SIGN THAT PUBLIC DISCUSSION OF MENTAL ILLNESS IS GROWING

via NBCNews

Prince William and Lady Gaga may seem like an unlikely pair, but they have joined forces to encourage young people to talk about mental health issues: http://www.nbcnews.com/news/world/prince-william-lady-gaga-join-forces-mental-health-issues-n747671

THE JAILHOUSE CRUELTY NEVER ENDS

Thanks to my friend Teresa Pasquini for alerting me to this. Not until you read fairly deeply into the story will you discover that Andrew Chaylon Holland, the helpless victim of this savagery, “began to manifest schizophrenia in his 20s,” that he had faced nine criminal cases between 2014 and 2016 for assaults “directly related to his mental illness,” that he had difficulty staying on the medications that stabilized his behavior, that in rational moments he declared his wish to continue psychiatric treatment and rehabilitation, and that even though a superior court judge had recommended treatment for him a the county’s mental health inpatient unit, he died after suffering through 46 hours in a restraint chair inside the county jail. Case closed.

The Dark Ages live on in contemporary America’s treatment of its seriously mentally ill. They will not end until American society faces up to this ongoing pageant of atrocity. Faces up and demands that, like disembowelment, drawing and quartering, keelhauling, slavery, child labor, forced sterilization, and burning at the stake, jail and prison abuse of the mentally ill (and every other prisoner) cease!

http://www.sanluisobispo.com/news/local/article144057364.html

BANISH THE OBSTACLES TO COMMON-SENSE INVOLUNTARY COMMITMENT–A REFORMER’S CALL

Dj Jaffe is one of the two or three most important advocates in America for mental healthcare reform. His powerful new book, INSANE CONSEQUENCES, catalogues his many well researched indictments of our nation’s tattered apparatus for helping those with serious mental illness, as well as his proposals for overhaul. I am honored to reprint his essay in Cato Unbound. It calls on policymakers to recognize the disastrous over-reach of “civil liberties” rationales that prohibit caregivers to intervene in a resisting person’s “psychotic break”–the exact moment in which medication and hospital treatment can do the most good and prevent the most harm.

I urge state and federal political leaders, psychiatrists, and parents of the afflicted to read this and join Dj Jaffe in his demand for reform!

Letters: A Libertarian’s Proposal to Reform Involuntary Commitment

August 22, 2012

Editors’ note: DJ Jaffe is the Executive Director of MentalIllnessPolicy.Org. We are pleased to publish his letter below.


Current civil commitment policies protect neither the liberty of persons with mental illness nor the liberty of the public. They have increased government intrusion, increased public costs, and are inhumane. Changing to scientifically based commitment procedures can increase the liberties of individuals with mental illness, increase the liberties of those without mental illness, and help downsize government. Therefore, improving civil commitment laws should be a goal of libertarians.

I have a relative with schizophrenia. Having said that, I agree with Herschel Hardin, a former leader of the British Columbia Civil Liberties Union, who has a son with schizophrenia, the diagnosis commonly found in people subject to civil commitment. He wrote:

The opposition to involuntary committal and treatment betrays a profound misunderstanding of the principle of civil liberties. Medication can free victims from their illness—free them from the Bastille of their psychoses—and restore their dignity, their free will and the meaningful exercise of their liberties.[1]

Because of the inadequacies of our current civil commitment practices, 5,000 individuals with mental illness commit suicide annually.[2] Another 200,000 are homeless.[3] Of course, those are not primary concerns to libertarians, most of whom believe that individuals have a right to kill themselves or live homeless.

Costs of the Status Quo

But as a result of our current restrictive commitment procedures, persons with mental illness kill 1,000 individuals annually, roughly 10% of all homicides.[4] The most likely victims are family members,[5] police, and sheriffs.[6] Take the parents of mentally ill Eric Bellucci in Staten Island. They were so fearful of their son, who had been hospitalized and involuntarily committed multiple times, that they locked him out of the house. So he camped in their yard. They begged to have him civilly committed, but the law required Eric to first become “dangerous.” So he did. On October 13, 2010 he stabbed both his parents. They are dead and Eric will be permanently incarcerated. Hardly a victory for individual liberties.

Other individuals with untreated mental illness kill so many they become famous and earn sobriquets like “Unabomber” Ted Kaczynski and “Fort Bragg Assassin” Aaron Bassler. Their families tried to get them treatment before they became killers. James Holmes, Seung-Hui Cho, and most recently Thomas Caffall each killed innocents and lost their own lives. But civil commitment laws don’t help prevent dangerous behavior, they require it.

Because of restrictive civil commitment laws, individuals with serious mental illness are regularly shot by law enforcement who believe their erratic and irrational behavior is putting their own safety or that of the public in immediate danger.[7] People with severe mental illnesses are killed by police in justifiable homicides at a rate nearly four times greater than the general public.[8] The recently released videos of Kelly Thomas being beaten by police in Fullerton, California[9] and Michigan police shooting Milton Hall are the latest examples.[10]

Another concern of libertarians is that our current system is causing massive incarceration. As Amanda Pustilnik noted, 300,000 individuals with mental illness are now behind bars, due to the inadequacy of civil commitment laws. 15-25% of all prisoners have a mental illness.[11] With reformed civil commitment laws, many may have avoided incarceration. As a result of poor commitment laws, we now have a jail-based system for the most seriously ill. That creates a major drain on local law enforcement.[12] And it is expensive to the corrections system. The Department of Justice estimates that it costs $15 billion to incarcerate the 300,000 mentally ill.[13] That hardly counts as small government.

The lack of better civil commitment standards puts government itself at risk. President Ronald Reagan was shot by mentally ill John Hinckley. President James Garfield was killed by mentally ill Charles Guiteau. Presidents Andrew Jackson and Theodore Roosevelt were shot by persons with mental illness. Congresswoman Gabrielle Giffords was shot by mentally ill Jared Loughner.

Clearly, the status quo is not serving the liberty needs of people with mental illness or the public safety needs of those without. It is also contributing to growth in government. Changes are needed that are grounded in science.

Knowledge about Schizophrenia Needed to Make Informed Changes

Untreated schizophrenia and untreated bipolar disorder are two of the disorders most likely to be represented among civilly committed populations. I’ll limit this discussion to schizophrenia.

Schizophrenia is a real disorder.

Dr. Schaler asserts, “’Mental illness’ generally refers to how certain people behave.” Not exactly. There is not yet a chemical marker that can diagnose schizophrenia. But claiming that schizophrenia doesn’t exist because there is no test is like saying colon cancer didn’t exist before the invention of colonoscopy. Schizophrenia, like Parkinson’s, is diagnosed by analyzing the resultant behavior. For Parkinson’s, the behavior is arm movement. For schizophrenia it is delusional speech and psychotic behavior, among others.

Dr. E. Fuller Torrey collected research proving schizophrenia is a real disorder. Individuals with schizophrenia have enlarged ventricles,[14] a reduced volume of gray matter[15] more neurological abnormalities,[16] more neuropsychological abnormalities,[17] and decreased function of the prefrontal area[18] compared to controls.

Schizophrenia Causes Impaired Thinking

John Stuart Mill’s introduction to On Liberty stated, “It is, perhaps, hardly necessary to say that this doctrine is meant to apply only to human beings in the “maturity of their faculties.” He was wrong. Some libertarians need reminding.

Science shows some individuals with schizophrenia are not in the “maturity of their faculties.” They don’t always have the faculties to formulate opinions although they almost always retain the ability to speak. Neurocognitive impairment is a core component of schizophrenia and is likely associated with the neurobiology.[19]

In the case of my own sister-in-law, this neurocognitive dysfunction was startling. Before schizophrenia, she was a bright college student. After developing schizophrenia, she became so cognitively impaired that she could not figure out that to change her pants, she had to first take off her shoes, because the pants wouldn’t fit over them.

Schizophrenia also causes individuals to have delusions.[20] John Hinckley shot President Reagan when he was off treatment because he “knew” it was the best way to get a date with Jodi Foster. Russell Eugene Weston Jr. shot two guards at the U.S. Capitol when he was off treatment so that he could find the “Great Safe of the U.S. Senate” where the “ruby satellite control” time reversal system could “sweep him away” to a time when he would not be deceased. When asked if he has a mental illness, he denies it.[21] Rather than being in control of his brain, his brain was in control of him.

Schizophrenia causes some individuals to hallucinate and hear voices. Walk down the street of any major city and you will see psychotic individuals screaming at voices only they can hear. Sometimes these voices command them to do things. Bad things. Being schizophrenic is not an exercise of free will that should be protected. It is a barrier to exercising free will that should be removed.

Schizophrenia prevents some people from even knowing they are ill. Anosognosia is being so sick you don’t know you are sick. It is common in schizophrenia because the brain, the organ charged with insight is impaired.[22] Because it also appears in bipolar disorder, many people have experienced it directly in the grandiose ideation of bipolar friends who are in the midst of an untreated manic stage. “Winning” as Mr. Sheen would say. People with anosognosia can truly believe they found a plan to save the world or that they are the Messiah. Why accept treatment when you’re the Messiah?

Individuals with schizophrenia think differently when treated than untreated. Nowhere is this more apparent than in their attitudes towards civil commitment. While, by definition, 100% of individuals who are civilly committed were opposed to it at the time of commitment, multiple studies show around 80% retrospectively express gratitude.[23]

The proper goal of libertarians should not be to ensure individuals who “lack maturity of their faculties” remain locked in “the Bastille of their psychosis.” Libertarians should work to restore free will and liberties.

Untreated Schizophrenia Is Associated with Higher Incidence of Violence

Nowhere is the debate over civil commitment less informed than when it comes to answering the question “Are people with mental illness more violent than others?”[24] It is largely irrelevant, because civil commitment is not aimed at the 25-40% of Americans some claim have a “diagnosable mental disorder”—your friends on Prozac.

But there is a subset of about 5% who have a very serious and persistent mental illness like schizophrenia.[25] The subset of the 5% group who go off treatment are more likely to become violent than others.[26] This is particularly true when medications that have previously prevented them from becoming psychotic, hospitalized, or violent are stopped. This is the tiny group civil commitment should be designed to help.

We now know that past violence is a good predictor of future violence in individuals with serious mental illness. So is abusing substances. Commitment for seriously mentally ill individuals who have a history of violence or substance abuse should not be as burdensome as commitment for those who don’t.

Medications Reduce Violence in People with Schizophrenia

By reducing hallucinations and delusions, and by restoring “maturity of faculties,” medication reduces violence. This should be readily apparent because almost everyone civilly committed because they were dangerous is eventually released—because they are no longer dangerous. The difference between their pre-commitment state and post-commitment state was the administration of medicines. From a libertarian perspective, it doesn’t make sense to allow someone who is known to need medicines to stay nonviolent to go off medications and become violent. Going off treatment imposes an obligation on the citizenry to pay taxes and expand government so they can be incarcerated. Incident of violence in someone who has mental illness and at the time was compliant with treatment are almost unheard of.

Persons with mental illness who have been stabilized on treatment don’t deteriorate instantly when the treatment is stopped. The medications stay in the blood for a while. As will be seen later, this knowledge opens doors to commitment venues that are less restrictive than inpatient commitment.

What is the current commitment law and how does it work in practice?

Individuals with mental illness are allowed to refuse treatment and cannot be treated in the community system unless they volunteer. For the most seriously ill, this is often an insurmountable hurdle because of their anosognosia, neurocognitive dysfunction, hallucinations, and delusions. Individuals who need the community mental health system the most cannot get in.[27] They are allowed to deteriorate to dangerousness and then become subject to the involuntary commitment system.

But getting into the involuntary system is harder than getting into the voluntary system. In general, many states require individuals to be imminently provably dangerous to self or others.[28] Other standards exist, but they are rarely used and often so narrowly interpreted as to be similar to the “dangerousness” standard. If committed, the individual is confined to a locked ward, which is the most restrictive setting short of incarceration. Once someone no longer meets the standard, he or she is released and free to go off medicines and become dangerous again.

Because the voluntary and involuntary systems are so hard to access, most of the seriously mentally ill who refuse treatment wind up in the criminal justice system with all rights removed. 300,000 are incarcerated, five times as many as are hospitalized. And those incarcerations were likely the result of infringing on someone else’s rights by committing a crime.[29]

Surely there is a better way. Surely this is not what libertarians want to defend.

What Should Be Done?

From a libertarian’s perspective, successful civil commitment reform would use commitment less, use it only when needed, steer individuals away from the most restrictive forms of commitment to less restrictive forms, and place greater reliance on the systems that require the least amount of government. We know how to do that.

The “danger to self” or “parens patraie” commitment standard is the one most likely to be considered problematic by libertarians. But they are presupposing the individual has the cognitive ability to avoid danger to self if he or she wanted. As the previously cited research shows individuals with schizophrenia become a “danger to self” because they develop delusions and hallucinations combined with anosognosia and neurocognitive impairments that prevent them from accessing treatment. While 5,000 mentally ill individuals commit suicide annually, and while libertarians can defend that, many more become dangerous to self by eating out of garbage cans, sleeping on the streets, letting wounds fester, and other activities their dysfunctional brains lack the ability to avoid.

The “danger to others” or “police powers” commitment standard is accepted by almost all, including libertarians. Quoting John Stuart Mill, “[T]he only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others.”[30] But Mill doesn’t tell us when to intervene. Should we intervene to prevent harm to others when the hallucinations start, when the person goes off medicines, when the person becomes psychotic again, when the gun is purchased, when the bullet loaded, when the gun is fired, or when the bullet hits its target?

The standard is now interpreted so narrowly that it does not apply until after the bullet is fired. As such it ignores the fact that individuals with serious mental illness may become predictably dangerous long before they become imminently dangerous. Because we prevent intervention until after dangerousness, we have to rely on the most restrictive form of commitment: inpatient commitment.

This fact was underscored to me in a West Virginia case where I recently testified. Linda R. Artimez, Director of the Supreme Court’s Division of Mental Hygiene, stated that while West Virginia allows the placement of individuals who are civilly committed in community settings like group homes, it almost never happens. Why? No judge is going to determine that an individual is “dangerous” and simultaneously put them in anything other than the most restrictive setting: a locked ward.[31]

The Advantages of Adding Other Standards for Commitment

Preventing the mass civil commitment and incarceration of people with mental illness requires lowering the commitment hurdle to something below imminently, provably dangerous. Lowering the hurdle would shorten commitments because the longer that treatment is delayed, the longer it takes to stabilize and restore the “maturity of their faculties.”[32] Lowering the commitment standard would also allow use of less onerous forms of commitment like outpatient treatment.

Libertarians may object, fearing that more people will have their rights removed. That is not true. The failure to use a lower standard results in 300,000 people having all their rights removed via incarceration and almost everyone who is committed, being committed to a locked ward.

Libertarians may point to abuse of civil commitment in Stalinist Russia or the United States. Those were due to the inefficacy of treatments and the lack of due process. Treatments are better now[33] and obviously all civil commitment systems need to include vigorous due process protections including independent administrative or judicial review; access to representation; and the ability to submit evidence, question witnesses, appeal decisions, and file habeas petitions. Maintaining strict due process does not increase the size of government. Commitment process uses fewer judicial and legal resources than incarceration. It’s not just a wash, it’s a net savings.[34]

Other Standards That Should Be Used

Once we understand that treatment can prevent violence in those prone to it and that the “choice” to go off medications is not being made of free will but because the brain is impaired, the libertarian objective should be to restore free will, not stand back so violence can occur.

Many standards accomplish that. A “grave disability” standard allows intervention when a seriously mentally ill person becomes “substantially unable, except for reasons of indigence, to provide for any of his or her basic needs, such as food, clothing, shelter, health or safety.” Few libertarians would let someone with Alzheimer’s or developmental disabilities go without treatment simply because they can’t fend for themselves. We should take the same position towards people with schizophrenia.

The “capacity standard” allows intervention when someone as a result of their “serious mental illness is unable to fully understand or lacks judgment to make an informed decision regarding his or her need for treatment, care or supervision.” This is the “lacks maturity of faculties” standard. If someone “due to mental illness, is unable to understand the advantages, disadvantages, or alternatives to a particular treatment, or is unable or unwilling to apply them to his or her situation and requires such treatment to prevent severe mental, emotional, or physical harm”[35] they too “lack the maturity of faculties” and libertarians should not object to their treatment.

By using these lower standards we can intercede with people who are likely to become violent, lose their own liberty, and infringe on the liberties of others or lose their own life due to their illness. By using civil commitment to restore free will, we can prevent massive incarceration of people with mental illness and the resulting bloating of government courts and corrections systems. We can send people to less restrictive forms of commitment, reduce the time in commitment and do a better job protecting the public. In other words, achieve libertarian objectives.

Use Less Restrictive Forms of Commitment

Some alternatives to inpatient commitment, in order from most restrictive to least restrictive, are guardianship, parole or conditional discharge from hospital after involuntary commitment, and Assisted Outpatient Treatment (AOT).

Guardianship procedures allow courts to assign someone else to make all decisions for the person appointed a guardian. He or she is in essence committed to following the guardian’s instructions, which could include staying in treatment. It is very intrusive, but unlike commitment to a locked ward or incarceration, it does allow community living. It is less expensive than incarceration or hospitalization and requires no expansion of government. Guardianship is used most frequently for those who have Alzheimer’s or developmental disabilities. Persons with serious mental illness would rarely need something this restrictive, but the lack of it sends people to something much more intrusive, restrictive, and expensive—like incarceration or inpatient commitment.

Parole and conditional discharge from a hospital after involuntary confinement allow individuals to leave locked facilities—jails and hospitals—and live in the community as long as they meet certain conditions. For mentally ill parolees, conditions could include the requirement to stay in violence-preventing treatment. Likewise, rather than releasing a mentally ill individual from involuntary commitment and allowing the individual to go off treatment again, we could release them with the requirement they stay in treatment. It is not overly expensive and allows individuals to maintain almost all their rights with very little government intrusion except in the narrow area where there is a community interest. Both should be used more frequently.

Assisted Outpatient Treatment is the new kid on the block and the most important and useful. Forty-two states have Assisted Outpatient Treatment (AOT), but no state uses it sufficiently. AOT is a court order to stay in treatment as a condition for living in the community. It is usually limited to those who have a past history of at least two incarcerations, involuntary commitments, or needless hospitalizations.[36] It is palatable to libertarians because it is only used after unfettered liberty has proven unsuccessful. The patient is monitored in the community and can be put in an inpatient setting if they fail in the outpatient setting.[37]

AOT furthers the libertarian goal of preventing people from being sent to more restrictive environments. Research on individuals treated under New York State’s AOT law, called “Kendra’s Law” found 83% fewer were arrested, 87% fewer were incarcerated, 77% fewer experienced psychiatric hospitalization, and length of hospitalization was reduced 56%.[38] In California, where AOT is called “Laura’s Law,” it cut incarceration 67% in one county and 78% in another. AOT cut hospitalization 46% and 86% in the same counties.[39]

AOT helps further the libertarian goal of preventing persons with mental illness from infringing on the liberties of others. In New York, after enrollment in Kendra’s Law, 46% fewer damaged or destroyed property and 43% fewer threatened physical harm to others. Patients who were more violent to begin with were nevertheless four times less likely to perpetrate serious violence after undergoing treatment.[40] The odds of arrest for a violent offense were 8.61 times greater before AOT than they were in the period during and shortly after AOT.[41]

AOT furthers the libertarian goal of keeping government small. In California, it saved $1.81 for every dollar spent. In New York, where approximately 1,800 individuals are under AOT it has been estimated to save $73,800,000 in incarceration costs and $36,000,000 in hospitalization costs for a total of $109,800,000.[42] Libertarians should support use of these less restrictive commitment venues.

Conclusion

Current civil commitment practices fail to result in the libertarian objective of having fewer individuals incarcerated, public safety protected, and government growth restrained. Using lower commitment standards combined with less restrictive treatment venues can reduce the number incarcerated, shorten length of commitments, improve safety of the citizenry, and reduce the size of government. Reforming civil commitment practices can free people with serious mental illness “from the Bastille of their psychoses—and restore their dignity, their free will and the meaningful exercise of their liberties.” There is a strong libertarian rationale for reforming civil commitment laws.

DJ Jaffe

https://www.cato-unbound.org/2012/08/22/editors/letters-libertarians-proposal-reform-involuntary-commitment

https://www.amazon.com/Insane-Consequences-Mental-Industry-Mentally/dp/1633882918

GRAPHIC VIDEO–CAUTION

LEST YOU THINK THAT THINGS ARE GOING JUST FINE IN OUR PSYCHIATRIC HOSPITALS

Via Buzzfeed

A psychiatric hospital and its director that are under state investigation. Riots that end with pepper spray. Staff who can’t begin to contain the violence. And patients as young as 5: https://www.buzzfeed.com/rosalindadams/shadow-mountain?utm_term=.hjOgkR5RE&ref=mobile_share#.sx1wjLNLB

A Penetrating Review From a Dear Old Friend

Mike Miner and I were inseparable buddies in our last year in the School of Journalism at the University of Missouri. In those lamb-white days of spring 1963 that meandered innocently toward the world-shattering assassination of the following fall, we rollicked through the kind of friendship that has mostly gone missing in the present world of dread and suspicion and the bristling arsenals of hip.

We played some college pranks. One of them I think involved a football in a classroom; I can’t remember much more than that. We covered sports together for the J-school daily newspaper, we got permission to resurrect the campus humor magazine, Show Me (recently banned for, horrors, profanity). We saved our quarters and pooled them to treat ourselves once a month to a $1.50 pizza in town. We went to the movies and entertained grateful patrons around us by shouting wisecracks at the screen. We showed our Brando-esque wildness (“What are you rebelling against?” “Whadday got?”) in other ways: by sliding saltshakers across restaurant table surfaces, hoping they would hover on the very edge, until one didn’t and the waitress rushed at us.

You know. Wild stuff like that.

And we talked and talked. About the “future.” About what we would “be.” And we wrote and wrote. Newspaper articles, jokes for the humor mag, stuff.

We kept the friendship together after graduation. Mike went into the Navy and I wangled a magazine assignment to Hawaii that coincided with his ship docking at Honolulu, and we did that town. (Saw the John Wayne/Patricia Neal navy movie “In Harm’s Way” together; walked out of the movie theater verklempt, although we’d never heard of that word then. Drowned ourselves in chocolate milkshakes.) Then I went back to Chicago and Mike went off to the South China Sea.

He made it through. After his tour was over, we newspapered together in St. Louis and then Chicago. Toured Ireland and London, and my easy, delightful companionship tested the limits of Mike’s capacity to long-suffer.

And then. . .you know. . .time is the longest distance between two places. . .I headed to New York; Mike stayed in Chicago.

I always believed that Michael was destined to be the major writer between us. He knew theater, and knocked out several good plays and wonderful poems. His wit was sly and dry, and his literary gifts even then were enormous. He was better than I ever was. Still is.

And lo and behold, he did become the major writer. At a weekly paper called The Reader, he has built a name for himself as an institution of superb, intrepid reporting and a writing style that could keep company with Ben Hecht, Mike Royko, all those Windy City giants. Whereas I was kind of a nomad, Mike committed himself to a place, and mined it deeply for story. Some other pretty good writers have done that. Faulkner.

We kept in touch a little. Facebook made it easier when it came along. Still, it was sporadic.

In July 2005 the “future” arrived for me. Right between the eyes. My younger son Kevin, deep in schizoaffective disorder, hanged himself in the family basement.

A decade later I got it together enough to write my book about mental illness: NO ONE CARES ABOUT CRAZY PEOPLE.

And then, this week, my old friend Mike showed up again. In the form of the review that you will find below.

You talk about verklempt. You talk about friendship.

Thanks, Mike. Game of saltshakers sometime?

In No One Cares About Crazy People a father addresses his sons’ mental illness

COURTESY RON POWERS
Ron Powers’s sons Dean, left, and Kevin, right, pictured here as children, both later suffered from schizophrenia.

As you read No One Cares About Crazy People you might think it’s two books or you might think it’s one. There’s the book author Ron Powers tells us that he set out to write—a critical history of societal responses to mental illness—and there’s the personal story that compelled him to write this book—the raising of two sons who became schizophrenic, one of whom killed himself. An agent told Powers that to write one he must write the other. And so he has.

For a time beginning in college and continuing to the Sun-Times—where he won a Pulitzer Prize for TV criticism in the early 70s—Powers and I were close and had the forward-looking conversations young men have. Never—I repeatedly thought as I turned the pages of Crazy People—did anything cross our imaginations close to what lay in wait.

Crazy People is his response to that rendezvous. It draws on the wit and anger I remember, on research compelled by circumstance, and on paternal devotion then untapped in either of us. Powers has collaborated before—with Ted Kennedy on Kennedy’s memoir, and with James Bradley on Flags of Our Fathers. In Crazy People, Powers, the reporter and stylish writer, collaborates with himself, the father with a story.

The social history of mental illness, no reader will be surprised to learn, is doleful.

“The world of mental illness,” Powers writes, is everywhere; it hides in plain sight. “Its camouflage . . . little more than the human instinct to reject engagement with the pitiable, the fearsome, the unspeakable.”

Rather than illness we’d see witchcraft; rather than humans in need we’d see menace, and we’d feel a duty not to assuage agony but to hide it from sight. The places where the mad were hidden gripped the public imagination for their gothic mystery. Powers tells the centuries-long history of the London madhouse known as Bedlam; in Saint Louis, as he surely remembers from his years there, an institution for the mentally ill was known to one and all simply as “Arsenal Street.”

You kept your distance from Arsenal Street.

Mental illness can hide in plain sight because we don’t like to think about it. But take your own inventory as I take mine. Two members of my book group have grown schizophrenic children. One daughter’s closest childhood friend is schizophrenic; another daughter’s grade school Spanish teacher lost her husband when he was stabbed to death during a psychotic breakdown by their schizophrenic son.

Powers and his wife, Honoree Fleming, raised sons Dean and Kevin in Vermont, where Powers wrote and Honoree, a professor, taught biochemistry and did research. Both sons were bright and creative, and Kevin was a guitar prodigy. The instructors his parents found for him soon threw up their hands—they had no more to teach him. But he was not yet 21 when he hanged himself in the basement of his family’s home.

Do madness and creativity go hand in hand? Powers devotes a chapter to this ageless question, to which there are correlations to be cited but no clear answer. Asked by a teacher in grade school to identify human needs, Kevin wrote, “I need music.” He inhabited, his father tells us, an “inaccessible” inner world of music, though the yield of that world can still be sampled today, as in a concert at Interlochen and an album the two brothers recorded together.

Powers places emphasis on the power of stress to trigger psychosis, and much less emphasis on the role of genetics, though years earlier his own younger brother had killed himself. Creativity and stress were palpable presences in the young lives of Dean and Kevin, and it’s those lives that preoccupy their father.

One Friday night toward the end of Dean’s junior year of high school, he took a curve too fast and his car slammed into a tree. The understanding around town was that Dean had been drunk, though he wasn’t. The girl next to him suffered injuries she was years recovering from, and her parents crusaded to see Dean thrown in prison. The high school principal banned Dean’s picture from the yearbook. Awaiting sentencing, prison a clear possibility, Dean wrote, in an essay, “my life is like a river and I am being swept away helplessly.”

And in Crazy People his father writes, “These were the days and months and events, I am convinced, that launched my eldest son into his rendezvous with schizophrenia.”

But today, Powers reports, Dean’s last psychotic episode a few years behind him, “he seems in possession of himself, aware of his limitations, and ready to live on his own in the wider world.”

Powers also introduces readers to a word I’d never heard or read before: anosognosia, or, “the false conviction within a person that nothing is wrong with his mind.” Powers calls it a “cruel joke.”

I’ve always supposed the joke is that when the meds work they make the patient feel so clear-headed he decides he doesn’t need them any longer. So he hides his meds, as Kevin did, or flushes them down the drain. Then he reverts. Confronted, he lies. But Powers says changing a patient’s ways isn’t as simple as screaming sense at him or waiting for him to learn from experience. He says anosognosia is actually a physiological condition disrupting the brain’s ability to recognize the condition it’s in; it shows up in 50 percent of schizophrenia cases and 40 percent of bipolar cases.

As his book concludes, Powers puts anosognosia to use as a symbol of obliviousness and denial—our own. He has seen what the mentally ill ask of the world—which is simply a place in it.

“The mentally ill people in our lives, as they strive to build healthy, well-supported, and rewarding lives for themselves, can show us all how to reconnect with the most primal of human urges, the urge to be of use,” Powers writes. “To put it another way: the mentally ill in our society are awaiting their chance to heal us, if we can only manage to escape our own anosognosia and admit that we need their help.”

Does putting the shoe on the other foot this way seem a sentimental stretch? I would say yes—if Powers were writing only about a set of issues he wanted to wrap up in a fancy ribbon. But the project’s too personal for that. He’s told us stories about the mentally ill burned at stakes, chained in dungeons, flogged and lobotomized, and treated to à la mode theories that they’d do just fine if turned out onto the streets, that they aren’t really ill at all because crazy people are the only sane ones. This is the history of society’s predisposition not to give a damn about Dean and Kevin!

And Powers won’t have it. They speak and we must listen. They are his sons.

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A STUNNING REVIEW IN THE WALL STREET JOURNAL!

When Your Sons Are Schizophrenic

 

In “No One Cares About Crazy People,” Ron Powers writes of parental love, bewilderment and rage at the vagaries of biological fate. John Donvan says it is one of the most engrossing accounts of raising a family he’s ever read.

Photo: Getty Images

 

Winning the Pulitzer Prize is one kind of writer’s dream. Nearly a year on the New York Times best-seller list is another. A third: when the best seller becomes a movie with a big-name director. Ron Powers is among the few to hit this particular trifecta. The onetime newspaperman won the Pulitzer for TV criticism in 1973, and “Flags of Our Fathers,” the immensely popular Iwo Jima history he co-wrote, arrived as a film in 2006, directed by Clint Eastwood. Mr. Powers’s newest book is a memoir, covering many of the years during which he scored these wins. A victory lap, however, this book is not. The story he relates—with searing humility and deep respect—concerns his two sons and the mental illness that flowered within them. “No One Cares About Crazy People” is a chronicle of deepening devastation recorded by a father able to do little in response to his boys’ suffering other than to witness and to love.

Mr. Powers’s memoir is the culmination of both those processes, and is motivated by his insistence on making us care—not just about his two boys, Dean and Kevin, but about all individuals and families wrestling with schizophrenia, bipolar disorder, acute depression and other forms of mental illness. His title signals his grim recognition that this will be an uphill battle. He pulled the phrase, verbatim, from an incident unrelated to his main story: In 2010, the future governor of Wisconsin, Scott Walker, was still serving as the Milwaukee County executive when a scandal erupted over the abuse of patients at the county mental-health hospital. Subpoenaed emails revealed Mr. Walker and his aides worrying about damage to his political future. In the midst of these exchanges, one aide, who later went to prison, attempted to reassure another member of the team with the blunt political assessment that “no one cares about crazy people.”

Unfortunately she was right—mostly. Few of us care about the challenges of mental illness until the emergency is inside our own homes. Mr. Powers didn’t—until his sons began showing symptoms as teenagers, which is usually when these conditions clearly manifest. But once he was awakened, the world he had entered frustrated and enraged him.

Mr. Powers gives away the climax of his story in the preface: Both his boys, starting at different times, were beset by schizophrenia, and for the younger one, Kevin, the illness proved fatal. At 20, after three years of struggle, he hanged himself, at home in the basement, while his parents slept upstairs. Mr. Powers’s decision to put this stunning revelation on his first page was a gesture of respect to his son’s memory. There would be no storyteller game-playing with Kevin’s life—no ominous foreshadowing, no false hopes for a happy outcome planted along the way. If anything, the author risks scaring away readers uncomfortable with darkness. But those who stay will learn not only what the stakes are but also why they are on this journey.

The stay is worth it, for what unfolds is one of the most engrossing accounts of raising a family I have ever read, one in which Mr. Powers makes universal his themes of parental love, bewilderment and rage at the vagaries of biological fate. At the start, he was just a dad, and his wife, the scientist Honoree Fleming, was just a mom. Neither had any experience in raising children with mental-health challenges. They weren’t experts in schizophrenia. Nor did they need to be, for the first 15 years or so. Mr. Powers’s early chapters conjure his family’s time of pure ordinariness—a quality he cherishes all the more because it was lost. He seems tormented by these recollections—his family’s “before” years—but also blessed by them. And by sharing them he lifts his book into something more elevated than a eulogy for Kevin.

Instead, Kevin lives again in Mr. Powers’s poignant portrait, which he pieces together from excerpts from middle-school essays; quotations from father-son bedtime conversations that sound as fresh as last night; and, most powerfully, Mr. Powers’s descriptions of Kevin’s musical talent. The young man was a true prodigy on the guitar, playing since age 4, and was on his way to making a career as a singer. You can find at least one of his teenage performances on YouTube, and his dad’s right—Kevin Powers was going to be great.

All of which makes his deterioration, with its declared inevitability, more moving and painful to observe. Mr. Powers, in the middle of it all, had no idea where his son’s life was heading or how to keep him from slipping deeper into trouble. Medications were tried. And hospitalizations. But Kevin eventually wanted no part of treatment. The laws limiting involuntary treatment made it difficult to counter Kevin’s preferences—a reality Mr. Powers laments. In a way, Kevin had moved past his parents’ help, which is one of the things that still eats at the father even now.

Another thing is the sorry history of American society’s response to mental illness over the past two centuries. Mr. Powers thumbnails this history in chapters alternating with his sons’ stories and aims his anger at the seemingly natural impulse most of us possess to shun the mentally ill, much as we do the severely developmentally disabled. There is a loneliness to being in either of these categories, a loneliness that also afflicts the families of affected individuals and that is exaggerated by the “solutions” developed, over time, for “dealing with the problem.” Thus Mr. Powers relates the many remedies put forth over the years by usually well-meaning people who, in profound ways, missed the mark. He covers the eugenics movement; the many decades when the severely mentally ill and developmentally disabled were warehoused in so-called asylums; and the scandal that followed the deinstitutionalization movement, when a benevolent assertion of civil rights led to the shuttering of mental-health centers, but without adequate provision for former residents’ continuing need for treatment or even basics like food and shelter. The result: a swelling number of homeless and the transformation of the prison system into a custodial program for people who should be getting help, not doing time.

The real scandal of Mr. Powers’s exposé—and he knows this—is that he is not revealing anything new. These failures have been described many times, by muckrakers and reformers, since the mid-19th-century. But each time the outrage proved short-lived, swallowed up by renewed indifference or perhaps mass amnesia. As the author keeps finding, society’s impulse to “other-ize” the mentally ill is constant: These individuals are politically voiceless and therefore easy to marginalize.

The most uplifting chapter in “No One Cares About Crazy People” is its brief epilogue, focused on the present. Mr. Powers talks about getting visits in his dreams from a guitar-playing Kevin, and he reports that his older son, Dean, who was given the same diagnosis as his brother, is now “doing fine.” Dean has acknowledged that he needs help. He is, says Mr. Powers, “in possession of himself, aware of his limitations, and ready to live on his own in the wider world.”

Still, you can hear the caution in those words. Mr. Powers seems to sense that the progress is provisional; that Dean, now 35, will always be at risk; and that his own fathering remains on trial. Assuming the best, though, Dean will outlive his parents, who are his current chief protectors. That is when he will need the rest of us to be on his side—his and all of those among us who face similar kinds of struggle. That’s why this book was written: to get us to understand, to empathize, to identify. In short, to make its title a lie.

—Mr. Donvan is the co-author of “In A Different Key: The Story of Autism.”

 

A SPLENDID REVIEW FROM THE NEW YORK TIMES!

One Family’s Story of Mental Illness and What Came After

 

The Powers family in 1985, with the author holding his son Dean, and his wife, Honoree, holding Kevin. Credit Powers Family Photograph

NO ONE CARES ABOUT CRAZY PEOPLE
The Chaos and Heartbreak of Mental Health in America
By Ron Powers
360 pp. Hachette Books. $28.

In the opening chapter of his extraordinary and courageous book, the author and critic Ron Powers writes about a recurring dream in which he imagines his sanity as resting atop “a thin and fragile membrane that can easily be ripped open, plunging me into the abyss of madness, where I join the tumbling souls whose membranes have likewise been pierced over the ages.” The “horror and helplessness of the fall,” he goes on, “are intensified by an uncaring world.”

In “No One Cares About Crazy People,” he joins those tumbling souls, two of whom are his beloved schizophrenic sons. He writes with fierce hope and fierce purpose to persuade the world to pay attention.

No doubt if everyone were to read this book, the world would change. But its clumsy title (taken from a stunningly cruel offhand remark by one of Scott Walker’s staffers) is painfully correct. The mentally ill are still viewed with fear or suspicion, as broken, as damaged goods or objects of pity. Still, Powers will surely help to correct that perspective; it’s impossible to read his book without being overcome by empathy for his family, respect for his two beleaguered boys and, by the end, faith in the resilience of the human heart.

Powers, whose books include an acclaimed biography of Mark Twain and, with James Bradley, “Flags of Our Fathers,” is a deft craftsman of sweeping tours of history but also intensely personal human narratives. He brings all his talents to bear in this account of his literature-loving, endearingly goofy, high-achieving family’s descent into hell. Powers, his college-professor wife, Honoree, and their children had a beautiful life in Middlebury, Vt., until their younger son, Kevin, a gifted musician, began to exhibit symptoms of schizophrenia at age 17. Three years later, in 2005, he took his own life. Dean, the Powerses’ elder son, also developed the disease but eventually found some stability and a productive life through vigilant, compassionate care. In the boys’ letters and emails to their parents, elegantly threaded through the book, you can hear the voice of a family holding tight to one another and frantically expressing love as a shield against an onslaught of pain. I’m not sure I’ve ever read anything that handles the decline of one’s children with such openness and searing, stumbling honesty. This sort of truth-telling is particularly difficult inside a family, where fictions are often deeply baked and compounded by what they have invented (or ignored) to survive tragedy. And this candor is always serving a larger purpose: “to arm other families with a sense of urgency that perhaps came to us too late,” Powers writes. “When symptoms occur in a loved one, assume the worst until a professional convinces you otherwise. Act quickly, and keep acting. If necessary, act to the limit of your means. Tough advice. Tough world.”

 

Powers’s stated objective, and one that he brilliantly fulfills, is “to persuade my fellow citizens in the Schizophrenic Nation that their ordeals, while awful, are neither unique to them nor the occasion for shame and withdrawal,” and “to demonstrate to those who fear and loathe ‘crazy people’ that these victims are not typically dangerous, weak or immoral, or in any other way undeserving of full personhood.” But he is less successful in his second goal: to call for America to “turn its immense resources and energy and conciliatory good will to a final assault on mental illness.” In doing so, he creates what feels like two books, alternating his family’s story with a densely reported, sometimes dizzying survey of mental illness through history, from 1403, when London’s notorious Bethlehem “Bedlam” Hospital first began accepting “lunaticks.” He shows how major leaps in science and innovation have found twisted applications in the care and treatment of the mentally ill — Darwin’s theories of evolution become the basis of Nazi eugenics; pharmaceutical companies promoted “wonder drugs,” freely exaggerating claims, playing down dangerous side effects and unjustifiably inflating prices. These are mainly horror stories, broken by the occasional crusader-heroes like Dorothea Dix, who fought for the establishment of America’s first mental hospitals in the 19th century.

More often, even the best intentions have had disastrous consequences. In the 1960s the deinstitutionalization movement shifted patients from large, crowded psychiatric hospitals to what was viewed as more effective and humane community settings. Today there are some 10 million Americans with mental illness and only 45,000 inpatient psychiatric beds, leaving the suffering to shuffle between “crisis hospitalization, homelessness and incarceration.” Jails and prisons are now the nation’s largest mental health care facilities. The worst data point: There are 38,000 suicides a year in this country, and 90 percent of the victims are mentally ill.

Midway through, the book fuses into a powerful coherence. Sweeping exposition and finely grained narrative weave together, as confusion, pain and uncertainty emerge in the Powers home. An email from Dean, in college in Colorado, about a football game — “I think that game was fixed, and probably by the government” — strikes Powers as odd. Dean’s behavior becomes erratic. His father blames drugs or alcohol.

Meanwhile, Kevin, studying at the Berklee College of Music, is increasingly anxious. Powers chalks it up to adolescence until Kevin calls at 4 a.m., giddy with the news that he has been selected to go on a concert tour of Russia. His parents try to make sense of it. “Such is the power of persuasion, or the need to believe, or something, that we tried to fit his announcement into some plausible context,” Powers writes. “He was pretty damn good, after all. Had he made it through an all-night winnowing process of deserving students?” When Kevin reports a few hours later that he’s boarded a Greyhound for Los Angeles, where he expects to be a rock star, they race from Vermont to intercept his bus. But they find that he had already been removed by a police officer and delivered to a hospital emergency room in Syracuse, where he was sedated. The doctor suspected bipolar disorder, which, he said, “was a better diagnosis ‘than the alternative,’ ” Powers writes. “Yet, uninitiated as we were, we thought that perhaps we knew.”

They learn, as does the uninitiated reader, how the mentally ill retain their humanity, with all its hues, through the perils of the damned, in and out of emergency rooms, chased by police officers, from one good day back into the abyss. Powers and Honoree do what all parents do. They fight right until the end, when they find their son’s body. Then they fight, with added ardor, to save their other son.

Dean also attempts suicide — but is rescued in time. He finds the right doctor, the right medicine, the right dose. He walks again in sunlight. Is he different, from peak to valley? Not in his essence, or in his bond with his brother, which animates the book. “I am grateful for the almost 21 years I was given with Kevin,” Dean writes in a letter to a local newspaper after his brother’s death. “And after God takes back a gift like Kevin, it is a small request to ask Him for enough hope and strength to endure the grief.”

Like many families that have struggled with mental illness, the Powerses have seen way beyond their reasonable share of darkness, but they do eventually find a kind of hope and strength. This brave book — which reads like the act of consecration it is — imparts both, and demands society do the same for all who struggle.