The author of the best-selling BRAIN ON FIRE is back with a riveting investigation into the life and works of David Rosenhan, the late Stanford psychologist known for his influential views that challenge the validity of psychiatric diagnoses. Her tour schedule of The Great Pretender is below. If you live in or near a city where she will be speaking, I urge you to attend.
I’m taking the liberty of reprinting the book-tour schedule sent to me and others this morning by my friend Susannah Cahalan. You may recall Susannah’s stunning 2012 memoir Brain on Fire: My Month of Madness, in which she chronicled her own descent into what appeared to be severe mental illness until she was rescued by a brilliant doctor who recognized it as a rare autoimmune disease of the brain. The 2016 film adaptation starred Chloe Grace Moretz as Cahalan.
In the 1970s, David Rosenhan sent seven volunteers into various psychiatric asylums around the country to test the validity of the doctors’ diagnoses and conclusions. The results shattered existing opinions of psychiatry and led to the closing of several hospitals. In this masterpiece of dogged, almost incomprehensibly persistent intellectual detective-work and sustained reasoning, Cahalan has exposed the flaws, the deceptions and the distorted understandings that found their way into society on the ballast of Rosenthal’s influence. The book is destined to become a standard of its genre and a daunting model for immersive journalism.
in conversation with the legendary St. Louis Post Dispatch columnist Bill McClellan.
NOVEMBER 13 – MINNEAPOLIS
Magers & Quinn — sign up here The Great Pretender‘s own “footnote” will be making a special appearance….(earlier in the day I will be doing a talk at the University of Minneapolis, email me for details).
I was honored to deliver this talk on November 4 at Austin, at the annual meeting of the American Association of Medical Colleges. AAMC is a 142-year-old organization dedicated to improving American health care through educational initiatives and state-of-the-art medical research. My invitation signaled that the AAMC has recognized mental healthcare as an essential part of their outreach.
I feel grateful to the distinguished outgoing president of AAMC, Darrell G. Kirch, MD, for his warm introduction, and to Stacia Gueriguian of the AAMC for her superb stewardship of the technical production. If you find the talk useful, I urge you to repost it on the web, and perhaps to recommend it to a university, public-school system, or community-access channel in your area.
While in Providence to give a talk to the powerful advocacy group, the Mental Health Association of Rhode Island I stopped in for an interview with Molly O’Brien, a young and talented host for the innovative public-affairs webcast GoLocalProv. Here is the clip:
With this message, I will be ceasing new entries on this blog related to my book, NO ONE CARES ABOUT CRAZY PEOPLE. I will leave the blog online for an indefinite period so that I might be of help for those of you looking for connections with others in the sub-universe of mental illness.
I thank the many people who have viewed and responded to my entries over these months. You have been thoughtful, brave, and generous with your responses and ideas regarding mental illness–your own, and those of people whom you love. And your kindhearted reactions to the music, photographs, and stories of and about my sons Dean and Kevin have warmed Honoree and me immeasurably. I hope that my essays and reportage about the scourge of mental illness has brought solace and encouragement.
I suggest that those of you seeking support and a safe place to share your stories will consider the private Facebook site Circle of Comfort and Assistance. Membership requires a sponsor, but I will be happy to consider sponsoring any of you who write to request it. I would like to thank my team of editors and publicists at Hachette, the publisher of NO ONE CARES ABOUT CRAZY PEOPLE, for believing in my book and committing themselves full-out to its success.
I thank my blog administrator Beth Jones for her unfailingly prompt and professional work. And I thank my literary agent, Jim “Agent Jim” Hornfischer, for doing whatever it is that agents do. Seriously, Jim, you are a writer’s dream of an agent and a close friend. Without your encouragement and guidance, my book would never have happened.
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.
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.
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.
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 CrazyPeople” 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.”
Rindfleisch, who was Wisconsin Governor Scott Walker’s Deputy Chief of Staff, wrote the hateful words in a 2010 email uncovered by the Milwaukee Journal Sentinel. To her campaign colleagues, she mocked and dismissed the depredations of the Milwaukee County Mental Health Complex, where a woman being treated for bipolar disorder died of starvation. Where workers sexually assaulted and impregnated patients.
“The fact was ungodly abuses happened at the Milwaukee County Hospital that were medieval in nature,” Powers says. “The rape of patients, starvation, naked patients walking around, physical abuse—there it is, in our time. It’s not something you have to look in an encyclopedia to find.”
Powers is an award-winning writer with criticism, narrative nonfiction, and biography to his credit. He is the author of Mark Twain: A Life and coauthor of the No. 1 New York Timesbestseller Flags of Our Fathers, which was adapted into a film directed by Clint Eastwood. He and his wife, Honoree Fleming, a pioneering biochemist, are the parents of two sons, Dean and Kevin, who were diagnosed with schizophrenia in young adulthood.
“This is the book I promised myself I would never write,” Powers writes in No One Cares About Crazy People. “And promised my wife as well. I have kept that promise for a decade—since our younger son, Kevin, hanged himself in our basement, a week before his twenty-first birthday in July 2005, after struggling for three years with schizophrenia.”
No One Cares About Crazy People is a treatise on the state of mental health care in America today—how we arrived at the disgust, hostility, and ignorance embodied by Rindfleisch and her ilk. It’s also the emotional story of the Powers family’s struggle with the fearsome scourge of schizophrenia.
“I did not want to commodify my sons,” Powers says of his hesitation to include his family’s struggles in the book—a decision that came at the behest of his literary agent, encouraged by his editors at Hachette. “I didn’t want to turn them into a profit center, even unconsciously. I didn’t want this to be a ‘poor daddy’ book. There are so many…unworthy motives you could [have] for writing a book like this.”
Powers spent a decade researching nosology, political history, and structures of care and governance of schizophrenia (i.e., how the police and the courts treat the afflicted). In the book, he traces mental health care’s shocking history: from “Bedlam” asylum in London, the scene of centuries’ worth of shocking abuses, through American deinstitutionalization; the deleterious denial enacted by popular figures like Dr. Thomas Szasz, author of The Myth of Mental Illness and L. Ron Hubbard colleague; the noble mental health care initiatives of Presidents Truman and Kennedy and mass defunding by President Reagan; and the consequences for those living with the disease today, bumping up against untrained police, ignorant lawmakers, and fearful neighbors.
“Schizophrenia is different from depression, it’s different from hysteria, it’s different from any kind of bad mood or grudges or the kinds of things we all encounter,” Powers says. “It has a genetic component and it flows through families—probably, almost certainly, has flowed through mine, although no one in my family was ever diagnosed…. It must be understood as different, and it requires different solutions than I think we traditionally apply.”
Forced to bear witness to the inadequacies of our current system, Powers has issued a clarion call to arms: to do better by those with mental illness, their loved ones, and communities; to move toward ameliorative policies that consider their health, well-being, and civil liberties. In short, that we start to care about “crazy people.”
“I hope you do not ‘enjoy’ this book,” Powers writes. “I hope you are wounded by it; wounded as I have been in writing it. Wounded to act, to intervene. Only if this happens, and keeps happening until it needs happen no more, can we dare to hope that Dean and Kevin and all their brothers and sisters in psychotic suffering are redeemed; that they have not suffered entirely in vain.”