GUNS FOR THE MENTALLY ILL!

You may have missed it, given the uncapped pipeline of news raging out of Washington, but on Friday, February 28, President Trump signed into law a Republican-backed measure to restore gun-owning rights to people afflicted with serious mental illness, such as schizophrenia. The rollback would relieve some 75 thousand mentally ill people from accountability to background checks.

Photo by Mika Järvinen (originally posted to Flickr as M4gery) [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons
Trump’s action struck down a congressional regulation spurred by President Obama as a response to the notorious 2012 massacre of 20 young schoolchildren in Newton, Connecticut. That particular butchery was carried out, via a (legally purchased) semiautomatic Bushmaster XM 15-E2S assault rifle, by the 20-year-old Adam Lanza in Newton, Connecticut. Lanza had begun that morning by putting four bullets into the head of his mother at their home with a (legally purchased) .22-caliber Savage MK II-F bolt action rifle. Then, carrying the Bushmaster and two (legally purchased) handguns, a Glock 20SF and a 9 mm Sig Sauer P226Lanza climbed into the family car and drove off to the nearby Sandy Hook Elementary School. He used the Bushmaster to shoot his way through a locked front-entrance door, then stalked the corridors and classrooms, gunning down children and teachers in small random clusters. In addition to his tally of 6- and 7-year-olds, Lanza murdered the principal, the school psychologist, three teachers and a teacher’s aide, and wounded two teachers. At least two of the teachers had been shielding children with their bodies when the Bushmaster’s bullets struck them. The dead teachers included the school psychologist and a part-time behavioral therapist.

Lanza, who had methodically paused to reload in the course of his meandering spree, then withdrew the Glock and shot himself in the head as police closed in.

A search into voluminous police reports later revealed that the young man underwent consultation at the Yale Child Study Center as an adolescent, and had been prescribed an antidepressant. The files revealed no diagnosis of serious mental illness.

Obama’s measure had infuriated Republicans and the National Rifle Association from the outset. (Technically, the rule required the Social Security Administration to inform the FBI about disability insurance recipients with mental impairments—and who needed a third party to manage their benefits–effectively disqualifying them from buying guns.)

Sam Johnson image via Wikipedia Commons

It was the Republican congressman Sam Johnson of Texas who introduced legislation to block the bill. (Around this same time, in late 2016, Johnson, in his role as chairman of the House Ways and Means Committee’s Subcommittee on Social Security, also released a plan that would drastically reduce that program’s benefits.)

Johnson’s GOP colleagues (along, of course, with the National Rifle Association) had condemned the Obama order as unconstitutional. Senator Charles Grassley of Iowa, according to one report (https://www.usnews.com/news/business/articles/2017-02-14/senate-wants-to-block-rule-on-guns-and-mentally-ill), went so far as to predict that before you knew it, the order would be keeping folks with eating and sleeping disorders from buying guns! (This line of reasoning might qualify as a suitable Republican party motto in its Latin form, Reductio ad Absurdum.)

Sen. Grassley image By United States Senate [Public domain], via Wikimedia Commons
All of which is by way of saying—brace yourself—that yet another of the most morally fraught public crises of our time, the question of powerful firearms in the hands of the mentally ill, has been distilled into ideology.

Let me acknowledge the two most formidable arguments posed by those who agree with the congressional GOPs who voted to roll back the rule.

One argument involves the impossibility of determining who, among the mentally ill, is a threat to commit deadly violence, and who is not. Homicidal schizophrenia is not predictable. Mental illness itself is not predictable. Sandy Hook was not predictable. (See Adam Lanza.) Therefore, the Obama rule was prejudicial, to the disadvantage of nonviolent people with serious mental illnesses. Or so one may persuasively argue.

The other argument restates the familiar Second Amendment case held by gun-rights advocates: restricting firearms possession by anyone is unconstitutional. Period.

Is there a logically airtight counter-argument to these positions? If there is, you won’t find it here. I am not by temperament an absolutist—not on any topic. Dammit. I kind of envy those who are, though I don’t much care to be around them. Absolutism, like carpet-bombing, gets rid of a lot of thorny impediments. It just ain’t my style.

And yet I believe that the new Trump law is wrong; an unnecessary risk to public safety, including the safety of people with eating and sleeping disorders; and an affront to those trying hard to invest the troubled American mental healthcare scene with clarity and moral purpose. I’ll explain, in my timorous, hanky-twisting way:

Schizophrenia is different. Guns are different. Each is different from its category on an order of magnitude that sets it apart from recourse to fixed ideas. Each poses a unique menace to safety, to the Self, to human life. When combined—when a firearm is made accessible to a schizophrenic person—these menaces increase in potency, even though any given afflicted gun-owner is statistically unlikely to commit violence.

Let’s take guns first. What is there left to say? Guns are instruments of killing. Increasingly, rationalizations aside, they are manufactured specifically to kill people. In this they are categorically different from (more intentionally lethal than) any other consumer product. The ideology of unconstrained firearms ownership has survived and hardened in the face of every interrogation of the Second Amendment’s ambiguities, every conceivable appeal to moral restraint, the safety of children in the household, common sense, self-evidently sensible safety measures. No argument I can make here will shift one grain of sand in that desolate desert. I might mention, for example, that my younger brother Jim, in the midst of a marital crisis in the 1970s, turned his hunting shotgun on himself and blew a hole in his head, leaving a widow and two young daughters. (Jim was untreated for any mental illness, and I do not take up his suicide in NO ONE CARES ABOUT CRAZY PEOPLE.) The responses to such tragedies from the gun-rights people are inscribed in the cosmos: Tough titty. These things happen. Shoulda seen a shrink. Law-abiding citizens’ rights. The only way to deter a suicidal man with a gun is with. . .

So let’s move on to schizophrenia.

Schizophrenia (along with its related afflictions such as bipolarity) is a brain disorder without parallel in human history. It is not a mood, reparable by therapy or good fortune. It is not an attitude, responsive to correction or coercion. It is not curable, though in many of the afflicted its symptoms may be controlled by antipsychotic medication. Such medication is resisted by a great many sufferers, whose judgment is crippled by the frequent companion scourge known as anosognosia, or the incapacity to understand that one is ill. The potential calamities enabled by anosognosia are self-evident. Thus, at least as it seems to me and thousands of others, schizophrenia victims require care and treatment that is different—more case-specific, more morally nuanced and always more undergirded with psychiatric insight—from treatment given to “normal” people in crises. This may mean, amidst hundreds of other considerations, keeping firearms out of the reach of certain mentally ill people—say, disability insurance recipients with mental impairments and who needed a third party to manage their benefits.

For understandable reasons—furthering fear and stigma, for instance—mental-illness advocates hesitate to emphasize or even admit the fact that psychosis and guns can combine to spread carnage. (This is one reason why the lessons of Sandy Hook have remained tragically muted.) Yet, as D.J. Jaffe, the outspoken director of the Mental Illness Policy Organization, has written: “. . .4 percent of those with mental illness are affected by serious ailments, such as schizophrenia or bipolar disorder, causing them to hallucinate or become delusional and psychotic. When these people go untreated they do have a higher incidence of violence than the general population. http://mentalillnesspolicy.org/consequences/violence-statistics.html It’s an unpleasant truth that the mental health industry has encouraged politicians to ignore. Without recognizing the problem, policymakers won’t take steps to fix it.”

 

And so here we are, preparing to cope with one more feckless and gratuitous disruption of the arduous project to make society safer—not only for potential victims of people in violent psychosis, but for the mentally ill themselves.

I will not pretend to vouch absolutely for the nosological claims I have advanced here. No one can. That is due to schizophrenia’s properties as different.

But enough disclaiming. I believe that mixing guns and serious mental illness is an abomination.

WORST NIGHTMARE

This article by Natasha Tracy in Huffington Post spells it out, folks: the menace that every parent and caretaker of a mentally ill victim has dreaded since Donald Trump (and Paul Ryan and others before him) gained power in national Republican politics. Our helpless, blameless charges are being pushed to the edge of a precipice.

So much of the money needed to combat serious mental illness and safeguard its victims is enfolded into the Affordable Care Act. Its repeal–perhaps not likely, but eminently possible–would be tantamount to a brutal eviction notice slapped on the millions of people who now live in some degree of humane circumstances thanks to mental hospitals, community care centers and other forms of supervision and medication. Back into the streets. Back into the mercies of predators. Back into deepening psychosis unchecked by medications and counseling. Back into their centuries-long prospects of incomprehension and early death.

It is clear that Donald Trump has not paid a seconds’ worth of attention to the realities of serious mental illness, and this fact increases the likelihood of a reign of terror upon these victims. In this, he is hardly alone among politicians. Recall that only a few weeks ago, Chris Christie was blithely opining that solitary confinement was just fine with him as a means of punishment–or emergency shelter. (The consensus among psychiatrists is that solitary confinement, even for brief periods, is the most catastrophic of all remedies in the criminal-justice system; it not only degrades the mental stability of “normal” prisoners, but drives those in psychosis deeper into irrecoverable madness.

I urge you to sign every petition, join every march, telephone every congressperson, take part in any coalition that has a voice in preserving Affordable Care. The alternative is a new Bedlam.

Read the full article here: http://www.huffingtonpost.com/entry/mental-health-care-in-a-trump-administration-devastates_us_58b5944ee4b0658fc20f9a25

ANOTHER MENTALLY ILL INMATE DIES IN JAIL

In NO ONE CARES ABOUT CRAZY PEOPLE, I write, “Too many of the mentally ill in our country live under conditions of atrocity.”

Here is one more among the unending examples of what I mean: Inmate, 23, who died in Orleans Parish jail Wednesday identified.

Adventures in Audioland

ron powersBack in the Friendly Confines (credit to Ernie Banks) of Castleton after completing work on the audiobook version of NO ONE CARES ABOUT CRAZY PEOPLE. The project was accomplished at a beautiful, hilltop, state-of-the-art recording sound studio, Guilford Sound, in the woodsy Green Mountains of Southern Vermont. http://guilfordsound.com/ The owner is the innovative former rock drummer Dave Snyder.

ron powersFar from an easy job (imagine filibustering a bill for four and a half days, or being Chris Matthews), yet worth the throat-tearing effort on a number of levels.

The process put me back in touch with the book in a far more concentrated, analytical way even than the process of writing it, which was strung out over more than two years.

Also, it amounted to a good prep (I hope) for any interviews that might come my way.

Finally—a bit of inside baseball here—no more foolproof method exists for detecting flaws in one’s work than reading it aloud. And yes, dammit, I came across some passages that cried out for further attention–including matters of repetition, which is one of my bad habits. Including matters of repetition, which is one of my bad habits. Ha-ha! a little writerly humor there!!
The process is highly physical. Reading aloud involves the entire body, even when one is sitting down. (I was often distracted by the vigorous circling motions of my own right hand as I read; and my creaking chair caused an unseemly number of re-takes.) The strain of it makes you aware of certain muscles in the throat that you seldom use to the point of stress. You become aware in part because, late in each day, you find that you cannot count on these flabby muscles to form the sounds you expect them to; they’re tired of it. Your mouth might be forming an “O,” but what comes out is a measly little “eeeee.” So you pause to go back and do it again, hoping to get there before the producer blares in your headphones, for about the eight hundred nineteenth time, “COULD YOU GO BACK AND DO THAT AGAIN?!”

A sip of water helps, but the price of sippage is seepage. Audible seepage. You must sit still for several seconds while the sip makes its way through your digestive system, every drip and gurgle of the journey dutifully recorded by the CIA surveillance-grade mic in front of your face, put there to ensure that no sound gets lost in the telephone-sized booth in which you are being held without bail.

You realize—horrors!—that the process does not stop when the workday ends. When at last you are ensconced in a booth in a local diner, reading the newspaper while spooning up the chili con carne, you come to a Twilight-Zone kind of realization: as you silently read the words on the page, you can hear yourself narrating them through your mind’s ear, in the same annoying singsong voice you have been spewing forth all day, as you involuntarily calibrate which syllables just ahead need theatrical stressing.

And here you thought showbiz was pretty.

What I liked best about the experience was the collaboration: with the very cool young sound engineer Matt Hall across the window in the Vermont studio (see photograph), and with an amazing blithe spirit and gifted producer named Bob Walter, who directed everything through our earphones from his own studio in Los Angeles. Bob immersed himself fully in the nuances of the book, and coaxed me gently into more fitting intonations at several points. The three of us were Very Professional and Serious in the early going, until we (inevitably) stumbled upon the realization that we were all born world-class wiseasses; at which point every “COULD YOU GO BACK AND—” break in the narration was filled by an interlude of wacky voices, improvised shtick, name-dropping and outrageous insults. Our antics kept the inevitable tension at a minimum and made the hard work go easier.

All of this in the service of an audiobook that I hope will convey my full measure of love for my beautiful sons, Dean and the late Kevin, and my passion for illuminating the great human tragedy of schizophrenia, the affliction that took over their lives yet did not manage to extinguish their soaring human spirits.

The audiobook is in post-production as I write. Plans are to integrate excerpts from the boys’ guitar performances as they coincide with elements of the narration.

ANNIE DON’T WAKE THE DAY

Dean and Kevin recorded this rollicking ballad in 2004. It is among the best of several pieces the two of them produced over that summer, a happy time for both of them, when Kevin visited his older brother in Dean’s Colorado Springs apartment. Kev’s schizophrenia had forced him to suspend his music education at the Berklee’s Music School in Boston, and the ensuing year would be his last. But this summer was filled with creative effort and close loving friendship between the two brothers.

Dean wrote and sings lead on “Annie Don’t Wake the Day.” He also created the visual montage that accompanies this song on YouTube. At about the 1:45 mark, the boys launch into blazing alternating guitar solos: Dean/Kevin/Dean/Kevin.

THE RIVER EAST OF HOME

Of all the music Dean and Kevin wrote and recorded together, this ballad is far and away my favorite. It is a quietly transfixing anthem of wayward drift and redemption. Dean composed it not long after his recovery from an addiction to alcohol that had taken hold of him after a terrifying car accident when he was 16, with him at the wheel. The boys recorded it at Dean’s apartment in Fort Collins, Colorado, where he’d invited his brother, by then afflicted with schizophrenia, to spend several months with him. Dean sings lead; Kev sings harmony and contributes the majestic solo midway through, which I describe below.

Remembering Kevin on his birthday. Dean wrote and sings lead on this luminous ballad, "The River East of Home," my favorite among all the work they did together. Kev sings harmony and comes in with a towering solo about halfway through.Be sure to push the sound button up.

Posted by Ron Powers on Thursday, July 21, 2016

 

FROM CHAPTER 15 OF NO ONE CARES ABOUT CRAZY PEOPLE, “. . .something unexplainable. . .”

Dean’s self-willed recovery—reprieve is probably the better word—held benefits for his younger brother. Kevin was able to make it through his spring semester [at the Berklee School of Music] without another setback.  Dean invited him to spend the summer in Fort Collins, passing up the chance to return to his beloved Front Range for road-building work. He had rented an apartment on the first floor of a modest brown wood-frame house in a residential neighborhood not far from the university campus. Kevin gratefully accepted, bringing with him his Martin and amp, and the prescription drugs that were now a part of his daily obligations.

The two of them had a fine old time, the best time of their lives together. They played coffeehouses and bars around Fort Collins and along the winding mountain roads above the city. Sometimes Kevin set aside his guitar and backed Dean up on a borrowed drum-set, playing as though it were the only instrument he had ever touched. Dean wrote a new flurry of ballads, including the two best pieces of his life, and the brothers captured them all on the TEAC recorder that Dean had used for his earlier songs. When Honoree and I arrived for a mid-summer visit, the two were as eager to let us hear them as Kevin had been to play the Booby pieces for me in the Burlington airport two years earlier. They tugged us into Kevin’s room almost before we had set our bags down, and flipped on the TEAC.

We listened first to “Annie Don’t Wake the Day,” Dean’s madcap romp about a night on the town with a frolicsome, laughing girl who skips and dances through the revels, sits in briefly with a bar band, then whirls on, “back out on the street with the bright lights shinin’ away.” Dean sings lead vocals and alternates with Kevin in a jubilant guitar bridge, two solos apiece, the brothers driving hard, a pair of young tigers bursting loose from their cages.

“It’s been a long, crazy night, but don’t wake the day!”

That was for starters. The anthem that followed, the cathedral of notes and lyrics that meditate on loss and journey and hope, on redemption-through-letting-go, stopped our breathing and cupped us in its guileless majesty.

Its title was—is—will always be—“The River East of Home.” Dean wrote it and sang lead; Kevin, harmony. A bridge in the midst of the verses brings up Kevin’s guitar in a cascade of notes that seem to fall from a high place and gather for a moment in a pool before overflowing and dropping again, until they find resolution in the flowing melody at the base.

The opening image is of a figure on horseback, forging along a western mountain path until horse and rider fetch up “at some forgotten fountain.” The rider tries to push his filly on through. “But though it wasn’t wide/She buckled and she balked/She couldn’t see the other side.” The rider tells us of his years of roving between the wilds and mountains. Sometimes he’s on an Arizona highway, right down that center line. Sometimes, crossing water, he falls, and stays down “until I’m good and ready. When I can’t fight the current no more/You’ll find me in the eddy.”

 

But always, the chorus tells us, the rider is searching. Just as Yeats’s wanderer searches for the silver apples of the moon, the golden apples of the sun, the rider is on a quest for the elusive River East of Home. It sounds as though his quest will be eternal. But then, “One chipped and faded chapel shines up out of the valley.” The rider ventures through the doorway, because a voice, long forgotten, calls him. “I said my life’s been driftin.’ He said that there’s an answer. And if I just believe, this slender reed becomes an anchor.

“I let the river go.”

TO MY FRIENDS WHO FOLLOW THIS BLOG

Beginning in a few days, I will be posting, on this blog, some audio and, later, video tracks of my late son Kevin in performance. These will showcase his more mature work–if “mature” is the right word to describe a gifted young musician who, in the fog of schizophrenia, took his life a week before his 21st birthday in 2005. I’ve published a few pieces before this, but they feature Kev mostly as an early adolescent, sometimes in duets with his older brother Dean–who also was struck by schizophrenia, but who is stabilized at age 35.

kevin-powers-guitar
Kevin’s hands

I have mixed feelings about offering up these audios and videos. From a personal standpoint, it is still difficult for my wife Honoree and me to hear Kevin’s music sixteen years after he left us. Until this past weekend, I had not been able to bring myself to look at the videos–recorded mostly at the Interlochen Academy for the Arts, where he spent his prep years–since his death. Last week I finally braced myself, dug the cassettes out of storage, and brought them to a technician in nearby Rutland for transfer to the MP4 format, which enables editing and sending the material to my blog administrator. On Saturday, notified that the transfer was ready for viewing, I returned to the studio. I made myself stand beside the technician and watch the monitor screen as it shifted from blue to footage of the Interlochen jazz ensemble, with a T-shirted Kevin pumping out one of his glorious solos. I held it together. At this writing, Honoree has not viewed the tapes, but she has signaled her determination to do so.

The second reason for my mixed feelings is related to the first. This blog is followed by many parents who have lost children of their own to the awful scourge of schizophrenia. It doesn’t take much imagination to understand that many of these good, bereaved people will experience the pain of recovered memory as they watch. For this, I am genuinely sorry.

Yet my reason for posting these sounds and images of Kevin has nothing to do with indulging my own sorrow, nor of activating anyone else’s. It certainly has nothing to do with promoting Kevin as somehow more deserving of attention than the countless other young victims of brain disorders. Quite the opposite: my goal is to celebrate the tremendous joyful life-force that was Kevin–and, by extension, the equally precious, and unique life-forces within all his brothers and sisters who have been taken or diminished by serious mental illness.

Every parent or other surviving relative of a mental-illness casualty harbors rich memories of a child in the full exuberance of his or her life–a time of hopes and dreams unlimited, until the unthinkable occurred.

Kevin was nothing if not generous and humble–he was “notorious” for giving up his own solo time to fellow musicians who yearned for a little spotlight. He would have held these young people in his big-handed embrace. He would have insisted, correctly, that each one of their lives was as precious and filled with potential as his own. He would have insisted on consecrating his music to all the beautiful young souls who seldom if ever enjoyed the pleasure of a “solo,” yet enriched the earth around them, each in his or her own way.

So, please: if you can, enjoy Kevin’s music in the same celebratory spirit that he played it: the spirit of life, and laughter, and friendship, and of giving up a solo to a friend every now and then.

“GO, SAID THE BIRD, FOR THE LEAVES WERE FULL OF CHILDREN…”

ron powersI made these photographs in Puerto Vallarta one December many years ago, just a few months after Kevin died. (It was a conference for biography-writers, of all the reasons to go to Puerto Vallarta!)

I am not a practicing Christian, but still, the symbolism of the dove–okay,  the pigeon–hovering over the small girls stunned me with its visual poetry.

And then Honoree and I walked across a small bridge arcing over a rocky stream, and I looked down at the beautiful egret, and saw my son.

I wish a happy, peaceful and redemptive New Year to all!

A MOTHER SPEAKS

Earlier this week I posted a call for caretakers of the mentally ill–usually parents, siblings and offspring–to throw off their habitual cloak of invisibility and silence, and launch a crusade against public cluelessness and apathy; in particular, public policymakers. The link below, focusing on my home state of Vermont, shows just one example of legislative inertia: the ongoing crisis of too few beds for too many patients in psychotic states:

https://vtdigger.org/2016/12/19/involuntary-psychiatric-hospitalizations-record-high/

And here is one searing response to my call for speaking out:

“I wonder what I would do if Tom should decide he can no longer bear this burden.  If I should find him gone one morning.  Would I lay down beside him, hug his lifeless body in my arms, and go to meet him?  Or would I give my life to him?  Tom’s voices threaten to kill him and his family. From his letters for help, which are heartbreaking, he says “they are certainly adding other types of frequencies that are causing extreme agitation, sometimes depression, anxiety, stress; voices described as scary or haunting or terrorizing; more death threats against me and my family and they won’t quit.  I have driven as far as the coast and cannot get this off of me.  The police just come and put me in the hospital.  I don’t know how to be more clear to them and they aren’t listening at all”. What if, in the dark of night, in his madness, he did not see the mother he loves but a horrifying delusional apparition there to harm him and his family; perhaps the act of killing me would finally get him the help he needs, a chance to quiet the voices and terrifying paranoia, and find some peace.

“I have only been afraid of Tom once, his delusions of people coming to harm him, and me not understanding.  I never know the right thing to do or say.  His brain is screaming at him, voices only he can hear, shouting down any shred of reason that may be left.  His despair and fear so great I am afraid he will lash out at anything, anybody nearby, not knowing what he is doing in his insanity. Any suggestions of getting help are met with incredulous sighs and anger.  Why don’t I listen, why don’t I understand, I am the one that needs a doctor, I am the one that is in denial.  I hide the knives that night.

“We leave Tom alone now. He doesn’t talk anyways, he doesn’t hear us, or if he does he responds with something unrelated and unintelligible. I buy health food and leave it around, hoping he will get some nutrition in him   He isolates in his room, sometimes for weeks at a time, not bathing, sitting so long his feet and legs swell up so bad he can barely walk, drinking coffee.  He is going mad in the room I had remodeled for him, to keep him safe for as long as I could.  I pray he will go into a coma and I can now call and say come get him and help him, he is a danger to himself.

“I go to do the dishes, but they are already done.  I don’t remember doing them.  I lose track of time, I wait.  The wolf at the door will surely come bursting thru any day now; it is almost six months of no meds.  One afternoon Tom comes to me, puts his arms around me and says ‘I love you mom.’  I’m still a light in his mind, I’m still there.

“The months go by.  I ask myself how much worse can it get, but I already know, much worse. My nightmares turn into terrifying faces coming out of the dark.”

Mary Welch

SPEAK OUT!

Scott Walker By Michael Vadon (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons
Scott Walker By Michael Vadon (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons
My upcoming book’s title, NO ONE CARES ABOUT CRAZY PEOPLE, is intended as ironic: it is taken from a notorious, subpoenaed email written in 2010 by an administrative aide to Scott Walker. The aide was trying to shield the then-Milwaukee County Executive from accountability for a mental-hospital scandal that was unfolding at the time.

In the few weeks that I have been publishing this blog, I’ve found myself thinking about an alternative title, one that lacks irony and only somewhat overstates the truth.

the screamThat title would be: NO ONE KNOWS ABOUT CRAZY PEOPLE.

For centuries, society has hired, or elected, custodians to see to it that the mentally tormented are kept out of sight and out of—well, out of mind. Those who take for granted their place in the “normal” world prefer to sidestep the colossal moral challenge—the primal fear—triggered by walking, talking evidence that people very much like them can go insane. (“There, but for the grace of jails. . .”) Thus, the mentally ill continue to struggle for their humanity under a cloak of social invisibility, and silence.

None of this is to suggest that people in the throes of psychosis should be left to roam the streets. Hospital treatment and supervision are imperative during such episodes. The problem is this: despite the growing consensus among research psychiatrists that a patient’s integration into a sympathetic community can dramatically reduce the symptoms of brain disorder, progress toward this goal remains slow: impeded by the cloak of invisibility and silence.

Dorothea Dix
Dorothea Dix

Few people have better understood the human spoilage guaranteed by this cloaking than the great pioneering reformer Dorothea Dix, whom I quote in the epigraph to NO ONE CARES ABOUT CRAZY PEOPLE. In remarks to the Massachusetts legislature prepared in December 1842, following her tour of mental asylums in the state, the small and sickly crusader declared:

“I have come to present to you the strong claims of suffering humanity. I come as the advocate of the helpless, forgotten, insane men and women held in cages, closets, cellars, stalls, pens; chained, naked, beaten with rods, and lashed into obedience. . .”

Time has brought improvement to the plight of insanity victims caught in psychosis—the untreated, the undiagnosed, the wrongfully incarcerated, those who refuse to confront their illness and aggressively repel efforts at help.

Time has not brought enough improvement. Not early enough improvement.

The cloaked suffering of the mad thrives, and it thrives. NO ONE CARES is laced with accounts of insane jail and prison inmates, many of them unindicted, who took their lives in their cells or in solitary confinement (I hope against hope that you might read this, Governor Chris Christie of New Jersey, and reverse your support for this gruesome form of soul-murder), and who thus died beyond the range of public attention, save for a few readers of transient news accounts.

Thus, “No One Cares” is fed by “No One Knows.” The two collide, and collude.

Thus far in this essay I have focused on the “invisibility” aspect of “No One Knows.” Of equal destructive importance, I believe, is the silence. The self-imposed silence that mutes the voices of those most entitled—and, I think, obliged—to break the silence.

I speak of the close friends and relatives, parents especially, of the afflicted. These people are qualified not by professional training or certification, but by a precarious vantage-point that no one else can share who are uniquely qualified by direct observation with psychosis.

And yet here is one of the most desolate truths about “No One Knows”: it is far too often a by-product of silence. Self-imposed silence. Silence maintained by those closest to the victims of mental illness who are in active psychotic states. This usually means their relatives. Typically, “relatives” means parents. And “parents” often includes the sub-category of single mothers, women who for one reason or another have been left to care for their volatile children—often male children, as a statistical fact. (Men typically develop schizophrenia between ages 15 and 24; women, between 25 and 34.)

Left to care, and left to scream in silence as police and community social-service agencies designed to help them often fail during episodes of crisis—or in pre-crisis. Police remain under-trained in this area, or not trained at all. In too many cases, the desk-man either shrugs off the frantic phone call or the squad arrives only to make matters worse. Paramedics and social workers feel hamstrung by coils of legal restrictions created to protect the civil rights of people in psychosis who “reason” that they don’t need help. (People in psychosis are, by definition, people deprived of reason.)

And so the family caretakers scream in silence—while their deracinated children scream aloud their suicide threats or violent threats against others, often including the caretakers, as the untreated psychosis deepens. and the cop on the phone explains (in essence) that the screamer cannot be detained unless he or she “constitutes a threat to others,” and that the uttered threat is not enough; the psychotic victim must actually carry out the threat, which, of course, in theory, law enforcement exists to prevent.

The caretakers scream in silence. And their urgent silent screams go unheard by the world around them. And the cloak remains in its suffocating place.

The reasons for self-imposed silence aren’t hard to track down. They’re rooted in human nature. The fear of embarrassment—stigma—is a fundamental one. To appeal publicly for help for a struggling insane relative is to acknowledge that one has an insane relative. Most people live their lives outside the community’s spotlight. To step into its glow for any reason can be terrifying. The imagined shame and ostracism such an admission might bring on is a powerfully, and sometimes fatally inhibiting burden.

Anxiety over the future of the victim is another. What if everybody knows she is schizophrenic? She will never get a job! She will never have friends! She will never marry!

And then there is the soul-crushing factor of futility. America, especially rural and suburban America, remains dotted—clotted—with service agencies, police departments, and courts that remain either stubbornly self-anesthetized to the gothic realities of psychosis, or else are paralyzed by the fear that any action they take might violate some law or statute or other restriction, real or imagined, that would make them civilly liable or criminally accountable for carrying out a good-faith intervention. Thus, far too many desperate mothers and fathers have called police, hospitals, lawyers—anybody—for help, against a background of menacing threats and the pounding upon a locked door, only to be told: “There is nothing we can do.”

This is surreal. This is grotesque. This is beyond the imagination of anyone in the “normal” world; only those who have endured it can appreciate the resulting dread that soaks the heart and blots out hope.

Schizophrenia has struck at both my children; once, fatally. I understand the heartbreak, the dread, the galactic frustration of my fellow survivors and sufferers who must watch their loved ones slip into a state that the world would prefer not to hear about, nor try to heal. I understand the powerful protective wish to remain silent.

And yet, in my core, I cannot accept the silence. I cannot accept it because silence is the lifeblood of “no one knows,” which in turn is the lifeblood of “no one cares.”

In my core, I want to confront all the silent sufferers—“confront” is the only word—and shout at them to shout their stories from the rooftops: to badger the newspapers and radio and television stations in their communities to pay attention to their stories, and amplify them, urgently and accurately, and damn the risks of stigma and anxiety and imagined futility. I want my fellow sufferers to raise a collective voice all across the nationwide archipelago of the mentally ill. I want an impassioned, fearless grass-roots movement to rise up and intersect with the hopeful, but top-down breakthrough of the recently enacted 21st Century Cures Act.

I want the “invisible” mothers and fathers and caretakers of our most helpless citizens to take up the banner of Dorthea Dix, and affront the conscience of emergency responders, police, doctors, judges, and the largely oblivious and benumbed legislators across the country. I want to see a great and vital conversation burst into public awareness: a conversation that until now has been conducted under the cloak: in furtive telephone calls, emails, hushed conversations, and within the several “confidential” websites where members may speak candidly under strict rules of confidentiality.

All these conversation forms are cathartic. None is enough.

I grant that my career choices have annealed me to public exposure and its consequences. My training and experience, now spanning five decades, has been in journalism, which has in turn led me to nonfiction narratives. Over this time I have learned gradually to overcome my own severe native reticence, and to place truth-telling (as I understand it) above all other considerations. I have grown comfortable with violating my own privacy. NO ONE CARES ABOUT CRAZY PEOPLE, if it is nothing else, is a testament to this.

I respect—I ache for—my good, grieving, terrified sisters and brothers who cannot yet imagine shouting their stories from the rooftops, seizing the world by its lapels and screaming, “YOU’VE GOT TO PAY ATTENTION!” I wish I could deliver them from their agony. I cannot. The hard truth (as I understand it) is that they must do it themselves, until their individual voices meld into one continuing thunderous voice. We must throw off the cloak. No one will do it for us.

More on this subject later in the week.