A Review of
No One Cares About Crazy People:
The Chaos and Heartbreak of Mental Health in America.
Reviewed by Ben Brazil
with the author of this book…
When Scott Walker was in the midst of his successful run for Wisconsin’s governorship, Milwaukee County Hospital faced allegations that its mentally ill patients had suffered vicious abuse. As Walker’s team worried about political fall-out – he was Milwaukee County executive at the time – an aid’s email offered reassurance. “No one,” she explained, “cares about crazy people.”
Ron Powers’ new book, which draws its title from that callous phrase, provides infuriating proof that it is entirely accurate, as well as heartbreaking evidence that it is not. On the infuriating side, Powers provides a nuanced, multi-layered history of the callousness, ignorance, greed, and ideological rigidities that have left the nation’s mentally ill in “conditions of atrocity” (xix).
On the heartbreaking side, Powers tells the story of his own beautiful, creative, and schizophrenic sons – one who still struggles with the disease, and another who succumbed to it, hanging himself just shy of his 21st birthday. Powers’ fierce tenderness toward his sons, revealed in family stories and old e-mails, gives the lie to his title. This is an author that cares profoundly about “crazy people,” and has written a sad, but extremely illuminating, book to jar others into doing the same.
Best known as a co-author of Flags of Our Fathers, a bestselling account of the World War II soldiers that raised the American flag over Iwo Jima, Powers has written fiction and won a Pulitzer Prize for television criticism. In No One Cares About Crazy People, however, he returns to what he does best: distill copious research into clear prose and well-told stories about the real world.
Powers is certainly not the first writer to turn personal experience with mental illness into fuel for a book on the subject. Among recent works, the most obvious comparison is to journalist Pete Earley’s Crazy: A Father’s Search Through America’s Mental Health Madness. In both cases, fathers of schizophrenic sons offer searing, closely researched condemnations of a system that is cruel, costly, and illogical.
Powers, however, does more than report on the existing system, which currently houses ten times more mentally ill people in prisons than in hospitals. Instead, he attempts to trace the multiple scientific, social, cultural, and economic vectors that have brought us to the present, shameful debacle.
As he tells this sprawling story, Powers draws on his own family history to give the book a narrative spine and emotional center. In particular, he chronicles his children’s charmed boyhoods in Vermont, as well as their inexorable slide into illness. We watch Dean, Powers’ older and surviving son, as a child with a precocious storytelling ability; as a teenager who makes a life-altering bad decision; and as a passionate young man struggling to live with major mental illness. Likewise, we watch as Kevin, Powers’ younger and deceased son, becomes a world-class guitarist before his schizophrenia emerges. Transcripts of e-mail exchanges give a jolt of immediacy to the tenderness between a good father and his talented sons.
These deeply personal reflections alternate with Powers’ researched chapters, which benefit from his storyteller’s eye for detail and character.
When he traces the history of asylums, for example, Powers begins with a British facility that originated in the 13th century and once charged admission to see “patients” – literal prisoners who slept on straw coated with urine and feces. “Bedlam,” as the institution was nicknamed, was guarded by gargoyles called “Melancholy Madness” and “Raving” (60).
From this lurid starting point, Powers continues through the movement for “moral treatment” and the reformism of Dorothea Dix, ending in the catastrophic 20th century decision to close large asylums. “Deinstitutionalization”, fueled by a disastrous overconfidence in “wonder drugs”, created a situation in which 1.3 million mentally ill people languished in jails and prisons in 2006 (321). Powers also devotes a searing chapter to the criminal justice system itself, with its hair trigger police shootings and casually abusive prisons.
He also takes aim at the pharmaceutical industry. Yet even as he highlights Big Pharma’s unscrupulous marketing and obfuscating approach to side effects, Powers also endorses its biology-based approach to mental illness. Indeed, he narrates scientific history with great flair – explaining, for example, how the search for allergy medication led, by route of antihistamines’ sedative effect, to the earliest psychiatric “wonder drug,” Thorazine.
Powers is at his explanatory best, though, when describing how culture and ideology have affected the treatment of the mentally ill. He devotes an entire chapter to the rise of eugenics, a pseudo-science that used Darwinian “survival of the fittest” to justify scientific racism and the forced sterilization of the “unfit,” including the mentally ill. Eugenics also inspired the Nazis, who made the mentally ill an early target for slaughter. Even today, Powers argues, it undergirds callous attitudes.
More controversially, Powers takes aim at the antipsychiatry movement, whose attacks on the very notion of mental illness dovetailed with both the logic of deinstitutionalization and the non-conformist mood of the 1960s and 1970s. While dealing quickly with thinkers as diverse as R.D. Laing, Ken Kesey, and Michel Foucault, Powers devotes most of his energy to Thomas Szasz, the Hungarian-born psychiatrist who burst onto the scene with 1961’s The Myth of Mental Illness. In essence, Szasz argued that “mental illness” was simply a phrase used to pathologize nonconformist, difficult behavior.
In 1969, Szasz partnered with Scientology founder L. Ron Hubbard to found the Citizens Commission on Human Rights. Among other functions, CCHR continues to resist laws that would make it easier to force people suffering from psychosis to take medication. This insistence – that the civil right to refuse treatment protects people too delusional to know they need help – has long infuriated parents like Powers, who cannot force their adult children to get treatment.
While he makes a few rhetorical gestures toward the schizophrenics who agree with the CCHR position, Powers might have done more to unpack its nuances, especially since it marks perhaps the major fault line in debates over mental health reform. That he neglects to do so is surprising, because Powers gives admirable attention to the links between the oft-demonized “otherness” of the mentally ill and the role of shamans, writers, artists, and other creative sorts who are gifted, and cursed, with the ability to think and live beyond standard conceptual barriers. In short, he appears to have at least some, limited, common ground with antipsychiatry logic.
At the end of the book, after walking readers through the gut-wrenching loss of one son and the ongoing struggles of another, Powers does offer a more hopeful final chapter, “Someone Cares About Crazy People.” It profiles advances, activists, legislative proposals, and treatments that promise to make a difference. Nonetheless, the overall tone of the book moves between heartbroken lament and angry jeremiad. Both fit Powers’ explicit goals for the book, which include telling sufferers that they are not alone and issuing a call to action.
But the purpose that lingers is “consecration” (xx) – as in consecrating a book to the beautiful son Powers lost and the beautiful, struggling son who lives on. For readers who have young children and family histories of major mental illness – and that group includes this reviewer – Powers’ book is a terrifying reminder not only of how suddenly and terribly mental illness can upend lives, but also of how little help our nation, our culture, and our health care system provides. Powers notes that he was “wounded” into writing it. He hopes that the book will, in turn, wound the rest of us “to act, to intervene.” (xxi)
As well we should.
Ben Brazil is assistant professor and director of the Ministry of Writing Program, Earlham School of Religion.