Book Review

Powers, Ron. “No One Cares About Crazy People. The Chaos and Heartbreak of Mental Health in America.” New York:  Hatchette Books, 2017.

Ron Powers promised his wife, Honoree Fleming, he would not write this book.

But ten years after his guitar prodigy son Kevin hanged himself in their basement a week before his twenty-first birthday in July 2005, after struggling with schizophrenia for three years; and then a few years later his older son Dean started experiencing the symptoms of schizophrenia and had a psychotic break --- Ron Powers changed his mind.

Powers started to reconsider his promise when he read the hateful words, “No One Cares About Crazy People,” in an email from Kelly Rindfleisch, who was Governor Scott Walker’s Deputy Chief of Staff in 2010 uncovered by the Milwaukee Journal Sentinel, mocking the horrible treatment of psychiatric patients in the Milwaukee County Mental Health Complex, he was shocked and angered. Patients treated for bipolar disorder and schizophrenia were starved, raped, impregnated, and walked around naked.

Powers hopes you will not enjoy his memoir and trenchant review of the history of mental health treatment in America.  He wants you to be wounded by his book --- wounded enough to do something about the state of help for the severely mentally ill in America.

Born in Hannibal, Missouri, Mark Twain’s hometown, Powers’ works include “Mark Twain: A Life.” With James Bradley, he co-wrote the 2000 number one New York Times Bestseller “Flags of Our Fathers,” made into a movie by Clint Eastwood. Powers was the first television critic to win the Pulitzer Prize.

Powers’ writing tears at your guts with his vast knowledge of our treatment of severe mental maladies, his intimate understanding of schizophrenia, and his heart-wrenching story of his two sons.

About his two sons, Powers says, “There is no greater feeling of helplessness than to watch two beloved sons deteriorate before your eyes, not knowing what to do to bring them back.”

Powers tells us that both of his sons suffered from schizophrenia and anosognosia. The latter is an inability to understand or have insight into your mental illness. Despite hallucinations, delusions, paranoia, you think you are mentally healthy.

Anyone who reads the history of our treatment of the severely mentally ill in America will feel nauseous, sad and angry. For example, “Life” magazine ran a story in 1946 with horrid  pictures of Pennsylvanias Philadelphia State Hospital at Byberry and Ohios Cleveland State Hospital. Movies such as “The Snake Pit,” in 1948 showed the hideous treatment of patients in mental hospitals.  

Powers recounts the “good intentions” of President Kennedy’s 1963 legislation that sought to provide more humane care for patients in psychiatric institutions. This transfer of patients to the community was prompted by the discovery of “miracle” drugs like the anti-psychotic Thorazine, aimed to cure schizophrenia. An aim that worked like a powerful rifle that misses the target.

With the consensus of political liberals and conservatives – for different reasons, we went from a nationwide peak of around 560,000 beds in 1955, to about 35,000 today --- half of what we need. Without these beds, we have about one-third of the homeless consisting of the mentally ill; more psychiatric patients in prisons than in hospitals; the mentally ill clogging emergency rooms and warehoused in the nursing homes.

Powers reminds us how some psychiatrists --- Thomas Szasz, R.D. Laing, and cult leaders such as the science fiction writer L. Ron Hubbard, creator of Scientology, have poisoned the well of psychiatric treatments, claiming such nonsense that mental illness is a myth. Szasz’s widely read book “The Myth of Mental Illness” (1961) propelled the antipsychiatry movement. Szasz wrote:

“My argument was limited to the proposition that mental illness is a myth, whose function it is to disguise and thus render more palatable the bitter pill of moral conflicts in human relations.”

Powers tells how Szasz teamed up with L. Ron Hubbard of Scientology fame backed by millions of Scientology member dollars to create the Citizens Commission on Human Rights (CCHR) established in 1969 headquartered in Los Angeles, California. Its stated mission --- and CCHR continues to this day – is to “eradicate abuses committed under the guise of mental health and enact patient and consumer protection.” On the CCHR website, they write:  PSYCHIATRY: AN INDUSTRY OF DEATH. Some protection.

There is some good news about progress in treating mental illness. For example, Congress has authorized 1.1 billion dollars to do an eight-state demonstration program . Mental Health Act introduced by our Democratic senator Debbie Stabenow which became law in 2014 and detailed criteria for treatment centers to become certified community behavioral health clinics. In 2016 Republican senator Roy Blunt of Missouri introduced a bill to add funding to 24 states to expand the demonstration program.

In 2008 the National Institute for Mental Health launched the Recovery after an Initial Schizophrenia Episode project. The NIMH just completed its first trials of the project in 2015 and finds much value in aggressive intervention for first-episode psychosis (1).

We have a long road to travel to bring the research and treatment of severe mental illness out from under the stigma of treatment and into the mainstream of competent care.

Perhaps the stigma and humiliation of mental illness will lessen as we discover the biological etiologies of psychiatric maladies and provide reliable and valid measures of illnesses of the mind.

 

(1)  Satel, Sally & Torrey, E. Fuller Torrey. “A Prescription for Mental-Health Policy.” “National Affairs, Number 31, Spring 2017.