Civil Liberties, Mental Health Care and Public Policy

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Reporter Pete Earley felt that he was standing “on the outside looking in” when he interviewed people for his articles and books about crime. But when his son, Mike, became psychotic, Pete found himself on the inside looking out. Combining the perspectives of the detached reporter and an affected party, he tells in Crazy about his frustrating search for care for his son and also about the fate of prisoners who are mentally ill.

Mike Earley suffered his first psychotic breakdown during his last year at college in Brooklyn. Over time he was diagnosed with bipolar disorder, schizophrenia, and schizoaffective disorder, each diagnosis bringing in its wake different drugs and different therapies. What a difference, Mike’s dad notes, between the precise medical diagnosis and treatment of, say, a broken leg and the impressionistic, trial-and-error labeling and treatment of mental illness.

Mike and his family found it tough to access mental health care. “Listen,” one police officer told Pete, “even though your son has broken into a house, unless you tell the medical personnel inside that he’s threatened to kill you, they aren’t going to treat him. We’ll end up taking him to jail, and you don’t want that to happen. You don’t want him in jail in his mental condition.”

Pete told lies to get treatment for his son, but even after admission into the hospital, Mike could not be medicated against his will. The lawyer appointed to represent Mike at a commitment hearing told Pete that she would work to get Mike released from the hospital, psychotic or not, if he did not want to be there.

Mike’s charges in connection with the break-in threatened to ruin his life, but he was lucky, and a felony was averted. In time he accepted medication, stabilized, and found work. By the book’s end Mike has reentered the community as a productive young adult albeit one dependent on psychotropic medication. Still, as Pete makes plain, many mentally ill Americans who run afoul of the legal system fare considerably worse.

For his portrait of disturbed prisoners, Pete Earley went to Miami, Florida, providing the historical background-the efforts of reformer Dorothea Dix, the emergence of psychopharmacology in the 1950s, and the movement to eliminate state mental hospitals in favor of community mental health centers starting in the early 1960s-for what he found there.

With deinstitutionalization, Earley reminds us, hundreds of thousands of troubled people poured onto the streets, where few resources awaited them. The community mental health centers were simply not equipped to treat the severely and chronically mentally ill. Over time, as their bizarre behaviors brought them into conflict with mainstream society, these disturbed people shifted, not back into treatment facilities, but into prisons and jails.

Some people, arrested for a minor crime, were held for a few days and released only to be arrested again and placed in jail. Others, charged with a felony, were sent to a hospital to be “made competent” and shipped back to prison, where they decompensated during the wait for trial until they needed to be returned to the hospital. Even today some prisoners spend years in this endless loop without ever getting appropriate medical care.

Earley followed several inmates through the system, onto the streets, and back into prison. He also spoke with a court social worker and two seasoned advocates. He learned about a pioneering facility that gives participants in its program a sense of community. He listened to family members describe the anguished deaths of kin who succumbed to drugs and crime when health care proved inaccessible. And he pondered the good fortune that had so far spared his son a similar fate.

Crazy not only describes the distressed person’s ordeal and that of the family members watching helplessly but also looks at the big picture. In so doing, it highlights questions about public policy and the priorities of contemporary American society at a critical moment in history.

  • Where can a concerned parent access the treatment needed to restore a child’s reason and thereby keep him, and society, safe?
  • When someone is chronically ill and unable to function, do we really want to set greater store by the right to liberty than by the right to medical care?
  • Does the risk of locking someone up unnecessarily or against his will inevitably trump the risk that an innocent person will die or be harmed for life by actions committed while he was out of his mind?

Which point of view should prevail on the many issues raised by Earley’s narrative? That of the sick person and those who love him? That of the surrounding society, with its need for prescriptive laws to balance competing interests? Whichever way we turn, we face fundamental questions about our national values. What basic rights should a citizen have? Who should decide?

As the disparity grows in this country between the few who have in excess and the many who struggle to get by, we may well ask which should count for more, the lofty ideals embodied in the Bill of Rights, with its eighteenth-century elite sensibility, or the essentials of life-including food, shelter, and medical care-that all citizens need to survive. Crazy is a worthy contribution to the ongoing debate.

Reviewed in this article: Pete Earley, Crazy: A Father’s Search Through America’s Mental Health Madness (New York: Putnam, 2005).

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