Crazy

No, this is not going to be a recounting of my chaotic week. And it isn't going to provide any more insight about my own struggle with mental illness. This is one of my favorite things...a GUEST BLOG!!!

Guest blogger, JoAnn, and I go way back. About 13 years ago, with a toddler, a baby on the way and a full-time job, I somehow found time to read 75 books a year AND spend hours on the computer "discussing" them. I "met" JoAnn on an AOL newsgroup called "BookNook" and subsequently renamed "Favorite Fiction" when we got tired of people who wanted to talk about their cats and their kids instead of BOOKS!!!

Over the years I have had the greatest respect for JoAnn's take on books. We haven't always agreed, but she's always presented cogent arguments to support her point of view. So, I was thrilled when she agreed to review Crazy for my blog. JoAnn doesn't have her own blog, but her daughter does and you can visit it here. And here is JoAnn's review:

Do you know what the largest mental health facility in the U.S. is? The LA County jail! It houses 3,000 mentally ill inmates.

If this shocks you, I would not be surprised. It is appalling indeed. Earley, a journalist for the Washington Post has written an absolutely chilling expose of the mental health treatment system in our affluent country. Or should I say "non-treatment system"? Shameful. The whole mental health services industry is an unbelievable nightmare, and it is almost impossible to conceive of anything worse.

Some shocking statistics:

•In 1955, 560,000 people were in mental hospitals with a total U.S. population of 166 million.

•By 2000, the U.S. population had increased to 276 million.

•Thus, there should have been over 900,000 people in mental hospitals in 2000.

•Instead, in 2000, there were only 55,000 people in mental hospitals!!!!

Lest anyone naively think that all of those hundreds of thousands of people were cured…..no. Tragically, this was all due to deinstitutionalization of mental health patients, as a reaction to deplorable conditions in state mental hospitals, all done without a safety net for these afflicted people. This was abandonment, not freedom. And the ACLU can take most of the “credit” for this horror. Civil rights laws were and are being used to prevent treatment – unless the patient consents. Yet many of these people are too ill to KNOW that they need treatment. Not only are many of those who are chronically mentally ill in denial as to their disease, so too are our society and the healthcare system in denial.

As one reviewer said, the REAL crime was when we stopped helping the mentally ill, under the guise of protecting their civil rights by turning them out of mental hospitals. Not that those "warehouses" are the answer, but neither is prison or living in a gutter. If civil rights mean equal opportunities, we should remember that if the chronically mentally ill persons are homeless, due to their permanent mental disability, they should have at least the opportunity to live the rest of their life in dignity in a place other than on the street or in prisons.

It did not take long after the vaunted reforms of the 1970's, when warehouses for the mentally ill were shut down, for reformers to notice that the mental-health millennium had not arrived. Inmates were freed from appalling conditions behind institution walls only to reappear on city streets, wandering at risk to themselves and sometimes to others as well as to civic propriety. The community health alternatives that were supposed to replace the oversize state hospitals remained wishful thinking. Even Geraldo Rivera, who was a proponent of deinstitutionalization, now says that this meant that the mentally ill were ''caught between good intentions and broken promises”. Large state psychiatric hospitals were supposed to be replaced by community-based treatment programs. Instead, countless numbers of people with mental illness were, and still are, left on their own without treatment or medical attention. Many have come to the attention of local law enforcement agencies, and jails and prisons increasingly have become a virtual dumping ground for people with mental illness.

Earley first became acquainted with this issue when his son was diagnosed as mentally ill with bipolar disorder and was prosecuted for a delusional act.  His son’s act was viewed as a crime rather than a psychotic episode and this spurred on his father to investigate the "criminalization of the mentally ill." Through a sympathetic judge, Earley was able to get access to the Miami-Dade County jail where guards told him that they routinely beat prisoners. He found out that Deidra Sanbourne, whose 1988 deinstitutionalization was a landmark civil rights case, died after being neglected in a boarding house after she was released from a mental hospital. This book is an indictment of those who fought to restore the civil rights of the mentally ill so that many can now "die with their rights on”.

Overconcern with patient's "rights" makes it next-to-impossible to treat them. Many of the untreated are thrown into prison, where they are housed without effective treatment, just as if they were fully responsible for their acts. Society perceives, often incorrectly, that a large expenditure of money would be necessary to do otherwise, so the problem does not get corrected.

The personal pain comes through in Earley’s writing, but he has also managed to distance himself enough to present a well-researched and thoughtful book which educates its readers.

He suggests that developing better, more lasting drugs with fewer side effects could ease this process. "Eighty percent of persons with mental illness can be helped with antipsychotic medication, yet civil rights laws are used daily to prevent patients from getting help." A public defender told Early that he helps mentally ill clients avoid hospitalization, even though this goes against his grain.

The US needs to invest in retirement-like homes, where chronically mentally incapacitated can live in dignity while under supervision and medication.

The average person has no idea of the hopeless, helpless position someone with a mental illness and their family are put in by the very people who we hope will HELP. As Mr. Earley points out in the book, who among us, particularly those in the medical profession, would walk by a person in pain, dying of cancer, without attempting to help? Who would send that person to jail to be locked up with murderers and rapists instead of to a hospital, where he would be given the medical treatment he needed? Who would suggest that no help could be given to him until he tried to kill himself or someone else? This is what happens to someone's son, daughter, mother, husband every day in this country.

Especially painful are the accounts of parents who find that the only way they can get some sort of medical attention for their children is to have them convicted of a felony.

These days, reformers appear to be focusing on luring or coercing the mentally ill into treatment, pressure once resisted by civil liberties advocates. Unfortunately, persons without insurance have little hope of obtaining quality medical care, and even less of receiving any type of mental health care; and most health insurance policies have strict limits on mental health coverage.

Crazy will frighten and enrage you; it will make you weep. If you know or love anyone with mental illness, it will give you greater understanding of how that person sees the world. Most of all, Crazy will make you want to change the laws.

For persons with mental illness, today's system represents a reign of terror and error. As a society, we can do better.