Crazy: A Book Review

  • Bebe Moore Campbell is quoted as saying: "For anyone in the thick of the battle for the mind of a mentally ill loved one, a new champion has emerged. Crazy is both a clarion call for change and justice, and an enthralling portrait of a father who refused to surrender."


    Pete Earley, an investigative journalist, wrote Crazy: a Father's Search Through America's Mental Health Madness, in response to his experiences with his son, who has bipolar, and his inside access to the jails in Miami-Dade County. His son, Mike, had been turned away from inpatient treatment because the doctor claimed he wasn't an "imminent danger" to himself or others.

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    Clearly delusional, Mike decompensated within forty-eight hours. He broke into a house where he took a bubble bath because he felt dirty. The homeowners were out of town. It required six officers to subdue him, and he was charged with two felony crimes.


    The book is part memoir, part expose. Dr. Poitier, the psychiatrist on C Wing on the ninth floor of the jail, where inmates with mental illnesses are housed, told Earley, "If our society says that barely surviving, that living on the street like an animal is acceptable for people who are mentally sick, then I say, ‘No! No! No!'" The father asked, "What about their civil rights? Their right to be crazy?" The doctor told him, "I've never had one person whom I've helped say, ‘Doc, I wish you would have left me crazy on the streets."


    Earley recounts the history of the civil rights law that prevented him from getting help for his son. Ironically, Dr. Birnbaum, the champion of this movement, had published his "right to treatment" theory and it was misconstrued. In the 1960s, patients were deinstitutionalized from life-long tours of state hospitals because most were locked in against their will and not given treatment. Birnbaum believed that legally the hospitals had to immediately begin treating patients or had to set them free regardless of their mental condition.


    His goal was to force states to begin treating the patients' illnesses. Instead, there was no safety net of community programs for them when they were discharged. The noble goal of freedom wasn't all it was cracked up to be. In a landmark case, the Supreme Court decided that mentally ill persons had the right to refuse medical treatment, including the taking of antipsychotic drugs. These drugs were over-prescribed in state mental hospitals to sedate and control patients. The Mental Health Law Project and the ACLU pushed against involuntary commitments, even when the person was clearly sick.


    In 1987, New York City mayor Ed Koch tried to get the homeless off the streets in one bitter cold winter. Joyce Brown was living on the sidewalk in front of a restaurant's hot-air vent for more than a year. The judge who defended her stated it was her choice to be homeless, and he argued that she should be allowed to live as she wished. Released from Bellevue, Brown decompensated, and went back to screaming, cursing, and defecating on the street.


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    Indeed, the only options for treatment seem to be the streets or the jails. For at least five years NAMI and other organizations have been fighting for the rights of prisoners and the homeless who have mental illnesses. Earley's son was lucky in that he spent two years on probation and avoided jail. The people with schizophrenia and bipolar that the author met in the prison weren't so fortunate. They revolved in and out of lock up, moving from the psych hospital to jail and back and forth. The doctors on the hospital would treat them until they were competent enough to stand trial, and then the inmates would decompensate.


    His own son, Mike, stopped taking his medication after he finished probation. With the help of Dr. Xavier Amador's book, I Am Not Sick, I Don't Need Help, he was able to convince Mike to take the medication again. Today the son has a full-time job.


    Crazy is a chilling, compelling expose of the jails-as-mental-hospitals syndrome. It chronicles what happens when people with mental illnesses are arrested for petty crimes, placed in jail and not given the medication that could help them think clearly. At this point I am no fan of the ACLU. I was lucky that when I relapsed, I was held in 4 pt. restraints, and involuntarily committed two hours later when the tranquilizer wore off and I was unstrapped.


    This sobering book is hard to read, but it must be read by anyone wanting to break this vicious cycle.


    In my next blog, I'll talk about the presidential candidates' viewpoints on ending the inappropriate jailing of Americans with mental illnesses, as well as their positions on mental health issues put forth in NAMI's questionnaire.

Published On: January 14, 2008