Monday, March 26, 2012

Review of Crazy

No no, we're not reviewing what it means to be "crazy."  

I recently finished reading Pete Earley's book,  Crazy: A Father's Search Through America's Mental Health Madness.  Fives stars, two thumbs up, all the way.  It was a quick and engrossing read, I think I got through the whole book in three sittings. 

Mr. Earley starts with the story of his son, a young man just finishing college, who becomes delusional and disorganized.  Efforts to clarify a diagnosis and get him treatment are a bit difficult, in part because he doesn't really want help, and perhaps because these efforts span two states as the son is in school in New York but the father lives in Virginia.  Earley goes to NY to fetch his son, and alarmed that he is so delusional, disorganized, and talking about death, he takes him to an Emergency Room in Fairfax, Virginia where he is told that the son can't be committed against his will unless he has already had a suicide attempt.  The son goes home, does some strange things, then breaks into a random house where he shatters pictures, leaves water faucets running, and takes a bubble bath.  He's no longer in the voluntary psychiatric system, per se, but is now charged with felonies that will prevent him from ever being licensed in his chosen profession.  A plea bargain is reached-- for misdemeanors/probation/treatment--  but in court, the prosecutor can't cut the deal because the homeowner-victim won't allow the crime to be pled out without a felony charge.  Does the victim really get to call the shots on what a criminal is charged with?  

Earley is understandably frustrated with the system and all the roadblocks in everyone's way.  He's worried about his son's future, and a bit terrified that his son will get sick again.  Mike can't catch a break, and his diagnosis and criminal record seem to call his life to a halt for a while.  The son does well on Abilify and Earley could be their spokesman.

 The author decides to explore the system by spending a year following patients in the Dade County (Miami) jails and talks about a psychiatrist he shadows who sees his patients for an average of 12.7 seconds.  Earley describes a whole jail unit full of really sick people who are combative, catatonic, and treatment-resistant, in a way I've never seen in nearly two decades of work in community mental health clinics.  Never....well.... Clink says this is all in a day's work for her, but it's not routine stuff for outpatient psychiatry.   The psychiatric unit he describes in the jail is disgraceful, with cold, naked prisoners lying on the floor next to the toilet, in need of blankets and kindness.  It felt like a human zoo, only in animal zoos, the creatures are treated better, I hope.   The tales Earley tells are sad ones, the people he follows end up still sick, imprisoned, or dead, and the system he describes simply doesn't work.  And the patients, some of them are so sick that there is simply no place on earth for them, and Earley faults the state mental hospitals for releasing them.  Even a well-monitored forensic patient ends up doing well, getting a job and living with his girlfriend, only to kill her.   It's all just horrible.  Real life outpatient psychiatry isn't so bleak, and while there are some awful and sad stories, there are many people who do fine.  I felt badly for Mr. Earley because he chose the most dismal of places to search for answers, and I think (or at least I hope) it's unlikely his son will end up in such devastation.  Along the way, he talks with other parents and becomes involved with NAMI.

The author does a good job of getting inside the mental health system.  I didn't agree with him on his easy separation of substance abuse and mental illness, and I don't think we know that drugs don't cause mental illness; they certainly exacerbate it, induce symptoms that mimic it, and make diagnosis and treatment nearly impossible in some settings. 

Mr. Earley is a proponent of involuntary treatment.  He talks to people while they are living on the street, eating from trash bins, victimized by rapists and robbers, and he doesn't buy that people should have the right to live this way.  Earley twice quotes Wisconsin psychiatrist Darold Treffert as saying they get to "die with their rights on."   He wants state hospitals back and he wants them to treat patients humanely.  

If you oppose involuntary treatment under any circumstances, read this book: it will either change your mind or raise your blood pressure.  

Oh, and if you'd like, try Mr. Earley's website and blog at