Crazy: A Father’s Search Through America’s Mental Health Madness

Many of the stories Earley investigates are influenced by, or are the result of, deinstitutionalization movements decades earlier. Deinstitutionalization began in the 1960s, partly in recognition of the poor and often abusive conditions at psychiatric hospitals; over the following decades, adults with mental illnesses or developmental disabilities were released from institutions without proper support systems. Earley views this movement as merely shifting where people with mental illnesses are put away: “[O]ur jails and prisons have become our nation’s asylums because there is nowhere else for the mentally ill to go” (354).

Part of the problem with deinstitutionalization, Earley suggests, is that it occurred at a time when the medical understanding of mental illness was more limited than it is today. Theories of mental illness often stressed environment—e.g., an individual’s upbringing—rather than potential biological causes. Earley argues that mental illness is a form of chronic illness without a cure, meaning it often persists throughout an individual’s life. For example, Gilbert, Jackson, and Hernandez each relapse several times. They struggle to take their medication and stay off the streets even though they know their mental illness will spiral again. However, the virtual inevitability of relapse is most pointedly brought home in Earley’s discussion of his son. Earley is dismayed by the idea of Mike relapsing, but as he shadows others with similar diagnoses hoping to find a “glimmer of promise” (316), he realizes that Mike relapsing is not a matter of if but a matter of when.

Deinstitutionalization is closely connected to many of the inadequate laws surrounding medicating people with mental illnesses that Earley discusses. In such cases, the desire to respect a person’s autonomy—in particular, their ability to make decisions about their own health—clashes with the reality of mental illness, which may impair decision-making. Although Earley suggests there are no easy solutions to the problem, he uses his experiences trying to obtain treatment for his son to suggest that the pendulum has swung too far in one direction.

The dangers of deinstitutionalization go well beyond the threat of relapse. The story of DeeDee Sanbourne reveals what can happen to someone released from a psychiatric hospital without adequate community mental health services. DeeDee cycled in and out of hospitalization, repeatedly losing contact with both her family and her ALF before eventually dying of a treatable medical condition. Nor is this the only possibility: Many of the people Earley profiles end up in prison. Through such stories, Early argues that an effort to treat people with mental illnesses fairly and compassionately has, if anything, worsened their plight.