No One Cares About Crazy People

by Ron Powers

  Interlochen accepted about 440 students for the 1999–2000 year. Of these, only eleven were guitarists.

  We didn’t have to ask Kevin whether he wanted to go off to this arts boarding school a third of the way across the country. The answer was all over his face.

  That September, I drove Kevin the nine hundred miles to Interlochen. It was a memorable ride. He and I chose a route that took us north to Montreal, then westward on Highway 17 for six hundred miles, skirting Ottawa and then the vast and pristine Algonquin Provincial Park, its primitive interior saturated with lakes and moose. We ate hamburgers at a log-built restaurant and gift shop along the route, which would become our traditional stopping-place on future trips. Traditions were important to both boys, but especially to Kevin. We stopped for the night in a motel in Sudbury, Ontario. At Sault Ste. Marie, we turned south into Michigan along Interstate 75. We crossed the Straits of Mackinac, linking Lakes Michigan and Huron, on the majestic suspended arc of the Mackinac Bridge that stretched five miles.

  Kevin was upbeat during the long drive, but he admitted to me that he was worried about meeting new people at the academy. For one thing, he said, he didn’t know any good jokes. I told him that jokes could be overrated, and the best way to make new friends was to ask them a lot of questions about themselves. This went for girls, too, I added. Girls especially.

  In our Sudbury motel room in Ontario, as I was unpacking toiletries from my suitcase, Kevin was sitting behind me on one of the twin beds. I heard acoustic guitar notes and turned around.

  The lamplight brought out the gold in Kevin’s hair, and he was in his usual playing position, bent forward a little, head down, the sole of one messy sneaker planted on the arch of the other.

  The piece was short, but lyric, and haunting, like a medieval ballad, and as it went on I stopped unpacking and sat down on the bed beside Kevin and listened. When he had finished, and when the quotidian sounds resumed—traffic horns, voices in the hall, TV sounds in other rooms—I asked Kevin where he’d learned it and how long it had taken him to memorize it. He shrugged and said that he’d made it up as he went along. He was just doing some finger exercises.

  Some weeks later, walking with him around the Interlochen campus during a visit, I brought it up again. I asked my son if he could reconstruct that piece from memory. He gave an absent shake of his head, his attention on a pretty girl riding a bicycle in and out of the sunlight. A temporary, beautiful, golden thing had passed through that motel room in Ontario that evening, and then vanished, a presence to be experienced only once, and briefly, and then never again.

  We reached Traverse City in the sunlit afternoon of the following day. We made our way around the lip of the small city’s sparkling harbor dotted with sailboats, and then on a two-lane road out of town past cherry orchards and scrub-pine woods, toward Interlochen. The campus shares its twelve hundred acres with a forest of virgin pine and maple trees about fifteen miles southwest of Traverse City. It is situated between Green and Duck Lakes. Most of its buildings—dormitories; studios; rustic visitors’ cabins; administration buildings; dance, art, concert, and theater performance spaces—are concentrated on a quarter of the acreage. The students walk among the pine and maple trees to get almost anywhere on the campus.

  The day was sunny, Green Lake shimmered behind the trees, and children—the young artists—walked and jogged and bicycled the paths, friends halting to squeal and hug one another after a summer away. I worried that Kevin might feel excluded as he watched them, and again, I was wrong: Kevin gave himself at once to Interlochen. He was cheerful as we registered him, met some faculty, and found his room in a trim, low-slung residence hall amid the aromatic pines, and met his new roommate, a simpatico pianist named Jesse. They hit it off right away. I heard no more anxious concerns about telling jokes.

  I hugged him close for our good-bye until he gave me a subtle nudge with his hip, and then I turned and got into the van for the journey home. As I shifted out of reverse, I put my arm out the window to give him a final wave, but he didn’t see me. He was standing in a cluster of Interlochen boys and girls, and he wore his lopsided grin. He was already commencing the happiest three years of his life.

  13

  Debacle

  On Halloween Day, 1963, President John F. Kennedy signed into law the last bill that would come before him: the Community Mental Health Act. Designed to solve, once and for all, the malingering scourge of decrepit mental asylums and barbarous care, the act provided $150 million over four and a half years to finance a massive experiment in human relocation. The money would be spent on grants to the states for establishing, via new construction or adaptation of existing facilities, community centers for treatment of the mentally ill.

  This marked the first attempt by the federal government to take an active role in the care of the insane. The various states would administer their local mental health centers largely autonomous of the federal government, whose role was to lessen the financial burden imposed on the states by providing periodic infusions of money.

  That was the plan to which Thomas Szasz’s antipsychiatric teachings lent some false legitimacy. It became one of the century’s most enduringly disastrous policy experiments for the mentally ill. The program that Kennedy had signed into action came to be known as “deinstitutionalization,” a name that carried the lilting harmony of silverware spilling from a cleanup tray. The very sound of the name, with all its bureaucratic syllables, suggested what would be the vast project’s overall record of shoddy planning and repeated bungling. The unintended consequences of deinstitutionalization have expanded seemingly beyond restraint. They reverberate strongly into our own time.

  The Community Mental Health Act—CMHA—was crafted by a group of psychiatrists and hospital executives brought together by Congress in 1955 as the Joint Commission on Mental Illness and Health. Its members, selected by the American Psychiatric Association and the American Medical Association, were well-meaning professionals, well informed for their time. As history has shown, their time was lacking in critical information and understanding about the nature of the mentally ill and the support they required. As the new law took effect, government-employed psychiatric workers commenced several years of moving about 560,000 patients out of the nation’s 279 mostly dingy and overcrowded state-run psychiatric warehouses. The corrections-system bureaucrats fortified most of them with a farewell jolt of the new potion Thorazine, which they seemed to assume would act on the damaged brains the way spinach acted upon Popeye’s forearms. Nearly half of the departing patients had been jammed into asylums glutted with more than three thousand patients each. In such conditions, as President Kennedy observed in something of an understatement, “individual care and consideration are almost impossible.”

  The patients’ destination was intended, by contrast, to be a sunlit archipelago: fifteen hundred small, freshly constructed “community health centers” (CHCs) scattered about the country. There, the previously institutionalized mentally ill would flourish (it was confidently imagined) in small-scale environments of clean, well-lighted rooms, healthy food, and the care of trained and sympathetic staff. Most of these patients would be near enough to their homes that they could sleep in a family environment. Their benevolent day care would be a modern iteration of the days of moral treatment, which had propounded psychic equilibrium as essential to mental health.

  President Kennedy had recognized the dire state of psychiatric hospitals as an opportunity to extend his agenda of New Frontier accomplishments. His sensitivity toward the mentally ill had almost certainly been sharpened by the plight of his sister Rosemary, who in 1941 became a victim of the Walter Freeman–James Watts lobotomy circus (see chapter 17). Kennedy took the unusual step of folding the two hundred thousand patients suffering “mental retardation” into his announced total of eight hundred thousand mental patients in state institutions whose relocation the act would finance. Many of these, Rosemary perhaps among them, were undiagnosed schizophren
ics.

  Most decisively, perhaps, the optimistic president and the Joint Commission as well were prodded to action by the supposed curative power of Thorazine. The drug and its successors would transform mental health care, for better and worse, through the decades.

  Thorazine made its debut in 1954, a year before the Joint Commission came into being. It is critically important to reiterate that neither this so-called “wonder drug” nor any of its successors “cure” patients of schizophrenia or its kindred afflictions. Their mission is to stabilize certain chemical processes in the brain, the regulation of serotonin and dopamine balances, for example, and thus modify the symptoms of the illness. The symptoms stay modified only as long as patients renew their intake of the drugs—stay modified in most cases. As we will see, this fundamental distinction between cure and stabilization was seldom spelled out in the early marketing of the wonder drugs. This obfuscation led a great many mentally ill patients of the period, not to mention their underinformed prescribing psychiatrists (who relied upon salesmen for the products to explain how they worked), to vastly overestimate the drugs’ functions and power. It is conceivable that deinstitutionalization might never have taken place had Thorazine not been misperceived as a cure.

  Among those who bought into the myth that the wonder drugs were cure-alls was President Kennedy:

  I am convinced that, if we apply our medical knowledge and social insights fully, all but a small portion of the mentally ill can eventually achieve a wholesome and constructive social adjustment. It has been demonstrated that 2 out of 3 schizophrenics—our largest category of mentally ill—can be treated and released within 6 months, but under the conditions that prevail today the average stay for schizophrenia is 11 years… It is clear that a concerted national attack on mental disorders is now both possible and practical… We can save public funds and we can conserve our manpower resources.1

  Three weeks later, John F. Kennedy flew to Dallas, where he was shot dead by a sniper.

  What can explain the monumental chain of blunders and miscalculations that ensued?

  The Joint Commission set about its work in the gentle twilight of one age of cultural misapprehensions about mental illness and the fiery dawn of another. In the twilight years, most people, including psychiatrists, still believed that Sigmund Freud had the discontents of the “mind” all figured out; believed in the existence of the “schizophrenogenic mother,” that mythical Meanie Mama whose coldness and rejection of her offspring literally drove them mad; believed (in complacent thrall to the Menninger brothers) that schizophrenia could be cured. And after 1955, as mentioned, almost literally everyone believed that Thorazine and its progeny could do the job. No muss, no fuss.

  And so it was just before the fiery dawn that the Joint Commission got busy building its bridges to nowhere.

  The first ray of merciless reality materialized in the form of the escalating Vietnam War. The number of US “advisers” multiplied after the president’s death until they gave way to a full-fledged fighting force, one that required constant, constantly increasing, and constantly more expensive infusions from the national treasuries of money and young men. The booming post–World War II economy absorbed much of this drain until 1973, when a global oil crisis and the severe stock-market plunge drove the country into recession. These crises largely account for the slashes in the CHC operating budget, freezing construction at fewer than 650 community centers, less than half the intended figure. This resulted in the stranding of about half of the 560,000 patients who were released or scheduled for release.

  Yet the great enforced exodus of mental patients did not stop when the money ran low. Like a charging rhino that had taken a bullet to its head, it rambled forward, dead on its feet and without the cognitive means to reverse its course. The outflow gained numerical momentum. Nor were there beds for those patients new to the system who needed inpatient care. “By 1980,” as Olga Loraine Kofman of Claremont McKenna College has written, “United States mental asylum populations plummeted from 560,000 to just over 130,000, leaving many of the chronically mentally ill homeless or incarcerated because of a lack of community follow-up care and housing. One-third of homeless people were believed to be seriously mentally ill.”2

  And the road to hell continued to receive the pavement of good intentions. In July 1965 President Lyndon Johnson, hurrying to consolidate his Great Society agenda in the lingering national sorrow over John F. Kennedy’s assassination, signed two companion pieces of landmark progressive legislation: the Medicare and Medicaid acts. (He had steered the historic but inflammatory Civil Rights bill into law the year before, invoking the late president’s vision for it; the following month, he would sign the Voting Rights bill into law.) Medicare proved its worth as a great and lasting benefit to American citizens. As, to a lesser extent, did Medicaid—with one crushing exception.

  Medicaid prohibited federal reimbursement to the states for psychiatric patients in state hospitals and any public facility that treated mental illness. The (good) intention was to speed deinstitutionalization along, and to hold the states responsible for care and treatment costs. But in fact, the states proved not interested in that kind of responsibility. Instead of welcoming this helpless horde of mental patients and finding the means to shelter and treat them, as the CMHA envisioned, the states—leery of spending an extra taxpayer dollar—whisked large numbers of them right along into private nursing homes and into—well, into the community. The nursing homes and the community would take care of them, and receive Medicaid reimbursement in return.

  Unfortunately, “the community” came to mean “the streets.” Most of the state-hospital refugees lacked the sophistication and the reasoning skills to proceed to the nearest private facility or community haven. Unless family members, friends, or kindhearted strangers took them in, they wandered at large. For thousands of them, the most severely incapacitated, their wandering led to jail or prison, where the taxpayer dollar covered the cost of hopelessness.

  The state most tragically influential in modeling the national approach to treatment (or lack of treatment) for the insane was California. With its population the size of a small nation (around 20 million people in 1969, nearly a tenth of the United States’ 205 million citizens) and its magnet pull for the wealthy and ambitious, the state has long reigned as a national bellwether. Its political, social, and cultural innovations drift eastward.

  Deinstitutionalization was no exception. The program enjoyed its most explosive implementation in the Golden State. It cross-fertilized with the Szaszian wave of dissent against the very notion of insanity that rose to greater prominence in the ’60s and ’70s counterculture and also with the Church of Scientology.

  Eight years after publishing The Myth of Mental Illness, Szasz, as mentioned, crossed the continent and, with the Scientologists, coestablished the Citizens Commission on Human Rights in Los Angeles. By then he had published two more books and given dozens of talks and broadcasts and written a steady flow of papers and articles. He was a worldwide celebrity, respected in many academic circles.

  His Scientology funding partner for the commission was the quasi-mystical former science-fiction writer L. Ron Hubbard. Hubbard had founded Scientology in 1953. Hubbard was respected in no academic circles at all, yet he had carved out an image as a kind of prophet among millions of people around the globe.

  Hubbard wore his red hair in a high pompadour. His lips were voluptuous, the lower one curling over his small dimpled chin. He’d served as a naval intelligence officer during World War II. He liked to wear ascots and often sported a cowboy hat. He cut some albums featuring himself crooning to his own jazzy compositions. They never made the charts.

  That was all right. His several books over the years, according to Scientology’s unverified claim, have sold more than 250 million copies.

  Like Szasz, Hubbard was fueled by near-obsessive antipsychiatry and insanity-denying convictions. (“PSYCHIATRY KILLS,” suggested a banner in one Scientology
parade.) He had in fact preceded Szasz as a mental illness denier, though his publications did not receive serious discussion in the academic world, perhaps because they advanced a somewhat unacademic argument: that thetans (billion-year-old human beings, except for the terrestrial body, which the phantasmal thetan must replace now and then, combing hospital nurseries as if shopping for a new wardrobe; it’s complicated) are immortal and that their lives are ruled by aliens from outer space. His 1950 book Dianetics: The Modern Science of Mental Health, self-published and a breakaway best seller, explained this and other principles overlooked by conventional science: for instance, that people not fortunate enough to have found Scientology risk having false ideas implanted into their minds by “implant stations” located on Mars or Venus.

  In 1969, Hubbard was expanding his “church” and propagating its doctrines with monomaniacal energy. In its sixteenth year of existence, the church already had gathered considerable wealth—all of it from individual donors, many of them politically conservative rich men and women in Southern California. Yet when Hubbard joined forces with Szasz, his holdings were pocket change compared to what was to come.

  Szasz by then was a worldwide celebrity of another sort: a rare intellectual celebrity. He had produced three more books and dozens of papers, articles, and speeches since The Myth of Mental Illness. His partnership with Hubbard was thus a marriage of convenience: Szasz had the legitimizing cachet, and CCHR had the necessary money. Szasz found kindred cause in CCHR’s mission: to “eradicate abuses committed under the guise of mental health and enact patient and consumer protections.”

  Szasz served on the commission’s board of advisers for forty-three years, until his death. Delivering the keynote at its twenty-fifth anniversary in 1974, he declared, “We should all honor CCHR because it is really the only organization that for the first time in human history has organized a politically, socially, internationally significant voice to combat psychiatry. This has never been done in human history before.”3 Yet his feelings about his involvement were mixed. He always made it clear that he had no organizational ties with Scientology and no affinity with their mystical beliefs.