No One Cares About Crazy People

by Ron Powers

  There is no evidence that either the libertarian-leaning Szasz or the flamboyantly right-wing Hubbard ever attempted to influence the California legislature regarding their beliefs and causes. They really didn’t need to. Southern California was heavily predisposed to agree. The region’s massive population, politically diverse and disengaged in decades past, had been coalescing toward the right since at least the early ’60s, and that suited Szasz and Hubbard just fine.

  “Southern California’s” borders are imprecisely defined. With its eight large metropolitan areas, including Orange County, on the southern rim of the Los Angeles city limits, it makes up two-thirds of the state’s population. Thus it was an extremely potent political trend-maker, in the state and in the nation. In the 1960s and ’70s, thanks in part to the vexations of the insane, the area began to harness and use that power and became a cradle of right-wing thought.

  CCHR enjoyed a reception perhaps beyond its expectations when it opened its doors in Los Angeles and started mailing and broadcasting and speechifying its fiery screeds. Southern Californians were predisposed to Szasz’s and Hubbard’s combined message that “mental illness” was a fraud, cooked up by phony “psychiatrists,” and that involuntary hospitalization and forced drug treatments were but devices for advancing a statist, totalitarian agenda if not an explicitly Marxist one. Many of the predisposed were state legislators, set a-quivering by the Red Scare.

  In 1966, Orange County Republicans spearheaded a drive to elect a right-thinking hero as governor of the state. Their man was the born-again Southern Californian and born-again conservative Ronald Reagan. (The former Midwestern baseball announcer had come to Hollywood to get into the movies in 1937, and stayed.) Reagan neither understood nor cared much about mental illness, but he liked to save a buck or two when he could. Among Reagan’s first acts as governor was to order the firing of 237 psychiatric technicians from the staff of the Patton State forensic hospital. The following year he ordered the canning of 212 more.

  That was for practice. Then Reagan signed the Lanterman-Petris-Short (LPS) Act.

  The chief author of this legislation was Assemblyman Frank Lanterman, a powerful Republican who represented Pasadena, which Fuller Torrey has called “the heartland of California’s anti–mental health movement.” Lanterman’s constituency, and allies, included such reactionary forces as the Minute Women of the U.S.A., the Daughters of the American Revolution, and the John Birch Society, which thought of mental health treatment as a “Marxist weapon” aimed at controlling people’s minds. As one scholar concluded, “This politically conservative culture made it natural for Lanterman to distrust psychiatry and especially involuntary commitment.”4

  LPS’s good intentions included providing “individualized treatment, supervision, and placement services by a conservatorship program for gravely disabled persons.” This aim proved a pipe dream. Over the next two years, tens of thousands of patients from the big asylums streamed out across the state, overwhelming the unprepared county and private treatment agencies and flooding the streets and the criminal justice system.

  The Lanterman-Petris-Short Act “set the precedent for modern mental health commitment procedures in the United States,” according to the published opinion of the Superior Court of California, County of Los Angeles. To paraphrase Henry Kissinger, this had the added misfortune of being true.

  Nevertheless, LPS became the national gold standard for clueless, destructive government interference in the interests of mentally ill people. Intended to accelerate deinstitutionalization, it instead served to barricade state hospital doors against the admittance of stubbornly resisting patients—at least until a hearing was held. Not a medical hearing, with psychiatrists, but a judicial hearing, with a judge and lawyers. Because stubbornly resisting patients almost always were patients in psychotic states who almost always were in the collateral grip of anosognosia, the legislation meant that the most desperately vulnerable of all sufferers were the ones least likely to get help.

  The act included other requirements almost guaranteed to inhibit necessary funding and to encourage the manipulation of both finances and patients. It stipulated, for instance, that California counties with more than one hundred thousand residents establish mental health treatment programs, with a 90 percent funding match from the state.

  Good luck with that. LPS found the states in no more a mood to cooperate than had the previous agencies been with CMHA. The states now were signalmen on Highway Good Intentions, rerouting the helpless insane to the hells of shoddy private nursing homes and board-and-care houses—and to the streets—and to the jails. No one, it seemed, cared about crazy people.

  Governor Reagan and his successors eventually closed nine of the fourteen state hospitals. In terms of financing, the federal government was in the clear.

  Politician Frank Lanterman himself later expressed regret at what became of his good intentions. “I wanted the law to help the mentally ill,” he told a reporter years later. “I never meant for it to prevent those who need care from receiving it.”5

  And a new category of American citizen was crystallizing: “the homeless.”

  The flow of the mentally ill out into the community was irreversible. Most of the new arrivals in communities found their sudden freedom terrifying. Most could not find Realtors willing to rent to them, or business owners willing to hire them. The new federal antidiscrimination laws prohibited this sort of thing; but how many of Dr. Szasz’s “mythically” insane could summon the wherewithal to report the injustices? Afflicted children were taunted by their new schoolmates and peers. Bias against “crazy people” among “respectable” residents of these communities quickly formed and hardened. More and more former state hospital patients found bleak refuge in the streets, and many of these became prison inmates.

  The criminalization of mental illness was in full swing.

  In 1970, with half of California’s mental asylum population already gone (its peak was 37,500 in 1959), Governor Reagan decided to get serious about deinstitutionalization. On the ballast of LPS, he ordered the release of thousands more mental patients from California’s large asylums into the community. The policy gained momentum and scope as the decade went on. In June 1972, for example, the governor approved the release of thirty-eight hundred mentally ill people from Agnews State Hospital, then in San Jose. This effectively closed down the mental health operations of the institution founded in 1885 and known as the “Great Asylum for the Insane.”

  And it contributed to the unofficial transformation of the Los Angeles County Jail into “the largest mental health provider in the county,” in the words of the former official in charge of the facility.

  And then, miraculously, things began to look up—or appeared to begin to look up. For a brief shining hour in the mid-1970s, it was possible to think that if this question could never be decided, its implications could at least be minimized to society’s satisfaction.

  Deinstitutionalization was fifteen years along when Jimmy Carter ascended to the presidency in 1976. A year after his inauguration, Carter created the first President’s Commission on Mental Health. First Lady Rosalynn Carter, a longtime advocate for the insane who had organized the annual Rosalynn Carter Symposium on Mental Health Policy in Georgia, served as the commission’s active chair, and she helped draft what might have been a landmark federal policy: the Mental Health Systems Act, which her husband submitted to Congress on May 15, 1979. MHSA was designed to streamline and coordinate the federal-state effort in combating mental illness, especially in the country’s drastically underserved small towns and rural areas. It guaranteed badly needed new funding for those financially imperiled community centers, provided for a sophisticated partnership to replace the disheveled and adversarial relationships between federal and state governments, and promised “special emphasis” on the needs of the chronically mentally ill: sufferers of schizophrenia, schizo-affective disorder, and bipolarity.

  After many months of hearings,
debate, and revision, the act was signed into law on October 7, 1980. It offered an array of “categorical” federal health programs that had not been tried before. Funding for categorical programs arrives with strict rules that limit how the funds are spent. Carter’s programs included an emphasis on the treatment of chronic mental illness—schizophrenia and its allied diseases—which had not previously been dealt with via federal funds at the community level. They also introduced federal grants for preventive projects and education in mental health care, and other grants to organize advocacy initiatives to protect the legal and social rights of the mentally ill.

  Years of continued innovation and civilized management—and hope for the mad—seemed to lie ahead.

  The Mental Health Systems Act survived for 310 days. On August 13, 1981, an old nemesis of mental health care struck again. Ronald Reagan, who the previous November had defeated Jimmy Carter to become the fortieth president, got Congress to effectively rescind the act.

  MHSA’s funding was among seventy-seven categorical grants obliterated by Congress at Reagan’s urging, to be supplanted by nine “block grants.” A block grant contains far fewer rules than a categorical one, giving expansive discretion to state and local governments as to its funding use—and also giving expansive new meaning to the phrase “in good faith.” The new president had in fact targeted eighty-five programs, hoping to squeeze them into seven, far less pricey, block grants.

  Congress instead consolidated seventy-seven categorical grants into nine block grants. With those changes, block grants came to make up 17 percent of total federal aid to state and local governments. They reduced funding by about 25 percent.

  MHSA vanished into the maw of Reagan’s Economic Recovery Tax Act of 1981, a stunning across-the-board measure intended to put an end to years of economic “stagflation,” as it was known—an economic miasma of anemic growth, high unemployment, and high inflation. On the theory that if taxes were cut for rich people and corporations, the saved wealth would be invested in growth and production (“supply-side” economics), the economic recovery act increased estate tax exemptions in phases from $175,625 to $600,000 by 1987, cut marginal tax rates by 23 percent over three years, and relieved corporations of $150 billion in tax obligations over five years. The cumulative reduction in taxes from 1982 to 1986 has been estimated at $749 billion, or about the same figure as the gross national product in 1966. Not every agency dependent on federal spending suffered, of course. Some were even enhanced. Defense spending increased 12.5 percent a year from the fiscal years 1981 to 1985, a total of 60 percent.

  Of course the government had to find some spending trim of its own to offset its historic tax reductions. So it vitiated nearly every domestic program available to cuts. It struck where resistance was weakest: at people and groups ill-suited to the demands of lobbying, or even the demands of voting, most of them, and therefore without political influence. It struck at the federally funded school lunch program, at Aid to Families with Dependent Children, at the food stamp program, at unemployment insurance, at low-income housing, at the mentally ill. It repealed all existing legislation covering these programs and replaced them with the austere “block grants.”

  Ronald Reagan seemed never to have thought much about mental illness beyond the political, social, and fiscal impressions he’d picked up as governor of California back during the years of L. Ron Hubbard’s and Thomas Szasz’s public-education efforts, and the general hatred toward the mentally ill then at large. In March 1981 he picked up some field experience in the phenomenon. He was shot in his left armpit at near-point-blank range, and nearly killed, outside a Washington hotel by the schizophrenic gunman John Hinckley Jr. From his hospital bed, the president disclosed to his visiting wife the sum of his soul-searching on the implications of the incident, and untreated psychosis on the streets, and the avalanche of available handguns, and the nation’s narrow escape from the trauma of enduring the second presidential assassination in barely more than seventeen years: “Honey, I forgot to duck.”

  The nation’s state and federal lawmakers did not forget to duck. Successive legislatures and congresses resiliently avoided the question of enlightened reform—for instance, overhauling the Lanterman-Petris-Short Act to allow evaluation and treatment against the will of people in psychosis, while honoring due process. And so in California and all around America hundreds of thousands of the untreated were “free” to continue along that tragic and at least partly preventable course.

  Deinstitutionalization (and California) did produce, however unintentionally, one group that grew into an institution of great benefit to the mentally ill. This was the National Alliance on Mental Illness, or NAMI.

  It began in 1974, with a small circle of Oakland and San Mateo parents whose children were victims of chronic mental illness. The parents became exasperated with the hostility directed at their sons and daughters, and with the ignorance that fed much of it, including ignorance within the hospitals. They began meeting around one another’s kitchen tables to plan some sort of coordinated response. Attendance grew, and so did the stories of helplessness and anger.

  In October 1977, the group calculated that they had enough support to form a state organization, which they called Parents of Adult Schizophrenics. One of its organizers was Eve Oliphant, a small, intense mother with long, dark hair and outsize glasses. She was already a growing celebrity in these circles, celebrated for her sharp, admonitory talks to psychiatric groups around the nation. A naturally buoyant woman—photographs of her as a young mother show her with a goofy grin, head tilted, radiating optimism—she, too, had been wounded into activism. One of her two sons had been diagnosed as schizophrenic and placed in the Napa State Hospital. Adding to her wash of torment, the doctors decided that she could not visit him. She would only make things worse, given that her son’s illness was all her fault: she was a by-god “schizophrenogenic mother”!

  Eve Oliphant and her allies launched a grassroots blitzkrieg around the state that quickly galvanized a community that had not even known it was a community. Heads of stricken families heard the rumblings, discovered one another, and formed affiliated groups. Following the classic trajectory of California-born ideas, the movement sped eastward through America.

  Eve Oliphant drew media coverage, some of which inadvertently revealed the complacency and condescension toward the disease and toward its new activists, especially the female ones. A writer for Oliphant’s local newspaper, the Times from San Mateo—a woman writer—trumpeted her as the “Peninsula’s ‘Little Lady’” who was going to “let the psychiatric community have it,” when she addressed the World Congress of Psychiatry. “She’s a little lady, but she’s packing an increasing wallop, and when she talks people listen,” the paper crowed.6

  The “little lady” did deliver her wallop. Oliphant blistered the learned, Freud-marinated attendees with her attack on their “schizophrenogenic mother” myth and other complacencies of the profession. At one point she laid out the reasons that the grassroots organizations had been formed. “We failed to understand,” she declared in a widely reprinted burst, “why parents of a child with leukemia were treated with sympathy and understanding, while parents of a child with schizophrenia were treated with scorn and condemnation.”7

  At a 1979 meeting in Madison, Wisconsin, the groups formally unified as the National Alliance on Mental Illness—NAMI. Eve Oliphant became the organization’s star and most persistent advocate—a kind of twentieth-century Dorothea Dix, presenting the strong claims of suffering humanity to hospitals, elected officials, newspapers, and anyone else who would, or wouldn’t, listen. She persisted, though progressively slowed by age, until she died in California in June 2010, two weeks before her ninetieth birthday.

  NAMI’s record of education, advice, and engagement in mental health issues is hardly free from criticism. Journalist and author Robert Whitaker, for example, has castigated the group for its unquestioning endorsement of antipsychotic medications and for acc
epting donations from drug companies such as Eli Lilly.8 Still, NAMI’s outreach has remained vigorous through the years.

  But by 2015, the nation’s prison system was so overstuffed with people whose reasoning capacities were impaired that a study published by the normally sedate Stanford Law School bristled with outrage: “When Did Prisons Become Acceptable Mental Health Care Facilities?” It was written and copublished by state senate pro tempore Darrell Steinberg, the Stanford law professor David Mills, and the Stanford Law School special projects director Michael Romano.

  Among its particulars: insane people in America “are far more likely to be treated in jail or prison than in any healthcare facility.” The mentally ill account for more than 350,000 inmates in US prisons, more than ten times those in psychiatric hospitals.

  “Although litigation-related reforms have resulted in a significant overhaul of prison mental health services… mental health care in prison still falls well below minimal constitutional standards, not to mention medical standards, in many important respects.”9

  Among the study’s many damning assessments, this one rings with particular eloquence:

  We have created conditions that make criminal behavior all but inevitable for many of our brothers and sisters who are mentally ill. Instead of treating them, we are imprisoning them. And then, when they have completed their sentences, we release them with minimal or no support system in place, just counting the days until they are behind bars once again. This practice of seeking to save money on the backs of this population comes with huge moral and fiscal cost. It is ineffective because we spend far more on imprisonment of the mentally ill than we would otherwise spend on treatment and support. It is immoral because writing off another human being’s life is utterly contrary to our collective values and principles.10