No One Cares About Crazy People

by Ron Powers

  He seemed to need solitude, and we allowed it. We’d installed a hot tub on the small brick patio at the rear of our house, and this became his refuge; he spent long stretches there, his chin on his chest, his guitar-playing posture. Motionless, impassive in the swirling water.

  The spells of giggling were still some months in the future.

  Dean flew home for the holidays, and the two of them spent a lot of time together, private and contemplative. Dean’s mood seemed to have lifted. He told us that he had passed the flight reading Thomas Wolfe’s great first novel, Look Homeward, Angel, and was spellbound by its towering bursts of lyricism: “O lost, and by the wind grieved, ghost, come back again.” When his plane landed at Burlington, Dean exited with the line of passengers, but the novel remained on his seat. “O lost!” he declaimed to us at intervals over the next few days, his hand over his heart. “O lost!”

  We picked up on a subtle deepening in his relationship with Kevin. Without making a big deal of it—he kept his tender feelings tightly guarded from family view—Dean made himself available to his younger brother, just as Kevin had done for him over the summer of Dean’s house arrest. They drove one night to hear a band in Burlington. They attended AA meetings together regularly for the three weeks they were home. It was a gossamer thing to watch, all but wordless, all but invisible to our eyes, yet beautiful, and full of hope.

  Berklee agreed to accept Kevin’s reenrollment for the spring 2003 semester, on condition that he attend regular sessions with a counselor on the academy staff. We agreed, and we also secured appointments with a psychiatrist in nearby Brookline. We located an AA chapter for him as well. We found him a small apartment on Burbank Street, four blocks south of his classes, and Kevin repacked his clothes and his black Martin and returned to school. An email in mid-February began: “Hey guys, I hope everything is going well with you!”

  All things considered I’m doing fine right now, I’ve kept a consistent day to day running routine. I feel pretty good overall, some days are rather hard and I think about using drugs (not plan, just think) but those periods really don’t last to long. The more I get a perspective on how irresponsible I was the more and more I want to be away from it entirely.

  On a brighter note, (and the trumpets call!) I’ve met a really great girl named Bianca. She’s really really cute, warm, and very nice, she’s great and things are going well. She seems to be very level headed and that’s rare to find here!

  All the best, and thank you both for your tireless support, Love, Kevin.

  The news from Fort Collins was bright, as well:

  thanks, i really enjoy the support from you guys, things got good yesterday, really good, i got some invitations to see music, a drummer came over and a bass player and i felt more confident in a jam than i ever remember and then i went out and listened to other musicians at an open mic, it was all good, and then i met a guitar player who wants to jam with me, so a lot seems to have happened yesterday after i wrote mom that e-mail, and i feel pretty good, so now for some reading, take care-

  Dean’s avidity for classwork, American literature in particular, continued, as he playfully kept letting us know:

  Have you ever read Mrs. Bridge? It’s dreadful and quite absurd, as Mrs. Bridge would say. It was good cause I got really emotionally involved with the book, but it makes you want to shake up Mrs. Bridge. You think our family had problems? This is a stark outlook on a rich family that has no understanding or compassion or emotions at all. You almost get that feeling that housewifes used to feel in the 40s. Anyhow, I’m gonna get crackin on homework.

  I took pleasure in keeping Dean supplied with upbeat—and genuine—responses to the musical CDs he sent us. His fingering technique kept improving, and the poetry of his lyrics could be stunning. He sang of angels with suitcases. Part of a verse in one song, called “Skipping Stones,” went: “Fathers and sons / Lessons shared / Don’t look at the past / Don’t show you cared…” At some summer lake, when Dean was a small boy, I had taught him to skip stones. He’d been delighted.

  Dean—

  Your songs show a pervasive, indomitable manliness. A braveness of vision, and an insistence on taking delight in the world that you live in, never mind how close that world came to engulfing you. I think it’s what will make you an important artist if you get the breaks you deserve. You are uncompromising, trusting of your best instincts, and at ease with wit, playfulness, tenderness and unabashed wonder at the bounties of this world. I cannot begin to tell you how much I admire you for this—both artistically and in matters of the soul. I am everlastingly proud to be your old man.

  I also let him know whenever someone in town mentioned him in a favorable way, which was far from rare. Dean’s probation period was set to expire in a few weeks, and he had let us know that he was anxious he would “screw it up” at the last minute. Further, both Dean and his mother suspected that the town had never forgiven Dean for his role in the accident. I didn’t share that impression, though I knew that some enmity still simmered, and that sympathy for Amy remained deservedly strong. To hearten him, I wrote to him about positive encounters I had with the locals:

  Guy came up to me at the Bakery about an hour ago. Leaned down and said, low voice, “I met your son at a meeting. He’s really a fine young man.”

  I go to the health club, some guy comes up and wants to talk about you. Mom and I go to Steve’s, all of a sudden some guy is sitting in our booth talking about you.

  I meant every word of these messages. Yet reading them again after all the years that have passed, I can discern another intention in them, unconscious at the time. It involved the end of his probation. In praising him and relaying praise from people who knew him, I was cheerleading him as well; I was willing him to beat his craving for bad substances, get healthy, stay healthy, believe in himself and in his art and in the love that people felt for him.

  My will wasn’t strong enough.

  17

  “We Have Done Pitifully Little About Mental Illnesses”

  War, to paraphrase Clausewitz, is the continuation of insanity by other means. The twentieth century exemplified this as no other period in history.

  The century just past accelerated developments in ever-newer, ever more mechanized, ever more terrifying and destructive weaponry. It made routine the strategies of “total” warfare, which metastasized from the ancient practice of relatively small professional armies facing one another across rural fields into the spectacle of million-man juggernauts sweeping across terrain and through towns and cities, butchering, burning, and raping indiscriminately.* (Both of these profanations had been tested in the latter stages of the American Civil War.)

  Infantry of the twentieth century were the first to employ poisonous gas and flamethrowers, and death camps where tens of thousands of civilians perished in gassy fumes. The century introduced programmed starvation, mass machine-gunning of noncombatant prisoners, torture, and sadistic bloody experiments on the bodies of conscious victims. The century introduced the aerial bombing, and then the firebombing, of great metropolitan centers. The twentieth century introduced the atomic bomb.

  One might expect to learn that the effects of these routinized atrocities upon the mental health of combatants and civilians of the twentieth and twenty-first centuries are incalculable. But that is not strictly true. They are at least roughly calculable, thanks to improvements in the sciences of tabulation and statistical sampling.

  It is possible to say with assurance, as did two psychiatric researchers writing in the journal World Psychiatry, that “among the consequences of war, the impact on the mental health of the civilian population is one of the most significant.” And that studies of general populations “show a definite increase in the incidence and prevalence of mental disorders.” And that “women are more affected than men.” And, of course, that the most vulnerable groups include children and the elderly.1

  Certainly war’s effects have always been keenly felt by veterans and the
ir families. Poets, correspondents, priests, medics—all have likewise experienced the shock of battle firsthand and witnessed its power to derange the human mind. Yet before the unpopular Vietnam War, nobody said much about it beyond these tight circles. The military code of manly silence, the hard strictures of patriotism, and medical ignorance of how the brain works made it all but unthinkable for a combatant to admit that he or she had become unhinged. Any soldier foolish enough to give voice to such unmanly sniveling risked being mocked by an officer or slapped around by a three-star general, then reviled as a coward and physically kicked out of the medical tent. The veterans brought their psychic wreckage home with them, awoke screaming in the night for decades, soaked their pajamas with sweat and urine, drank themselves insensate, filled themselves with pills of all kinds, brawled with their wives or in the workplace—and, all too often, ended the torture by killing themselves.

  It took a president who himself had known intense, highly mechanized combat—had known it as he screamed out artillery orders in the chaos of a massive and decisive battle—to awaken the federal government and push it, for the first time in its history, into a role of responsibility in the financing and the care of warfare’s psychic casualties—and from there to a share of responsibility toward all of the nation’s mentally ill.

  The president who spurred Congress into action on mental health was Harry Truman. On November 19, 1945, before a joint session of Congress, Truman declared:

  There is… special need for research on mental diseases. We have done pitifully little about mental illnesses… There are at least two million persons in the United States who are mentally ill, and as many as ten million will probably need hospitalization for mental illness in the course of their lifetime. Mental cases occupy more than one-half of the hospital beds, at a cost of about 500 million dollars per year—practically all of it coming out of taxpayers’ money.2

  Truman’s call to action on mental illness came as the embers of history’s greatest, ghastliest war still glowed in Japan and Germany. The speech was an elaboration of a bold transitional challenge that Truman had issued two months earlier, on September 6, just four days after the United States accepted Japan’s surrender that formally ended the war.

  Truman’s September address to Congress had been shrewdly timed. Less than a year earlier the small Missouri senator had only reluctantly accepted the summons of Franklin Delano Roosevelt to join the Democratic ticket and run for vice president. In office only three months, he’d been thunderstruck at the news of Roosevelt’s death on April 12. But he had regained his combative self-assurance in time to drop two atomic bombs on Japan in early August, forcing the end of World War II. Now Truman was at his full cruising speed. He’d hammered out an ambitious peacetime domestic agenda, and he wanted it enacted sooner rather than later. Perhaps calculating that some of its items were more radical than those even of his late beloved boss, Truman chose a moment when America’s patriotic exhilaration was at the flood, and when grief over the lost national father—who after twelve years in office had become “virtually the presidency itself,” in the words of David McCullough3—was still fresh. Thus he rolled out his agenda under the title that the dying Roosevelt had introduced in his State of the Union address on January 11, 1944: a “Second Bill of Rights.”

  In his own version, Harry Truman ventured where not even FDR had dared to tread. His left hand chopping the air in emphasis, Truman all but dared Congress to enact a program that had already stirred up fiery partisanship, and would continue to do so for the rest of the century: compulsory, federally administered health care.

  Truman anticipated the hornet’s nest he had stirred up. And yet, instead of pouring all his energies into the idea’s defense, he pivoted to another offensive on November 19: he introduced his crusade for government mental health funding.

  Thus Truman widened the definition of health to encompass the brain.

  If American outreach toward its insane and psychologically troubled population can be said to have experienced a golden age, it began here.

  The president had little chance of seeing his larger dream realized. Universal federal health care, long since common in western European countries, had appealed to Americans as well in the years before World War I. Theodore Roosevelt had run on it in his 1912 “Bull Moose” campaign to recapture the presidency, but he lost the election. Franklin Roosevelt sent signals in 1933 that he would revive the idea as part of his Social Security bill, the centerpiece of his transformative “hundred days” of New Deal legislation. But he backed off. By then, federal health care had aroused the snarling attention of a powerful natural enemy, the American Medical Association.

  The AMA had organized in 1847 in Philadelphia to rescue the public from the quackery, ignorance, and shambolic training standards that were rampant among physicians. Less than a century later, reformers were wondering whether the public needed rescuing from the AMA. The organization had hardened into an interest group: one dedicated to enriching its member-doctors and borrowing the ruthless tactics of the newly fashionable political consultants to smear those who might encroach upon its interests. “Those” included presidents. When he learned that the AMA was planning to attack his federal health-care initiative, Roosevelt withdrew it from the bill—more out of annoyance than intimidation. He would get to the issue another time. As the White House physician, Ross McIntire, told a colleague, “The president knew that the American Medical Association would stir up opposition… there is no way of appeasing that crowd.”* 4

  But Roosevelt died before that “other time” arrived. And when the stubborn, defiant Truman took it up—in 1946 and again in 1950—“that crowd” hit him with all it had.

  “This is not socialized medicine!” Truman had insisted in his September 6 oration. “The American people are the most insurance-minded people in the world! They will not be frightened off from health insurance because some people have misnamed it ‘socialized medicine.’ I repeat—what I am recommending is not socialized medicine! Socialized medicine means that all doctors work as employees of government. The American people want no such system. No such system is here proposed.”5

  The AMA would be the judge of that. The group bellowed that it damn well was “socialized medicine,” and by-god “anti-American” in the bargain. As for the president and his fellow communistic-type pinkos in the administration, why, they were nothing but “followers of the Moscow party line.” Before the AMA was finished, Republican senator Robert Taft of Ohio was baying that compulsory health insurance came out of the Soviet constitution, and Republicans were boycotting congressional hearings. Lest anyone was still a little hazy as to where the AMA stood on the issue, one of its members quoted Lenin himself to the effect that “socialized medicine is the keystone to the arch of the Soviet state.” At any rate, all this reasoned argumentation was good enough for Congress, which voted federal health care down.

  Truman seethed. “I put it to you,” he railed during a campaign stop in Indianapolis during his famous come-from-behind reelection campaign in 1948. “Is it un-American to visit the sick, aid the afflicted or comfort the dying? I thought that was simple Christianity!”6 Almost no one believed that Harry Truman stood a chance of winning that election against Thomas E. Dewey, so he might have been wise to put the issue aside and come back to it later.

  But Truman had no intention of ditching his federal health-care crusade, even though it likely cost him precious votes. He squeaked through to victory anyway.

  Yet he still couldn’t beat the AMA. In 1950, when Truman reintroduced his federal health-care measure to Congress, the AMA counterattacked with the most vicious propaganda onslaught that money could buy. The group paid $1.5 million to the wholesome-looking California husband-and-wife team of Clem Whitaker and Leone Baxter, the founders of Campaigns, Inc., the nation’s first political consultancy firm. Whitaker and Baxter struck the template for nearly all political consultants to come, flooding national and local media with relentles
sly dishonest facts about federal care and playing to Americans’ worst instincts. They managed, for instance, to link “the opiate of socialized medicine” to both Hitler and Stalin.7

  Such was to be the fate of health-care reform bills and initiatives for the ensuing sixty-five years, until the association decided to support the Barack Obama administration on the Health Care and Education Reconciliation Act of 2010.

  Viewed in this context, it is a tribute to Truman’s bulldog willpower that he did not withdraw from the fight, but planted his two-toned shoes and launched his second, equally radical parallel campaign: federal guarantee of financial protection for treatment of the mentally ill. Here, he drew on strong allies. He had the indispensable support of many psychiatrists inside and outside the armed forces. These experts testified powerfully in Congress for the cause. The leading advocates were the two most celebrated American psychiatrists of the time, the Kansas-born Menninger brothers, Karl and Will. We will shortly examine the history-changing careers of these two forces of nature.