No One Cares About Crazy People

by Ron Powers

  Tower, setting, and philosophy of treatment—which emphasized the humanity of the patient, her comfort, exercise, and intellectual stimulation—all of this resonated strongly with the waning moral care era. Patients and their families arriving at Topeka by train or over dusty roads, perhaps after hours or days of chugging along through a dry, blank dust-bowl landscape, were greeted by a billboard whose message stood apart from the ubiquitous Burma-Shave signs: “WELCOME TO TOPEKA, KANSAS, THE PSYCHIATRIC CAPITAL OF THE WORLD.”

  An important event in the rise to national fame was the publication of Karl Menninger’s debut book in 1930, The Human Mind. The intended readership was medical students, but this was among the first books on Freudian-derived psychiatry to be written by a professional yet in language that lay readers could understand. It was a call to liberate the mentally ill from the shadows of “otherness.” It advocated the inclusion of psychiatric principles into the professions, education, and everyday life. It boldly gave voice to a truth that not many people were comfortable contemplating: few if any differences existed between mental asylums and jails.

  Most audaciously for that era of entrenched stigma and fear of “maniacs,” The Human Mind maintained that the differences between mentally ill and normal were matters of degree, not of kind. Neurological science would later demonstrate that this assertion was but partially true at best, and naive. The chronic diseases—schizophrenia and its related disorders—were indeed beyond the healing power of Freudian “talk” therapy alone, the root system of Menninger’s approach. Yet Karl was convinced that psychotic illness was reversible. He was a big fan of Freud, though he disagreed with the emphasis the Master placed on sex as a font of human motivation—at least publicly. Privately, he ratified it several times.

  He had undergone Freudian analysis in 1930. Inspired, he’d traveled to Vienna in 1934 to meet Freud and discuss his methods. Freud kept him waiting and then treated him, as the great Ring Lardner put it in another context, like a side dish he had not ordered. Menninger went home mad. Still, Karl’s message on “degree” had value that ordinary people could understand and respect, even as it assaulted their prejudices. Here at last was a point of view that demanded dignity and acceptance for those selfsame “maniacs” of the town, the state, the nation, the earth.

  Karl Menninger would write eleven books in all. His first led to a long-standing advice column in the Ladies’ Home Journal, which further cemented his rapport with middle Americans. This in turn earned him the folksy nickname Dr. Karl, an honorific that only after several decades would be bestowed (or self-bestowed) again, this time upon Dr. Phil.

  He was a complicated man, and his complexities increased as he aged. While avuncular in his column and charming in his public appearances or when hobnobbing with the likes of Eleanor Roosevelt, Margaret Mead, Aldous Huxley, and Hollywood celebrities, Dr. Karl could be a dour, demanding, irascible man away from the spotlight. His Vulcan-like personality could intimidate underlings. Sometimes even dignified Viennese doctors on his staff felt his sting. “He was… quite arrogant and immensely abrasive,” recalled one of them.20

  Over the years these spells of crankiness hardened and played their part in his downfall in the institution he had created.

  Karl being Karl, the role of public ambassador for the growing enterprise was left to his younger brother, and Will Menninger was born to that task. He joined the family business after graduating from Cornell College of Medicine in 1924 and studying psychiatry at St. Elizabeth’s Hospital in 1927. In 1941, anticipating the imminent need that war would produce, Will assisted Karl in creating the Menninger Foundation for Psychiatric Training and Research. The following year Will was appointed director of the Psychiatry Consultants Division in the office of the Surgeon General of the United States Army. He oversaw the upgrading of the US classification of mental disorders. This document standardized the process by which Army psychiatrists evaluated the mental health of masses of new servicemen and psychically damaged veterans. It was adopted by all the armed services.

  By 1944, Will had risen in the Army to brigadier general and chief of Army neuropsychiatry. He knew that the war’s end would soon increase the flood of “battle fatigue” cases, as they were still called. He issued a call for federal support in an initiative to train and hire hundreds of psychiatrists and staff to process the onrush.

  His next step placed him in his historic alliance with President Truman. On July 3, 1946, Truman signed the act that created the National Institute of Mental Health. Will was among the chief architects and most persuasive lobbyists for this partnership with the federal government.

  The early postwar years proved as needful of their profession as the Menningers had anticipated. As the psychoanalyst and author Kate Schechter has written, “Medically oriented, psychoanalytically trained psychiatrists like William Menninger spearheaded the rapid buildup of psychiatric forces during and after the war, and they soon found themselves at the top of a pyramid of mental health manpower and resources, directing research programs, university departments, and hospitals.”21

  The Menningers symbolized psychiatry’s brief golden age. Thanks largely to them, not only the armed services but the American public was embracing the mental healing professions as never before. Psychoanalysis, once scorned as arcane and fraudulent, had become a middle-class status symbol; virtually a consumer product.

  In retrospect the golden age was not all that golden. The various Menninger clinics and sanitaria, justly celebrated for their professionalism and abiding decency toward their patients, presented a misleading picture of asylum life in America. It was as awful as it had always been, for the most part. In cities and towns across the country, the mentally ill continued to be mistreated, tortured, deprived of warmth and fresh air and healthy food and human sympathy. A succession of investigative journalists, both print and broadcast, was about to shine its lights into these caverns of atrocity.

  The result of this scrutiny, however, would be all too glumly familiar to the universe of the insane: unintended consequences.

  In their heyday, Karl and Will Menninger had performed miracles. They had been instrumental in healing, or at least easing, the suffering of tens of thousands of veterans from the psychic damage of World War II. They had resurrected and sustained, for a while, the highest principles of moral care. They had managed the unthinkable task of budging the great American middle class off its great American hindquarters and persuading it to attend to its mental health. Psychiatry for the masses at last was a respectable commodity. As for those kooky people who had to be locked up in “insane asylums”—well, somebody was doing something for them. Weren’t they?

  The early postwar years were a time as Dynaflow-driven as a Buick Roadmaster (if one could take one’s mind off nuclear annihilation, at least). Psychiatric care was just as comfy as Linus’s security blanket (a “transitional object,” in the hep new lingo). In the words of the psychologist and scholar Jeremy Safran, the friendly neighborhood shrink “became a purveyor of conservative American middle class values rather than a culturally subversive force.” Safran added acutely, “Mental health, by extension, tended to be defined in terms of conformity to those values.”22

  As the 1960s began, some new varieties of “culturally subversive force” were abloom in the nation. Dissent against authority spread, widening its targets: the New Left’s consolidation at Port Huron in 1962, the formation of the counterculture after the assassination of President Kennedy in 1963, the Free Speech movement at Berkeley in 1964, bloody race riots in Selma and Montgomery in 1965, followed by the first anti-Vietnam student march in Washington, followed by the first urban race riot (Watts). The Rev. Dr. Martin Luther King Jr. was gunned down in April 1968 and urban rioting lasted for days; Robert Kennedy was assassinated in June. The women’s movement was launched with a demonstration at the Miss America pageant in Atlantic City. Antiwar crowds rioted at the 1968 Democratic Convention in Chicago. Yale University broke tradition by admitting wo
men. The Weathermen staged their Days of Rage in Chicago. People began to wonder whether the whole world was going crazy. (And, as mentioned, Thomas Szasz arose to tell them it was not!) Soon, though, that fanciful question became a serious proposition, and a justification for many to celebrate individual madness.

  Eclipsed by these history-changing events, nearly all of which dealt blows to traditional authority in government, race relations, education, and family—eclipsed, and virtually forgotten—lay the archipelago of the insane. And the fragile archipelago fragmented even further.

  18

  “Primoshadino”

  It was around dinnertime on a rainy day in mid-March 2003 when the damned ringing telephone once again brought us devastating news. We were in the kitchen. Honoree was watching pasta boil in a pot while stirring some shrimp in crumbs and olive oil. I was chopping a vegetable salad. My wife reached for the phone and held it to her ear for a few moments, and then her mouth opened and I think she lost color. She listened for several moments more, and then she began to speak to Dean in a fast, whispery voice. She listened again, and then she said, “Dad is right here. I’m going to put him on.” She held the phone in front of her and cradled the speaker tightly. “Dean is in trouble,” she said. “He’s violated his probation. He thinks he’s going to be arrested and put in prison.”

  I didn’t know how to respond. So I carefully lowered myself until I was flat on the kitchen floor, looking up at the overhead kitchen light, my hands stretched out wide. I lay like that for a little while. I wanted to lie like that for the rest of my life. But instead I got to my feet, took the phone from Honoree’s hand, and put the receiver to my ear.

  Dean’s voice was choppy and thick with agony. A urine analysis had come back with traces that prompted his probation officer in Fort Collins to tell him her patience was at an end. She was considering placing him under arrest. Conviction would lead to a prison sentence.

  Dean had remained on probation because his nolo contendere felony conviction was still on the books back in Vermont. A lawyer we’d consulted had told us we had a good chance of getting it expunged, but Dean was not up to facing another courtroom unless he had to. (His final probation hearing was scheduled for the following January.) The dread of prison, which had hung over Dean for years, had arisen again, undead, implacable. And too much a horror for our son to bear.

  Dean told me what he had told his mother. He didn’t know what to do. My own feverish mind supplied dreadful possibilities. From childhood, Dean had loved to figure out ways to escape tough jams. Watching a movie with us, he could predict what the hero or bad guy had up his sleeve. Often Dean’s strategies involved finding tricky ways to escape.

  I convinced myself that Dean was going to bolt. To flee up into the Rockies, the Front Range where he had happily worked in the previous summer’s sunshine. Dean had always romanticized the wilderness, but he didn’t really know it. Now (as I convinced myself) he was about to entrust it with his life, alone, in winter, supplied with God knew what meager cash, food, clothing, or protective weaponry. (Maybe a knife, maybe not. As for a gun, Dean had never owned or fired one of any kind.) The Front Range in March, where nighttime temperatures dipped below freezing, where snowstorms blew up suddenly, where human habitation was sparse (and in any case off-limits to a fugitive). Where no one alone and on the run, inexperienced in wilderness survival, could expect to last for very long. Days, perhaps.

  O lost.

  We held him on the phone for a long time, alternately reasoning and pleading with him through our own haze of helpless terror. His replies continued to sound desperate. Yet he did not hang up. I tried to convince him that a prison sentence was not a sure outcome, and that if he did have to serve (the thought had tortured me as well), he would be released at some point, and we would support and protect him. Dean listened.

  I made a request that had come from somewhere beyond my conscious thoughts: “Stand with us, Dean.” I wasn’t even sure exactly what I meant. The words sounded precious as soon as I’d said them. And they drew no response. The line was quiet. Dean was listening.

  “Stand with us, Dean,” I said again.

  “Stand with us.”

  He did stand with us. And we stood with him. And nobody loses all the time. His probation officer decided to give him one more chance.

  A few months later, we met Dean at the Burlington airport in April for his spring break. We stood in the arrival/departure lounge and gazed through the window at his plane as it taxied to the gate. I turned to Honoree on impulse and said, “I really hope that I will live long enough to see Dean at peace with himself.” The passengers, kids mostly, with stocking caps and skis, filed through the door into the lounge, and there was Dean, near the end, and he spotted us and grinned in a way that we had not seen in years, and his eyes were bright, and when he greeted us the affected deepness in his voice was gone, replaced by the softer voice we used to know. And I realized that I had lived long enough.

  On the drive from the airport down to Middlebury, he told us that his near miss with a jail sentence had jolted him out of his drugs-and-alcohol torpor and he had quit both, cold turkey. He had volunteered to answer phones on an AA hotline in Fort Collins. He had rejoined the world.

  “I’m making friends with people who were invisible to me when I was in the life,” he told us from the backseat. “Food tastes better. I’m thinking more clearly.”

  He added: “I miss the highs. But I will never miss the lows.”

  Dean’s self-willed recovery—reprieve is probably the better word—held benefits for his younger brother. Kevin was able to make it through his spring semester without another setback. Dean invited him to spend the summer in Fort Collins, passing up the chance to return to his beloved Front Range for road-building work. He had rented an apartment on the first floor of a modest brown wood-framed house in a residential neighborhood not far from the university campus. Kevin gratefully accepted, bringing with him his Martin and amp, and the prescription antipsychotic that was now a part of his daily obligations.

  The two of them had the best time of their lives together. They played coffeehouses and bars around Fort Collins and along the winding mountain roads above the city. Sometimes Kevin set aside his guitar and backed Dean up on a borrowed drum set, playing as though it were the only instrument he had ever touched. Dean wrote a new flurry of ballads, including the two best pieces of his life, and the brothers captured them all on the TEAC recorder that Dean had used for his earlier songs. When Honoree and I arrived for a midsummer visit, the two were as eager to let us hear them as Kevin had been to play the Booby pieces for me in the Burlington airport two years earlier. They tugged us into Kevin’s room and flipped on the TEAC almost before we had set our bags down.

  We listened first to “Annie Don’t Wake the Day,” Dean’s madcap romp about a night on the town with a frolicsome, laughing girl who skips and dances through the revels, sits in briefly with a bar band, then whirls on, “back out on the street with the bright lights shinin’ away.” Dean sings lead vocals and alternates with Kevin in a jubilant guitar bridge, two solos apiece, the brothers driving hard, a pair of young musical tigers bursting loose from their cages.

  “It’s been a long, crazy night, but don’t wake the day!”

  That was for starters. The anthem that followed, the cathedral of notes and lyrics that meditate on loss and journey and hope, on redemption-through-letting-go, stopped our breathing and cupped us in its guileless majesty.

  Its title was—is—will always be—“The River East of Home.” Dean wrote it and sang lead; Kevin sang harmony. A bridge in the midst of the verses brings up Kevin’s guitar in a cascade of notes that seem to fall from a high place and gather for a moment in a pool before overflowing and dropping again, until they find resolution in the flowing melody at the base.

  The opening image is of a figure on horseback, forging along a western mountain path until horse and rider fetch up “at some forgotten fountain.” The ri
der tries to push his filly on through. “But though it wasn’t wide / She buckled and she balked / She couldn’t see the other side.” The rider tells us of his years of roving “between the wilds and mountains.” Sometimes he’s on an Arizona highway, straight down that center line. Sometimes, crossing water, he falls, and stays down “until I’m good and ready. / When I can’t fight the current no more / You’ll find me in the eddy.”

  But always, the chorus tells us, the rider is searching. Just as Yeats’s wanderer searches for the silver apples of the moon, the golden apples of the sun, the rider is on a quest for the elusive River East of Home. It sounds as though his quest will be eternal. But then, “one chipped and faded chapel shines up out of the valley.” The rider ventures through the doorway, because a voice, long forgotten, calls him. “I said my life’s been driftin.’ / He said that there’s an answer. / And if I just believe, this slender reed becomes an anchor.

  “I let the river go.”

  At the end of the summer, Kevin decided to stay on with Dean in Colorado and reenroll at Berklee the following spring. With Dean attending his classes, Kevin had time on his hands, and he spent some days walking around the college town. While he did not experience a psychotic break during these weeks, we learned that his encroaching disease played an occasional cruel trick on his consciousness. He wrote to us that he was having spells of racist thoughts—which bewildered him, because he had never in his pacific life harbored a racist sentiment. Adding to this torture was a kind of dualism: even as these hateful thoughts gripped him, another part of his mind somehow stood apart, looking on, appalled and awash in guilt.

  But a few wisps of grace were still available to Kevin, and he seized on one. The odds against the serendipity of this particular incident, and his spotting it, were long. But then so were the odds against his contracting the disease. On one of his strolls, Kevin spotted an African American man waiting at a corner bus stop. As he neared, he heard the bus bouncing along behind him, and then watched as it streaked past the would-be passenger. Kevin hauled out his mobile phone, retrieved the bus company’s number, and reported the driver.