Book Review: No One Cares About Crazy People

No One Cares About Crazy People is Pulitzer Prize-winning and New York Times bestselling author Ron Powers’ exploration of his two sons’ journeys with schizophrenia, combined with a sweeping social history of mental health care and attitudes towards those with mental illness. He skillfully interweaves these separate threads, drawing the reader along from the early days of Bedlam to the tragic loss of one of his sons.

It’s heartbreaking to read about the toll that mental illness has exacted on the Powers family. The obstacles that arose in accessing care for sons Dean and Kevin are particularly concerning. The historical picture that’s painted is both eye-opening and frightening.

The social history of mental illness

Bedlam has made its way into the modern English lexicon, but its origins were in England in 1247. It was officially designated as a mental institution in 1666. Powers starkly captures the abuses that occurred at Bedlam and similar institutions, including overcrowding, poor hygienic conditions, use of shackles for prolonged periods, and physical and sexual assaults. Such practices were slow to change; even now, the mentally ill are often mistreated, particularly in correctional institutions. Powers deftly ties these elements together, giving the reader a strong sense of the connectedness between past and present.

Powers touches on social Darwinism and eugenics, which were practiced far more widely than is generally known. It’s unsurprising that forced sterilizations of the mentally ill were carried out in Nazi Germany, but Powers informs us that in the United States, an estimated 60,000 forced sterilizations of the mentally ill were performed in the 20th century. Between 2006 and 2010, 148 female sterilizations were carried out in the state of California. This practice wasn’t made illegal until 2014, a jaw-dropping reminder that truly, no one cares about crazy people.

Powers covers a broad range of 20th-century influences on mental health care in the United States, including the anti-psychiatry movement, “treatment” strategies such as lobotomies, and misguided beliefs that antipsychotic drugs such as chlorpromazine could “cure” schizophrenia. John F. Kennedy’s Community Mental Health Act began a wave of deinstitutionalization, which led to a ballooning of the homeless population and large numbers of mentally ill ending up in the criminal justice system. Powers points out that, in many ways, this approach criminalized mental illness, and the effects remain widespread to this day.

Asking why

As any questioning parent might, Powers tries to identify factors that could potentially have contributed to both of his sons developing schizophrenia. Both Kevin and Dean were highly artistic and passionate about music, raising the as yet unsolved question of whether mental illness is linked to traits like artistic creativity or scientific genius.

In his teens, Dean was socially vilified after a female passenger was seriously injured when the car he was driving crashed. He was falsely accused of drunk driving and made into a sort of social pariah, and Powers suspects that the stress related to this incident likely contributed to the development of his son’s mental illness.

Involuntary treatment

Powers raises the contentious issue of involuntary treatment. The precedent for modern legislation in the United States can be found in the era of former president Ronald Reagan; deinstitutionalization was a key aim and decision-making was placed in the hands of the courts rather than medical professionals. This can mean significant delays in accessing much-needed treatment.

Powers argues strongly that involuntary treatment should be more readily available before a mentally ill person reaches a crisis stage, as once they reach the point where they present a risk to self or others, it may be too late. He addresses anosognosia, a common symptom of schizophrenia experienced by both of his sons, which impairs one’s ability to recognize the nature of their illness and the need for treatment. This caused significant negative consequences in the Powers family, which Powers points out to strengthen his argument.

Powers’ account of his son’s illness journeys heart-wrenchingly captures the powerlessness that can go along with loving a mentally ill person. Kevin was initially diagnosed with bipolar disorder before the full extent of his psychotic symptoms unfolded; that led to a delay in getting him started on antipsychotic medication. Before his suicide, he saw his treatment team regularly, and was still passionate about his music and focused on the future. Not once did he speak openly to anyone of suicide, leaving those who loved him powerless to intervene.

Stigma

Powers openly challenges the social stigma and lack of understanding regarding mental illness. He likens schizophrenia to cancer: “a predator without peer and impervious to cure”. He identifies numerous ways in which those with mental illness can contribute to their communities, and emphasizes the importance of having the right types of supports that can make that happen.

The book concludes with a powerful call to action:

The mentally ill people in our lives, as they strive to build healthy, well-supported, and rewarding lives for themselves, can show us all how to reconnect with the most primal of human urges, the urge to be of use, disentangling from social striving, consumer obsession, cynicism, boredom, and isolation, and honoring it among the true sources of human happiness. To put it another way: the mentally ill in our society are awaiting their chance to heal us, if we can only manage to escape our own anosognosia and admit that we need their help.

There are many voices that can contribute to the dialogue around mental illness. Embracing all of these voices can allow us to construct a more coherent social narrative regarding mental illness. No One Cares About Crazy People makes a strong contribution to that narrative by improving awareness and challenging stigmatizing beliefs. It will also resonate deeply with those whose lives have been touched in some way with mental illness.

No One Cares About Crazy People is available on Amazon (affiliate link).

You can find the author’s blog on the website No One Cares About Crazy People. The book is also being made into a documentary film.

You can find my other reviews on the MH@H book review index or on Goodreads.