Jason’s Ranting & Raving

Those who don’t read have no advantage over those who can’t.

Book Review: Crazy by Pete Earley

Posted by jaystile on December 13, 2008

Crazy by Pete Earley is an investigative book taking a look at the current state of mental health in this country. This book was precipitated by his son’s onset of psychosis and arrest. Pete Earley’s son, Mike, was diagnosed with bipolar disorder. During a psychotic episode Mike broke into someone’s house to take a bubble bath. This was after multiple attempts by his parents to get him treatment that were denied because Mike did not want treatment. His story is sewn in between the stories of others with mental illness. ‘Crazy’ a non-fiction book was copyrighted in 2006 and weighs in at 361 pages. Overall, this book is well written and researched with a focus on mental health in the Miami area. It is definitely worth reading.

What is crazy?
Before we get too far into this review we should probably define the term ‘crazy’. The way it is used in this book is: total bat-shit, out-of-your-mind, eating out of garbage cans, defecating on yourself, screaming at people, hearing voices, seeing dead people, everyone is out to get you, kind of crazy. The John Nash (A Beautiful Mind) kind of crazy is not discussed. Mental illness comes in two main flavors, mood disorders and thought disorders. Mood disorders describe uncontrollable feelings without reasons, extreme depression or mania. This is called Bipolar disorder and is still known by its old name of ‘manic-depressive’. The next are thought disorders where one hears or sees things that aren’t real. This is schizophrenia. But if you’re really lucky then you will a have both which is known as schizoaffective disorder.

Carl describes what it is like to be schizophrenic:

“It’s fucked up, man. You want to know what it’s like? How do I know you are here right now? How do I know I’m not imagining all this? Close your eyes. What if when you opened your eyes, you discovered you was now in New York City instead of at Passageway in Miami? Then you closes them again and when you opened them you were in Los Angeles? Or maybe New Orleans? Or Russia? What if every time you opened your eyes it was like you were somewhere else? That’s what it’s like sometimes for me. You ever have a dream where you flew? Them’s the kind of things my brain tells me is true and I can’t tell.”

The Current State
The current state of the mental health system is pretty appalling. Patients are usually first encountered by police who are not trained to deal with the mentally ill. This usually results in excessive force being used that sometimes results in death. Then instead of going to a mental health facility to get help, they go to jail to get punished. They are usually segregated from the other prisoners so they will not be abused. There is a cyclical process where the mentally ill are evaluated to see if they are competent to stand trial for the crime they committed. If not, they are sent to a hospital where are taught to be competent. Then they go back to jail to await trial where they stop taking their medication or are given different types to reduce costs, then they go crazy again, get sent back to the hospital, then back to jail, etc… Renee Turolla researched the Miami area justice system and said about one individual, “The criminal justice system kept repackaging him with medication. Its priority was to make him look and sound competent so he could continue down the assembly line like so many widgets”.

The mental health facilities in jails have been evaluated before. A panel of experts made recommendations to the jail but Pete Earley had different observations:

“They’d recommended that inmates not be held naked in cells. I’d seen them in C wing naked in cells. They’d recommended that inmates be issued blankets and mattresses. I’d seen them in C wing without blankets and mattresses. They’d recommended that inmates be allowed to speak to doctors in private. There was no privacy on the ninth floor. They’d recommended that the officers working there have special training. None of them had.”

A Problem with Civil Rights
One of the main problems is that you cannot force someone to take medication. They have a right to be as crazy as they want to be. When you ask a crazy person, after they have been medicated, if they should take their medicine the answer is usually, yes. When you ask them when they are crazy they answer, no. Dr. Poitier is the psychiatrist at the Miami jail and was questioned by Prosecutor Leathe at a hearing regarding the mental state of a patient and whether or not the doctor could forcibly treat him.

Dr. Poitier: Yes. At one point in the jail, he was almost catatonic.
Leathe: But didn’t he take his medicine this morning?
A: Yes. He took it today because he knew we were coming to court.
Q: What will happen if he stops taking his medicine again?
A: He will decompensate.
Q: And what will happen if he decompensates?
A: He could ultimately die, because when he doesn’t take his medicine in jail, he stops eating.
Q: Why wouldn’t he take his medicine?
A: He has a lack of insight and doesn’t realize he needs it.

Lack of insight seems to be the real problem with mental illness. Those with mental illness do not think they are sick or they know they are sick but do not trust anyone to help them. They can be paranoid and delusional thinking everyone is out to get them. Pete Earley was interviewing Carl at Passageway,

“Carl,” I said, “if the police had taken you to the hospital and asked if you wanted to be given medicine, would you have gone willingly?”
“Hell, no! When you’re crazy like that, your paranoia sinks in and you think everyone’s trying to poison you.”
“Would you have fought them?”
“Absolutely, and I got several ass-kickings to prove it”
“So you would have rather been left alone on the streets than forced to take medicine?”
“Yes and no. I would have been angry and fought, but if they had stuffed pills down my throat, I would have kissed their asses and thanked them once I got my mind back, because no one wants to be crazy like that”

A Little History
In 1955, some 560,000 Americans were being treated for mental problems in state hospitals. Between 1955 and 2000, our nation’s population increased from 166 million to 276 million. If you took the patient-per-capita ratio that existed in 1955 and extrapolated it on the basis of the new population, you’d expect to find 930,000 patients in state mental hospitals. But there are fewer than 55,000 in them today. Where are the others? Nearly 300,000 are in jails and prisons. Another half million are on court-ordered probation. The largest public mental health facility in America is not a hospital. It’s the Los Angeles County jail.

In the 1960s a trend took place called deinstitutionalization. It was found that many of the state asylums were terrible places. Have you seen ‘One Flew over the Cuckoo’s Nest’? That was not an exaggeration and the current institutions aren’t a rose garden. We did not understand the brain then as well as we do now. Most mental illness was thought to be caused by outside factors, like your mommy didn’t love you enough. So the institutions used things like Freudian psychoanalysis and behavior modification techniques to ‘help’ people. Various treatments of the time including water therapy (spraying with a hose), cold therapy (freeze the crazy out), electro shock therapy (destorying parts of your brain with electricity), and lobotomies (scrambling your brain with an ice pick).

Then came Thorazine. The first drug to really help mental illness. But then it was abused to keep patients in a near catatonic state.

Needless to say, the civil rights lawyers of the time helped speed up deinstitutionalization. But the pendulum swung to far to the other direction. A mentally ill person’s family and doctor are not able to get the person the help that they need unless the mentally ill person says they will accept treatment. But again, the problem with mentally ill people is that they have a lack of judgment and don’t think they are crazy. The biggest problem with deinstitutionalization is that is just dumped mentally ill people on the street. Where they acted crazy and then got thrown in jail.

What do do next?
Rachel Diaz from the National Alliance for the Mentally Ill (NAMI), “There is no magical pill out,” she warned. “The most important thing for all of us to remember is that our loved ones are sick. They did not ask for these diseases any more than we ask to get the flu. Remember, too, that we are not the victims. We suffer because we care, but the mentally ill are the real victims.”

There is some progress being made. In Miami a man has established Passageway, a half-way house for the mentally ill who have committed felonies. The benefits of this are that the patients have the maximum amount of freedom possible. They attend daily therapy sessions where they are drilled on the techniques to recognize the symptoms of their mental illness. They are compelled to interact with other patients to prevent withdrawal. They go on outings to help reestablish their social skills. Also, they voluntarily take their medication to control the symptoms of their mental illness otherwise they have to go back to jail or an institution. Pete Earley supports this as the model for helping and reintegrating people with mental illness back into society.

I’ll finish with a thought from Pete Earley: What is missing in our system today are modern, long-term treatment facilities where the chronically mentally ill can receive good medical attention and, if necessary, can live safely until they can be moved into less restrictive facilities.

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One Response to “Book Review: Crazy by Pete Earley”

  1. hymes said

    Pete Earley only investigated jails, he did not and has not despite being requested to, investigate the state of Virginia’s (where he lives) state and private mental hospitals. If he did or would, he would discover that folks stuck in our state hospitals are no better off than folks stuck in our jails in this state. But I guess he knows that somewhere inside and that is why he will not investigate the true state of long term care facilities.

    Your description of crazy is beyond offensive to practically slanderous to folks living with mental illness as well as completely inaccurate. People can live very well with mental illness with or without drugs depending on the person and there are many treatments besides drugs. Also the pendulum has swung too far in letting parents totally off the hook in the creation of mental illness. There is no proof that mental illness is a brain disorder, no blood test, no scan that can distinguish a person with mental illness from someone without and no proof that trauma does not lead to mental illness. In fact studies show that the vast majority of adults with mental illness experienced abuse or trauma at home or elsewhere in childhood or adulthood. It is not nature or nurture, it is probably both with external to home experiences added in.

    The lack of insight myth has been going on for about 100 years now but it is baseless and equally unproven. Studies show people stop taking drugs because of the horrible side effects of the drugs, not because they don’t think they are sick.

    But thanks for slandering the most vulnerable in our society on your blog. /snark off

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