Damon Tweedy is an assistant professor of psychiatry at Duke and author of “Black Man in a White Coat: A Doctor’s Reflections on Race and Medicine.”
As a young medical student, I learned about schizophrenia mostly by keeping my distance, both literally and figuratively. I’d never encountered a person with the disorder (that I knew of) before my six-week rotation at a state psychiatric hospital, and I’m not proud to admit that these men and women — tortured as they were with paranoid thoughts and scary voices that only they could hear — somehow seemed less than human to my 23-year-old eye. When the rotation ended, I was eager to move on to see other patients who interacted with me in ways I considered normal.
It’s this mixture of fear and indifference, widespread in our country, that author Ron Powers boldly confronts in his heart-wrenching new book, “No One Cares About Crazy People.” Powers, a Pulitzer Prize-winning journalist and successful nonfiction author (“Flags of our Fathers,” “Mark Twain: A Life”), comes at this subject first and foremost from a personal vantage point: “Schizophrenia was particularly interested in the Powers family, and no amount of disinterest on my part was going to change that.” His younger son, Kevin, received the diagnosis as a teenager, and despite a few brief periods of hopeful calm, he ultimately succumbed, killing himself shortly before his 21st birthday. A few years later, Powers’s older son, Dean, was also diagnosed with schizophrenia, and after many hospitalizations and treatments, he has now reached a point of relative stability. Still, his life is far different from where it seemed headed during his adolescence.
This family odyssey, one Powers travels with his wife, Honoree, could have stood alone as a book itself, taking its place in the genre of memoirs on mental illness. Instead, Powers draws on his journalistic talents to explore the past and present landscape of mental health treatment in America. We learn crucial details about the widespread closure of psychiatric hospitals through the 1960s and 1970s, the limitations of antipsychotic medications, and the inability of an underfunded public mental health system to care for the chronically sick. Powers persuasively asserts that these forces have led to rising rates of homelessness and incarceration among the mentally ill, where they “live under conditions of atrocity.” In the midst of this sweeping overview, Powers gives us powerful stories of real suffering and societal apathy toward the plight of our fellow citizens. Their struggles must not be forgotten as we continue to debate reforming our health-care system.
While the book offers much to contemplate about mental health treatment on a larger scale, many readers will be most drawn to Powers’s personal story, which is interwoven throughout the narrative. We follow Dean and Kevin through their boyhood explorations of rural Vermont, enthusiasm for youth baseball and football, and teenage loves. Many pages are devoted to Kevin’s prodigious skills on the guitar; for much of his life, he seemed destined to become a professional musician. Dean also showed talents for music and writing. Powers poignantly uses Kevin’s and Dean’s journeys to illustrate how those with mental illness are “people who have known love, laughter, inventiveness, hope and the capacity to dream the same dreams of a future that other people dream.” On a personal level, he doesn’t want his sons defined only as a psychiatric illness, or in Kevin’s case, by his final act. In that respect, the book is, among other noble goals, Powers’s effort to preserve his sons’ humanity.
This human aspect of mental illness can’t be overstated. Early in medical school, I saw those with serious psychiatric problems as people best avoided. Not until I lived through the experience of a close friend becoming manic and psychotic did I begin to truly consider the full personhood of those afflicted. My interactions with the mentally ill changed. As Powers so astutely observes: “To begin consciously searching into the world of mental illness is to see it snap into focus before your eyes. It is everywhere. It has been hiding in plain sight, awaiting notice.” Indeed, after my friend’s ordeal, I began to see how common psychological problems were among the medical patients I treated and the many ways they made people even sicker. All too often, I saw doctors neglect these emotional concerns. At the end of my medical internship, feeling that a great need for patients was being unmet, I chose to pursue my training in psychiatry.
Powers concludes that the future of mental health in the United States is being shaped along two trajectories: a flourishing research enterprise juxtaposed with a chaotic system of delivering care. Part of the chaos stems from our limited ability thus far to translate brain research data into the diagnosis and treatment of people with psychiatric illness. But another element is related to the fear and apathy that continue to surround the subject. To this end, Powers hopes his story will have an impact: “I hope you do not ‘enjoy’ this book,” he writes. “I hope you are wounded by it; wounded as I have been in writing it. Wounded to act, to intervene.”
By Ron Powers
Hachette. 360 pp. $28