I have exciting news! The City of Baton Rouge has chosen, CRAZY: A Father’s Search Through America’s Mental Health Madness, as its One Book, One Community selection this summer. 
In 2006, Baton Rouge joined more than 400 American cities that participate in this national reading program. In a letter informing me that CRAZY had been chosen, Abby Hannie, a member of the Baton Rouge’s program steering committee, explained:
The One Book, One Community initiative was formed to promote a common city-wide reading experience to increase intellectual and cultural dialogue among readers and to exchange ideas for the purpose of raising awareness and visibility with regard to a particular community issue.
The idea is to get everyone in a city to read and discuss the same book. Two of the most popular selections chosen since the first program was launched in 1998 in Seattle have been To Kill A Mockingbird by Harper Lee and Ray Bradbury’s Fahrenheit 451.
That’s pretty heady company.
I wrote Crazy, which refers to our broken mental health system and not persons with mental disorders, to help expose how our jails and prisons have become our new mental asylums and why this is wrong. Because of that, I am thrilled that the Baton Rogue community will be exposed to what is happening, not only in other states, but Louisiana, as well.
A recent state-by-state study found there is a 4.6 to one chance that a person with a severe mental disorder in Louisiana will end up in jail rather than in a hospital getting treatment.
That’s shameful.
I will be speaking about my book in Baton Rouge at 7 p.m. on July 28th at the LSU Cox Communications Academic Center for Student Athletes during a public meeting. My publisher, Berkley Books, has generously donated 135 copies to the East Baton Rouge Public Library and Barnes and Noble and the LSU Stephenson Entrepreneurship Institute are working to publicize and coordinate the event.
One of the most exciting benefits of being chosen is that several talented individuals have developed a Reader’s Study Guide for my book. It is being distributed at local libraries to facilitate questions and discussions about mental health laws and the criminalization of persons with mental disorders. Some NAMI groups have been distributing it too!
I am working with my computer whiz son, Evan, to see how we can post the Study Guide on my webpage for easy download. I hope it can help promote discussions in NAMI groups or in college courses which are using my book as a teaching tool.
Because we don’t yet have a downloadable verison on the webpage, I am adding the Reader’s Gudie at the end of this blog.
I want to thank the city of Baton Rouge for selecting my book and, more importantly, for calling attention to the need for mental health reform in our nation.
THANK YOU BATON ROUGE ONE BOOK, ONE COMMUNITY!
STUDY GUIDE FOR CRAZY: A FATHER’S SEARCH THROUGH AMERICA’S MENTAL HEALTH MADNESS
prepared by Phyllis Heroy
with assistance from Mary Stein and Andi Abraham
(feel free to copy and use this guide)
His most recent book, Comrade J, is about Russian defector Sergei Tretyakov, the remarkable true story of the man who ran Russia’s post-Cold War spy program in America.
Pete Earley says, “My job as an author is to tell you interesting stories. Sometimes that means taking you places where you normally wouldn’t go, such as inside a maximum security penitentiary, or introducing you to people who you normally wouldn’t meet, such as the American traitors: John Walker Jr., and Aldrich Ames. Besides entertaining you, I believe authors, especially journalists, should expose wrongs. That’s what my books, Circumstantial Evidence, and Crazy: A Father’s Search Through America’s Mental Health Madness, represent.”
Pete Earley had no idea. He’d been a journalist for over thirty years, and the author of several award-winning-even bestselling-nonfiction books about crime and punishment and society. Yet he’d always been on the outside looking in. He had no idea what it was like to be on the inside looking out until his son, Mike, was declared mentally ill, and Earley was thrown headlong into the maze of contradictions, disparities, and Catch-22s that is America’s mental health system. The more Earley dug, the more he uncovered the bigger picture: Our nation’s prisons have become our new mental hospitals. Crazy tells two stories. The first is his son’s. The second describes what Earley learned during a year-long investigation inside the Miami-Dade County jail, where he was given complete, unrestricted access. There, and in the surrounding community, he shadowed inmates and patients; interviewed correctional officers, public defenders, prosecutors, judges, mental-health professionals, and the police; talked with parents, siblings, and spouses; consulted historians, civil rights lawyers, and legislators. The result is both a remarkable piece of investigative journalism, and a wake-up call – a portrait that could serve as a snapshot of any community in America.
“Suffering delusions from bipolar disorder, Mike Earley broke into a stranger’s home to take a bubble bath and significantly damaged the premises. That Mike’s act was viewed as a crime rather than a psychotic episode spurred his father, veteran journalist Pete Earley (Family of Spies), to investigate the “criminalization of the mentally ill.” ….parents of the mentally ill should find solace and food for thought in its pages.” Publishers Weekly
“The author was so upset by what happened to his son after he was arrested for breaking into a house while in a delusional state that he set out to discover just how the mental-health system works in America today. What he found is that the new insane asylums are prisons, neither safe nor humane places. In Miami—the city was chosen for Earley’s investigation because it has a high percentage of mentally ill residents—the author was given wide access to the Miami-Dade County Jail. He spent a year there observing how mentally ill prisoners are treated. He followed their cases through the courts and traced their progress once they were back on the streets. Earley also interviewed a Miami judge, lawyers, psychiatrists, patient advocates and the founder of a halfway house. He draws a bleak and disturbing picture. The closing of state mental hospitals that began in the 1960s left most patients homeless and without access to the community services that were supposed to form their new safety net, he reports; by the 1990s, jails and prisons were being swamped by psychotic prisoners. Society has gone backwards in it handling of the mentally ill, he argues, and we must develop modern long-term treatment facilities where they can be helped and kept safe. The author’s own frustrating experience with his son convinced him that commitment laws are heavily biased in favor of patients’ civil rights and against intervention and treatment; he urges bringing doctors and patients’ loved ones back into the decision-making process. [This is] An urgent plea for change that gains force by putting a human face on a sociological problem.” Kirkus Reviews
“CRAZY is both a clarion call for change and justice, and an enthralling portrait of a father who refused to surrender.” Author Bebe Moore Campbell
Mental illness is a topic many people try to avoid thinking or talking about. Just hearing the words raises dark, irrational fears in our subconscious mind. Yet, if we pay attention to the news, we cannot escape it; it is an ever present issue in our society. John Hinckley, Jr. is still in prison for the 1981 attempted assassination of President Ronald Reagan. Who can forget the horror of the shootings at Virginia Tech University in 2007, a day in which one student who had been diagnosed with an anxiety disorder took the lives of 32 students and faculty and wounded many others before committing suicide? Earlier this year, the nation was horrified by an attack at a public meeting Arizona Sen. Gabrielle Giffords was holding with constituents. A young man who had shown signs of mental problems shot and killed six people, including a 9-year-old girl and a respected judge and wounded 13 others, including Sen. Giffords, who was shot in the head, is still in a rehabilitation facility and may never completely recover.
Why are so many people with mental illness going untreated? The answer to that and many other questions about mental illness are found in this insightful, thoroughly researched book.
Notes for book discussion leaders:
MIKE’S STORY
The author chose to introduce the issue of treatment of the mentally ill in America by telling about the beginning of his son Mike’s problems. Discuss what happened in the beginning of Mike’s illness, the trip from New York back to the Earley home in Virginia, his early attempts to get help for his son, and the crisis that developed.
1. If you had been in Pete’s shoes, do you think you would have handled the situation the same as he did or in a different way? If different, how?
3. What did Earley learn about the treatment of the mentally ill during his first encounters with medical and law personnel and what effect did that have on him? (pages 2-5)
4. This book is informative but also raises emotional responses in the reader. After reading about Mike’s psychotic episode in which he broke into a house and took a bubble bath, what was your first reaction? Did your feelings change as you learned more about the reaction of the mother and her refusal to drop criminal charges against Mike? If you were taking part in a mock trial, whose side would you prefer to be on? In what way might your gender or life experiences have a bearing on your feelings about the issues and “sides” in this situation?
5. How did what Earley learned in Miami affect his relationship with his son? (275-283)
MENTAL ILLNESS IN AMERICA:
TREATMENT, MEDICAL ASPECTS, AND PUBLIC POLICY
What drives public policy and treatment, and what effects do they have on the mentally ill population and those who seek to help them?
1. Discuss how the mentally ill were treated in the early days of America; establishment of state hospitals driven by reformer Dorothea Dix; early drugs; attacks on the psychiatry profession in the 1960s; the One Flew Over the Cuckoo’s Nest effect and the mass release of many mental patients into communities with no plan; and the lack of adequate funding. (Chapter 4, pp. 64-72)
2. Public policy and the legal rights of the mentally ill are the focus of Chapter 12 (pp. 150-161). Discuss the role of Dr. Morton Birnbaum, the ACLU, and the Mental Health Law Project’s involvement in the Donaldson Case in which the U.S. Supreme Court ruled that “A finding of “mental illness: alone cannot justify a State’s locking a person up against his will…” (pp. 150-155).
3. Pete Earley noticed that all the protections for the mentally ill were pushed through the Federal government before it was determined that mental illness is caused by a chemical imbalance in the brain. He asks, “Were the civil rights safeguards passed two decades before still needed?” (p. 159).
When Earley discusses the issue with Robert Bernstein, an attorney with the Mental Health Law Project, Bernstein and Earley take different positions. Bernstein argues that the government should improve the mental health system and the mentally ill should not be forced into treatment while Earley believes many people’s mental illness is so severe they are not capable of thinking coherently and making rational decisions about treatment. (pp. 160-161)
Dr. E. Fuller Torrey, founder of the Treatment Advocacy Center, argues that forcible treatment of the mentally ill should be legal “since half of these mentally ill individuals do not think there is anything wrong, they will not take medications [voluntarily].” (p. 219)
Which argument do you think is more convincing?
A YEAR INSIDE
Pete Earley spent a year inside the Miami-Dade County jail investigating what happens to mentally ill people. He emphasizes that he chose Miami because of the large percentage of mentally ill inmates, but what he found there is representative of what occurs in cities across the United State. In Miami, Pete Earley met and spent time with several individuals who helped him learn more and better understand the system from different viewpoints.
Discuss the roles, contributions, or situations of each of the names listed. If possible, assign each name to a group member in advance to discuss with the group.
1. Dr. Joseph Poitier was the psychiatrist assigned to the Miami-Dade jail, and Earley observed and learned much on his first day of rounds with Dr. Poitier and in future meetings with him. (pp. 45-57, 86-88)
2. Judge Steven Leifman of the Eleventh Judicial Circuit in Miami has worked for decades to help the mentally ill get treatment. Discuss his experience and background and the reform ideas he has advocated. (pp. 58-61)
3. Judy Robinson has been a major force in Miami as a leader of a local chapter of NAMI (National Alliance for the Mentally Ill) and an advocate of Crisis Intervention Team (CIT) training for police officers, citing Memphis, Tennessee as a positive role model in this area. (104-117)
4. The criminal justice system has borne the burden of the law and frequently is ill equipped to deal with the situation. Discuss examples of the treatment of the mentally ill in the Miami jail and on the street by police; lack of training in crisis intervention, and other problems. (pp. 41-42, 45-48, 80-84,132-134)
5. The case of Alice Ann Collyer is an eye-opening one that exposes how broken the mental health system is in terms of effectiveness and cost. (pp. 176-182) An even worse example is Deidra Sanbourne whose suit against the state made her famous, yet she was dumped into the community after years in a state hospital without a proper treatment and supervision plan when the hospital was turned over to a private agency and run with tragic consequences. (184-207)
6. Pete Earley selected a few mentally ill prisoners to follow during the year to learn more about what happens to individuals. April Hernandez, Freddie Gilbert, and Ted Jackson suffered from different mental problems, but all seemed to have a chance of maintaining a life outside prison with the proper support. As Earley follows their lives for the next year, he learns that the support they receive is inadequate and ineffective. (Gilbert- 85-88, 143-149, 245-248, 314-316, 352-353; Jackson- 88-98,169-173, 249-257, 284-288; Hernandez- 258-269, 289-293)
LOOKING FOR A RAY OF HOPE
After a year in Miami, Early felt a sense of sadness that had less to do with exhaustion than the lack of hope. It was then he remembered a note he had seen that mentioned a treatment program called Passageway.
Discuss Tom Mullen and his role in setting up and running Passageway. What factors seem to be the most critical to their success as opposed to other programs? (pp. 319-341)
GENERAL DISCUSSION QUESTIONS
1. What did you learn about mental illness and treatment of mentally ill individuals?
2. What preconceptions did this book support or dispel?
3. Did your opinion of mental health issues change and if so, how?
4. Re-read the passage at the beginning of Section 5 of the book, entitled “Déjà vu” ([unnumbered] page 343). What is your reaction to this passage? Would it have had the same impact if placed elsewhere, earlier in the book, for example? Explain the reasons for your answer.
5. What questions did this book leave you with about treatment and laws concerning the mentally ill in our community and state? Note: In 2008, the Louisiana legislature passed Nicola’s law which made it easier for someone with a severe mental illness to receive treatment. Read more at http://www.treatmentadvocacycenter.org/index.php?option=com_content&view=article&id=214&Itemid=149
QUOTES
Discuss the person, context, and setting associated with each quote.
1. “Let’s hope it’s drugs,” the psychiatrist said after interviewing Mike…. “It’s better than the alternative.” He explained, “Your son might be mentally ill.” (p. 10)
2. “If you ask people today where the mentally ill are in our society, they will tell you they’re in state mental hospitals. They’re wrong….They are in our jails and prisons.” (p. 37
3. “Mentally ill people don’t belong in jail”…”By its very design, a jail like ours is intended to dehumanize and humiliate a person. It’s supposed to have a negative impact, to bring an inmate down, to make him not want to come back. This sort of atmosphere is counter to treatment or helping improve anyone’s mental health – including the people who work here.” (p. 57)
4. “Taking these drugs is not like swallowing an aspirin…. Mental illness is not going to disappear because you take a pill. You do not become well. The sickness will always be there because the chemistry in your brain is not correctly balanced.” (p. 104)
5. “At that moment I felt like a man trying to grab smoke in the air.” (p. 131)
6. “I’ve never had one person whom I’ve helped say, “Doc, I wish you would have left me crazy on the streets.” (p. 145)
7. “By the 1990s, frustrated parents were repeating a new term, coined by Wisconsin psychiatrist Darold Treffert. The mentally ill were being allowed to “die with their rights on.” (159)
8. Tom Mullen, director of Passageway, a program created to help the most feared and most hated of all the mentally ill in Miami, those who have committed horrible crimes, says, “Passageway is a parish. We care about one another. We are a community…. It’s that connection, that caring – the fact that we tell these people that their lives matter regardless of what they have done – that makes this program work…. At Passageway we never say anyone has run out of chances.” (p. 341)
ENRICHMENT AND EXTENSION ACTIVITIES
These activities are designed for use by adult or student groups or classes.
1. In partnership with another reader/student, use information and detail gathered from Crazy to write a dialogue between Pete Earley and a patient he tracked when gathering notes for his book. Deliver your dialogue before your group/class.
2. Interview a local mental health professional about deinstitutionalization, the relationship between mental health and homelessness, local programs to serve those with mental health issues and their families, or other issues raised in this book.
3. Clip current newspaper and magazine articles which deal with mental health issues. Summarize them and relate them to issues in Crazy.4. Formulate a list of mental health services available in your area.
5. Ask several people to define mental health terms raised in Earley’s book. Record their definitions and analyze them in comparison to recognized professional definitions of the conditions. Evaluate the level of understanding of these mental conditions indicated by your interview subjects’ responses.
6. This reader’s guide includes a photo of Pete Earley posed in front of a painting by his son. Write down your ideas about what the painting suggests. Share them with a partner or with your group/class.
7. Chapter 4 – Read The Snake Pit by Mary Jane Ward or Ken Kesey’s One Flew Over the Cuckoo’s Nest or view the movies. How do these works relate to concepts in Earley’s book?
8. Research Dorothea Dix (chapter 4) and her contributions to the US mental health system. Support your answer with documented detail.
9. Research the Marielito Cubans (chapter 5). How does their story impact mental health problems in the United States. Support your answer with documented detail.
10. Research NAMI (the National Alliance for Mental Health). Relate your findings to what you learned in Earley’s book ( See chapters 7 and 8).
11. Pete Earley refers to dreams he experienced during his research travels for his book. (See chapter 3, p. 62; chapter 9, p. 120.) as well as to Mike’s struggle to separate dreams from reality (Mike’s Story – 2, pp. 27-28). Comment on the implications of these dream references, based on interpretations given by Earley and your own opinion.
Enrichment and Extension Activities prepared by Ann Biggers
About the author:
This is great, Pete! I hope this encourages an actual discussion on the state of mental health care in this country. I do hope it opens eyes.
We disagree on many points, especially concerning involuntary commitment. You mentioned in a previous post that the doctor who plays Dr. Spivy never One Flew Over as an anti-mental hospital movie, and you have written frequently about how you see things as having changed and those safeguards no longer appropriate. Things have gotten better; but, if you truly speak to those who have been inpatient, you will find the chief complaint to be that they didn’t feel listened to and, if you probe, you will find that they believe restraint and seclusion was overused. It’s so easy to say that due to their mental illness they can’t truly see if the professionals’ reactions were appropriate; but that’s not true. We can. It is a universal complaint, or at least among adolescents (my age group). That’s in the nice, private hospitals, too. Never-mind the maltreatment going on in the state hospitals still open – including the one that Cuckoo’s Nest was filmed at! – and how awful those facilities still are. The LA Times had a series of articles recently. Also, the presence of mental illness alone does not, and should not, qualify one for inpatient – even psychosis. That’s ridiculous, in my opinion.
(Also, a neurological and biochemical basis has been suggested for years. Lobotomies? They came about because the doctor thought there was a physical basis, and it could be treated surgically. So, while we know more now and the theory is more accepted, those abuses DID happen when the idea was out there.)
I do think, overall, we fight for the same basic cause. Prisons should not be the new asylums. That needs fixing. Group homes need fixing. Assisted housing needs to be in place. Community centers need to be established. Insurance needs to cover all health issues equally. Hospital visits, when they do happen, need to be covered until a person can safely live and function in the community; not the “when the insurance runs out after a few days”. (If a person only needs 7 – 10 days to get to a point of safety, self-care and some level of functioning, then that is fine. If they need more? Then they need more.) I support adding the “grave disability” clause to the involuntary hospitalization requirement. That makes the most sense, in my opinion.
I know I may be considered an exception to the rule, instead of the rule. I still struggle in school; but, overall, I have a very high level of IQ and functioning. I am going to early-admit to college, and work towards my MD – psychiatry, of course. I am off medication, and though I still experience severe symptoms (including psychosis), my GAF scores remain pretty untouched these days. I am in no way suggesting these should be the goals for everyone. Just that things are not as good as you think, and the safeguards, though they should be modified a bit, need to stay.
A message to Pete Early,
I appreciate your writings. You have brought up some excellent topics. I am happy to note that your Book on Crazy, has had so much popularity. I plan to read this sometime.
I heard about your book through the Baton Rouge one book, one community program this past Saturday. I just finished reading it and have told family, friends and co-workers about this book. The entire time I was reading your book, I would have to stop and tell my husband about what I had just read. I was SHOCKED by your book. I had NO idea the state of mental health care in this country. I’m a twenty something degreed professional, married with children, had a great upbringing, and consider myself a conservative, after reading your book I also found that I was ignorant about the plight of the mentally ill. I just assumed that when the ill were arrested that they were given care, obviously not the case….I just want to share with you how this has change my thinking. When the shootings in Arizona occured and even the VT shootings a couple of years ago, I remember thinking what is wrong with these kids’ parents, were they just so oblivious that they didn’t see their child had a problem or were they ignoring the problem and embarrased…I now realize that these kid’s parents most likely did see a problem, most likely did try to get their children treatment, but were unsuccessful due to the many laws that protect their “right” to be mentally ill. While reading your accounts of the conditions on the 9th floor, I kept thinking to myself that I wouldn’t do that to a dog. I often see commercials for the ASPCA condeming the conditions of pounds, etc, now I think that there should be an initiative to show the country what is going on in prisons and ALFs. Your book has prompted me to email my representatives and asking them to support mental illness initiatives and provide funding. I don’t know how much good my one emails will do, but your book is reaching the masses and I believe itwill make people wake up and take action. Your book has made me feel embarrased of all the times that I ignored a homeless person, or looked down upon them. I am a Catholic and considered myself a good Christian, but I was not treating my fellow man with the dignity and respect they deserved. I also assumed that this was someone else’s problem, well your book has now opened my eyes.