No One Cares About Crazy People

No One Cares About Crazy People Plot Summary

Introduction

Mental illness remains one of the most misunderstood and stigmatized health conditions in modern society. Despite affecting millions of lives, it continues to be treated with indifference, fear, and even contempt by many institutions and individuals. This indifference is not merely a matter of personal prejudice but has become systematically embedded in our healthcare systems, criminal justice procedures, and social policies. The consequences of this neglect are devastating - both for those suffering from mental disorders and for society as a whole. The human cost of our broken mental health system is incalculable. Families watch helplessly as loved ones deteriorate without adequate care. Individuals with treatable conditions end up homeless, incarcerated, or dead because they cannot access appropriate treatment. Meanwhile, the financial burden on society grows exponentially as we pay for emergency services, prison cells, and other reactive measures rather than investing in prevention and proper care. This crisis represents not just a failure of healthcare but a profound moral failure that reflects our societal values and priorities.

Chapter 1: The Shameful History of Mental Illness Treatment and Stigmatization

Throughout history, those afflicted with mental illness have endured horrific treatment. Before modern psychiatry, many societies viewed madness through supernatural lenses—either as demonic possession or divine inspiration. Shamans often stood between communities and those exhibiting aberrant behavior, sometimes drawing the afflicted person's mental pain into themselves in a healing way. The infamous Bethlem Royal Hospital in London, commonly known as "Bedlam," epitomizes the darkest chapter in the treatment of mental illness. Established in 1247 as a religious sanctuary, it began accepting "lunaticks" around 1403. By the 17th century, Bedlam had become synonymous with cruelty. Patients were chained to walls for years, beaten, starved, and displayed to paying visitors for entertainment. The facility's administrators hired keepers from the lowest social strata who took sadistic pleasure in tormenting those under their control. A reform movement emerged in the late 18th century known as "moral treatment." Philippe Pinel in France and William Tuke in England pioneered more humane approaches. Pinel famously removed the chains from patients at Paris's Bicêtre Hospital in 1793, while Quaker William Tuke established York Retreat in 1796, designed as a sanctuary rather than a prison. In America, the Friends Asylum opened in Philadelphia in 1813, followed by Worcester State Hospital in Massachusetts in 1833, where Dr. Samuel Woodward greeted each arriving patient personally and freed them from confinement. The tireless reformer Dorothea Dix emerged as a champion for the mentally ill in the 1840s. After discovering half-naked "lunatics" caged in a Massachusetts jail, she embarked on an eighteen-month investigation of asylums throughout the state. Her 1843 "Memorial to the Legislature of Massachusetts" remains a landmark in advocacy: "I come as the advocate of helpless, forgotten, insane men and women... confined in cages, closets, cellars, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience." Her efforts led to the founding of thirty-two asylums by 1880. Despite these reforms, the 20th century brought new horrors. Many abandoned asylums now stand as decaying monuments to failed compassion, some even converted into commercial "haunted houses" that exploit and trivialize the suffering that occurred within their walls. This commodification of mental illness reflects society's continued unwillingness to confront the reality of psychiatric suffering with genuine empathy and understanding.

Chapter 2: Understanding Schizophrenia: A Complex Brain Disorder Beyond Misconceptions

Schizophrenia remains one of the most complex and misunderstood mental illnesses, affecting approximately 1% of the global population. Unlike popular misconceptions that equate it with "split personality," schizophrenia is a chronic brain disorder characterized by distortions in thinking, perception, emotions, language, sense of self, and behavior. These distortions often manifest as hallucinations, delusions, disorganized thinking, and abnormal motor behavior. The scientific understanding of schizophrenia has evolved dramatically over the past century. Modern neuroscience has revealed that schizophrenia involves structural and functional abnormalities in multiple brain regions, particularly the prefrontal cortex, hippocampus, and certain subcortical structures. Neuroimaging studies consistently show differences in brain volume, neural connectivity, and neurotransmitter activity between those with schizophrenia and neurotypical individuals. The dopamine hypothesis—which suggests that symptoms arise from an overactivity of dopamine in certain brain pathways—has been central to understanding the disorder, though more recent research points to the involvement of other neurotransmitters like glutamate and serotonin. Genetics plays a significant role in schizophrenia, with heritability estimated at around 80%. However, the genetic architecture is extremely complex, involving hundreds of genetic variants, each contributing a small effect. The Schizophrenia Working Group of the Psychiatric Genomics Consortium has identified over 100 genetic loci associated with increased risk. This genetic predisposition interacts with environmental factors—including prenatal complications, childhood trauma, cannabis use, and urban upbringing—in what scientists call the "stress-vulnerability model." The onset of schizophrenia typically occurs in late adolescence or early adulthood, a critical period of brain development. This timing is not coincidental; it corresponds with the final stages of neural pruning and myelination in the prefrontal cortex. The prodromal phase—the period before full psychosis develops—can last months or years and often includes subtle cognitive changes, social withdrawal, and declining functioning that may go unrecognized until a psychotic break occurs. Treatment approaches have evolved from purely institutional care to a combination of pharmacological and psychosocial interventions. Antipsychotic medications remain the cornerstone of treatment, working primarily by blocking dopamine receptors to reduce positive symptoms like hallucinations and delusions. However, these medications often fail to address negative symptoms (such as emotional flatness and social withdrawal) and cognitive deficits, which can be more debilitating in the long term. Comprehensive care now emphasizes early intervention, cognitive behavioral therapy, family education, and social skills training alongside medication management. Despite significant advances in understanding, schizophrenia remains a profoundly challenging condition with no cure. The recovery journey is highly individualized, with some achieving significant symptom reduction and functional improvement while others experience a more chronic course. This variability underscores the heterogeneous nature of the disorder and the need for personalized treatment approaches that address the whole person, not just their symptoms.

Chapter 3: Deinstitutionalization: How Good Intentions Created a Humanitarian Crisis

The deinstitutionalization movement of the 1960s and 1970s represented one of the most significant social policy shifts in American history. Driven by a coalition of fiscal conservatives seeking to cut state budgets and civil libertarians horrified by conditions in state hospitals, the movement promised to replace warehouse-style institutions with humane community care. Between 1955 and 1994, the resident population in state mental hospitals declined from 558,922 to just 71,619, a reduction of nearly 90 percent. This dramatic shift occurred without the promised community infrastructure to support it. The Community Mental Health Act of 1963, signed by President Kennedy, authorized funding for community mental health centers (CMHCs) intended to provide comprehensive services in every community. However, of the planned 1,500 centers, only 789 were ever built, and those were chronically underfunded. The centers that did exist often focused on the "worried well" rather than those with severe mental illnesses who had been deinstitutionalized. This implementation failure created a service vacuum that has never been adequately addressed. Legal changes further complicated the situation. The 1975 Supreme Court decision in O'Connor v. Donaldson established that states could not confine non-dangerous individuals who could survive outside an institution. While protecting civil liberties, this ruling made it increasingly difficult to provide treatment to individuals who needed it but did not meet the narrowly defined criteria of being an imminent danger to themselves or others. The resulting "revolving door" pattern—brief hospitalizations during acute crises followed by discharge without adequate follow-up—became the norm. The consequences of deinstitutionalization without adequate community support quickly became apparent. Homelessness among the mentally ill skyrocketed, with studies consistently showing that 30-40 percent of homeless individuals suffer from severe mental illness. Boarding homes and single-room occupancy hotels became de facto asylums without treatment or oversight. Families, unprepared for the responsibility thrust upon them, struggled to care for severely ill relatives without professional support or respite care. Perhaps the most devastating outcome has been the criminalization of mental illness. As hospital beds disappeared, jail and prison cells replaced them. Today, the three largest providers of psychiatric care in the United States are not hospitals but jails: Los Angeles County Jail, Rikers Island in New York, and Cook County Jail in Chicago. An estimated 356,000 inmates with serious mental illness are housed in prisons and jails, compared to approximately 35,000 in state psychiatric hospitals. This criminalization represents a return to the pre-asylum era when jails served as the primary housing for the mentally ill. The financial costs of this failed policy are staggering. Emergency room visits, repeated short-term hospitalizations, incarceration, and chronic homelessness are exponentially more expensive than providing appropriate ongoing care. A 2014 study estimated that serious mental illness costs America $193.2 billion annually in lost earnings alone. The human costs—measured in suffering, lost potential, and lives cut short—are incalculable.

Chapter 4: The Criminalization of Mental Illness: Jails as America's New Asylums

The criminalization of mental illness represents one of the most profound systemic failures in American society. Police officers have become the de facto first responders to mental health crises, despite most having minimal training in recognizing or de-escalating psychiatric emergencies. This dangerous intersection of law enforcement and mental illness too often ends in tragedy, as illustrated by the case of James "Abba" Boyd, a homeless man with paranoid schizophrenia who was shot and killed by Albuquerque police in 2014 while camping without a permit. Body camera footage showed Boyd, confused and delusional but not threatening, being confronted by heavily armed officers who ultimately fired multiple rounds into him as he appeared to be walking away. Similar incidents occur with alarming frequency across the country. Keith Vidal, a schizophrenic teenager in North Carolina, was shot by police who had been called to help during a psychotic episode. These deaths represent the most visible failures of a system that criminalizes behaviors stemming from untreated mental illness. Less visible but equally devastating is the daily funneling of mentally ill individuals into jails and prisons for minor offenses related to their conditions—trespassing while homeless, creating disturbances during psychotic episodes, or self-medicating with illegal substances. Once incarcerated, people with mental illness face conditions that exacerbate their disorders. Jails and prisons are characterized by constant noise, bright lights, overcrowding, and an atmosphere of threat and violence—environments virtually designed to worsen psychiatric symptoms. Treatment is minimal or nonexistent; a Department of Justice study found that 83% of jail inmates with mental illness receive no treatment whatsoever. Many are placed in solitary confinement, either as punishment for rule violations stemming from their illness or supposedly for their own protection. This isolation, known to trigger hallucinations even in healthy individuals, is particularly devastating for those already experiencing psychosis. The human cost of this systemic failure is illustrated by cases like Bradley Ballard, a schizophrenic inmate at Rikers Island who died after being locked in his cell for seven days without medication, insulin for his diabetes, or adequate food—all because he made an obscene gesture to a guard. Jerome Murdough, another mentally ill inmate at Rikers, literally baked to death in an overheated cell. Kalief Browder, who developed mental illness during nearly two years in solitary confinement while awaiting trial for a crime he didn't commit, later died by suicide after his release. This criminalization represents a direct consequence of failed deinstitutionalization policies and inadequate community mental health services. Without accessible treatment options, crisis intervention teams, supportive housing, and case management services, people with serious mental illness inevitably encounter law enforcement. The resulting cycle of arrest, incarceration, release without treatment, and rearrest wastes public resources while failing to address the underlying medical condition. The financial costs are staggering. Housing a mentally ill person in jail or prison costs substantially more than providing comprehensive community treatment. A Stanford Law School study concluded: "We have created conditions that make criminal behavior all but inevitable for many of our brothers and sisters who are mentally ill... This practice of seeking to save money on the backs of this population comes with huge moral and fiscal cost."

Chapter 5: Family Devastation: The Personal Cost of a Broken System

The devastation of mental illness reverberates through families in ways that statistics cannot capture. Parents watch helplessly as bright, promising children transform into strangers before their eyes. The onset is often insidious—subtle personality changes, withdrawal from friends, declining academic performance—easily mistaken for typical adolescent struggles. By the time psychosis becomes unmistakable, families find themselves navigating a labyrinthine system that offers little guidance and even less hope. The search for treatment becomes a full-time occupation, consuming financial resources and emotional energy. Parents describe spending hours on the phone with insurance companies, begging for coverage of necessary treatments. They drive hundreds of miles to find available hospital beds during crises. They remortgage homes and deplete retirement savings to pay for care not covered by insurance. Even wealthy, well-connected families find themselves stymied by a system designed to provide the minimum care possible for the shortest duration possible. The unpredictability of severe mental illness creates a constant state of hypervigilance for families. They monitor medication compliance, sleep patterns, and subtle behavioral changes that might signal an impending crisis. They develop elaborate safety plans and hide sharp objects during periods of suicidal ideation. Many parents describe sleeping in shifts to ensure their adult children don't harm themselves or wander away during psychotic episodes. This vigilance exacts a devastating toll on caregivers' physical and mental health, with studies showing elevated rates of depression, anxiety, and stress-related illnesses among family members of the mentally ill. Legal barriers compound family suffering through privacy laws that prevent information sharing. Parents who have cared for their children through years of illness suddenly find themselves excluded from treatment decisions when their child turns 18, regardless of the severity of their condition. HIPAA regulations, though intended to protect patient privacy, often prevent families from providing crucial historical information to treatment providers or receiving information necessary for safe discharge planning. The cruel irony is that these same families are expected to provide housing, financial support, and day-to-day care without the information needed to do so effectively. The grief experienced by families of the mentally ill is complicated by its ambiguous nature. Unlike the death of a loved one, mental illness offers no closure, no socially recognized rituals for mourning. Families grieve the person their loved one might have been while simultaneously caring for the person they have become. This "ambiguous loss" is particularly painful because it remains unacknowledged by a society uncomfortable with mental illness. Friends and extended family often withdraw support, unable to understand the chronic nature of the struggle or offering simplistic solutions that imply the family isn't trying hard enough. Perhaps most heartbreaking is the isolation families experience in a culture that still views mental illness through a lens of shame and blame. Parents internalize societal messages suggesting they caused their child's illness through faulty genes or parenting mistakes. Siblings hide their family situations from friends and romantic partners, fearing stigma by association. The resulting isolation comes precisely when families most need community support, creating a secondary trauma that compounds the primary suffering caused by the illness itself.

Chapter 6: Pharmaceutical Profits vs. Patient Welfare: An Ethical Failure

The discovery of chlorpromazine (marketed as Thorazine) in the 1950s heralded a revolution in psychiatric treatment. For the first time, a medication could reduce psychotic symptoms, offering hope to patients and families devastated by schizophrenia and similar disorders. This breakthrough transformed psychiatry and created enormous profit opportunities for pharmaceutical companies. However, the relationship between Big Pharma and mental health care quickly became problematic, characterized by exaggerated claims, hidden risks, and prioritization of profits over patient welfare. Marketing practices for psychiatric medications have consistently pushed ethical boundaries. Early Thorazine advertisements promised miraculous transformations, showing before-and-after images of wild-eyed patients becoming docile and compliant. These campaigns targeted not just psychiatrists but general practitioners with little training in mental health, encouraging widespread prescribing for conditions far beyond the medication's approved uses. This pattern continues today, with pharmaceutical companies routinely paying billions in settlements for illegal "off-label" marketing of psychiatric drugs, particularly to vulnerable populations like children and the elderly. Clinical trials for psychiatric medications have been systematically manipulated to exaggerate benefits and minimize harms. Companies routinely suppress negative studies, selectively publish positive results, and design trials to favor their products. A notorious example is the case of selective serotonin reuptake inhibitors (SSRIs), where unpublished data revealed these antidepressants were barely more effective than placebo for mild to moderate depression, despite being marketed as revolutionary treatments. For antipsychotics, companies have downplayed severe side effects including massive weight gain, diabetes, movement disorders, and increased mortality in elderly patients. The revolving door between regulatory agencies and pharmaceutical companies undermines oversight. FDA officials who approve medications frequently take lucrative positions with the same companies they once regulated. Meanwhile, pharmaceutical money flows to academic researchers, medical journals, and professional organizations that shape treatment guidelines. The American Psychiatric Association, which defines mental disorders through its Diagnostic and Statistical Manual (DSM), has faced criticism for the pharmaceutical ties of panel members who expand diagnostic categories in ways that create larger markets for medications. The pharmaceutical industry has also played a central role in the medicalization of normal human experiences. Conditions once considered within the spectrum of normal human variation have been reframed as chemical imbalances requiring pharmaceutical intervention. Grief becomes depression; childhood energy becomes ADHD; teenage angst becomes bipolar disorder. This expansion of diagnostic boundaries serves market interests while subjecting more people to powerful medications with significant risks. For those with severe mental illnesses like schizophrenia, the pharmaceutical industry's practices have had particularly devastating consequences. While antipsychotic medications can be life-saving for many, the industry's emphasis on compliance and maintenance therapy often comes at the expense of recovery-oriented approaches that might ultimately reduce medication dependence. Long-acting injectable antipsychotics, heavily marketed as solutions to "non-compliance," raise troubling questions about patient autonomy and the right to make informed treatment decisions.

Chapter 7: Toward Compassionate Reform: Evidence-Based Approaches to Mental Health Care

Despite decades of systemic failure, promising developments in treatment approaches and community care models offer hope for transforming mental health services. The recovery model, which emerged from consumer advocacy movements, has fundamentally shifted the paradigm from managing symptoms to supporting individuals in building meaningful lives despite mental illness. This approach recognizes that recovery is not synonymous with cure but rather encompasses improved quality of life, hope, empowerment, and social connection—even with ongoing symptoms. Scientific advances have dramatically improved our understanding of mental illness and treatment efficacy. Neuroimaging techniques reveal the brain changes associated with psychotic disorders, while genetic research identifies risk factors and potential targets for intervention. Cognitive remediation therapies address the cognitive deficits that often persist despite symptom improvement with medication. Meanwhile, psychosocial interventions like Cognitive Behavioral Therapy for psychosis (CBTp) and Family Psychoeducation have demonstrated effectiveness in reducing relapse rates and improving functioning. Early intervention programs represent one of the most promising developments in schizophrenia treatment. These specialized services target young people experiencing their first episode of psychosis, providing comprehensive, phase-specific treatment during the critical period when intervention can most effectively alter the illness trajectory. Programs like NAVIGATE in the United States and OPUS in Denmark have demonstrated impressive outcomes, including reduced hospitalization rates, improved employment and educational achievement, and decreased suicide risk. The success of these programs challenges the pessimistic view that schizophrenia inevitably leads to deterioration. Innovative housing models address the fundamental need for stable, supportive living environments. Housing First approaches provide immediate access to permanent housing without requiring treatment compliance as a prerequisite, recognizing that housing stability is itself therapeutic. Supportive housing programs that combine affordable housing with flexible services allow individuals to live independently while receiving appropriate levels of support. These models have demonstrated cost-effectiveness compared to the revolving door of hospitalization, incarceration, and homelessness. Peer support services, provided by individuals with lived experience of mental illness, offer unique benefits that complement traditional clinical care. Peer specialists model recovery, provide hope, navigate systems, and offer practical coping strategies based on personal experience. Research shows that peer support can reduce hospitalization rates, increase treatment engagement, and improve quality of life. The integration of peer specialists into treatment teams represents a significant shift toward more collaborative, recovery-oriented care. Criminal justice diversion programs interrupt the cycle of criminalization by redirecting individuals with mental illness from incarceration to treatment. Mental health courts, crisis intervention team (CIT) training for police officers, and pre-booking diversion programs have shown success in reducing arrests and connecting individuals to appropriate services. These approaches recognize that behaviors stemming from untreated mental illness are health issues rather than criminal matters requiring punishment.

Summary

The catastrophic failure of mental health care systems represents one of the most profound moral failures of modern society. By examining the historical trajectory from asylum warehousing to pharmaceutical exploitation to criminalization, we confront an uncomfortable truth: our treatment of the mentally ill reflects not just policy mistakes but a deeper societal indifference. This indifference persists despite overwhelming evidence that comprehensive, humane approaches to mental health care are both possible and cost-effective. The continued suffering of millions with serious mental illness and their families stands as an indictment of our collective values and priorities. The path forward requires nothing less than a fundamental reimagining of how we understand and respond to mental illness. This means rejecting false dichotomies between biological and psychosocial approaches, between autonomy and treatment, between institutional and community care. It means investing in evidence-based practices while respecting the lived experience and inherent dignity of those with mental illness. Most importantly, it means acknowledging that mental health care is not merely a medical issue but a matter of social justice that demands our collective attention and action. Until we recognize that everyone should care about "crazy people," we will continue to perpetuate a system that fails those most vulnerable and diminishes our shared humanity.

About Author

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Ron Powers

Ron Powers (born 1941) is a Pulitzer Prize-winning journalist, novelist, and non-fiction writer. His face include White Town Drowsing: Journeys to Hannibal, Dangerous Water: A Biography of the Boy Who Became Mark Twain, and Mark Twain: A Life. With James Bradley, he co-wrote the 2000 #1 New York Times Bestseller Flags of Our Fathers.Powers won the Pulitzer Prize for Criticism in 1973 for his critical writing as TV-radio-columnist for Chicago Sun-Times about television during 1972. He was the first television critic to win the Pulitzer Prize.In 1985, Powers won an Emmy Award for his work on CBS News Sunday Morning.Powers was born in 1941 in Hannibal, Missouri — Mark Twain's hometown. Hannibal was influential in much of Powers' writing — as the subject of his book White Town Drowsing, as the location of the two true-life murders that are the subject of Tom and Huck Don't Live Here Anymore, and as the home of Mark Twain. Powers has said that his fascination with Twain — the subject of two of his books — began in childhood:"When I was a little boy in Hannibal, he was a mystic figure to me. His pictures and books and images were all over (my friend) Dulany Winkler's house, and I spent a lot of time there. I just wanted to reach out and touch him. Eventually I was able to."In addition to writing, Powers has taught for the Bread Loaf Writers' Conference, the Salzburg Seminar in Salzburg, Austria, and at Middlebury College in Middlebury, Vermont.Powers is married and has two sons. He currently resides in Castleton, Vermont.

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