I first heard of this amazing book in a post by A Journey With You, and immediately after finishing the post I put a hold on the book at my local library, eager to get started on it.  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.  The toll that mental illness has exacted on the Powers family and the obstacles that arose in accessing care for sons Dean and Kevin are heartbreaking, while the historical picture painted is both eye-opening and profoundly disturbing.

Bedlam has made its way into the modern English lexicon, but its origins were in England in 1247, and it was officially designated as a mental institution in 1666.  Powers starkly captures the abuses that occurred at Bedlam and other institutions like it, including overcrowding, poor hygienic conditions, use of shackles for prolonged periods, and physical and sexual assaults.  Such practices were slow to change, and as the book points out, 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, and this practice was not made illegal until 2014, a jaw-dropping reminder that, as the book title suggests, those with mental illness are treated as somehow “less than”.

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.

As any questioning parent might, Powers tries to identify factors that could potentially have contributed to 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.

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 where they present a risk to self or others, as by this point it may be too late.  He addresses anosognosia, a common symptom of schizophrenia experienced by both of his sons, that 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.

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

Powers openly challenges the social stigma and lack of understanding regarding mental illness. He likens the mental health condition of schizophrenia to the physical health condition of 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 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.  It is essential to hear the voices of those with lived experience of mental illness, and those voices can’t be replaced by the voices of love ones or professionals.  However, embracing all of these voices can allow us to construct a more coherent social narrative regarding mental illness.  This book makes a strong contribution to that narrative by improving awareness and challenging stigmatizing beliefs, and it will also resonate deeply with those whose lives have been touched in some way with mental illness.

You can read my previous book review here:

Birth of a New Brain by Dyane Harwood