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Book Review: Crazy (2006)

Imagine if the only way you can help a loved one is to lie to the police, say the person threatened your life and hope they are arrested.

That’s a situation an untold number of Americans face every day. As journalist Pete Earley explores in Crazy, America’s jails and prisons are its new mental institutions. But Earley isn’t relaying this information as a casual observer. It comes from firsthand experience.

Earley tells two related stories in this book. One is about his son, Mike, who suffers a breakdown and is diagnosed with bipolar disorder. The other is Earley’s investigation of this country’s mental health system, one that takes him to Miami and an exploration of the psych ward of the Miami-Dade County Jail and the resources available to those impacted by mental illness. Earley personalizes the lives of people most of us shun or studiously avoid on the street and the impact of their circumstances on themselves, their families and society.

Because it is that much more personal, Earley’s account of Mike’s story is compelling. Mike had his first psychotic episode during his senior year of college. During a later delusional state, Earley drove to New York to get Mike and took him to the emergency room in the hospital of their hometown. There, Earley learned that because his son was an adult, he could not be treated unless he was likely to hurt someone or himself or consented to treatment. Mike said he wasn’t planning on hurting anyone and refused medications because they were “poisons.” He was released with no treatment.

A few days later, Mike broke into a house to take a bubble bath, causing extensive damage to the interior. He was arrested and charged with two felonies, launching Earley directly into the relationship between the criminal justice system and mental health. It is a system of two evils. Is it better to have your loved one unmedicated on the street or in jail? That conundrum is the focus of most of the book.

The statistics are staggering. Fifty years ago, more than half a million Americans were in state hospitals for mental problems. Although the nation’s population increased 66 percent by the year 2000, there are now fewer than 55,000 patients in state mental hospitals. More than 300,000 mentally ill individuals are in jails and prisons with another 500,000 on some form of court-ordered probation. In fact, the country’s largest public mental health facility is the Los Angeles County jail, which houses 3,000 mentally disturbed inmates.

But Earley’s journalistic eye makes this far more than a recitation of figures and statistics. He explores the pharmaceutical breakthroughs and societal and legal changes that led to “deinstitutionalization,” the wholesale discharge of the mentally ill from state mental institutions. He takes us to the psych ward in the Miami-Dade County Jail and meets with mental health advocates, doctors, those who suffer from mental illness, and their families and friends. For some, the story may be even more disturbing than Mike’s.

As just one of numerous examples Earley recounts, consider the 48-year-old woman who shoved, but did not injure, an elderly woman at a bus stop after accusing the woman of stealing her thoughts. She was arrested but found incompetent to stand trial. By the time Earley sees her, she had been shuttled between the state hospital and jail for more than three years as they attempted to make and keep her “mentally competent.” She still had not stood trial.

This revolving door is far too common, Earley finds. The mentally ill — who make up a significant portion of the homeless in the country — bounce among the streets, the criminal justice system and mental health centers. When in custody or under daily supervision, those with schizophrenia, bipolar disorder or schizoaffective disorder who receive proper pharmaceutical management can try to get a handle on their problems. Yet when that does not occur, continued use of the proper medications becomes problematic and the mentally disordered end up as bad or worse than when the cycle started.

Using highly readable prose to put human faces on this self-perpetuating vicious circle and exploring potential alternatives to the myriad problems, Crazy perhaps amounts to advocacy of the best sort. Nor does this become a soap box screed. Instead of letting his self-interest step too far across the boundary between objectivity and one-sidedness, Earley’s personal experience always leads back to a fundamental question: What if it was you or your child, sibling or parent? Such a question is an important step in understanding and helping a significant number of powerless and debilitated people whose safety net is tattered and threadbare.


Jails are not where the mentally ill belong.

Pete Earley, Crazy

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