I hope you do not “enjoy” this book. I hope you are wounded by it; wounded as I have been in writing it.

Ron Powers knows craziness inside and out. His book is part-expose, part-memoir. Not only does he unveil the atrocious way demoniacs/lunatics/maniacs/mentally ill have been abused throughout history, he also shares a very personal story about how mental illness has ravaged his family.

Powers primarily examines schizophrenia, the mother of all mental illnesses. The most debilitating. The one most resistant to treatment. This is the illness Powers’s sons Kevin & Dean have. But this diagnosis does not define them. They are creative, compassionate young men. Powers describes how his sons were moved by music and this passion for artistic expression gave them direction and purpose. But, as their minds gave way to the mental illness within, they would lose the capacity for anything coherently creative. Only chaos.

But this book is about much more than a father’s deep affection for two sons afflicted by a wicked illness. Powers also traces the harrowing history of how poorly persons with illness have been treated in the name of medical science, such as at Bethlam (later Bedlam):

Around 1403, the hospital began to accept a handful of “lunaticks” for care, and employed a few monks to look after and try to cure them. The monks were happy to oblige, and they set about beating their charges. (They probably believed that they were striking at the evil spirits.)

Yet, Powers is not entirely pessimistic regarding the history of mental health care. He highlights a more moral approach, such as the efforts of  Samuel Woodward, superintendent of the State Hospital which, in 1833, became the first state-financed sanctuary.

[Woodward] greeted each arriving patient personally. If they had been transported from another asylum or prison, he would use his own large hands to free theirs from confinement.

Another reformed who made a positive impact on humane mental health care was Dorothea Dix.

Dix had been swept into a cohort of British reformers, many of them Quaker, who introduced her to the madhouse netherworld. Dix came home bristling to be of use to such incarcerated souls. One day in March 1841, she volunteered to teach Sunday school to some women confined at the East Cambridge (Massachusetts) jail. Afterward, a jailer reluctantly escorted her to a heavy locked door. He opened it and the chilly air inside blew a heavy stench into their faces. The scream had come from within a group of huddling, half-naked “lunatics” who had been encaged in the hovel for years — in the company of convicted violent criminals, as was still common. She asked the jailer how this could be. He comfortably (and, as things turned out, famously) assured the small lady that she should not bother herself; the insane could not feel heat or cold.

Woodward, Dix, and other reformers worked tirelessly “to inspire or shame the legislature into action.” Through their efforts 32 asylums were built, each devoted to the health and well-being of persons afflicted with mental illness. Dix died peacefully in her guest apartment of one of these asylums, in 1848.

Soon after the death of reformers like Woodward and Dix, asylums focused more on warehousing than healing were constructed. The travesties of war, the advance of industry, and the rising population, mixed with inadequate funding to create a perfect storm of cruel inhumanity toward those most vulnerable.

True to our basest selves, many of these decrepit asylums have been recently purchased,…

…by entrepreneurs attuned to the American appetite for the macabre, especially in the computer-generated forms of garroting, throat-slashing, and torture. These businessmen and women, rejoicing in the caricature presented by the old sanctuaries, have made it pay: by refurbishing the cells and apartments with stage-set spooks and sorcerers and sinister scientists with bloody smocks, and splashing fake blood on the walls.

Surely things are not all that bad? I mean, not after we closed down so many of those institutions for the insane? Not since we have developed more reliable psychotropic medicine to reduce the radical extremes of a mental illness? Not since famous people from Hollywood and elsewhere have gone on record as having a mental illness?

The truth is, the more things have changed, the more they have stayed the same. Actually, in many respects, the worse they have become. Closing mental asylums has left persons with serious illness with no place to call home. Today, the largest institutions for persons with mental illness are prisons, jails, and the streets. Privacy laws and personal rights make it next to impossible to care for loved ones who are hell-bent on destruction.  Newer and better anti-psychotics don’t help if a person has a psychological resistance to take them (anosognosia).

So what is our hope? Where does our help come from? Powers concludes his book pointing back to persons like Dean and Kevin, his sons.

… the future of care for the mentally ill will depend upon whether Americans can recognize that their psychically troubled brothers and sisters are not a threat to communities, but potential partners with communities for not only their own but the community’s regeneration.

True healing is not dispensed with a magic pill. A cure is not effected with some tremendous therapy. These things are necessary, sure, but not the answer.  The problem of mental illness is chemical, and emotional. It is also relational and spiritual. When we become partners together along a path of purpose, healing will begin to happen.