Book Reflection | No-One Cares About Crazy People by Ron Powers

There are endless amounts of misconceptions regarding mental health that are actively circulating through society. Ron Powers tries to combat some of those misunderstandings by sharing his personal story involving schizophrenia in his book, No One Cares About Crazy People. Powers describes the journey he and his family went through after both of his sons were diagnosed with schizophrenia along with some background information into mental illness. He focuses on theories from neuroscientists, psychiatrists, historical encounters with law enforcement, and the changes in politics surrounding the mentally ill. By pairing both his own story and the historical context, he sets the stage up perfectly for gaining a better understanding of mental illness and why his son’s journeys unfolded they way that they did.

 To understand mental illness in the United States, we can look at circumstances even globally to see where the influence and progression has come from. London found itself involved in the early urbanization of congregating those with mental illness after repurposing a building built in 1247 that was initially used as a religious sanctuary. This facility was called Bedlam (Powers, 2017, p.59). After sitting as a sanctuary, the building transitioned into a hospital, an almshouse, and finally a sanctuary for the insane. This occurred under the power of King Henry VIII in 1547 when he gained control over Bedlam and officially had the shelter run by a charter in Moorfields. Powers stated, “Moorfields epitomized the rebuilding of London after the Great Fire of 1666 – outside its walls. Its dark and sinister interior came to symbolize something quite the reverse” (Powers, 2017, p.60). This building was built with the hopes of exhibiting goodwill and benevolence, but it really fostered cruelty and mistreatment by fellow inmates or employees.

 In 1813 in Philadelphia, Pennsylvania, The Friends Asylum for the Relief of Persons Deprived of the Use of Their Reason open up as the Nation’s first private psychiatric hospital (Powers, 2017, p.68). 20 years later, the State Hospital became the first state-funded sanctuary of the mentally ill in Worcester, Massachusetts. Being the hometown of asylum investigator, Dorothea Dix, Worcester also marks the place where Dix began her journey understanding the needs of the mentally ill. She visited various asylums around the United States and even in Europe to investigate how effective the patients were being treated. She was on a mission to determine if the asylums were actually helpful to the patients. “At the end of her journey, she was convinced that moral treatment asylums were in fact benefiting patients” (Powers, 2017, p. 70). Dix was instrumental in founding 32 asylums by 1880.

Again, in the 19^th century, an extremely hazardous and invasive procedure was developed to treat schizophrenia by a Portuguese neurosurgeon named Egas Moniz. The treatment was described as “The modern lobotomy – the back-alley abortion of brain surgery” (Powers, 2017, p.273). The procedure entailed strategically placing a metal rod into the frontal lobe to sever the nerve fibers responsible for emotion, because the clinicians in charge of performing the procedure believed these patients had too much emotion and some needed to be cut out. Even after winning a Nobel Prize for the advancements, patients were still dying, had limited emotional affect, lost bladder or bowel function, or was prone to emotional outbursts.

Another founder of a significant concept in mental illness is Thomas Szasz of Hungary. Szasz claimed the idea of mental illness not a problem with the individual, but their behavioral choices were seen as bothersome to those around them (Powers, 2017, p. 158).  He also emphasized the behavior of the individuals are on a spectrum and are not finite. Szasz was even advocating that hospitalizing people due to mental illness was inhumane and comparable to slavery. He had both valuable and unsupportive contributions to the psychology community.

Dean and Kevin Powers, sons of Ron and Honoree Powers, were both diagnosed with Schizophrenia. Growing up in the same household and even sharing the same diagnosis, still both men had completely different experiences from the disorder. Kevin, the younger of the two, was diagnosed first and had a turbulent life up until he died by suicide at the age of 20. Dean on the other hand still had a difficult time navigating the diagnosis, but he eventually gained some control and knows how to properly manage his disorder now.

Kevin likely had a more severe symptoms due to several factors. He had experimented with drugs and developed a substance use problem at an earlier age. It is unknown what kind of drugs or how much was taken because Kevin could have been hallucinating when disclosing that information. In an article in the Dialogues in clinical neuroscience stated, “The link between the use of substances and the development of psychosis is demonstrated by the high prevalence of substance abuse in schizophrenia” (Winklbaur, Ebner, Sachs, Thau, & Fischer). Substance use could be a factor leading to psychosis and/or a comorbidity among those with mental illness. Kevin’s drug use likely contributed to his severe symptoms. He also faced a turning point in this life after Dean suffered a traumatic car accident. After Dean went through that experience, he required a lot of attention and support from his parents. Kevin responded by isolating himself and putting all of his energy into music. Kevin developed a bit of an obsession when it came to playing and perfecting his music. This pressure was not sustainable for Kevin’s mental state.

During the period of discovering his diagnosis, Kevin struggled to get consistent answers. He was initially diagnosed with bipolar disorder following a psychotic incident requiring hospitalization during his first year of college. The misdiagnosis lead to added stress and improper treatment initially. After getting on the correct medication and treatment, Keven stabilized and was even headed back to school. Eventually, Kevin felt so good with his treatment that he decided he no longer needed to take his medications because he was feeling fine. He was unaware and unaccepting of what the diagnosis and treatment actually entailed. Unfortunately, due to a combination of the effects of substance use with a mental illness, a major life stressor, being away from home, and inconsistent treatment, Kevin developed severe symptoms ultimately leading to his death.

Sharing a diagnosis does not mean the Powers brothers shared the same experience. Overall, Dean did well in sports, stayed motivated, played music, and worked hard. Unlike Kevin’s more obsessive nature with playing music, Dean used that time as a relief more than a source of stress. There was still his fair share of difficulties, like the serious car accident he was involved in as a teenager. He was put under house arrest after claims that he was drunk driving with a friend. The friend was injured in the accident and was hospitalized for weeks. This was major deal for Dean, but he had great support from his parents that lead him to develop better coping skills and resilience. Discovering these skills was one of the major factors separating the product of Dean and Kevin’s lives. It is thought that this accident was one of the major stressors that initiated Dean’s symptoms. Overall, Dean’s symptoms didn’t start until later in his life compared to Kevin. Dean began experiencing symptoms at an older age, adding to the reasoning behind his increased resilience.

The treatment progress was not a smooth road for Dean either. While his symptoms were less severe, Dean struggled with consistent medication administration, refused hospitalization, had drug and alcohol use, and even attempted suicide. Eventually, he began consistent treatment with a psychiatrist and remained compliant with medications by receiving Haldol injections. His treatment began with a rapid and accurate diagnosis of schizophrenia. Receiving this efficient treatment right away is a huge factor contributing to Dean’s better grasp around the disorder. That along with his coping skills and later onset all contributed to Dean having less severe symptoms and more reliance through his diagnosis of schizophrenia.

 Following this book, I find myself hurting for those with a mental illness. I appreciate the blend of some etiology behind mental illness and the profound experience the Powers are going through. One of the most moving pieces of this story was how incidents like the death of Keith Vidal played out (Powers, 2017, p.5). This moment could have had a non-lethal ending if there was proper education, training, and communication by that law enforcement for that day. By not understanding what interventions are needed to deal with psychosis, the officers further agitated Keith. There was also miscommunication regarding the “weapon” he was holding. This occurrence highlights the need for a better process when working with people going through psychotic episodes. Reflecting back on this situation, it inspires me to make a point of creating and going through a detailed safety plan with my patients and their support people. Even well-managed, well-behaved, and stable individuals with mental illness are at risk for an incident occurring. A thorough safety plan can even ensure a higher chance of safe care and gives anyone around something to look at if there is a question as to how the situation should be handled.

 There is no doubt that a nurse will see mental illness even when working on non-psychiatric floors. While I don’t plan to specialize in psychiatric nursing, mental illness will be a significant part of my treatment plans for my patients. By knowing the prevalence of mental illness and how it effects the entire body, I will be more equipped to address any needs or considerations my patients might need.  It’s important to understand how coming in with an understanding of the condition and empathy will be the greatest tools when caring for people with a mental illness.

References

• Powers, R. (2017). No one cares about crazy people: The chaos and heartbreak of mental health in America. New York, NY: Hachette Book Group.
• Winklbaur, B., Ebner, N., Sachs, G., Thau, K., & Fischer, G. (2006). Substance abuse in patients with schizophrenia. Dialogues in clinical neuroscience, 8(1), 37–43.