Crazy: A Father’s Search Through America’s Mental Health Madness

“It was 2 p.m. now, and during the past twenty-four hours I’d watched Mike slip deeper and deeper into his own delusional world. Because it was his mind that was sick, I was being told that I had to back off and leave him to leave him to face his madness alone. I had to watch as he gradually continued to lose all touch with reality.”

As a father and journalist, Earley struggles with feeling helpless when confronted by his son’s bipolar disorder. By allowing readers access to his own sense of vulnerability, Earley gives valuable context and personal stakes for his work on Crazy. From this moment on, Mike serves as a motivational force for Earley’s investigations. In addition, opening the book with Mike’s story gives readers who may not know anyone with a mental illness a way to empathize with and understand the rest of Earley’s reporting, supporting the theme of Invisibility, Stigma, and the Need for Community.

“I couldn’t answer most of her ‘whys.’ My son had been psychotic. How do you explain the actions of a mentally ill person? But I apologized again, and then again.”

When Earley attempts to apologize to the family impacted by his son’s erratic behavior, he finds it difficult to make them understand how his son’s mental illness is outside of anyone’s control. This lack of sympathy, and the shaming of parents like Earley, underlies many of the tensions Earley ends up exploring in his reporting in Miami. This lack of understanding or context for mental illness, Earley suggests, is what lands many people with mental illnesses in jail rather than in a treatment program that could prevent crimes from happening.

“‘Mentally ill people don’t belong in jail,’ Dr. Poitier continued. ‘By its very design, a jail like ours is intended to dehumanize and humiliate a person. It’s supposed to have a negative impact, to bring an inmate down, to make him not want to come back. This sort of atmosphere is counter to treatment or helping improve anyone’s mental health—including the people who work here.’ By the time he had finished his rounds, Dr. Poitier had either spoken with or visibly observed all of the ninety-two inmates on the ninth floor. I checked my watch. His rounds had taken nineteen and a half minutes to complete. That was an average of 12.7 seconds per inmate.”

Dr. Poitier serves as an anchor and authority for Earley while reporting in Miami. His opinion expressed here will be proven true by Earley’s investigation into how the jail approaches handling people with mental illnesses. In the final sentence, Earley calculates how little time Dr. Poitier spent with each of his patients. This point is a subtle, ironic nod to the book’s title, Crazy, which ultimately refers more to the systemic problems in the mental healthcare system than it does to mental illness itself.

“Dr. Poitier was waiting in his office with a tattered book. ‘If you really want to understand what is happening here on the ninth floor,’ he explained, ‘you should read about the past.’”

This piece of advice sets the stage for Earley to learn more about how American society has moved from treating patients in hospitals to incarcerating them. This introduces another thread in the book: one of examining history, medicine, public policy, and social stigma to understand how today’s mental health care system came to be.

“Each morning, the large black man [Freddie Gilbert] would strip off his Ferguson gown, stand naked in the center of the cell, and stare out into the corridor. It was as if the cell’s glass front that separated him from the rest of the cell block was a television screen and we were moving across it like actors in a confused drama. I began stopping by his cell each afternoon, intentionally inserting myself in his field of vision so that he had to make eye contact with me. I would smile and sometimes wave. But he never responded. His face remained blank.”

Freddie Gilbert is one of the first incarcerated individuals Earley follows. Gilbert’s near catatonic state, as well as his refusal to acknowledge Earley, creates a disquieting atmosphere. Amplifying the discomfort is the jail setting, especially Earley’s references to the “cell’s glass front,” “television screen,” and “actors in a confused drama” (87). Patients like Gilbert are so trapped within their own illness that it is as if they exist in another story entirely—one that no one else seems able to penetrate. This situation makes Gilbert’s exposure even more disturbing: Earley points out his nudity to highlight Gilbert’s overall vulnerability in this moment.

“I watched the faces of the parents sitting around the table and wondered how they did it […] I began to sweat. A feeling of dread washed over me. After Mike had begun taking his medication and was discharged from the hospital psych ward, I had felt a sense of hope. Surely, the worst was behind us when it came to getting him medical treatment. But sitting here at this table now with these other parents, I was starting to realize that there were no guarantees when it came to mental illness, and as simpleminded as it might seem, I was beginning to understand that bipolar disorder was not like a cold that would go away if Mike took his medicine.”

After sitting in on NAMI meetings for families of people with mental illnesses, Earley reflects on his own worst fears for his son. Hearing the other parents talk about relapses and run-ins with law enforcement makes him realize that just because his son’s condition has improved doesn’t mean the fight is over. It also foreshadows further incidents with the other incarcerated individuals that Earley is following, all of whom will eventually relapse.

“We lock up people with mental illnesses because they terrify us. We are afraid of them and even more frightened of what they symbolize. We want to believe they did something that caused their insanity.”

Earley’s investigation has given him enough evidence to view the social stigma around mental illness as a means of distancing oneself from people with mental illnesses. The conflation of mental illness with moral weakness is used by many to distance themselves and therefore not confront the reality that mental illness can happen to anyone. By repeatedly invoking the collective “we,” Earley implicates himself as well as the reader as parts of a system that stigmatizes people with mental illnesses.

“The federal government says mental illness is a chemical imbalance, and because of that it’s a sickness […] But deep down, we don’t want to believe that’s true. Because if we did, we would have to admit: It could happen to us. It could happen to me.”

Building off the quote above, Earley continues to use “we” to make clear that everyone in society holds some responsibility for stigmatizing people with mental illnesses. This time, he points out how doing so stems from a collective fear of becoming “crazy”—and stigmatized—oneself. By explicitly stating where the shame surrounding mental illness comes from, he raises questions about decisions regarding law enforcement, criminal justice, and treatment.

“[Office Mario] Garcia said that it seemed odd to him that instead of finding ways to help people with mental illnesses move off the streets, the city had been forced to adopt stringent guidelines to protect their rights to live on them and to remain crazy.”

Throughout the book, the relationship between law enforcement and people with mental illnesses remains fraught. Earley is sympathetic to the police officers to a point, as his provocative phrasing here suggests: Rather than framing noncompliance with treatment in terms of a right to control one’s body, Earley describes it as the right to “remain crazy.” The situation is emblematic of The Dangers of Deinstitutionalization.

“[I]f it weren’t for CIT training and the issuing of Tasers, that man would be dead. There’s no question. In the past we would have shot and killed him.”

A police officer says this to Earley to emphasize the importance of CIT training. This point is also meant to remind the reader of Mike’s encounter with the police, which was only peaceful because an officer had shot and killed a man in mental crisis the day before. This contrast highlights the seemingly random nature of police interactions with individuals with mental illness and the potential for fatal consequences.

“If a state couldn’t lock up a person because he was mentally ill, then at what point could it intervene?”

This question is posed in a myriad of ways throughout the book. Because of rulings requiring that adults with mental illnesses must consent to treatment, it becomes difficult to identify when the state can intervene and force them to be medicated. This situation frustrates Earley, especially regarding his son’s well-being, as well as medical professionals like Dr. Poitier.

“The nurses, social workers, and Dr. Poitier saw the inmates as patients. The officers saw them as prisoners.”

Earley utilizes parallel sentence construction to highlight an important difference between the attitudes of the correctional officers at the Miami-Dade County Pretrial Detention Center and the attitudes of the medical and social work staff there. Even though the ninth floor is specifically reserved for those with severe mental illnesses, the correctional officers view these people as prisoners first, while medical staff see them as patients, leading to clashes of opinion and priority later in the chapter.

“The inmates I see every day on the ninth floor are among society’s most marginalized citizens. Early on, I thought, if I can help them, then I’m doing my job as a doctor and I’m also giving back to my community.”

Dr. Poitier says this to Earley while telling him how he came to work as a forensic psychiatrist in jail. He views working with prisoners as a form of social justice and giving back to the greater Miami community. His understanding of the prisoners as patients gives the reader a better understanding of why he continues working in the jail despite the obstacles he faces as a physician.

“‘There was a time,’ Dr. Renoso continued, ‘when a patient like this would have spent her entire life in a state hospital, because she is such a sick woman. I worked in a state hospital and I know how horrible the conditions in them were. But is her life any better today? Have we really helped her? At least there, she might have had access to some programs or some art therapy. Now she’s in a cell all day.’”

Dr. Renoso echoes many of Dr. Poitier’s sentiments but brings her own experience of having once worked in a state hospital. She adds context to the argument for longer-term treatment options by saying that while state hospitals were far from perfect, there was at least a chance that people with mental illnesses could have access to various forms of therapy and other necessary resources.

“In investigating Sanbourne’s life and death, I had uncovered an ugly truth. Sanbourne had been warehoused for nearly two decades in a state mental hospital, only to be discharged and warehoused again—this time in an ALF boarding home. Her life had not gotten better after she had been discharged […] How many others were there living in Miami in rooming houses? They’d not been saved, they’d simply been better hidden. They’d become even more invisible.”

Earley uses what he learns from investigating DeeDee Sanbourne’s death to gesture outward. Sanbourne’s story is tragic, but it also points to the invisibility of people with mental illnesses, who can easily become lost in a system that is not set up to serve their best interests. This “warehousing” makes it easier for patients to be not only mistreated but objectified as well.

“Yes, I still thought she had overreacted. Yes, I still thought she had become hysterical. But I began to see her differently. I began to see her as the reader of this book whom I wanted to reach. She was the audience I most needed to persuade.”

Earley tries his best to understand the unnamed woman whose house Mike broke into, but he struggles to do so. By beginning to view her as a reader rather than an adversary, Earley realizes that his investigation has the potential to educate others about their own prejudices as well as the broken systems that surround them. He implicates the readers once again, especially those who find themselves resistant to empathizing with people with mental illnesses and their loved ones.

“The more Jackie [Hernandez] gushed about how great her daughter was doing, the more uncomfortable I became. She deserved the truth. But I’d promised Hernandez that I wouldn’t reveal what she was doing. As a journalist, I could rationalize my silence. Promises in my profession are a sacred trust […] But as a parent, I felt required to tell Jackie while she could still intervene.”

This passage highlights one of several ethical dilemmas Earley encounters in his reporting for the book. Jackie, April Hernandez’s mother, is proud of her daughter’s progress, but she does not yet realize that her daughter has stopped taking her medication. Though Earley decides not to break his trust with April, he does so with a heavy conscience. Like many of the figures Earley shadows, he often faces impossible decisions.

“I wanted to believe Mike would never go off his medication, never have another relapse. But I knew too much now to be so confident.”

The inevitability of Mike one day relapsing begins to set in for Earley, who has now spent enough time in his investigations hearing from patients, doctors, social workers, and parents to know that it will be impossible to avoid. His confidence that his son will fully recover wanes as he learns more, forcing him to confront whether his expectations for Mike’s future are realistic, especially considering how fortunate Mike has been in his encounters with law enforcement.

“If I’d happened upon those two cases completely by chance, how many others like them were out there? How many went unnoticed every day in the courthouse? How many other mentally ill inmates had slipped into jail under the radar or were shuffled between the jail and forensic hospital simply because no one knew what to do with them, or, as the psychiatrist had so aptly put it, because there was ‘no place’ for them ‘in our society?’”

Here, Earley sees how patients can become stuck in the revolving door shuttling between hospitals and prisons while attempting to become well enough to stand trial. Many will recover in the hospital but be forced to wait for a trial date for so long while in prison that they end up relapsing, which sends them back to the hospital again. Earley emphasizes that he’s found two cases “by chance” to amplify the fact that he wasn’t looking for them, meaning there are likely many more out there for someone who cares to look. This is another way in which people with mental illnesses can become invisible within the system, as well as another way in which stigma, civil rights, and the law often are hopelessly tangled.

“From the start, I knew I would have a difficult time finding a ‘success’ story in Miami […] It wasn’t exhaustion that was causing the sense of sadness that I felt. It was a lack of hope. I wanted to find a glimmer of promise—not only because I wanted to include an inspiring story in this book, but because I wanted to believe that my son was not doomed to the grim realities that I’d found here.”

The two stories that Earley wished to tell in this book—one about his son, the other a larger story of individuals with mental illness in the Miami-Dade County justice system—have, in many ways, completely merged. Earley investigates his son’s mental illness and shadows people with mental illnesses to try and find a silver lining for Mike’s story. Much of Earley’s reporting is motivated by his desire to find a solution for his son as well as others like him. When he realizes that he may not find it in Miami, he becomes convinced that there is no hope for Mike’s future either. The reader is meant to question whether there can ever be a happy ending for the people Earley is following—and what would need to change for there to be one.

“You want to know what it’s like? How do I know you are here right now? How do I know I’m not imagining all of this? Close your eyes. What if, when you opened your eyes, you discovered you were now in New York City instead of at Passageway in Miami?”

Carl is a client with schizophrenia at Passageway. Here, he describes questioning his own reality, fearing that he has imagined the entire thing. This confusion and disorientation remind the reader of how far he’s come but also the stakes that come with a potential relapse. Although Earley follows several people with mental illnesses, Carl can articulate his experience clearly and powerfully, and it is obvious that his time at Passageway has helped him get there. His state speaks well of Passageway as a successful model for long-term treatment, which Earley advocates for later.

“A parish is a place where they can be inspired by one another and their leaders. It’s a community where everyone is encouraged to follow a set of behaviors that will perpetuate their wellness. And that’s what we’ve created here. Passageway is a parish. We care about one another. We are a community. That’s our so-called ‘secret to success.’”

Throughout the book, Earley points out that there is no predetermined “place” for those with chronic mental illness in American society. Mullen tells him that by making Passageway a place where individuals can take responsibility for themselves and enjoy a feeling of belonging, all while they have access to a community, he sets people up for a better chance of success than a state hospital or jail. This success proves that many people with mental illnesses are willing to take their medication and live as residents in a facility as long as they are respected and have access to therapy and services to help them live independently in the future.

“[D]einstitutionalization was a cruel hoax, and the wholesale closing of state hospitals was abandonment, not freedom.”

At the end of his reporting, Earley draws conclusions based on his intensive research about how deinstitutionalization from the 1960s through the 1980s created a terrible ripple effect for those with chronic mental illnesses. By calling this move “abandonment,” he draws attention to the fact that a well-meaning movement to better living conditions for people with mental illnesses did not actually give them “freedom.” Instead, it led to a variety of other ways in which these same people could be abused or taken advantage of, often while unhoused or in jail.