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

This chapter begins with a description of the layout of the ninth floor as well as a description of its atmosphere—smelly, cold, and noisy. Earley watches a new prisoner arrive and be forced to strip naked in front of the other prisoners in their cells before he is allowed to wear a white uniform. Incarcerated individuals on suicide watch are forced to remain naked in their cells. Earley follows Dr. Poitier on his rounds as he speaks to his patients. As Earley soon realizes, “Each cell has its own story” (51). One of the prisoners is introduced as Freddie Gilbert, a man who was unhoused, is mute, and has a chronic mental illness.

Earley sees firsthand how Miami-Dade County Public Health/Correctional Health severely restricts the kinds of medications that can be prescribed to prisoners due to cost, resulting in complications for some of Dr. Poitier’s patients. Dr. Poitier tells Earley that he does not believe people convicted of crimes should be jailed if they have mental illnesses; they would be better off receiving treatment elsewhere. After following Dr. Poitier on his rounds, Earley determines that the doctor spends “an average of 12.7 seconds per inmate” (57).

After touring the ninth floor, Earley walks across the street to the courthouse to visit Judge Steven Leifman, who has a reputation for being a tireless advocate for people with mental illnesses. Judge Leifman tells Earley he became interested in mental health advocacy while interning for a Florida state senator in the 1970s when a constituent with a mental illness came into the office. After attending law school, he found it difficult to effect change as an attorney, a realization that led him to become involved in politics and eventually be appointed as a judge. He used his subsequent power to organize the Eleventh Judicial Circuit Court Criminal Mental Health Project so that the courts, law enforcement, local government, businesses, and social services could better coordinate support for citizens with mental illnesses. Later in the day, Earley takes a walk at night and encounters an unhoused man at the bus stop outside the jail. He then has a nightmare that he finds Mike on the jail’s ninth floor.

Dr. Poitier gives Earley a book on the history of American psychiatric institutions to persuade him that the United States’ policies are, in many ways, moving backward. Advocates such as Dorothea L. Dix lobbied for mental institutions to open in every state by 1900 to better serve the needs of those with severe mental illnesses. Conditions in these facilities were often poor due to the medical community’s lack of knowledge surrounding mental illness’s causes and treatments. Patients were often abused, restrained, and isolated. With little regulation or safeguards, many lived in substandard conditions.

In 1946, Life magazine published an investigative exposé of mental institutions. President Truman reacted to the outrage by signing a bill that would create the National Institute of Mental Health (NIMH). This development intersected with the evolution of psychiatry and new medications such as chlorpromazine (marketed under the trade name Thorazine). These medications gave false hope that mental illnesses could now be “cured,” and they paved the way for President Kennedy to support community mental health centers in the 1960s, a move that would ultimately lead to deinstitutionalization. The money President Kennedy had promised for community health centers was forgotten during the Vietnam War, leaving little transitional support for people with mental illnesses who had been newly released. By the 1980s, many of these former patients were ending up in jail.

This chapter zooms in on Miami’s history with incarcerated individuals with mental illness. Earley focuses on the work of Renee Turolla, a Miami citizen who participated in a public watchdog volunteer group. She noted that Cuban dictator Fidel Castro sent more than 125,000 refugees to Miami in 1980 over six months. Many were incarcerated individuals or single young men with mental illnesses. Known as the “Marielito Cubans,” many ended up caught in a cycle of crime and mental health crises.

Turolla then followed specific incarcerated individuals’ stories to get a better sense of how many were slipping through the cracks. Because of deinstitutionalization and the Marielito flotilla, Miami’s jails were overwhelmed, and judges found themselves confused about how to proceed. She began an investigation, interviewing psychiatric nurses, correctional officers, and administrators at the jail. After releasing her findings in 1985, Turolla expected reforms to follow, but instead, she found her report shelved. She encourages Earley to follow incarcerated individuals as they cycle from the jail out onto the streets so that he can see for himself if conditions have improved since her report in the 1980s.