This is a deeply emotional book about an important topic, and it seems to have found a large audience (judging by the number of holds at my local library if not the number of ratings on Goodreads). It’s a great idea, alternating between nonfiction chapters about the nature and history of mental illness and a memoir of the author’s family, including two sons with schizophrenia. And as a journalist, the author has an engaging writing style that kept me wanting to read on. It is marred, however, by odd choices in structure and focus. In the end, there is far less about mental illness in it than I expected, and the author’s major policy proposal involves disempowering the very people to whom he claims he wants to give a voice.
The larger part of this book is the nonfiction, much of which is history. The author writes a bit about the spiritual roles often held in traditional societies by people who would today be defined as mentally ill, before discussing the history of asylums (they seem to have started out somewhere between prisons and zoos, to be later reformed in the era of Dorothea Dix and then deteriorate again). And other low points: eugenics (Hitler was all about wiping out mental illness through murder, but the U.S. pioneered forced sterilizations), lobotomies (shudder), and deinstitutionalization (the U.S. closed most of its asylums in the 1960s, resulting in many of the mentally ill winding up on the streets or incarcerated). For no reason I could discern, the chapter about the aftermath of WWII comes after the deinstitutionalization chapter, but it’s otherwise roughly chronological.
Powers’s writing style is engaging, and there is useful information here for those who don’t know much about the topic, but the nonfiction portions could have been much better. When the subject is science – what is schizophrenia, or the link between mental illness and creativity – there’s little actual science and lots of authorial speculation; Powers spends more time detailing debunked theories with emotional appeal for him than laying out the facts. When the subject is history, he has a tendency to go off on tangents at best loosely related to the topic of the book: the eugenics chapter goes into detail on how Darwin came to travel on the Beagle, but neglects to mention that forced sterilization went on in the U.S. until the 1970s.
The chapter on antipsychotics is particularly off-base. I expected this chapter to answer such questions as: how effective are antipsychotics? What is it like to be on them? How have these drugs changed in the sixty-odd years since they first became available? What are their disadvantages? Instead we get a history of the development of the precursors to the first antipsychotic drugs, including biographical details of involved scientists, and then a long catalogue of misdeeds by drug companies, often not related to psychoactive drugs at all. There’s even a discussion of the intricacies of patent law that cause medication to be expensive in the U.S. in the first place, and mention of Bernie Sanders bussing seniors up to Canada to buy cheaper meds. As a piece of journalism it’s fine, but that isn’t why I picked up this book.
The memoir portion is equally marked by odd choices of focus. Three-quarters of it takes place before either of the author’s sons begins showing signs of schizophrenia. I understand the author’s desire to focus on the happy events in their lives, and even his drive to include supportive emails he sent his kids over the years. Perhaps one of his goals was to get readers invested in Dean and Kevin as people rather than seeing them as representatives of an illness. But a good writer could have done that while focusing on the years when they were actually sick (they’re still people, which is supposed to be the author’s point, and they’re hardly psychotic all the time). And this structure winds up giving the impression that life ends with schizophrenia, that everything worth telling in his sons’ lives happened beforehand – even though one of them is alive and apparently doing well.
Again, there’s a lot of authorial speculation and tangents here. He theorizes that his older son, Dean, was moody and withdrawn as a teenager because he was in the early stages of the disease, never mind that Dean’s first psychotic episode seems to have come around age 30. He discusses at length the social and judicial consequences of a car accident when Dean was 17, during which it becomes clear that he has a bone to pick with the other teenager’s family (who previously wrote their own book). Dean’s own opinions are noticeably absent. The author will mention that he never asked how Dean felt about a particular event, or doesn’t know some fact from Dean’s life, leaving me wondering why he didn’t just walk downstairs and ask. Memoirists generally have living, non-estranged family members read their manuscripts and share their memory of events, which could only have improved this book.
Finally, though there’s little discussion of specific policy proposals, Powers advocates throughout the book for parents having increased authority to force treatment on their unwilling adult children. Of course, early diagnosis and treatment is extremely important to health outcomes, and it was clearly agonizing for Powers and his wife to watch Kevin go off his meds, insisting that he’d gotten better. But having recently read a horrifying account of involuntary commitment in another memoir, I’m hesitant to say we should do this more, and concerned by the author’s pooh-poohing of civil liberties concerns. A basic tenet of a free society is that adults get to make their own life decisions, even if their judgment is terrible, as long as they abide by the law. If someone is incompetent, the court can appoint a guardian. Powers apparently believes this option is insufficient because there can be delay (in which case the delay is the problem) and, bafflingly, because this is “not a medical hearing, with psychiatrists, but a judicial hearing, with a judge and lawyers.” Um, yes, this is how government works; it’s called due process of law and why courts exist. There’s nothing stopping psychiatrists from testifying in them.
At any rate, the author doesn’t seem to have thought this proposal through. Does he believe in involuntary treatment only during episodes of acute psychosis, or indefinitely once someone has a diagnosis? His experiences make it seem like the latter. In which case, what diagnoses are sufficient? How long does someone have to be stable to get their rights back? Does he think parents should have this power for life, or only while their children are financially dependent young adults? How would he prevent situations like Rosemary Kennedy's, where less conscientious parents choose a treatment that destroys their child in an attempt to make her easier to manage? If the ill person is married, does the spouse get to dictate treatment? Has he considered the ways mental illness already leaves people vulnerable to domestic violence (“you’re crazy, so no one will believe you”)? There's a long history of inconvenient women forced into mental institutions, because people given power over others don't always exercise it well. It doesn’t appear the author has considered the implications of his ideas beyond his own pain, and while his experiences are a valid consideration, the inquiry can’t stop there.
So in the end, while there is some good journalistic writing here and I found the book more engaging than a 2-star rating implies, it falls short of the author’s stated goals. He writes in the introduction that he wants reading the book to hurt, and he wants to give a voice to people with mental illness. The book includes a few tragic stories taken from the news, dealing with police shootings and suicide in prison, and certainly his son’s suicide is one of the most tragic events a family can experience. But far more page time is spent on Powers family vacations and why the author hates Thomas Szasz. And I’m confused as to how he believes he’s given anyone a voice when there’s no indication he interviewed anyone with mental illness for the book; even his own surviving son appears to have had no involvement. Raising awareness is good, but this book is too much of the author’s feelings and too little of anything else. What a wasted opportunity.