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My Brother Ron: A Personal and Social History of the Deinstitutionalization of the Mentally Ill Paperback – June 28, 2012
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About the Author
Clayton E. Cramer is a software engineer by day who teaches history at the College of Western Idaho at night. His work has been cited in U.S. Supreme Court decisions, as well as in dozens of decisions from federal appellate courts and state supreme courts. He lives in Idaho.
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This was the height of the psychoanalysis influence on psychiatry. Fortunately, the chief of the service where I was working was a former analyst who realized that Freud had nothing to offer the psychotic patient. He taught me to talk to the sane part of the patient and ignore the "crazy" part. The early drugs, like chlorpromazine (Thorazine), allowed much better interaction with these chronic schizophrenics. Some of them explained what it was like to be "crazy," their preferred term. I witnessed Electroconvulsive treatment (ECT) and saw the "lucid interval" that often followed the session. The patients usually lapsed into psychosis again after a few hours but the desire was to try to prolong the effect and this led to repeat sessions.
The author does a great job with the history and goes into far more detail on the legal aspects than I did in the chapter on psychiatry in my own book, A Brief History of Disease, Science and Medicine. He writes about "The fever treatment" that won a Nobel Prize for Wagner-Jauregg, the advocate, in the 1920s. This was a result of success with syphilis using fever when the drugs were inadequate and toxic. The legal history is important as the legal maneuvers of anti-psychiatry forces were the proximate cause of the disaster that followed. The homeless problem appeared in the 70s as the mental hospitals emptied and the former patients found nothing to replace them. The Community Mental Health Centers, as the author so well describes, were intended to take the place of the state hospitals but were never adequate, especially in the era of "talk therapy," where a single psychiatrist could only see eight to ten patients a day.
I teach medical students and take them to the homeless shelters in Los Angeles every year so they can see where their County Hospital patients come from, and return to after hospitalization. They are able to see the futility of prescribing medicines when the patient has no clock or refrigerator to time the dose or preserve the drug between doses. The author relates the incidence of mental illness among the street population. The managers of the shelters tell me and my students that 60% of the homeless are psychotic and 60% are drug and alcohol addicts. Half of each group is both. For the first few years, we had an amazing guide, a former homeless man now working for the city. He would regale us with stories of his ten years on the street addicted to crack cocaine. He took us to shelters and to homeless hideouts where he warned us not to go there without him.
This book is a source for anyone who wants to know how things got so bad and why the families of psychotic patients are so frustrated with the "advocates" who block treatment or commitment of those unable to care for themselves. One of my students' patients was a man with a severe leg infection that threatened amputation. He lived on the sidewalk in front of a Pasadena church. He refused parishioners' offers of housing, telling them he was waiting for the perfect apartment. He barely kept his leg with intense treatment. After treatment, he returned to the street. This is a national tragedy and the reasons are well explained in this book. I can't recommend it highly enough.
Mr. Cramer's emotional energy and motivation for writing the book is derived from his brother Ron's lapse into schizophrenia, which he uses to illustrate changes in mental health paradigms (and the associated personal pain) but it is not primarily about Ron. It is about the history of the various ways, privately and governmentally, that America has dealt with mental illness from colonial times to the present.
Although Mr. Cramer's vocation is primarily software engineer, his avocation is historian, an amateur in the very best sense of the word who has also taught history at the college level. He applies the same depth of research and quality as he did in earlier efforts, which have been cited in a Supreme Court of the United States decision. This is not a dashed-off effort, it is a serious, documented, but very readable history.
At $1.49 for the Kindle version, this is more steal than deal, and well worth your time.
My Brother Ron clearly reflects the pain and futility that those that love the mentally ill go through. Within this framework he developes the history and tragedy that is the current situation. Clarity and scholarship are rarely combined as well as in this book.
A "must read" for everyone who cares about others.