New Book Shows a Man’s Tragedy via Mental Healthcare Reforms

What is the best way to tell the story of mental healthcare in America? Is it one of increasing progress out of a dark past? Is it a story of unremitting horror?

How you tell the story depends upon your criteria for "progress" and "horror." A new book by David Rosen, "The Best Minds: A Story of Friendship, Madness, and the Tragedy of Good Intentions, narrates modern mental healthcare as a tragedy. But it is a particular tragedy—the tragedy of lost opportunities.

Oxford University Press says a tragedy is "A serious drama with an unhappy ending involving the protagonist's downfall." Rosen's book, which tells the story of his childhood friend Michael Laudor, is tragic.

Laudor was a precocious child prodigy who graduated from Yale University summa cum laude in just three years, went on to land a high-paying job in finance, and then suffered a devastating attack of schizophrenia. However, he recovered and managed toget through Yale Law School andso to land a major book and movie deal.

Imagine Entertainment was set to make a film about his life, starring none other than Brad Pitt. But then, horrifically, Laudor relapsed and, while off of his medications, murdered his beloved girlfriend. His triumphant story was over.

While telling us these events, Laudor weaves in an account of deinstitutionalization, the process by which the old state mental hospitals were closed down and replaced with "community care." As it turned out, the solution was wildly deficient. People who might have lived out their lives in hospitals now found themselves on the streets or in dire poverty, and the stigma of mental illness never left them. Rosen makes some important points in connecting this story to Laudor's.

Laudor came of age in the 1970s, at the height of deinstitutionalization. Though based on good intentions, community care was underfunded and often reliant on dubious theories of what mental illness was. The upshot was that deinstitutionalization lowered the life outcomes of people living with serious mental illness. As Rosen points out, the largest mental health facility in America today is the Los Angeles County Jail.

The broadside against the mental hospitals was bipartisan. Activists, both left and right, agreed that mental hospitals were stifling, controlling, ineffective hulks. Journalistic exposés showed that people suffering from severe mental illnesses were often badly neglected and mistreated in the state hospitals.

Further, the treatments they received seemed actively harmful—lobotomy being the most notorious. Scholars often reinforced this attack with theories that mental institutions were loci of "power" intended to destroy independent thought. The asylum became a metaphor for total social control.

Much of the critique was valid. America's mental healthcare system was a blunt instrument that did a great disservice to many sufferers. But the solution, it turns out, was even worse.

Laudor's story is enmeshed in this history. Though he finds treatment in a respected mental unit, his experience is an ambivalent one, and upon his release, he keenly feels the stigma of his diagnosis. Because society had not replaced the old system with anything better, Laudor ultimately must face his horrible disease alone. He winds up off his medication, and disaster ensues.

Today, he lives in a maximum-security mental institution that is essentially a prison. In other words, rather than being placed in a crowded state hospital, Laudor finds himself somewhere even worse.

This is the tragedy of Laudor's life and modern mental healthcare. But it is a tragedy of missed opportunities, according to the book. If well-cared for, Laudor may not have committed murder. Additionally, sensational, horrific stories like his overshadow the major progress in mental healthcare.

Here is one example from Rosen's book.

The landmark desegregation case, Brown v. Board of Education (1954), saw the first-ever use of psychological testimony at the U.S. Supreme Court. African American psychologists Kenneth and Mamie Clark demonstrated that Black children preferred white dolls, illustrating the devastating, stigmatic consequences of racism. Their psychological test proved instrumental in dismantling America's segregated school systems.

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In many other ways, mental healthcare has improved society. People today are more willing than ever to admit they need help and seek it out. Many treatments are life-changing and beneficial.

To understand the progress in light of some tragedies is to see the history of mental healthcare in a complex light. It is not all bad, and it is not all good. There is still much room for improvement and understanding. It is essential that we know this complex history so that we might better serve those who suffer every day.