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Crazy In America: The Hidden Tragedy Of Our Criminalized Mentally Ill, by Mary Beth Pfieffer (Carroll & Graf, 2007, 280 pp. $15.95)

Reviewed by David Preston

Imagine how tough your life would be if you were trying to cope with schizophrenia or severe depression. Plenty tough, right? Now imagine yourself, a schizophrenic, being suddenly torn from the shelter of your family, denied medication, and tossed into a punishment cell, essentially a sensory-deprivation box, for weeks, months or years at a time. Incredibly, this scenario is all too common in America, and Mary Beth Pfeiffer, in her new study, Crazy in America: The Hidden Tragedy Of Our Criminalized Mentally Ill, explains just how and why it happens. Pfeiffer's book recounts the life (and death) stories of six men and women whose mental illness leads them into conflict with an uncomprehending and, for the most part, uncaring legal system.

One subject, Shayne Eggen, is already a veteran of juvenile psych wards by age sixteen. As a young adult Shayne lapses into psychosis during one of her rare periods of freedom and, under the influence of a delusion, stabs a sheriff?s deputy with a steak knife. Shawn is then sentenced to two and one half years in an adult women's prison but, due to her inability to adapt to prison life, serves much of her time in punishment cells, with a predictable impact on her mental health. If the juvenile system gave Shawn little of the therapy she needed, prison gives her almost none. When her release date arrives she?s given the standard $200 and sent on her way. Shawn quickly re-offends in the throes of another delusion and is promptly returned to prison to begin the cycle again. After several incidents of self-mutilation, two suicide attempts, and more agonizing months spent in solitary confinement, Shawn is a broken human being: the victim of a penal system that?s structurally incapable of distinguishing between genuinely criminal behavior and sickness.

Although not all of Pfeiffer?s stories end with a death, the broad outlines of each case are depressingly similar. The names of the prisons change, as do the specific crimes involved. But the pattern is the same: A child is born, symptoms of illness occur in early adolescence, and a healthy mind gradually becomes unbalanced. Eventually?inevitably perhaps?an act of violence occurs. Then the police are called in, and things fall apart. From that point forward the subject is seen primarily as an offender, not an ill person, and any question of therapy takes a distant back seat to the exigencies of punishment.

Ironically, many of Pfeiffer?s subjects are self-aware enough to beg for psychiatric help from behind prison bars but, in a classic catch-22 situation, their pleas are dismissed by prison authorities as ?manipulating.? Such physicians and therapists as are available in prison often give only the most cursory?and often incorrect?diagnoses and treatment. In one case a prison medical specialist determined that a young prisoner with multiple suicide attempts was ?not a danger to himself.? The prisoner hung himself in his cell a few days later.

In fact, four of the six subjects commit suicide behind bars, primarily in reaction to being denied treatment and medication by prison staff or after being put into isolation cells. Two others die, in separate incidents, on the street within blocks of their homes, at the hands of police who, unaware that they are dealing with a mentally ill person, react to what should be no more than a public-disturbance situation with deadly force. Again, although the details differ, the pattern of confrontation and punishment?as opposed to understanding and treatment?is the same.

Unfortunately, in the America of today, medical treatment is simply not an option for many mentally ill people?especially the poor?and as community mental health budgets are cut more each year, hospital psychiatric units are downsized. Yet even as money is being squeezed out of the health care system, it?s being tossed by the bucketful at prisons by shortsighted, tough-on-crime politicians. With so many fewer hospital beds and so many more prison cells, is it any wonder that our prisons have become a dumping ground for the mentally ill?

Pfeiffer spent long hours talking with her subjects? families, as well as to police and prison officials involved in the human tragedies she describes. Admirably, she never succumbs to the temptation to coddle her subjects or minimize their offenses. In trying to humanize these subjects, however, Pfeiffer devotes too many pages to background information. Mixed in with the biographical detail are frequent references to mental health and prison budget figures, numbers of psychiatric beds lost versus prison cells built and so forth. As a result the writing sometimes comes across as an ungainly mixture of human interest-type reporting and PowerPoint slide show. Nevertheless, the book makes a lucid and devastatingly effective case for a shift in public policy towards treating mentally ill offenders, rather than simply incarcerating them.

David Preston is a freelance writer based in Seattle, Washington.

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