I used to get mad at my brother for being crazy.
Because some of the time, he wasn't crazy. Or he didn't act crazy. In those good spells, he could be the together older brother, a guy who was good with tools, had a precise pool shot and a talent for massaging brown clay into sculptures of beautiful women. He could take apart the engine of a car or motorcycle, lay out the pieces in neatly labeled envelopes, fix what was broken and put it all back together so it worked. He could talk physics and chemistry and make a good spaghetti. He could see into people and make perceptive remarks.
Most of the time, though, he could barely function. He would hang from a cigarette as if it alone sustained him, and pace back and forth because he couldn't be still and couldn't figure out where to go. He would stare at people and things too long and not answer when spoken to.
In his worst times, he acted completely crazy. Hallucinating, he lined his walls with crinkled aluminum foil to try to block out the voices only he could hear. His movements grew stiff and jerky. His stare seethed with anger.
Or even worse, he would soar on optimism, exuberantly telling me he'd finally cured himself and would be all right from now on that look lighting his eyes.
I would look at him acting so crazy, and sometimes I thought: Come on, John, knock it off.
You're probably also involved in craziness somehow. The issue cascades through communities and families. Most of us don't talk about it much, because it's too personal. Too burdened with despair and desperate hopes, guilt, blame, feeling sorry for others and ourselves. We're not even supposed to use the word "crazy." It's politically incorrect, but it's the most succinct description I know.
This story needs to be aired because it has meanings beyond vicious fate and one family struggling to cope. It's about people needing help in general, and how that isn't much in fashion these days. And it illuminates dark aspects of Western culture that we prefer to keep hidden.
One in six
One out of every six people in this country will suffer a diagnosable episode of mental illness this year. One out of every 17 is seriously mentally ill, a category of disasters that includes bipolar disorder, major depression and schizophrenia.
The National Alliance on Mental Illness, an advocacy group founded in 1979, gives the United States the grade of "D" for our systems of mental health awareness and care nearly complete failure. Nationwide, we spend more than $100 billion per year on it. The total keeps rising, and the number of people being treated keeps rising. The wider impacts on society the annual costs of untreated mental illness total another $100 billion.
The only feel-good rush on this issue came during the 1950s to the 1970s, when nationwide reforms freed many people from long-term warehousing in mental hospitals. Now we have one-tenth the number of hospitalized crazies we had back then. But we traded one set of failures for another we have more mentally ill people in jails and prisons than in hospitals. And in our communities and on the streets, the billions of dollars have fallen short, and mostly we've chosen to look away from the sick rather than set up adequate treatment and support.
I'm focusing on the deficiencies in our systems of public care, for those who can't afford private psychiatrists and thus fall onto the ragged safety nets. Even for the wealthy, though, there are no easy answers, if there are any answers at all.
For my brother, it worked like this: John was born in 1947 in Tucson, Ariz., where our parents had moved for the healthy, dry air. Then they moved to California, where I was born, and then Indiana, then Illinois, where my younger brother, Mike, was born. Our father, Ray Sr., was an entrepreneur who chased opportunity while suffering physical illnesses and subtle symptoms of craziness, including unpredictable moods and an inability to stay in one place.
As Ray Sr. failed in business, he aimed his demand for perfection and his angry frustration at his first seed. In his eyes, John couldn't do anything right.
Like many crazy people, John probably had his illness encoded into his genes, and childhood stress activated it. From the time he was an infant he rarely smiled. By fourth grade, he had trouble concentrating. He was hearing his own thoughts. Our mother, Kate, took him to his first psychiatrist. More clouds emerged.
When John was 13, Ray Sr. went into the hospital for an operation for symptoms that turned out to be cancer, and John punished himself: He took a baseball bat into his bedroom, locked the door and began smashing his toys. Kate and I stood outside the door listening to the breakage, calling to him, getting no response. Kate didn't know what to do and phoned an Episcopal priest, who came in his black outfit and called through the door, "John, do you know who this is?"
John's voice came through the door, "Santa Claus?" and he kept on with the bat. I remember grinning at his crazy humor.
Our father finally killed himself with cigarettes and lung cancer when John was 15, I was 13 and my younger brother was 10. Kate finished raising us, taking a series of jobs, including elementary school teacher, editor of educational materials, real estate agent and finally an adjunct English teacher at a community college. All of this has been toughest on her.
John's path alternated between periods of lucidity and paranoia and hallucinations. He made a few unsuccessful attempts at college, then enlisted for four years in the Army, hoping the structure would straighten him out, serving in the South and Germany as a radar technician. Then he had a few brief civilian jobs. He tried enlisting a second time, but by then he had been diagnosed as schizophrenic, so the Army had no more use for him.
He began what would eventually become hundreds of sessions with psychiatrists and counselors. He tried outpatient treatment and hospitals run by universities, counties, private businesses and the Veterans Administration, the long grind of antipsychotic medications, even shock treatments. At times he wandered the streets incoherently, or landed in jail.
The first years of John's intermittent care were in the Illinois system. Then he and my mother returned to Tucson, where he spent 17 years in the Arizona system. I left Illinois for Colorado, but wound up in Tucson for most of John's crazy years there. I was old enough to be a better witness, and I saw how the Arizona system was itself crazy and sad.
Our family didn't have a lot of money for treatment. John got by mostly on small disability payments from Social Security and the Veterans Administration, and whatever the public mental health care system could do for him. Arizona's system, like those of the other Western states, is a complicated array of dozens of agencies and companies, some of which operate to make a profit on craziness.
The federal government provides some money through programs such as Medicaid and Social Security disability, but state governments are in the driver's seat. Every year, the legislatures and governors allocate state money for the systems, and it doesn't have much to do with what's needed. The principle is called "managed care," which really means managing costs.
"It's an oxymoron approach," says Chick Arnold, a lawyer who has pressed a class-action suit against Arizona's system since the 1980s, demanding a series of improvements. "The companies (and agencies) get a finite amount of money to provide an open-ended commitment for service for a growing population. They can't do it. ... The system is designed to screen people out, not in. It's all about cost containment."
At most, John would see a psychiatrist for one 15-minute visit per month. He would take meds for a while, stabilize and then stop taking them. He would fly for weeks or months, then crash.
Sometimes when he had bad spells, my mother and I would ally with local prosecutors and go to court, testifying against him, saying he was a danger to himself or others, the legal standard for court-ordered commitment to treatment. The commitment would last for a week or so in a locked hospital ward, then longer periods of follow-up and mandatory meds outside the hospital, sometimes for as long as a year. Always the commitment would end, and then the cycle would begin again. All this is familiar to people who pay attention to crazy people.
When he wasn't in hospitals, John lived wherever Tucson landlords would rent to a crazy person, usually cockroach-infested dives. In the bad spells, he forgot to eat and grew extremely thin. Or he got mad at everything and everyone, sometimes attracting the cops. The busts I know about were for leaping out of bushes and threatening strangers with a hammer, for taking the hammer into a convenience store and causing a disturbance, for tearing the windshield wipers off a parked car, throwing rock salt into the swimming pool in his apartment complex, and for forgetting to show up in court.
Most of the world had no sympathy for him. Banks dunned him with extra charges for bounced checks, and he would struggle to keep track of all his bills, especially the ones from ambulances and other mental health providers, with their complicated deductibles and formulas for benefits. Bills from the phone company, other utilities, car insurance and the dentist often came faster than he could afford.
In desert heat above 100 degrees, he went around in a long-sleeved shirt with a T-shirt under it, and long pants. He wore down the heels of his shoes with his pacing. He loaned money to "friends" and never got it back. He was incapable of bargaining and often got rooked. Now and then, he picked fights with strangers and put up no resistance as the blows began to fall punishing himself like that.
I would get angry at him, wanting him to take his meds, regardless of their side effects uncontrollable pacing, stiffness of posture, facial grimacing because the alternative seemed worse to me. Now and then he threatened to commit suicide. I got tired of hearing it. Sometimes I secretly wished for him to die, thinking it was the only way for him to find relief, and also because it would end my duty.
Then in 1995 at the age of 47, he bought a pistol from a guy he found in the classified ads, took it home to his latest one-room apartment in Tucson, lay down on his bed, and, sometime during the night, shot himself in the head. I do not know the exact date of his death only that it was sometime in late April or early May because it took a while for his body to be found. He was that alone at the end.
No one knows exactly what leads up to any person committing suicide, says John McIntosh, a psychology professor at Indiana University South Bend who has studied 50 years of nationwide statistics. But he's one of the experts who've noticed that, collectively, Westerners lead the nation in suicide rates.
Nine of the top 11 suicide states are in the West, a trend that holds year after year and decade after decade. And the degree of the lethal regional difference is stunning: Nevada, Montana, New Mexico, Wyoming, Idaho, Utah, Colorado, Arizona and Oregon range from 19 to 15 suicides per 100,000 people more than twice as high as New York and Washington, D.C., the healthy end of the scale.
Some 8,000 Westerners will kill themselves this year, a hefty portion of the national total of more than 30,000 suicides. Much of the cause, McIntosh suspects, is embedded in our Western culture.
"Potential contributors," he says carefully, "include the personality or attitudinal or worldview differences across the country."
Patty Limerick, a prominent Western historian at the University of Colorado, frames it more frankly: In the West, "we won't admit our sorrows until they become cataclysmic."
Westerners by nature tend toward transience. The early white settlers came here to escape or find something new and better that Big Rock Candy Mountain and the same urge continues today. Waves of migration come from other regions. People bounce from California to Montana to Arizona, thinking nicer scenery will somehow solve their problems, or that they'll find a fresh start in a booming city, or forge deep connections in some small rural town.
When nothing is solved, the beautiful mountains or rivers or deserts become a taunt. And guns, the most popular instrument of suicide, are easily available.
"We encourage people to move here and lie to them about it being paradise," says Arnold, the Arizona mental health lawyer. Western states, exploding with population growth, have flimsy communities. Families are strained or fragmented by the churning. Our frontier mentality makes us suspicious of government and public services. We expect people to tough it out on their own.
"The dream of a freer life, independence, that kind of individualism, works against community and familiar structure," explains Bill Handley, an associate professor at the University of Southern California who studies how Western writers deal with these themes. "There's a whole literature of loneliness in the West."
Among the other cultural factors linked to suicide: Westerners are the least likely to attend church. We're more likely to abuse alcohol and prescription drugs. We have high rates of divorce. A 1992 study even found that country music, with its refrains of loneliness and failure, could contribute to suicide rates.
Sheila Linwood, who runs a suicide-prevention group in Grand Junction, sees high rates of suicide among the young men who work far from their families in the booming construction and oil and gas fields.
"It's huge isolation," she says. When they suffer depression and other mental illness, she says, "They really do feel like no one else in the world can understand, no one is going to help them out. It's not a healthy atmosphere."
Some suicides never make it into the statistics, she says. "If you're putting up an oil derrick, it's dangerous work, and if you have a mental health condition, you may not take the precautions you need to take."
I don't know whether my brother would've fared better if he'd stayed in the Illinois system. I do know that when he moved back to the West, his chances worsened. But he was a Westerner, in his origin, his conclusion and his transience. He lived in at least six states, two countries, and more than a dozen apartments and houses in Tucson alone, not including hospitals.
I go around with thoughts that I should've done more for John. I also understand how one person's mental illness strains the whole family.
In Tucson, I saw him roughly once a week. On holidays and other special occasions, he came over to the house where I lived with my wife and kids. He tried to interact, but sometimes was too far gone. The kids called him Uncle John, and he was sweet to them, but generally he wasn't good in groups.
So most of the times I was with John in the desert, it was just the two of us (my younger brother took his own path, to New Mexico, Europe and California). We had our routines: I took John out for burritos, or we went to a bar to shoot pool. We went to movies, where he could lose himself in the big screen. He helped me work on my cars. Our best escapes were the hikes we took into the embrace of canyons.
When I decided to leave Tucson, fleeing the sun-baked urban mess chasing my Big Rock Candy Mountain, headed north to the Rockies and then Bozeman, Mont. I thought about taking John with me. It seemed close to impossible, on top of moving the wife and kids and facing who knows what changes ahead. My wife thought I was crazy to consider it.
When I told him we would move soon, he took off driving his old Scout, heading north, fully crazy and somehow imagining, I think, that he could prove he could relocate himself. He drove about 120 miles and ended up out of gas and with a dead battery in an old mining community, walking beside the road for hours, hungry and hallucinating.
The cops there scooped him up, thank you, and called me, and my wife and I drove up and brought the Scout back to Tucson. They committed him to a hospital and long-term outpatient meds, again. And we left without him.
The last time he and I talked, about nine months after I moved away from Tucson, it was a long-distance call. My life still felt shaky from the move and I was under more than the usual stress. I picked a fight with him about his driving. He spent too much of his paltry income on gas, insurance and repairs, and for too long I had lived with the fear that he would hurt someone else by driving when he was crazy or acting out his anger. I told him angrily that he should sell that old truck.
Within a few weeks, he did sell it. He used some of the money to buy the gun.
There was a lot of turnover, and his case manager changed four times during his last year. Tucson had a lousy bus system, like many Western cities, and that also helped kill him: He ended up amid strangers and without wheels, trapped in one place with only his madness. He lost his last shreds of hope.
He pulled the trigger in the springtime, the season of suicide. A few days later, a comedy videotape arrived in my mailbox. He had ordered it for my kids.
Bearing the burden
In the 13 years since John killed himself, there have been some improvements in the mental health care system. New medications have fewer side effects. But still there are no cures, and horror stories are legion.
Recent scandals in Western states include physical and sexual abuse, even suicides, right inside hospitals. More changes are needed, but they must be cataclysmic, not just incremental. We must change the way we think about mental health. As Dr. Bruce Kahn, with the nonprofit Valley Mental Health in Salt Lake City, says, "We need a health care policy that would not discriminate based on which organ of the body is afflicted."
When I returned to Tucson for John's funeral, I went hiking in Tanque Verde Canyon our favorite at sunset. I found water and went barefoot into it. Walking up the trail out of the canyon, alone in the dusk, I heard a great horned owl hooting. The huge bird was perched atop a tall saguaro cactus silhouetted against the full moon. I watched the owl for a long time. The owl tipped forward to let loose each hoo-hooo-hooo-hooo! with all the volume and force in its body. Hoot after hoot.
On that trip, I also went to the apartment where John killed himself. I felt the terribleness there. Then another strange thing happened: The feeling changed to something golden, like a sunrise coming into the room and into me.
I am not a religious person, but I could feel John in it, telling me he had finally found a better place. I have never felt that feeling again. It is not enough to put my turmoil to rest. But I am proud of how he bore his burden, and I understand that he needed to find a way out.
After these experiences, I know how people can be single-issue voters. There are some who care about nothing except abortion, or gun rights. For me, the need to improve public mental health care outweighs other political issues. A champion of funding for the mentally ill could trash a few rivers and still have my vote.
I can't say that better funding would've prevented my brother's suicide. But it might improve the day-to-day lives of others.
If I were in charge, my program for crazy people would include a decent apartment, a good burrito, movies, hikes. And cats and dogs and whores, so the crazy people can touch and be touched physically, without judgment. And a place for hammering things to smithereens, without endangering other people.
My thoughts will not be welcomed by all who are touched by mental illness and suicide. But maybe this story will resonate in your life, offer you some support for decisions you've made, both good and bad. I hope it will also raise awareness. That's all I can offer.
Ray Ring is senior editor of High Country News. To read a longer version of this story, visit hcn.org.