Idaho Man Writes History Of The De-institutionalization Of The Mentally Ill

Sep 13, 2012

In the 1960’s, America began to take the mentally ill out of institutions. This led to consequences, especially for those who weren't ready or able to be de-institutionalized. 

An Idaho man has taken a closer look at this.  Clayton Cramer's self-published book, “My Brother Ron,” details his older brother’s life and struggle with schizophrenia. Cramer, who teaches history at the College of Western Idaho, told Samantha Wright about the moment when his brother's world began to unravel. 

"We were out shopping one day, my Dad was in the store and my brother and I were out in the car.  And he suddenly got out of the car, walked up to this complete stranger, an older guy sitting on a bench, picked him up by the scruff of his shirt, and said “What did you say to me?  Well, don’t you say it again!” [Then he] dropped him back down again."

Q. Just out of the blue?

A. Just out of the blue.  And all I could think was what?  My brother had never been a bully, he had never given me any reason to think of him as a violent or dangerous person.  And yet, very suddenly, over a relatively short period of time he had gone from an honor student at UCLA, to a person who was, I later found out, seeing patches of color appearing on the walls that he didn’t know what was the cause of it.  And these hallucinations are at the core of schizophrenia. 

Q. You use Ron’s story, and what you call his fall into schizophrenia, as the focal point for the book?

A. Yes.  I decided it would be a little more interesting if I sort of took both a personal account of this tragedy and what it did to our family and intersperse it with more of a scholarly history of how and why de-institutionalization of the mentally ill happened.

Q. You go way back.  We’re talking colonial America, 1600’s, basically early American mental health institutions were non-existent, how come?

A. People live in small towns for the most part.  There’s only a few cities of more than 1,000 people in the entire country.  Those that are actually dangerously violent are usually locked up.  Families are sometimes told, build an asylum for your son.  Lock him up, care for him.  We’ll give you a little bit of money to help with this.  It was a fairly humane strategy I would say.

Q. Over time things started to change, you write mental hospitals started opening in the early 1800’s and they soon spread?

A.  Yes, they became something that every state eventually had, state mental hospitals.  There was also pretty clear evidence that mental hospitals were a safety measure from a public safety standpoint.

Q. Let's jump ahead to after World War II.  In the ‘50’s states are spending more and more money on mental hospitals.  What marked a change in the ‘60’s where we get into de-institutionalization.

A. There are several things that happen together.  I call it the perfect storm of bad public policy.  State hospitals in the ‘30’s and ‘40’s had in fact become abominable, they were crimes against humanity what was going on in some of them.  Partly there was no funding available because of the Depression and World War II. 

There were a lot of elderly senile who, once Medicare was established, were moved out of the state mental hospitals into private nursing care.  There was also an increasing view that due process had to be very, very precisely followed. 

There weren’t really informal procedures for involuntary commitment but where it used to be a preponderance of evidence was the requirement, now the courts began to take the view that it had to be almost as severe as the requirements for criminal conviction.

Q. So folks were de-institutionalized, a lot of folks who maybe shouldn’t have been?

A. Yes.  There were certainly people who were de-institutionalized who benefited from it.  There were people who were clearly able to operate in a community setting and it worked reasonably well.  But there were a lot of others for whom it did not work and this is one of the reasons homelessness became a major problem in the late 1970’s and the early 1980’s.  A lot of people who had either been in hospitals or who might have been hospitalized in say 1960 or even 1970, now they might be briefly held for observation and turned back out into the street.

Q. This is one of the things that happened to your brother, he was in and out of mental hospitals throughout the ‘70’s.

A.  Yes, and actually in the ‘80’s as well, on occasion.  He’d be in for observation three days.  They would recognize there was something seriously wrong.  He would be held for 14 days for what was called intensive treatment.  After 14 days on thorazine, no judge is going to hold him, he won’t seem very dangerous.

Q. So your brother is sort of the poster child for the book.  Someone who went through this process over and over again?

A. Yes and he was by no means alone.  There are, as I understand it, a couple of million hospitalizations each year for mental illness in this country of which the overwhelming majority are these observational holds.  People that are there for anywhere from a few days to perhaps a week or two and then they are released and typically a few months to a few years later they are back in.  Unless of course they go on to commit a mass murder in which case, suddenly, the system is prepared to hold them for a while. 

Q. Where is Ron now?  How’s he doing?

A. Well, he lives out on the Oregon Coast with my Mom.  Like a lot of schizophrenics in older age, he’s certainly not quite as scary as he once was.  I think the small town he lives in, I mean people know there’s something wrong, but I think that they mostly assume that he’s retarded or something, even though he’s actually very, very intelligent.  But in a small town, much like colonial America, this sort of works out.  He hasn’t given anyone there reason to fear for their safety and everyone seems to get along with him reasonably well.

Clayton Cramer teaches history at the College of Western Idaho and is a software engineer.  He’s written several books.  His latest, “My Brother Ron,” is a self-published book that explores the history of the de-institutionalization of the mentally ill in America. 

Copyright 2012 Boise State Public Radio