There was a time when Michael Laudor was one of the most prominent mentally ill people in the United States, and by extension, the world. The youngest son of an upper-middle-class family in Westchester county, Laudor was marked as a brilliant mind from childhood, frequently referred to as a genius. He breezed through the curriculum in high school, impressing everyone around him with his eccentric and sharp mind. He finished his undergraduate education at Yale in three years, then got a job with the prestigious (and well-remunerative) financial firm Bain Capital. But in his early 20s, Laudor was beset by hallucinations and paranoia, experiencing sometimes-violent delusions that frightened his devoted parents. He was diagnosed with schizophrenia and spent eight months in a psychiatric facility. Undeterred, he emerged to attend Yale Law School, where he became a favorite of the dean and championed by the faculty. He was profiled in a glowing
I believe that there is a connection with those opposing involuntary commitment to treat the mentally ill and the mentally ill that is a common deficit in cognitive control. For the mentally ill it is a biological/electro-chemical malfunction of brain function... or possibly a physical deformity or brain injury-related. For these not-helpful advocates it is personality and brain wiring that does not manifest to be defined as mental health disfunction, but generally these are people that would benefit from some cognitive behavior therapy to learn how to compartmentalize and control their overheated emotional impulses and reactions.
Because these advocates are generally well-educated they have a modicum of self-awareness of their control issues. It bothers them but not to the level of motivating them to seek self-improvement. Instead they wrap themselves in what ever victim identity shroud of protection they can find. They become vulnerable narcissists armed to the teeth with both defensive and passive-aggressive vocabulary designed to prevent any criticism of their behavior.
But they have an emotional empathy connection with the mentally ill because of this lack of control. They project a scenario that basically says "if they can involuntarily commit mentally ill people, they can do the same with me because I too lack control of my critical thinking apparatus at times."
Most of them KNOW they are doing harm to the mentally ill by refusing to accept their need for forced treatment... but they promote it for their own selfish reasons to prevent the system from blurring the lines and capturing them too. And historically we do have some evidence that, for example, the "hysterical female" would be sent to the asylum.
I think a solution is for those that want to see better treatment services for the mentally ill, to work on specific definitions and an iron process for diagnosis that supports involuntary commitment. Personally I would like to see some more services to help those that need cognitive behavior therapy, but the line between irrational behavior and mental illness should be defined.
I just read this book because of your review. And, having done so, I think you got it exactly right. The book is powerful—yet it would benefit from pruning. Also, just how close were the two men after high school? After all, Laudor was not invited to Rosen’s wedding and Rosen never met Laudor’s girlfriend, who is the victim at the center of this sad tale. In some ways, the straining to show an ongoing relationship reminds me of Ann Rule’s book about Ted Bundy, The Stranger Beside Me.
This is so true and so eloquently said. A family member was almost killed by all this destigmatization. She has the maturity of a child, so was in the ICU four times in six months, unable to care for her diabetes and other ailments. Thankfully the landlord did not renew the Section 8 leases so the hospital was forced to send her to skilled nursing. This view of mental illness is just ruining lives.
I can only comment on Utica State Hospital, which had a protracted decline, from which the last patients were transferred out in 1977, before Reagan. I would be interested in if there were political drivers as well, and I am sure that there is a long and complex story, but my understanding is that the dismantling of the massive in-patient New York State system was driven by health care policy over a long period of time.
Well argued Freddie. Good stuff. I want to read this book now. I couldn’t help think of David Foster Wallace (minus the murder of course; DFW went inward versus outward), another brilliant yet tortured mind. I heard you interviewed on The Unspeakable recently and you discussed the whole de-institutionalism thing.(Wasn’t that Reagan in the eighties versus JFK in the early sixties though?) I agree with you. It’s scary how young people today in droves are acting out, sort of creating their own ‘mental illnesses’ which in turn harms actually mentally sick individuals who need serious help. Tragic. The taboo now against saying that mental illness leads *sometimes* to violence is absurd. This feels very woke/identity-politics based.
Since you mentioned ‘good intentions’ I’ll share this here; some of your readers may enjoy it:
This book will be on my pre-order list. But I wanted to add a few comments related to Freddie's comments/views on the deinstitutionalization that occurred. My family, on my father's side, has had a long multi-generational struggle with depression, mental health and alcohol abuse. In fact, it still impacts my sister and her kids in a big way.. I found out a few years ago from my aunt, that when my paternal grandmother had had her 3rd miscarriage bookended by the birth of her son, she had a prolonged years long bout with post-partem depression exacerbated by alcohol abuse. This was in the mid-1950s. She was finally institutionalized 3 times over the period of 1 1/2 years. Treatments included isolation, shock therapy, and drugs. My aunt had/has mixed feelings about that period in her life, having to help raise her younger brother. She hated that her mother's depression was so debilitating and the mixed feelings about how she was treated back then in the mid-50s where women's mental health issues were still seen signs of non-compliance and/or hysteria. Yet my grandmother eventually was able to manage her depression. She was a wonderfully loving grandmother who hid her illness from her grandkids in monumental ways. The topic is still a sensitive subject for my aunt and uncle. Both of whom have dealt with depression and both have their own views on how their mother was treated.
If anything, this book review rightly points out that there is far too much complexity involved with recognizing and treating the very-mentally ill to simply wave away the inconveniences that they can and do violent things to themselves and others. Acknowledging that is not a disservice to the mentally ill but recognizing that for those with the most debilitating mental illnesses they will need the most direct interventional services possible if the effort is to help them. Sweeping it under the rug does no one any good.
I continue to love Freddie's post on mental illness. My instincts are conservative, and anti-stigma campaigns will always seem fake to me. When I read Freddie's reporting on mental illness, I feel like I'm being treated like I'm an adult, and can actually sympathize with people suffering from mental illness.
I don't know how it is in other parts of the country, but here in rural Oregon, getting an appointment with a psychiatrist is very difficult. There is a wait of six months to a year. This is even if you are willing to pay out of pocket. This is even if you've gone to a therapist and get a recommendation.
Accessing the mental health system is so full of obstacles its difficult for people to wade through.
I wonder if part of what motivates this dangerous narrative of mentally ill folks as equally self-actualised, autonomous agents as everyone else, comes out of the fearful, unspoken truth that over the last ten years social media has rendered most of us increasingly incapable of truly exercising free will, parading a fake hashtag-ready self-actualisation that maps perfectly onto the algorithms of advertisers. My friends who are most severely mentally unwell are unassimilable (indeed, my best friend often complains that most everyone has blocked him out on social media - which is sadly true - and fuels his fears around a secret online group targetting him). This unassimilable difference is a profound threat to the endlessly catalogued model of identity upon which social media depends, which is where folks like the Twitter poster above are fighting their battles.
In this superb essay, Freddie discusses the well-intentioned yet irresponsibly deployed Community Mental Health Act ... closing in-patient facilities and creating "a system that we never bothered to build, forcing thousands of severely ill patients out of the institutions and into the jails or onto the streets." When I was a kid in the late'50s - early 60's, my Dad, an underpaid high school teacher, used to work nights & summers as a ward attendant at what was then called Utica State Hospital to make ends meet. One small anecdote about the dopiness of mental health policy thinking at the time: during the summers, one of Dad's jobs was to supervise patients as they worked the vegetable gardens on the Utica State grounds. The fresh produce from the gardens was used to feed the patients. Dad said the patients loved the sunshine & sense of purpose, and, in fact, were incentivized for good behavior to have the privilege. Then the directive came from above that having patients work in the facility gardens was exploitative and cruel (perhaps modern lexicography would be stigmatizing) and the gardens were turned back into lawn. Utica State Hospital was one of those facilities that was closed not long after Dad stopped working there. Out of this phony compassion, Utica, as a city, suffered from the consequences of their emptying & closing in-patient facilities, drugging the severely mentally-ill clients and leaving them to fend for themselves on the streets or to terrorize their families. Two nearby mental health facilities interesting were converted into maximum security prisons. Real progress!
>Nevertheless, checks and pills were what remained of a grand promise, the ingredients of a mental healthcare system that had never been baked but were handed out like flour and yeast in separate packets to starving people.
That's the kind of almost-overwrought-but-just-manages-to-pull-it-off metaphor that I like in Good Writing. Great choice of excerpts for this review - and I'm reminded that I really like your book reviews just in general. I do love Scott Alexander's 20,000 word reviews as well, but brevity is sometimes the soul of wit, and you hit that sweet spot nicely. Well done.
The particular weird dissonance for me wrt Mental Health Awareness* has been...almost everywhere else in the left firmament, it's well-accepted that Prevention Is Cheaper Than Cures, and a big part of American healthcare is its fundamental reactivity. This is how you get so many problems being underdiagnosed and overdiagnosed simultaneously...perverse incentives meeting public pressure to Do Something, chronic visits to the ER because one doesn't actually have primary care. But whereas this argument is employed with zeal when it comes to, say, cancer screenings...it's mysteriously absent in the sort of situation depicted here, where Nothing Can Be Done unless and until a poor victim (and their victims) have a brush with Real Violence. And sometimes it's still not enough, despite such clear proofs, because it's just __that hard__ to access the flimsy mental health infrastructure in general. If they even exist in the first place...
Obviously, balance is necessary at both ends of this horseshoe - we (arguably) over-institutionalized in the past, the same way today there's decent evidence we could probably reduce looking for colon cancers and it'd be a net improvement of health and $. But the balance is so clearly out of whack with mental illness that I don't think it makes sense to pretend otherwise, no matter one's noble intentions to Reduce Stigma. At the end of the day, one really has to ask the hard question of how much accommodation ought to be made for the mentally ill, vs the costs they impose on everyone else in society. It shouldn't take people literally being murdered (a clear mismatch); one should be able to have good-faith discussions about, say, feces and needles on the sidewalks, harassment on public transit, etc. Bad things are bad, actually, and normalizing/condoning behaviours __we otherwise would not tolerate from the non-mentally ill__ is just perverse. (Not to mention endless free press for Fox News - the personal is political!) Thank Ye for making this clearer to some people.
*as an old friend used to say, paraphrasing: "Who the hell __isn't__ aware of [mental illness]?" I don't want to get conspiratorial and say this really means awareness advocates don't actually want the problem to go away, because then they'd be out of a job, via Iron Law of Institutions...but there's definitely that element of, Raising Awareness is the sort of 40,000 ft. view, safe way to Do Something and earn delicious #clout without really having to fight in the trenches. Which you've also lamented repeatedly.
As it happens, I had brief but intense encounters while at Yale with a person who suffered from severe mental illness.
I saw first-hand elite indifference (which is not a cruel "who cares about the losers?" sentiment but rather a good-natured, achievement oriented feeling that we are here for the shiny things, and we will not spend a lot of effort or time on the grubby, messy things).
I've also had intense and alas not brief experience of dealing with mental illness in the person of my mother, who was severely troubled but never saw a shrink (because, as she would bellow, red-faced, when the subject came up, she wasn't the crazy one). And there was nothing more painful to hear as a teen-ager than some smug ignoramus saying that everything is a spectrum and mental illness is all a matter of cultural convention and power, man.
What people want most to see in these problems is nothing. They want to deny them, forget them, explain that they're not really there. Freddie's diagnosis, I think, is exactly right.
I believe that there is a connection with those opposing involuntary commitment to treat the mentally ill and the mentally ill that is a common deficit in cognitive control. For the mentally ill it is a biological/electro-chemical malfunction of brain function... or possibly a physical deformity or brain injury-related. For these not-helpful advocates it is personality and brain wiring that does not manifest to be defined as mental health disfunction, but generally these are people that would benefit from some cognitive behavior therapy to learn how to compartmentalize and control their overheated emotional impulses and reactions.
Because these advocates are generally well-educated they have a modicum of self-awareness of their control issues. It bothers them but not to the level of motivating them to seek self-improvement. Instead they wrap themselves in what ever victim identity shroud of protection they can find. They become vulnerable narcissists armed to the teeth with both defensive and passive-aggressive vocabulary designed to prevent any criticism of their behavior.
But they have an emotional empathy connection with the mentally ill because of this lack of control. They project a scenario that basically says "if they can involuntarily commit mentally ill people, they can do the same with me because I too lack control of my critical thinking apparatus at times."
Most of them KNOW they are doing harm to the mentally ill by refusing to accept their need for forced treatment... but they promote it for their own selfish reasons to prevent the system from blurring the lines and capturing them too. And historically we do have some evidence that, for example, the "hysterical female" would be sent to the asylum.
I think a solution is for those that want to see better treatment services for the mentally ill, to work on specific definitions and an iron process for diagnosis that supports involuntary commitment. Personally I would like to see some more services to help those that need cognitive behavior therapy, but the line between irrational behavior and mental illness should be defined.
I just read this book because of your review. And, having done so, I think you got it exactly right. The book is powerful—yet it would benefit from pruning. Also, just how close were the two men after high school? After all, Laudor was not invited to Rosen’s wedding and Rosen never met Laudor’s girlfriend, who is the victim at the center of this sad tale. In some ways, the straining to show an ongoing relationship reminds me of Ann Rule’s book about Ted Bundy, The Stranger Beside Me.
This is so true and so eloquently said. A family member was almost killed by all this destigmatization. She has the maturity of a child, so was in the ICU four times in six months, unable to care for her diabetes and other ailments. Thankfully the landlord did not renew the Section 8 leases so the hospital was forced to send her to skilled nursing. This view of mental illness is just ruining lives.
A great NYT story on the homeless.
https://www.nytimes.com/2023/03/19/us/phoenix-businesses-homelessness.html?smid=nytcore-ios-share&referringSource=articleShare
It seems to me that mental illness reaching or approaching the point of violence most often involves misogyny. No? Has anyone written about this?
I can only comment on Utica State Hospital, which had a protracted decline, from which the last patients were transferred out in 1977, before Reagan. I would be interested in if there were political drivers as well, and I am sure that there is a long and complex story, but my understanding is that the dismantling of the massive in-patient New York State system was driven by health care policy over a long period of time.
Well argued Freddie. Good stuff. I want to read this book now. I couldn’t help think of David Foster Wallace (minus the murder of course; DFW went inward versus outward), another brilliant yet tortured mind. I heard you interviewed on The Unspeakable recently and you discussed the whole de-institutionalism thing.(Wasn’t that Reagan in the eighties versus JFK in the early sixties though?) I agree with you. It’s scary how young people today in droves are acting out, sort of creating their own ‘mental illnesses’ which in turn harms actually mentally sick individuals who need serious help. Tragic. The taboo now against saying that mental illness leads *sometimes* to violence is absurd. This feels very woke/identity-politics based.
Since you mentioned ‘good intentions’ I’ll share this here; some of your readers may enjoy it:
https://michaelmohr.substack.com/p/chris-rock
This is what I pay my 50 dollars for. Thank you, Freddie, for the passion and the ruthlessly clear thought.
This book will be on my pre-order list. But I wanted to add a few comments related to Freddie's comments/views on the deinstitutionalization that occurred. My family, on my father's side, has had a long multi-generational struggle with depression, mental health and alcohol abuse. In fact, it still impacts my sister and her kids in a big way.. I found out a few years ago from my aunt, that when my paternal grandmother had had her 3rd miscarriage bookended by the birth of her son, she had a prolonged years long bout with post-partem depression exacerbated by alcohol abuse. This was in the mid-1950s. She was finally institutionalized 3 times over the period of 1 1/2 years. Treatments included isolation, shock therapy, and drugs. My aunt had/has mixed feelings about that period in her life, having to help raise her younger brother. She hated that her mother's depression was so debilitating and the mixed feelings about how she was treated back then in the mid-50s where women's mental health issues were still seen signs of non-compliance and/or hysteria. Yet my grandmother eventually was able to manage her depression. She was a wonderfully loving grandmother who hid her illness from her grandkids in monumental ways. The topic is still a sensitive subject for my aunt and uncle. Both of whom have dealt with depression and both have their own views on how their mother was treated.
If anything, this book review rightly points out that there is far too much complexity involved with recognizing and treating the very-mentally ill to simply wave away the inconveniences that they can and do violent things to themselves and others. Acknowledging that is not a disservice to the mentally ill but recognizing that for those with the most debilitating mental illnesses they will need the most direct interventional services possible if the effort is to help them. Sweeping it under the rug does no one any good.
I continue to love Freddie's post on mental illness. My instincts are conservative, and anti-stigma campaigns will always seem fake to me. When I read Freddie's reporting on mental illness, I feel like I'm being treated like I'm an adult, and can actually sympathize with people suffering from mental illness.
I don't know how it is in other parts of the country, but here in rural Oregon, getting an appointment with a psychiatrist is very difficult. There is a wait of six months to a year. This is even if you are willing to pay out of pocket. This is even if you've gone to a therapist and get a recommendation.
Accessing the mental health system is so full of obstacles its difficult for people to wade through.
I wonder if part of what motivates this dangerous narrative of mentally ill folks as equally self-actualised, autonomous agents as everyone else, comes out of the fearful, unspoken truth that over the last ten years social media has rendered most of us increasingly incapable of truly exercising free will, parading a fake hashtag-ready self-actualisation that maps perfectly onto the algorithms of advertisers. My friends who are most severely mentally unwell are unassimilable (indeed, my best friend often complains that most everyone has blocked him out on social media - which is sadly true - and fuels his fears around a secret online group targetting him). This unassimilable difference is a profound threat to the endlessly catalogued model of identity upon which social media depends, which is where folks like the Twitter poster above are fighting their battles.
In this superb essay, Freddie discusses the well-intentioned yet irresponsibly deployed Community Mental Health Act ... closing in-patient facilities and creating "a system that we never bothered to build, forcing thousands of severely ill patients out of the institutions and into the jails or onto the streets." When I was a kid in the late'50s - early 60's, my Dad, an underpaid high school teacher, used to work nights & summers as a ward attendant at what was then called Utica State Hospital to make ends meet. One small anecdote about the dopiness of mental health policy thinking at the time: during the summers, one of Dad's jobs was to supervise patients as they worked the vegetable gardens on the Utica State grounds. The fresh produce from the gardens was used to feed the patients. Dad said the patients loved the sunshine & sense of purpose, and, in fact, were incentivized for good behavior to have the privilege. Then the directive came from above that having patients work in the facility gardens was exploitative and cruel (perhaps modern lexicography would be stigmatizing) and the gardens were turned back into lawn. Utica State Hospital was one of those facilities that was closed not long after Dad stopped working there. Out of this phony compassion, Utica, as a city, suffered from the consequences of their emptying & closing in-patient facilities, drugging the severely mentally-ill clients and leaving them to fend for themselves on the streets or to terrorize their families. Two nearby mental health facilities interesting were converted into maximum security prisons. Real progress!
Sold! (By which I mean I just preordered a copy.)
>Nevertheless, checks and pills were what remained of a grand promise, the ingredients of a mental healthcare system that had never been baked but were handed out like flour and yeast in separate packets to starving people.
That's the kind of almost-overwrought-but-just-manages-to-pull-it-off metaphor that I like in Good Writing. Great choice of excerpts for this review - and I'm reminded that I really like your book reviews just in general. I do love Scott Alexander's 20,000 word reviews as well, but brevity is sometimes the soul of wit, and you hit that sweet spot nicely. Well done.
The particular weird dissonance for me wrt Mental Health Awareness* has been...almost everywhere else in the left firmament, it's well-accepted that Prevention Is Cheaper Than Cures, and a big part of American healthcare is its fundamental reactivity. This is how you get so many problems being underdiagnosed and overdiagnosed simultaneously...perverse incentives meeting public pressure to Do Something, chronic visits to the ER because one doesn't actually have primary care. But whereas this argument is employed with zeal when it comes to, say, cancer screenings...it's mysteriously absent in the sort of situation depicted here, where Nothing Can Be Done unless and until a poor victim (and their victims) have a brush with Real Violence. And sometimes it's still not enough, despite such clear proofs, because it's just __that hard__ to access the flimsy mental health infrastructure in general. If they even exist in the first place...
Obviously, balance is necessary at both ends of this horseshoe - we (arguably) over-institutionalized in the past, the same way today there's decent evidence we could probably reduce looking for colon cancers and it'd be a net improvement of health and $. But the balance is so clearly out of whack with mental illness that I don't think it makes sense to pretend otherwise, no matter one's noble intentions to Reduce Stigma. At the end of the day, one really has to ask the hard question of how much accommodation ought to be made for the mentally ill, vs the costs they impose on everyone else in society. It shouldn't take people literally being murdered (a clear mismatch); one should be able to have good-faith discussions about, say, feces and needles on the sidewalks, harassment on public transit, etc. Bad things are bad, actually, and normalizing/condoning behaviours __we otherwise would not tolerate from the non-mentally ill__ is just perverse. (Not to mention endless free press for Fox News - the personal is political!) Thank Ye for making this clearer to some people.
*as an old friend used to say, paraphrasing: "Who the hell __isn't__ aware of [mental illness]?" I don't want to get conspiratorial and say this really means awareness advocates don't actually want the problem to go away, because then they'd be out of a job, via Iron Law of Institutions...but there's definitely that element of, Raising Awareness is the sort of 40,000 ft. view, safe way to Do Something and earn delicious #clout without really having to fight in the trenches. Which you've also lamented repeatedly.
As it happens, I had brief but intense encounters while at Yale with a person who suffered from severe mental illness.
I saw first-hand elite indifference (which is not a cruel "who cares about the losers?" sentiment but rather a good-natured, achievement oriented feeling that we are here for the shiny things, and we will not spend a lot of effort or time on the grubby, messy things).
I've also had intense and alas not brief experience of dealing with mental illness in the person of my mother, who was severely troubled but never saw a shrink (because, as she would bellow, red-faced, when the subject came up, she wasn't the crazy one). And there was nothing more painful to hear as a teen-ager than some smug ignoramus saying that everything is a spectrum and mental illness is all a matter of cultural convention and power, man.
What people want most to see in these problems is nothing. They want to deny them, forget them, explain that they're not really there. Freddie's diagnosis, I think, is exactly right.