TRANSFORMING MADNESS

Clearly, we could be doing much more to help those with mental illness. This is a thoughtful consideration of what social settings, assistance, and connections would offer the most help to those striving to return to productive, fulfilling lives. Novelist Neugeboren wrote earlier of his brother Robert’s severe, chronic, incapacitating mental illness (Imagining Robert, 1997). Here he relates travels and visits to facilities, and conversations both with mental health care professionals and with those who’ve made it back to a more normal life from severe illness; all undertaken while undergoing a parallel search for a more humane life and home for his brother. Robert Neugeboren has for years lived in locked psychiatric wards, punctuated by brief, unsuccessful forays to hopelessly inadequate community residences. His story and others related here drive home the message that not only is our biological understanding of mental illness grossly incomplete, but that progress in improving care has been distressingly slight. Neugeboren patiently examines a few outstanding facilities (one in New Hampshire, one in the Bronx, N.Y., to which Robert eventually was transferred) and sets out suggestions for an ideal facility. He suggests, in the end, small, community-based assisted living facilities similar to those we now have for the elderly, which could be adjusted for level of care as regressions and remissions occurred and “so that one was not living only with others who suffered from serious mental illness. And cost should be a consideration.” Neugeboren pegs an excellent Boston-area supervised residential program with strong support services to cost between $25,000 and $35,000 per person per year, while “the cost of keeping my brother on a locked ward without anything resembling psychological, vocational or educational counseling—without anythingi that might offer the possibility for a fuller, more productive life outside a hospital—is, according to the New York State Office of Mental Health, $127,000 a year.” An affecting personal story, coupled with a well-supported plea for revolutionizing care.