Managing Madness in the Community

Book excerpt: While mental illness and mental health care are increasingly recognized and accepted in today’s society, awareness of the most severely mentally ill—as well as those who care for them—is still dominated by stereotypes. Managing Madness in the Community dispels the myth. Readers will see how treatment options often depend on the social status, race, and gender of both clients and carers; how ideas in the field of mental health care—conflicting priorities and approaches—actually affect what happens on the ground; and how, amid the competing demands of clients and families, government agencies, bureaucrats and advocates, the fragmented American mental health system really works—or doesn’t. In the wake of movies like One Flew Over the Cuckoo’s Nest and Shutter Island, most people picture the severely or chronically mentally ill being treated in cold, remote, and forbidding facilities. But the reality is very different. Today the majority of deeply troubled mental patients get treatment in nonprofit community organizations. And it is to two such organizations in the Midwest that this study looks for answers. Drawing upon a wealth of unique evidence—fifteen months of ethnographic observations, 91 interviews with clients and workers, and a range of documents—Managing Madness in the Community lays bare the sometimes disturbing nature and effects of our overly complex and disconnected mental health system. Kerry Michael Dobransky examines the practical strategies organizations and their clients use to manage the often-conflicting demands of a host of constituencies, laws, and regulations. Bringing to light the challenges confronting patients and staff of the community-based institutions that bear the brunt of caring for the mentally ill, his book provides a useful broad framework that will help researchers and policymakers understand the key forces influencing the mental health services system today.