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On Untreated Mental Illness and the Health Care Debate

Because of all the news coverage of Republican efforts to kill people, I’ve been thinking a lot about mental health care lately. But that’s not why I impulsively picked up Richard Russo’s Elsewhere: A Memoir at the library—I picked it up and started reading it just because I kind of like Richard Russo. But there it was, a memoir-length reminder of the hell of untreated mental illness, both for the person with the illness and the family and friends—everyone becomes hostage to the illness.


It’s a memoir of his life with his mother, whose mental illness was never diagnosed and never treated. After her death, when his own daughter Kate was diagnosed, Russo was shocked to read the description of a mental illness that matched her symptoms, too late to help her but right on time to feed his own recriminations, his own sense that he could have done more or should have done different. But before that was a lifelong project of coming to understand that something wasn’t quite right with his mother, a problem for the only child of a single mother, because there was no fixed point, nothing for comparison, no way to say, “No, this isn’t normal.” As a child who grew into a young man who grew into a man and then a middle-aged man, there was just . . . living with it, and perhaps the most poignant part of the memoir is the realization that for the first thirty-five years of Russo’s marriage, he and his wife were never alone, but their whole relationship grew and developed to fit the contours of his mother’s needs.

And he spent all that time wondering why she couldn’t just be rational. In a memoir that is as hard on himself as on his mother, he admits that at a certain point, he had stopped hoping for her to change or improve:

At some point along the spectrum of what we like to think of as ‘real time,’ I simply flatlined and, without admitting it to myself, conceded defeat and started just going through the motions. This was why my dreams were haunted. Because I’d given up on someone I loved, someone who’d never, ever, given up on me. I couldn’t speak because the only thing left to say was I’m sorry, and the person I needed to say it to was gone. (205)

And this is, in some ways, a best-case story for untreated mental illness. Here was a woman whose illness was not so severe as to make her a danger to herself or others. Here was a woman whose determination to hold it together sometimes allowed her to hold it together, whose family loved her and wanted to help her, whose son became a famous novelist and thus could provide for her in her old age. But it was exhausting and painful for decades for a whole family. After his daughter’s diagnosis, he read about the disorder:

The language of this book was neither comic nor euphemistic. Here my mother’s “nerves” were anxieties and panic attacks. Nor were such distinctions merely semantic. Crippling anxieties and incapacitating panics (unlike nerves) were serious conditions that demanded treatment. Mental illness, like physical illness, first required diagnosis, then appropriate therapy. Kate had already gotten the first and was embarking on the second. My mother had received neither, and the result had been precisely what the Portland anxiety specialist predicted. She’d gradually been eaten alive. (221)

What is a worst-case story? The story of Terrill Thomas, who died of dehydration in a jail in Milwaukee after prison guards turned off the water to his cell, haunts me. He had bipolar disorder; he was black. If he’d been thirsty, he would have said something, wouldn’t he? But he didn’t, and now he’s dead, and if you think anyone’s going to go to jail for how he was treated, may I just mention #PhilandoCastile, #FreddieGray, #EricGarner, and on and on and on?

When I think about the evil-minded efforts of House and Senate Republicans to kill Obamacare, I think of mental health care, because that’s what is most personal to me. I don’t believe I would be alive, and if I were, my life would suck, but for the fact that my father’s employer, Hallmark Cards, provided top-notch health insurance to him and his family. From summer of 1989 to spring of 1993, four long years, I had a weekly therapy session with a licensed clinical social worker, along with psychiatric consultations and medication as needed. Four years! Four years of weekly therapy! When I think of it, I’m astonished. By the early 1990s, health insurance plans were cutting back on mental health coverage, pushing people to get fixed up with maybe six weeks of cognitive behavioral therapy. Even then, I felt lucky—but now I know the word is “privileged.” Now, with high-deductible plans the norm and somewhere upward of 20 million Americans about to lose their health insurance coverage, mental health care looks more and more like a luxury, something for the privileged few.

We humans are so fragile. Our bodies are fragile, and our minds, souls, personalities are as well. An experience of trauma, a fluke of brain chemistry, an abusive relationship—any or all can cause permanent damage. Russo’s mother, born just before the Depression, grew up in a time when there was no treatment for most of the mental illnesses that cause so much suffering. Now we have treatments—not easy, not automatic, but there are options. But in order to fund tax cuts for people rich beyond the dreams of avarice, we’ll let people die—there are people who, if they had access to my dad’s insurance plan of the late 1980s, could have good lives, like the life I’m grateful for each day. But instead they’ll die, maybe of suicide, maybe of risk-taking, maybe of opioids . . . maybe even of dehydration, because they’re not well enough to ask for the water they need.


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