Two Years Among the "Crazies"

An anthropologist joins a group of mental outpatients

For Sue Estroff, 28, it was the most troubling time of her life. Along with her "fellow" patients, she attended psychiatric clinics, took a powerful antipsychotic drug, joined in group therapy and even found herself distrusting the doctor. Indeed, at times she experienced all the misery of madness, including moments of almost suicidal depression. Yet Estroff is not at all insane. Rather, she has just spent two remarkable years studying certifiable "crazies" (their own term) by living among them.

Many behavioral scientists have explored the world of the mentally ill behind hospital walls. But Estroff, a post doctoral fellow in psychiatric anthropology at the University of Wisconsin, probed a different world. She is the first live-in scientific observer to spend an extended period with a growing new cadre of mental patients: those who have been, In psychiatric jargon, "deinstitutionalized." Now totaling as many as 500,000 across the U.S., these are mental patients who are regarded as sufficiently good risks to be allowed to dwell in the community at large, yet remain under professional care as psychiatric outpatients.

For her study, Estroff joined 43 deinstitutionalized patients under a Madison, Wis., team led by Psychiatrist Leonard "itein and Psychologist Mary Ann Test at he Mendota Mental Health Institute. The ground rules she established put her in what she called a "triangular" position with both sides. But in fact she was closer to the patients, pledging to guard their confidences while sitting in on staff sessions. Almost immediately, even trivial questions became moral quagmires. Should she tell patients that she had gone to a staff party? (She didn't.) Should she let the doctors know when she had information they did not have? (Only when she suspected one patient was planning to kill himself.) Still worse, she found herself confronted by a crazy-house con game that she dubs "reciprocal exploitation." Anybody who had money or goods was expected to share them. Could she then refuse demands for cigarettes, money or meals? Ultimately, she lent occasional cigarettes and took patients to restaurants on the grounds that meals provided interview time.

Both from talking with her new companions and from sharing their experiences, she came to understand the network of catch-22 dilemmas that constantly plagued them. Cast out of a womblike hospital world, they were led into work programs intended to help them re-enter society. But the jobs were so lowly (example: slipping rings onto drapery rods at 50-c- an hour) that they only underlined the crazies' alien status in the community. Many simply preferred to collect the special federal stipends available to them when they filled out forms that officially recognized their mental impairments --and further ostracized them. Says Estroff: "The system encourages people to get well, while at the same time showing them that the one way they can exist is to sell their craziness."

Estroff saw similar contradictions in the use of such medications as lithium carbonate and Prolixin Decanoate. These "meds" soothe psychotic symptoms, but bring on strong side effects that work as badges of distinction between the patients and outsiders: a freezing of facial expressions, hand tremors, and jiggling of the legs when seated (known by the patients as "the Prolixin stomp"). Most patients knew they were taking "meds" because they were different from "normies"; yet when they tried to be normal by refusing medication, their behavior often became more bizarre. Estroff herself tried Prolixin to experience its effects, but quit abruptly after six weeks of tremors, only to plummet into near-suicidal despair. Said she: "It was the closest I ever got to being crazy, and the closest I want to get."

Now back in the outside world feeling sane but "sadder" and "quieter," Estroff has vowed to keep studying the plight of deinstitutionalized mental patients, as well as that of the struggling psychiatric workers. But only under one condition. Says she: "I will not do this type of field work alone again."

This file is automatically generated by a robot program, so viewer discretion is required.