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Book Review: Crazy in America:
The Hidden Tragedy of our Criminalized Mentally Ill
by Mary Beth Pfeiffer
Reviewed by: Joel A. Dvoskin, Ph.D.
American Psychology-Law News, Summer 2007

It is a tired cliché in our business that people sometimes "fall through the cracks." But this cliché is not only hackneyed; it is dangerously misleading. As we learn in Crazy in America, the gulf that exists between America's mental health and criminal justice systems is a vast canyon. When people fall, it is not through a crack but into an abyss.

Great teachers are almost always great story-tellers, and with this book, Mary Beth Pfeiffer cements her credentials as both. Relying on her natural gifts as a story-teller, buttressed by years of painstaking research, Pfeiffer tells a now all-too-familiar tale in a powerful way that might just make a real difference in American public policy. That this public policy failure involves at least two vast systems is exactly the point, and it is a point that is made with surgical precision.

After only a few pages, it becomes clear to the reader that Pfeiffer is a skillful journalist. She must have been an excellent reporter, as evidenced by her ability to gather an impressive amount of information about her subjects and her subject. But here, Pfeiffer is working not as a reporter but as a columnist. She tries hard to be fair, but makes no pretense of objectivity; this book has an unabashed point of view. Her goal is to convince, to educate, and to advocate. Reporters convey facts; Pfeiffer's goal is to communicate meaning, and to instigate action.

Like Bruce Perry's recent classic, The Boy Who Was Raised as a Dog, Pfeiffer interlaces the tragic stories of six flawed but likeable human beings -- Shayne, Luke, Alan, Peter, Jessica, and Joseph – with an impressive analytical critique of America's equally flawed but far less likeable policy shifts in the public provision of mental health and criminal justice.

Pfeiffer's characters were repeatedly told that they were too unstable -- too sick -- to qualify for treatment. In other words, the Catch-22 of Joseph Heller's fiction had come to horrifying life in the jails of Iowa, Texas, and Florida – you can get mental health treatment as long as you don't need it too badly. In fiction, such obscenities are comedy; in real life they are too tragic to fathom.

The book is not perfect. Pfeiffer, for example, uncritically cites flawed research that supports her point of view about segregation, and ignores the realistic needs of correctional administrators to occasionally remove some extremely violent inmates from general population to protect the staff and other inmates they endanger.

But these flaws are small, and do nothing to weaken the book's overarching premise, that punishment is not and never will be a useful or humane treatment for serious mental illness. For these inmates with the most severe forms of mental illnesses, segregation to punish inmates for behaviors that are obviously beyond their control. For people with serious mental illness in the community, police practices that are other wise sensible result in tragedy – for the officers and the people whose lives they ended – when applied rigidly to people who needed something flexibility and skills that are not always part of police training.

In the book's most shocking and infuriating scene, Shayne is accused of "manipulating" her captors, even after she has plucked out her own eyes in response to her demons. Human beings confined alone in 5' by 8' cells for years on end are accused of "attention-seeking," in spite of the rather obvious rebuttal that attention is the one thing they almost never receive. It is almost impossible to believe that this book is not a work of fiction, the perverse musings of a gifted, twisted writer of horror stories. But you can't make this stuff up. Pfeiffer grabs us not with imagination, but with truth.

In other words, this horror story is all too real. Pfeiffer, to her credit, fights off easy answers. She writes of Shayne tragic story as "a litany of a person, a family, and a system that was helpless against an illness." Instead of blaming the correctional officials who have been forced to treat illnesses that they do not understand, instead of blaming understaffed and under-funded mental health centers for turning people away, instead of blaming police officers who truly believed that deadly force was required, Pfeiffer's finger of blame is pointed squarely at each and every one of us.

Americans are not stupid, even if we often act as though we are. Politicians tell us that they will cut taxes. They don't tell us that our roads will crack, our bridges will collapse, our infants will die, and our surviving children will be ignorant. They don't tell us that some of those among us with mental illness will be callously allowed to spiral into preventable misery and death. They don't tell us, and we pretend that we don't know. Americans are not stupid, but we have become increasingly greedy and selfish, and it's not the fault of politicians. They are not the cause of our greed; they are the result. We elect the ones who lie to us, and who tell us what we want to hear. Meanwhile, for Shayne and Luke, for Alan and Peter, for Jessica and Joseph, the costs of our greed are too troubling to witness.

A witness, of course, is exactly what is needed. Ultimately, Mary Beth Pfeiffer's gift to us is to witness these unspeakable crimes against humanity, and to witness them in a well-informed manner. She is not pessimistic; quite the contrary. It is her well informed optimism – the absolute knowledge that we can and must do better – that fuels her anger. If enough people read this book, it will be impossible to sustain the delusion that we can have a humane and sensible society for free. If enough people read this book and pick up the phone or write a letter, it will be impossible to sustain the myth that this is the best that we can do for our most disabled citizens, their families, and ultimately ourselves.

Book review from the May 2007 NAMI Advocate, the newsletter of the National Alliance on Mental Illness

Crazy in America: The Hidden Tragedy of Our Criminalized Mentally Ill

Mary Beth Pfeiffer

(Carroll & Graf, 2007)

This is an upsetting book, which is as it should be. One feels restless, even impatient, trying to summarize it. Every chapter is keen in detail. Then, suddenly, the lyrics of a Bob Dylan song come to mind, to help capture its essence:

How many times must a man look up

Before he can see the sky?

Yes, 'n' how many ears must one man have

Before he can hear people cry?

Yes, 'n' how many deaths will it take till he knows

That too many people have died?

Drawing from California, Florida, Iowa, New York and Texas, the book uses six case studies to expose the national scandal in which the mental healthcare system keeps failing and the criminal justice system takes over.

The six case studies—each of which constitutes a separate part of the book, with three chapters in each part—shows the scandal up-close and personal. They are not dry recitations of statistics or policy prescriptions.

One study involves the odyssey of a 39 year old woman with a history of 25 hospitalizations who tears out her eyes while in solitary confinement.

Another is about a man who is shot and killed, after a police officer seeks to scold him about urinating in public but doesn’t know how to deescalate his terrified response.

Still another involves an 18-year-old boy who hangs himself after being abandoned in a small cell for eight weeks.

“People with mental illnesses lack the basic tools for survival,” Pfeiffer notes. “They see things that others don’t, yell out to silent voices, think in chaotic patterns. They are often crippled by irrational fears or weighted down by profound feelings of sadness. Yet the hallmark of prison life is regimentation and control. Obedience is expected to be instantaneous and unquestioned.”

To be sure, statistics are seeded throughout the book.

Out of 2.2 million prison and jail inmates in America, approximately 330, 000 struggle with mental illnesses.

In Florida, so many people are killed by police that one 1998 study said that they account for 20 percent of the nation’s total.

Two of the persons profiled in the book were among 24 people in the Tampa Bay area killed during police confrontations from 2004 to 2006. About three dozen police officers were involved. None were criticized for their actions—and the deaths were ruled “justifiable,” “appropriate,” or “excusable.”

In a legal sense, the rulings may have been correct—the officers involved were often traumatized by the experience. But Pfeiffer points out that in 2000, the Tampa Police Department instituted Crisis Intervention Training (CIT). By 2003, three hundred officers took the course. But today, the number has dwindled to only ten to fifteen each year.

The Tampa officer who shot one of the men profiled in the book had not taken the CIT course. Only three hours of her initial police training covered mental illness. In more than 30 training courses taken by her in the fours years preceding the tragedy, not one had anything to do with mental illness. This in a state where one in four of the people arrested have a mental illness.

The decline in Tampa’s CIT program points to a key sickness: the lack of sustained leadership and commitment by those in authority and power to do what’s necessary and right, rather than simply look for “quick fixes.”

Pfeiffer offers a “Top 10 List” of reforms to keep people with mental illnesses out of the criminal justice system:

  1. Stop building prisons
  2. Invest in special prison units for those people with mental illnesses who do belong in prison
  3. Train prison corrections officers to work with and respect people with mental illnesses
  4. Invest in prison rehabilitation programs to curb recidivism
  5. Stop putting people with mental illnesses into solitary confinement
  6. Roll back punitive drug laws; invest in drug treatment programs that allow people to fail and then keep trying
  7. Train police officers how to respond to people with mental illnesses in crisis.
  8. Invest in inpatient and outpatient mental healthcare services in the community
  9. Pass insurance parity and extend Medicaid coverage to include stays in state psychiatric hospitals
  10. Invest in housing—and eliminate rules that keep non-violent and reformed felons out of public housing.

None of these are quick fixes. But they will help focus discussion of steps needed to do what’s right. It also may be the first list to frankly include stopping the construction of new prisons and repealing punitive drug laws, and instead forcing investment in community services at the front end.

The book may be disadvantaged by similarity in title and topic to Crazy: A Father’s Search Through America’s Mental Health Madness, published last year, which was a finalist for the 2007 Pulitzer Prize, as well as NAMI’s 2007 Outstanding Media Award for Advocacy. But they are different book that complement each other. Both should be given to every governor, state legislator and Member of Congress as part of advocacy for reform.

One advantage of Crazy in America is that each case study stands alone. Along with the preface and afterword, only one case study, or any combination of them, need be read to get the point.

Yes, too many people have died.


May 2007

Contact: Barbara Monteiro, Monteiro & Company, Inc., 212-832-8183, bam@monteiroandco.com

Crazy in America:

The Hidden Tragedy of Our Criminalized Mentally Ill

By Mary Beth Pfeiffer

The nation witnessed a horrific example of failed mental health care recently when a mentally ill man killed 32 people at Virginia Tech in Blacksburg, Va. While his case was extreme -- and rare -- Cho Seung-Hui was typical of thousands of psychotic people across America whose path to jails and prisons was rooted in a deficient mental health system.

In her new book, Crazy in America: The Hidden Tragedy of Our Criminalized Mentally Ill, (Carroll & Graf; Publication date: May 22, 2007; $15.95, paperback) Mary Beth Pfeiffer tells the stories of six people whose mental illnesses thrust them into the arms of police and into jails, prisons and juvenile facilities that were ill-prepared to care for them. The results were shocking and preventable: Suicide, self-mutilation, death at the hands of frightened and poorly trained police.

Pfeiffer, a long-time investigative reporter who was a 2004 Soros Justice Media Fellow, puts a human face on the national scandal in which thousands of mentally ill people tangle daily with police. Pfeiffer shows how, once incarcerated, people who are sick are punished again and again for behavior that is psychotic but not criminal.

Crazy in America is a book about a society that has abandoned a segment of its weakest and most vulnerable citizens in an age of shuttered mental hospitals, anemic community care and tough sanctions for those who violate the public peace and order. "We have become so inured to the criminal justice alternative," Pfeiffer writes, "that there is a growing trend in mental hospitals to arrest patients who assault staff during psychotic episodes. Not too long ago, these people would not have been considered candidates for arrest, based - correctly - on the theory that they had little control over their actions. No more."

The unforgettable people in the book include Shayne Eggen, a spunky woman in her 30s who had long believed she was an Indian princess. She gouged out both her eyes, in separate incidents, while incarcerated in Iowa. Pfeiffer recounts the journey that brought Shayne to the gates of the Iowa Correctional Institution for Women: a diagnosis of schizophrenia at the age of 14; a succession of mental hospitals from which she sometimes escaped or was released without follow-up care; and a crime that could have been avoided had officials heeded the warning flags that Shayne and her family were desperately waving.

Shayne Eggen went to prison a beautiful woman with long brown hair, piercing blue eyes and a sickness that overwhelmed the resources of the Iowa prison system. She emerged -- after spending months in the prison "hole" - missing teeth from an attempt to gnaw her finger off, scarred from having chewed a hole in her cheek, and blind to all but a hint of light. Her eyelids, Pfeiffer writes, hung "like silent curtains over empty sockets."Among the most challenging inmates in Iowa's history, Eggen even became pregnant by another inmate, going through labor in shackles until the moment of delivery. Eggen's story is an amazing one of will and survival, a story of a woman who was not protected from her madness -- and was punished for it as well.

In a recurrent theme of Crazy in America, Pfeiffer shows how people like Eggen are routinely shunted to the furthest edges of prison society for unconscionable periods in solitary confinement. The use of such psychologically harmful confinement came back into fashion in the 1990s in the form of "supermax" cells and prisons, which have become dumping grounds for the mentally ill, places where inmates cry, scream and self-mutilate. Pfeiffer follows Joseph Maldonado and Jessica Roger from their rocky childhoods in loving but troubled families to their delivery to a regimen of sensory deprivation that led to their deaths. An estimated 25,000 Americans are locked in such units, described by judges as "virtual incubators of psychosis, and the mental equivalent of putting an asthmatic in a place with little air to breathe."

Beyond exposing horrific practices behind bars, this book also tells the story of a shrunken mental health system that has made police the first responders in psychiatric emergencies -- with disastrous consequences. In two of Pfeiffer's profiles, mentally ill men began the day as unarmed, law-abiding citizens on the verge of breakdown. After police intervened, they were suspects who had racked up a litany of crimes such as resisting arrest and aggravated harassment; these charges ultimately helped exonerate the officers who killed them.

Since 1990, Pfeiffer writes, an already decimated system of psychiatric hospitals has lost 57,000 beds - 40 percent of the total. And while prison budgets tripled in the last two decades of the 20th century, mental health spending rose by just a fifth. The upshot: "America's mental health service delivery system is in shambles," a Presidential commission on mental health concluded in 2002. The nation rated a "D" in a report card on mental health care in 2006 by the National Alliance for the Mentally Ill.

The nation's dearth of mental health care coupled with tougher sanctions for drug use, parole violations and other offenses has delivered thousands of mentally ill people to the halls of justice. America's intolerance of drug addicts sent Luke Ashley, a 24-year-old Texan with bipolar disorder, to a jail cell where he hung himself. His offense was to possess two pills of the drug ecstasy. Luke’s mother, Tricia, had been Luke's counselor, confessor and champion and had advocated for her son on every step of his terrible journey. But her efforts were no match for an overwhelming illness -- and a systemic failure.

Incarceration has become the answer to too many problems in America, Pfeiffer asserts. "Prison should be the domain of the truly deserving, those who rob banks, mug old women, and kill wantonly," she writes. "Yet it is the place where there is always a bed, where another body and soul could be crammed in until by 2005, nearly 2.2 million of us were behind bars." This has made America's lockups into de facto mental institutions.

"When someone has a documented history of mental illness," the judge said in sentencing one of Pfeiffer's subjects, "there ought to be a place where there could be both isolation and treatment." The problem: There was no place. And so Jessica Roger, who had been hospitalized 25 times from age 11 to 15 and had committed her crime at 16, went to a maximum security New York State prison where she committed suicide. Crazy in America offers a prescription for change so that people like Jessica, Joseph, Luke and Shayne are offered care and compassion -- rather than handcuffs and a jail cell.

ABOUT THE AUTHOR

Mary Beth Pfeiffer is a widely published journalist, researcher and author. Her work has appeared nationally and she has won wide acclaim with awards from the Scripps Howard Foundation, National Headliner Awards, Inter America Press Association, National Council on Crime and Delinquency, New York State Associated Press Association, New York Publishers Association and the National Mental Health Association, among others.

CRAZY IN AMERICA:The Hidden Tragedy of Our Criminalized MentallyBy Mary Beth PfeifferCarroll & Graf PublishersPublication date: May 22, 2007

Price: $15.95 Paperback

ISBN-13: 978-0-78671-745-3, ISBN-10: 0-7867-1745-9

Article published: May 27, 2007, Cedar Rapids Gazette
Mentally ill behind bars

Independence, Ia. -- Shayne Eggen has no regrets about the Greek tragedy that mental illness has made of her life, but the 43-year-old Decorah woman who gouged out both her eyes while incarcerated wants you and other Iowans to know the consequences of punishing people for their madness.

``People need to know about this. I don't want this to happen to anyone else. It's horrible,'' Eggen said this month during an interview at her home of the past two years, the Mental Health Institute at Independence.

Eggen said her interaction with the criminal justice system -- and its infliction of solitary confinement as a means to control her unruly behavior -- made her already miserable life even more painful and difficult.

``I will never let go of my resentment of the way I have been treated,'' she said.

Eggen's life story is the first of six case studies in a new book, ``Crazy in America: The Hidden Tragedy of Our Criminalized Mentally Ill,'' written by investigative journalist Mary Beth Pfeiffer.

Pfeiffer, 53, of Stone Ridge, N.Y., maintains that Eggen and about 330,000 other Americans who formerly would have been treated at state mental health institutions now are incarcerated in prison systems that lack the resources and expertise to care for them.

Many of them, like Eggen, end up in solitary confinement, where disproportionate numbers of them commit suicide or mutilate themselves, Pfeiffer said.

``The system did not have an answer for people like Shayne. There aren't many places for mentally ill people who can't live independently,'' said Margaret Stout, executive director of the National Alliance on Mental Illness Iowa.

Though the Iowa Department of Corrections declined to comment on Pfeiffer's book, none of its officials having read it, the department acknowledged in an April 2006 report to the state Board of Corrections that the percentage of mentally ill inmates in Iowa prisons is double the national average.

On June 30, 2005, 2,902 of the 8,578 inmates in Iowa prisons had been diagnosed with mental illness -- that's 33.8 percent, which compares with 16.3 percent for all state prison inmates.

Of those 2,902 inmates, more than 95ƒpercent had been diagnosed with chronic ailments, such as depression and bipolar disorder, which are incurable though often amenable to treatment.

At the Iowa Correctional Institute for Women at Mitchellville, where Eggen plucked out her left eye while in solitary confinement, 340 of the 600 inmates in 2005 -- 56.7 percent -- had been diagnosed with a mental illness.

The report also noted that the state's largest mental health facility is the clinical care unit at the penitentiary in Fort Madison, with 200 beds.

In the late 1950s and early 1960s, the ``deinstitutionalization'' of mental health facilities sent many of the patients into communities that did not have the resources to care for them, the state corrections report said. That exodus, the report said, ``contributed to the institutionalization of the mentally ill in local jails and state prisons.''

Pfeiffer puts it more bluntly: ``The nation formerly housed people with mental illnesses in large, impersonal, often abusive institutions called mental hospitals. Today, it houses them in large, impersonal, often abusive institutions called prisons.''

The depopulation of Iowa's four state mental hospitals … down from 5,336 patients in 1955 to fewer than 200 today -- began in the 1950s with the introduction of Thorazine and other pyschotropic drugs, which enabled outpatient treatment of many formerly institutionalized mental health patients, said Dr. Dan Gillette, superintendent of the Mental Health Institute at Cherokee and a medical director of the Iowa Department of Human Services.

Other factors fueling the transition, according to Pfeiffer, were the 1963 Community Mental Health Centers Act, which mandated that community-based systems replace custodial care hospitals, and subsequent legal rulings that defined the rights of mentally ill people to refuse treatment.

That transition has been accompanied by a declining commitment to mental health care, according to Gillette.

In 1950, mental health patients consumed 54ƒpercent of the U.S. health dollar, which compares with less than 13 percent today, he said.

As Pfeiffer details Eggen's life, doctors diagnosed her with schizophrenia at age 14, and her mother, Elizabeth Vou Vakis, now of Detroit, signed papers making her a ward of the state, a legal requirement then for families who could not afford alternate care.

Eggen spent almost all of the next 20 years in a succession of mental institutions before finally running afoul of the law in 1997 when she stabbed then-Decorah Police Chief Ben Wyatt in the shoulder with a steak knife.

While in the psychiatric unit at the Iowa Medical and Classification Center at Oakdale, awaiting evaluation of her competence to stand trial for the stabbing, Eggen became pregnant in a laundry room tryst with another inmate and, shackled until the moment of delivery, gave birth to a son while in prison.

Her son, Angelo, was immediately taken from her because authorities feared she would harm him … a thought Eggen says she never entertained.

``I didn't get to hold him when he was a newborn,'' Eggen said in the recent interview. ``I went to the nursery every hour or two to look at him through the window. I know he knew who I was.''

One of Eggen's sisters adopted Angelo, who comes with his family to visit her several times a year, Eggen said.

``He calls me Aunt Shayne, but he knows I'm his mother,'' she said.

Eggen served 2ƒ1/2 years in the Mitchellville prison before her release in August 2000.

She spent a troubled few weeks in Decorah before setting a fire in her apartment above the Donlon Snyder Pharmacy in downtown Decorah and stabbing Richard Sorenson, 38, of Decorah, with a knife on Sept. 30, 2000.

Three weeks later, in a glassed-in suicide-watch cell at the Winneshiek County Jail, Eggen plucked out her right eye.

What was she thinking?

``I was thinking of a Bible verse (Mark 9:47), `And if thine eye offend thee, pluck it out,'‚'' Eggen said.

Eggen began her second stint at Mitchellville in April 2001 and was assigned to the segregation unit -- ``the hole,'' as inmates call it -- after she attacked an inmate in 2002.

On Dec. 21, 2002, during a later stint in the segregation unit, Eggen plucked out her left eye. This time, Eggen said, she was thinking of the lyrics of a heavy metal song that referred to not needing eyes to see.

Eggen said she wanted to be in solitary confinement at Mitchellville.

``I thought it was calling my name,'' she said. ``I wanted to go in all naked and cold, to eat with my hands, to tuck myself in a rubber bed with a nylon blanket and depend on my own breath for warmth.''

As befits a woman suffering from schizophrenia, Eggen is of two minds about her life at the Mental Health Institute in Independence.

In the presence of others, she says it's the best place she's ever lived.

Later, while momentarily out of earshot of her caretakers, she blurts: ``I don't like any of the people here.''

Eggen said she takes pleasure in music, cigarettes and diet green tea and looks forward to communion on Tuesday and visits from her aunt and guardian, Pat Jewell of Decorah, every Wednesday.

In 2004, Jewell, 62, filed a lawsuit alleging that state prison officials were deliberately indifferent to Eggen's medical and psychiatric needs.

That lawsuit is still pending in U.S. District Court in Des Moines, but Jewell said good faith negotiations on a settlement are continuing.

Jewell said she remains hopeful the suit will end in a settlement that will assure Eggen the care she needs to live a life free of self-harm and the opportunity to harm others.

Jewell said her guardianship and her weekly visits have brought her closer to her niece.

``It's made me love her more. We talk about things and laugh. She gives me purpose,'' Jewell said.

Eggen said she has no definite plans for the future and no regrets about the past.

``This has been the greatest experience,'' she said. ``I have done so much, a lot of it painful to myself and others. But I have lived a most fulfilling life.''

The Des Moines Register
Iowan who blinded herself in prison profiled in book

By TONY LEYS
REGISTER STAFF WRITER

May 28, 2007

Independence, Ia. - Shayne Eggen is unsure how to feel about having her experiences recounted to a national audience.

Eggen is one of the main subjects of a new book describing what happens when mentally ill Americans tangle with law-enforcement officials. She said she's tired of talking about her experience, but she wants people to know about it. "I just want to make sure it never happens again - to anyone."

Eggen, whose numerous problems include schizophrenia, used her finger to blind herself at the state women's prison in Mitchellville in 2002.

Her supporters say she'd been held in solitary confinement for weeks at a time, because the prison's staff did not know how to handle her. They also say she would not have been imprisoned if the mental-health system had helped keep her from raging out of control and setting a fire during an aborted suicide attempt at her Decorah apartment.

Eggen, who now lives at the state Mental Health Institute in Independence, is the focus of the first three chapters of "Crazy in America," a new book by investigative journalist Mary Beth Pfeiffer. The book graphically describes the tragedies that result when people with mental illnesses are arrested and imprisoned because society's capacity to help them has withered.

"To be mentally ill like Shayne was to live a life of indignities and incapacity, of helmets and restraints, shackles and handcuffs, needles and pills," Pfeiffer wrote. "She was held against her will. She was used and thrown away. She was discharged so that she might be someone else's problem."

Eggen is unique among the six people profiled in the book. She was the only one to survive.

The others, who were in New York, Florida, Texas and California, either died during confrontations with police or committed suicide behind bars.

Pfeiffer's book grew out of another incident she described in a 2004 piece in the New York Times Sunday Magazine. The author later was drawn to news of Eggen's tragedy, she said in an interview from her New York home. "She is a composite of so many of the ways we have failed people with mental illness in America."

Pfeiffer noted that Eggen's parents had to sign her away as a teenager so she would qualify for state assistance. After that, Eggen bounced from institutions to chaotic freedom, then back to institutions. At one point, Iowa authorities bused her to Texas in what Pfeiffer described as a cynical attempt at "Greyhound therapy."

Pfeiffer said America's prisons are recreating the shameful conditions that used to be seen in insane asylums. Her book slams the common use of solitary confinement to punish prisoners for behaviors caused by their illnesses. Eggen's experience shows how such isolation can inflame the problem, Pfeiffer said.

"There was sign after sign that she didn't belong in the very difficult confines of a solitary confinement cell, yet prison officials put her back there and kept her there, day after day, month after month."

Margaret Stout, executive director of the Alliance for the Mentally Ill of Iowa, said she hopes the book draws attention to the issue. She said the root cause is that America emptied most of its mental institutions in the 1960s and 1970s, but never built sufficient community-care systems to deal with mentally ill people.

Stout said many police departments and prison agencies have improved their training and policies. "They've made some progress, but there's a need for more," she said.

Prison leaders declined to comment on the book.

Eggen's family filed a federal lawsuit against the prison system in 2004. Her aunt, Patricia Jewell of Decorah, said lawyers are negotiating a settlement. She said it hinges in part on finding a suitable community facility where Eggen could live.

Jewell, who is Eggen's legal guardian, said she's glad the book was written, even if it rips open old wounds.

"I read Shayne's chapters and I was devastated," she said. "I want things to change, and I want people to read it - but it really hurts."

Jewell and Eggen discussed the book and Eggen's prospects last week while sitting at a picnic table outside the state Mental Health Institute in Independence.

Eggen, 43, lives in a locked ward in a room with two other women. She talked about how she would like to live somewhere where she could receive help but still have some independence. She would like to be close to nature, she said.

As Eggen spoke, a crow cawed from atop a nearby pine tree. "The crow's saying what's wrong and what's right," she said. "He's the law."

Her aunt smiled at her. "You like listening to birds, don't you, Shayne?" she said.

"Yeah, I do," Eggen said. "They're free."

Reporter Tony Leys can be reached at (515) 284-8449 or tleys@dmreg.com

http://desmoinesregister.com/apps/pbcs.dll/article?AID=/20070528/NEWS/705280334/1001/NEWS

Staten Island Advance
Punished for being mentally ill
By Judy L. Randall
STATEN ISLAND ADVANCE
Sunday, July 1, 2007

Native Islander pens book about lack of treatment and understanding for those with maladies in prison

A compelling new book by a former Advance reporter offers stark insights into the criminalization of thousands of mentally ill Americans, by law enforcement and government bureaucracies that do not know how to treat – let alone understand – their maladies.

"Crazy in America," by Mary Beth Pfeiffer, a Westerleigh native, outlines in chilling and often raw detail the case histories of the most vulnerable among us – those who suffer from clinical depression, are bipolar or schizophrenic.

Take the case of Shayne Eggen of Iowa who, though diagnosed with schizophrenia, was shuttled from home to hospital to prison amid a series of increasingly violent outbursts beginning in the late 1990s. Left untreated, she committed barbaric acts of self-mutilation while incarcerated, including gouging out both of her eyes and dislodging several of her teeth when she tried to chew off one of her fingers.

She was also raped while in prison and handcuffed while giving birth.

As with the other states in Ms. Pfeiffer's case studies, New York, California, Florida and Texas, the closure of hospitals and psychiatric facilities "pushed the mentally ill to the streets," she writes, while "other forces drove them into prison and kept them there," including substance abuse and violent psychotic outbursts, in large measure because there was no one to monitor whether they took their medication.

Society, Ms. Pfeiffer writes, was "not prepared for this onslaught."

And all too often in prisons, overwhelmed and understaffed by untrained personnel, she adds, "psychotic breakdowns are not cause for medical intervention but for overwhelming shows of force."

Patient-prisoners are routinely held in solitary confinement in what is called "the hole," "violent cells" or "the box" to isolate them after violent behaviors, but are offered no treatment options upon release.

For many, sadly, suicide seems the only option.

One such victim, Jessica Roger, who spent time in various upstate New York psychiatric and prison facilities, wrote a plaintive letter home crying out for help: "They took my sheets, my blankets and my mattress out of my cell because I keep hiding under the bed and covering myself so they can't see me ... Mommy I really feel like hurting myself but I am afraid to tell these people because I do not want them to put me in a cold ... cell with nothing but a thin mat and a gown."

A multi-pronged approach is needed, as Ms. Pfeiffer sees it, from enhancing mental health insurance coverage to legislation currently pending in Albany, known as the SHU Bill, that regards special housing units or solitary confinement placements as inappropriate for those with major mental health disorders.

Linda Wilson, executive director of the Staten Island chapter of the National Alliance on Mental Illness, hailed Ms. Pfeiffer as a "great advocate for people who have mental illness."

Ms. Pfeiffer was a general assignment reporter at the Advance specializing in the environment from 1976-82. But during that time, she recalled during a telephone interview the other day, she did her first reporting on her current area of expertise with a series on the deinstitutionalization of the mentally ill, the closure of psychiatric centers and the emergence of group homes.

Ms. Pfeiffer is a graduate of Blessed Sacrament School, St. Joseph by-the-Sea High School and Marist College, where she earned a degree in English. After her stint at the Advance, she moved to the Poughkeepsie Journal, where she worked for 22 years as an investigative reporter and editor winning numerous awards, including being named a 2004 Soros Justice Media Fellow.

She lives in Stone Ridge, N.Y., with her husband, Robert Miraldi, also formerly of Westerleigh and a one-time Advance reporter, who is now a professor of journalism at SUNY New Paltz.

Judy L. Randall is a news reporter for the Advance. She may be reached at randall@siadvance.com.

CAP: Mary Beth Pfeiffer outlines the case histories of those who suffer from clinical depression, are bipolar or schizophrenic in "Crazy in America."


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