Families & Mental Illness

Washington Post journalist Steve Luxenberg learned he’d had an aunt, institutionalized for mental illness in 1940 and hidden by his mother for more than half a century. His new book, Annie’s Ghosts: A Journey Into a Family Secret , tells the story.

How has our approach to mental illness changed since the 1940s?
We don’t put people in mental institutions at nearly the rate we did then. In 1955, there were 550,000 patients. The country’s population is nearly double now, so you’d expect a million today. Instead we have fewer than 50,000.

Why is that?
New medicines allowed people to be treated at home. Then, later, the legal standard changed. In the ‘40s, many states had a legal obligation to give “treatment and care” to their “defectives.” Now, you cannot be forced into an institution unless you are a danger to yourself or others.

And that’s a good thing, right?
Yes. But what’s good for the patient’s rights may not be good for the family. The family might not be able to care for a patient whose behavior is erratic. That’s the ongoing conflict.

You had trouble accessing your aunt’s medical records. Why?
Medical-records management people are in charge of saying “no” to protect people’s privacy. But if we shut off medical records of people long deceased, we’re locking up information that families and medical providers ought to know. As scientists learn more and more about the genetic basis of all kinds of illnesses, access to records is an issue we’re going to have to confront.

— Sharon Male