I used to get mad at my brother for being crazy.

Because some of the time, he wasn’t crazy. Or he didn’t act crazy. In those good spells, he could be the together older brother, a guy who was good with tools, had a precise pool shot and a talent for massaging brown clay into sculptures of beautiful women. He could take apart the engine of a car or motorcycle, lay out the pieces in neatly labeled envelopes, fix what was broken and put it all back together so it worked. He could talk physics and chemistry and make a good spaghetti. He could see into people and make perceptive remarks.

Most of the time, though, he could barely function. He would hang from a cigarette as if it alone sustained him, and pace back and forth because he couldn’t be still and couldn’t figure out where to go. He would stare at people and things too long and not answer when spoken to.

In his worst times, he acted completely crazy. Hallucinating, he lined his walls with crinkled aluminum foil to try to block out the voices only he could hear. His movements grew stiff and jerky. His stare seethed with anger.

Or even worse, he would soar on optimism, exuberantly telling me he’d finally cured himself and would be all right from now on – that look lighting his eyes.

I would look at him acting so crazy, and sometimes I thought: Come on, John, knock it off.

You’re probably also involved in craziness somehow. The issue cascades through communities and families. Most of us don’t talk about it much, because it’s too personal. Too burdened with despair and desperate hopes, guilt, blame, feeling sorry for others and ourselves. We’re not even supposed to use the word “crazy.” It’s politically incorrect, but it’s the most succinct description I know.

This story needs to be aired because it has meanings beyond vicious fate and one family struggling to cope. It’s about people needing help in general, and how that isn’t much in fashion these days. And it illuminates dark aspects of Western culture that we prefer to keep hidden.

One out of every six people in this country will suffer a diagnosable episode of mental illness this year. One out of every 17 is seriously mentally ill, a category of disasters that includes bipolar disorder, major depression and schizophrenia.

The National Alliance on Mental Illness, an advocacy group founded in 1979, gives the United States the grade of “D” for our systems of mental-health awareness and care – nearly complete failure. Nationwide, we spend more than $100 billion per year on it. The total keeps rising, and the number of people being treated keeps rising. The wider impacts on society – the annual costs of untreated mental illness – total another $100 billion.

The only feel-good rush on this issue came during the 1950s to the 1970s, when nationwide reforms freed many people from long-term warehousing in mental hospitals. Now we have one-tenth the number of hospitalized crazies we had back then. But we traded one set of failures for another – we have more mentally ill people in jails and prisons than in hospitals. And in our communities and on the streets, the billions of dollars have fallen short, and mostly we’ve chosen to look away from the sick rather than set up adequate treatment and support.

I’m focusing on the deficiencies in our systems of public care, for those who can’t afford private psychiatrists and thus fall onto the ragged safety nets. Even for the wealthy, though, there are no easy answers, if there are any answers at all.

For my brother, it worked like this: John was born in 1947 in Tucson, Ariz., where our parents had moved for the healthy, dry air. Then they moved to California, where I was born in an ambulance, and then Indiana, then Illinois, where my younger brother, Mike, was born. Our father, Ray Sr., was an entrepreneur who chased opportunity while suffering physical illnesses and subtle symptoms of craziness, including unpredictable moods and an inability to stay in one place. As Ray Sr. failed in business, he aimed his demand for perfection and his angry frustration at his first seed – John. In his eyes, John could never do anything right.

Like many crazy people, John probably had his illness encoded into his genes, and childhood stress activated it. From the time he was an infant he rarely smiled. By fourth grade, he had trouble concentrating. He was hearing his own thoughts. Our mother, Kate, took him to his first psychiatrist. More clouds emerged. When John was 13, Ray Sr. went into the hospital for an operation for symptoms that turned out to be cancer, and John punished himself: He took a baseball bat into his bedroom, locked the door and began smashing his toys. Kate and I stood outside the door listening to the breakage, calling to him, getting no response. Kate didn’t know what to do and phoned an Episcopal priest, who came in his black outfit and called through the door, “John, do you know who this is?” John’s voice came through the door, “Santa Claus?” and he kept on with the bat. I remember grinning at his crazy humor. Smiling was my nature, and I did it so much that Kate thought something might be wrong with me.

Our father finally killed himself with cigarettes and lung cancer when John was 15, I was 13 and my younger brother was 10. Kate finished raising us, taking a series of jobs, including elementary school teacher, editor of educational materials, real estate agent, and finally an adjunct English teacher at a community college. All of this has been toughest on her.

—-

John’s path alternated between periods of lucidity and paranoia and hallucinations. He made a few unsuccessful attempts at college, then enlisted for four years in the Army, hoping the structure would straighten him out, serving in the South and Germany as a radar technician. Then he had a few brief civilian jobs. He tried enlisting a second time, but by then he had been diagnosed as schizophrenic, so the Army had no more use for him. He began what would eventually become hundreds of sessions with psychiatrists and counselors. He tried outpatient treatment and hospitals run by universities, counties, private businesses, and the Veterans Administration, the long grind of antipsychotic medications, even shock treatments. At times he wandered the streets incoherently, or landed in jail.

The first years of John’s intermittent care were in the Illinois system. Then he and my mother returned to Tucson, where he spent 17 years in the Arizona system. I left Illinois for Colorado, but wound up in Tucson for most of John’s crazy years there. I was old enough to be a better witness, and I saw how the Arizona system was itself crazy and sad.

Our family didn’t have a lot of money for treatment. John got by mostly on small disability payments from Social Security and the Veterans Administration, and whatever the public mental-health care system could do for him. Arizona’s system, like those of the other Western states, is a complicated array of dozens of agencies and companies, some of which operate to make a profit on craziness. The federal government provides some money through programs such as Medicaid and Social Security disability, but state governments are in the driver’s seat. Every year, the legislatures and governors allocate state money for the systems, and it doesn’t have much to do with what’s needed. The principle is called “managed care,” which really means managing costs.

“It’s an oxymoron approach,” says Chick Arnold, a lawyer who has pressed a class-action suit against Arizona’s system since the 1980s, demanding a series of improvements. “The companies (and agencies) get a finite amount of money to provide an open-ended commitment for service for a growing population. They can’t do it. … The system is designed to screen people out, not in. It’s all about cost containment.”

At most, John would see a psychiatrist for one 15-minute visit per month. Most of his interactions with the system came through his case managers and counselors, each of whom juggled many dozens of patients. Much of the treatment is based on medications that try to soothe or dampen the brain chemistry. John would get his meds in pills, liquid potions or injections. All the meds had bad side effects, such as tardive dyskinesia – uncontrollable pacing, stiffness of posture, facial grimacing.

John would take his meds for a while, stabilize, and then stop taking them. He would fly without meds for weeks or months, then crash. Sometimes when he had bad spells, my mother and I would ally with local prosecutors and go to court, testifying against him, saying he was a danger to himself or others, the legal standard for court-ordered commitment to treatment. The commitment would last for a week or so in a locked hospital ward, then longer periods of follow-up and mandatory meds outside the hospital, sometimes for as long as a year. Always the commitment would end, and then the cycle would begin again. All this is familiar to people who pay attention to crazy people.

John tried taking megavitamins and nutritional powders. He paid to consult with psychics. Once, he drove to California to try to talk to the guy who wrote a popular book on primal scream therapy. The guy refused to see him.

When he wasn’t in hospitals, John lived wherever Tucson landlords would rent to a crazy person, usually cockroach-infested dives. In one big apartment complex that was filled with various losers, one of his neighbors got stabbed, and the police helicopter regularly flew over with its glaring spotlight and warlike noise. The wait for federal subsidized housing stretched out for years, and he could rarely take advantage of it.

In the bad spells, he forgot to eat and grew extremely thin. Or he got mad at everything and everyone, sometimes attracting the cops. The busts I know about were for leaping out of bushes and threatening strangers with a hammer, for taking the hammer into a convenience store and causing a disturbance, for tearing the windshield wipers off a parked car, throwing rock salt into the swimming pool in his apartment complex, and for forgetting to show up in court. Landlords evicted him for hurling rocks through his windows and breaking his door. During visits to our mother’s house he broke dishes, threw a hammer through the wall, broke furniture, or pounded on the front door demanding to be let in. One time when they were driving together, he became agitated and told her, “Pull over or I’ll put your face through that windshield.” Sometimes the cops took him to hospitals, and sometimes to jail. At least once he set a fire in his cell.

He had a series of troubled cars – a Ford Falcon, a Mercury Comet, a Ford Pinto, and then an old International Harvester Scout. He worked on them constantly to keep them going. During bad spells, he caused a few car wrecks.

Most of the world had no sympathy for him. Banks dunned him with extra charges for bounced checks, and he would struggle to keep track of all his bills, especially the ones from ambulances and other mental-health providers, with their complicated deductibles and formulas for benefits. Bills from the phone company, other utilities, car insurance and the dentist often came faster than he could afford.

In desert heat above 100 degrees, he went around in a long-sleeved shirt with a T-shirt under it, and long pants. He wore down the heels of his shoes with his pacing. He loaned money to “friends” and never got it back. He was incapable of bargaining and often got rooked. Now and then, he picked fights with strangers and put up no resistance as the blows began to fall – punishing himself like that. One of the times I talked him into going to a hospital, we sat on chairs in the waiting room, and suddenly he curled down onto the floor, a catatonic escape.

Music could soothe him. In his lucid spells, he liked a good joke. He could talk Arizona Wildcats basketball. He had a persistent hope of creating something special and lasting, a breakthrough in physics or some other wild dream. One time I asked him what he was up to, and he said, “The never-ending battle against entropy.” I had to look it up: the natural tendency of all things in the universe to fly apart.

I would get angry at him, wanting him to take his meds, regardless of their side effects, because the alternative seemed worse to me. Now and then he threatened to commit suicide. I got tired of hearing it. Sometimes I secretly wished for him to die, thinking it was the only way for him to find relief, and also because it would end my duty.

Then in 1995 at the age of 47, he bought a pistol from a guy he found in the classified ads, took it home to his latest one-room apartment in Tucson, lay down on his bed, and, sometime during the night, shot himself in the head. I do not know the exact date of his death – only that it was sometime in late April or early May – because it took a while for his body to be found. He was that alone at the end.

I know there are many dedicated professionals in Arizona’s mental-health care system. But sometimes it seems as if the system mostly amounts to passing out guns. Maybe for some crazy people that’s the only effective treatment.

 —-

“No one knows” exactly what leads up to any person committing suicide, says John McIntosh, a psychology professor at Indiana University South Bend who has studied 50 years of nationwide statistics. But he’s one of the experts who’ve noticed that, collectively, Westerners lead the nation in suicide rates.

No other measurement of mental illness distinguishes the West so clearly – not rates of depression and “serious psychological distress,” not the shortages of money for treatment. In public spending on mental-health care, for instance, some Western states are below average, with New Mexico and Idaho nearly last, while some Western states are above average.

For suicide, nine of the top 11 states are in the West, a trend that holds year after year and decade after decade. And the degree of the lethal regional difference is stunning: Nevada, Montana, New Mexico, Wyoming, Idaho, Utah, Colorado, Arizona and Oregon range from 19 to 15 suicides per 100,000 people – more than twice as high as New York and Washington, D.C., the healthy end of the scale. The rate in Washington state is nearly as high as its neighbors in the region, and even mellow California ranks 50 percent higher than New York and D.C.

Some 8,000 Westerners will kill themselves this year, a hefty portion of the national total of more than 30,000 suicides. Much of the cause, McIntosh suspects, is embedded in our Western culture. “Potential contributors,” he says carefully, “include the personality or attitudinal or world-view differences across the country.” Patty Limerick, a prominent Western historian at the University of Colorado, frames it more frankly: In the West, “we won’t admit our sorrows until they become cataclysmic.”

Wallace Stegner is considered the Shakespeare of the West, one of our most important writers and thinkers. He wrote of the region’s “geography of hope,” and the inevitable poisonous disappointments that blossom from that hope. His life fits the pattern. “Stegner experienced a hardscrabble childhood. His father, George, a failed farmer and career bootlegger, dragged long-suffering wife Hilda and their two boys to remote locations,” says Carlin Romano, in a review of a new biography of Stegner. “The Stegners lived in 20 different residences over 10 years to avoid raids on George’s bootlegging. … At one point, Hilda deposited Stegner and his brother in a Seattle orphanage, one of the writer’s most painful memories. … He came to hate his abusive father …”

Wallace Stegner’s father committed suicide (and killed his mistress) in a Salt Lake City hotel in 1939. Four years later, Stegner published an autobiographical novel, Big Rock Candy Mountain, which “yields insights into the origins of the most important themes of his life and writings – how man relates to his family and to his surrounding environment,” according to Patricia Rowe Willrich, a literary critic who profiled Stegner shortly before his death in 1993. In Big Rock Candy Mountain, Stegner described a character, Bo Mason, based on his father:

“He was born with the itch in his bones. … He was always telling stories of men who had gone over the hills to some new place and found a land of Canaan, made their pile, got to be big men in the communities they fathered. But the Canaans toward which Bo’s feet had turned had not lived up to their promise. People had been before him. The cream, he said, was gone. He should have lived a hundred years earlier.

“Yet he would never quite grant that all the good places were filled up. There was somewhere, if you knew where to find it, some place where money could be made like drawing water from a well, some Big Rock Candy Mountain where life was effortless and rich and unrestricted and full of adventure and action, where something could be had for nothing.”

Stegner’s themes echo. Westerners by nature tend towards transience. The early white settlers came here to escape or find something new and better – that Big Rock Candy Mountain – and the same urge continues today. Waves of migration come from other regions. People bounce from California to Montana to Arizona, thinking nicer scenery will somehow solve their problems, or that they’ll find a fresh start in a booming city, or forge deep connections in some small rural town. When nothing is solved, the beautiful mountains or rivers or deserts become a taunt. And guns – the most popular method of suicide – are easily available.

“We encourage people to move here and lie to them about it being paradise,” says Arnold, the Arizona mental-health lawyer. Western states, exploding with population growth, have flimsy communities. Families are strained or fragmented by the churning. Our frontier mentality makes us suspicious of government and public services. We expect people to tough it out on their own. “The dream of a freer life, independence, that kind of individualism, works against community and familiar structure,” says Bill Handley, an associate professor at the University of Southern California who studies how Western writers deal with these themes. “There’s a whole literature of loneliness in the West.”

Among the other cultural factors linked to suicide: Westerners are the least likely to attend church. We’re more likely to abuse alcohol and prescription drugs. We have high rates of divorce. A 1992 study even found that country music, with its refrains of loneliness and failure, could contribute to suicide rates.

Sheila Linwood, who runs a suicide-prevention group in Grand Junction, Colo., sees high rates of suicide among the young men who work far from their families in the booming construction and oil and gas fields. “It’s huge isolation,” she says. When they suffer depression and other mental illness, she says, “They really do feel like no one else in the world can understand, no one is going to help them out. It’s not a healthy atmosphere.” Some suicides never make it into the statistics, she says. “If you’re putting up an oil derrick, it’s dangerous work, and if you have a mental-health condition, you may not take the precautions you need to take.”

I don’t know whether my brother would’ve fared better if he’d stayed in the Illinois system. I do know that when he moved back to the West, his chances worsened. But he was a Westerner, in his origin, his conclusion and his transience. He lived in at least six states, two countries, and more than a dozen apartments and houses in Tucson alone, not including hospitals. Sometimes he was willing to seek help, but often he was reluctant. He was also a victim. All the very crazy ones are born into it, or hit with it, regardless of the choices they make or how they try to live their lives.

I go around with thoughts that I should’ve done more for John. In Tucson, I saw him roughly once a week. On holidays and other special occasions, he came over to the house where I lived with my wife and kids. He tried to interact, but sometimes was too far gone. The kids called him Uncle John, and he was sweet to them, but generally he wasn’t good in groups. So most of the times I was with John in the desert, it was just the two of us (my younger brother took his own path, to New Mexico, Europe and California). We had our routines: I took John out for burritos, or we went to a bar to shoot pool. We went to movies, where he could lose himself in the big screen. He helped me work on my cars.

The hikes were the best times we shared. We liked to go at sunset. One trail meandered through washes in the Tucson Mountains to a pioneer’s homestead that had fallen into decay. The roof and windows were gone, and just stone walls remained on a concrete pad. Sometimes we hiked up the canyons of a bigger range, the Santa Catalinas, where we often found the magic of water flowing in the desert. Or I would drive us up to the summit of that range for hikes in the cool pines. John would sit on the passenger seat next to me, refusing to look at the panoramic views out his side window. He just stared straight ahead, but I know the scenes outside registered in him and helped him.

Our favorite hike was Tanque Verde, a canyon between two ranges, where we almost always found water. I would take off my shoes and persuade him to take off his, and we would wade on the sandy bottoms as the sunset flared into dusk and bats emerged on fluttering wings.

I always said goodbye to John with a hug. He liked that, too. He rarely felt the touch of other people. Over the years he had a few girlfriends who valued his intellect, his intensity and his struggle, but they all ultimately gave up on him. At least one was a fellow crazy, and two were counselors with their own troubles. Counselors aren’t supposed to lie down with people like John because it’s considered unprofessional and unhealthy. But I saw them as heroic.

He was so alone that sometimes he would call me and say nothing, just looking for a voice. Sometimes I got angry at the long pauses, when his calls interrupted my life. I felt I was expected to carry him, but I had competing duties to my wife, my kids, and myself. “Family members feel badgered,” says Clarke Romans, director of the National Alliance on Mental Illness’s Tucson chapter. “The mentally ill person sucks the attention of most of the family. Others in the family feel shortchanged. Families walk around with this aggravated sense of rage, because they’re not getting the services they deserve.”

—-

When I decided to leave Tucson, fleeing the sun-baked urban mess – chasing my Big Rock Candy Mountain, headed north to the Rockies – I thought about taking John with me. It seemed close to impossible, on top of moving the wife and kids and facing who knows what changes ahead. My wife thought I was crazy to consider it. When I told him we would move soon, he took off driving his old Scout, heading north, fully crazy and somehow imagining, I think, that he could prove he could relocate himself. He drove about 120 miles and ended up out of gas and with a dead battery in an old mining community, walking beside the road for hours, hungry and hallucinating. The cops there scooped him up, thank you, and called me, and my wife and I drove up and brought the Scout back to Tucson. They committed him to a hospital and long-term outpatient meds, again. And we left without him.

The last time he and I talked, about nine months after I moved away from Tucson, it was a long-distance call. My life still felt shaky from the move and I was under more than the usual stress. I picked a fight with him about his driving. He spent too much of his paltry income on gas, insurance and repairs, and for too long I had lived with the fear that he would hurt someone else by driving when he was crazy or acting out his anger. I told him angrily that he should sell that old truck. Within a few weeks, he did sell it. He used some of the money to buy the gun.

There was a lot of turnover, and his case manager changed four times during his last year. He ended up amid strangers and without wheels, trapped in one place with only his madness. Tucson had a lousy bus system, like many Western cities, and that also helped kill him. He lost his last shreds of hope.

He pulled the trigger in the springtime, the season of suicide. A few days later, a comedy videotape arrived in my mailbox. He had ordered it for my kids.

In the 13 years since John killed himself, there have been some improvements in the system. New medications have fewer side effects. But still there are no cures, and horror stories are legion.

Prodded by many lawsuits, Arizona has increased its spending on mental health. Now, it’s eighth in the nation – but that still works out to $136 per capita, about half the price of a small iPod. Tucson has a few more services for crazy people, but case managers still suffer burnout. “The ratio is way up in the 70 to 100 clients per case manager,” says Romans. “That kind of ratio makes it impossible for case managers to actually do their jobs. It contributes to a high turnover rate – people quit because they can’t help people like they thought they could.”

“The Arizona system is not particularly good,” says Bob Hess, director of the National Alliance on Mental Illness’ Arizona chapter. “But as a nation we’re not good – basically everyone stinks together.”

For 12 years, I’ve lived in Bozeman, Mont., a prosperous New West college town. If you’re crazy in Bozeman and having a serious breakdown, you’ll probably be hauled more than 100 miles, to the nearest hospital psych ward. On some nights every psychiatric bed in Montana is full. Then the Bozeman hospital (which has no psych unit) might admit you to spend the night under watch of a security guard.

Recent scandals in Western states include physical and sexual abuse, even suicides, right inside hospitals. More changes are needed, but they must be cataclysmic, not just incremental. We must change the way we think about mental health. As Dr. Bruce Kahn, with the nonprofit Valley Mental Health in Salt Lake City, says, “We need a health-care policy that would not discriminate based on which organ of the body is afflicted.”

I think back to how John would get frustrated and smash things he cared about. Sometime in the 1970s, when he was living in Illinois with Kate, I came from Colorado for a visit. Somehow he got pissed off at the car he had at the time, the old Falcon. He took a hammer and began beating on it in the driveway.

From inside the house, I could hear the kawack of the hammer blows on steel and the tinkling broken glass. I went out, thinking I might be able to handle it. When I confronted John in the driveway, though, he didn’t seem to know me. He walked around the crumpled machine, selected another spot and smashed it. I asked him to move the car down the street, telling him he was disturbing the neighbors – grasping for sanity. Wild-eyed, he said he wanted to do it here. He held the hammer over his head and glared at me, scaring me. I grabbed his wrist and punched him on the forehead. He punched me and ripped my shirt as I took the hammer and pulled away. We faced each other, panting for air and bleeding onto the blacktop. Then I thought, What the hell? I handed him back the hammer and went back into the house. The hammer blows began anew.

Now my only regret about that scene is that I didn’t appreciate the statement he was making. I should have built a bonfire, eased back in a lawn chair and shouted encouragement: “You missed a spot, John! There’s a piece of chrome trim sneering indifference! Go get ’em, crazy John!”

When I returned to Tucson for his funeral, I went hiking in Tanque Verde Canyon at sunset. I found water and went barefoot into it. Walking up the trail out of the canyon, alone in the dusk, I heard a great horned owl hooting. The huge bird was perched atop a tall saguaro cactus silhouetted against the full moon. I watched the owl for a long time. The owl tipped forward to let loose each hoo-hooo-hooo-hooo! with all the volume and force in its body. Hoot after hoot.

On that trip, I also went to the apartment where John killed himself. I felt the terribleness there. Then another strange thing happened: The feeling changed to something golden, like a sunrise coming into the room and into me. I am not a religious person, but I could feel John in it, telling me he had finally found a better place. I have never felt that feeling again. It is not enough to put my turmoil to rest. But I am proud of how he bore his burden, and I understand that he needed to find a way out.

I inherited John’s toolboxes, including that ball-peen hammer. And I have a cardboard box with a few things I gathered from his last apartment: a little plastic trophy he won in a pool tournament, triangles for his mechanical drawing, the classified ads where he shopped for the gun. And notebooks in which he kept meticulous journals at times. March 16, 1987: “Just when you think you have an upper hand …”

I remember him most vividly when I’m driving by myself, no one there to distract me, and a song comes on the car stereo. There are many sad songs that honor outlaws, victims of crashes and other tragedies. There are no songs for the mentally ill. But a few of Bruce Springsteen’s ballads remind me of John, like “Philadelphia,” about a gay man wandering the streets as he dies of AIDS, and “Highway Patrolman,” about the bond between brothers. And there’s Steve Earle’s ballad with the line: “Even Jesus couldn’t save me, though I know He did His very best … Swing low, swing low, swing low and carry me home.”

I’ll look over, and there he is, sitting on the passenger seat just like he used to. “Hey, Juaaan,” I say, drawling the amusing nickname only he and I knew. He doesn’t turn, just sits stiffly and stares straight ahead, like he did in life. Or I’ll see him in the corner of my eye, standing in the corner of a room in my house, stiff with his hands shoved in his pockets. If I look directly, he vanishes. Many people have ghosts like this. We don’t talk about it to anyone.

I watch my children for any signs of the craziness, hope to hell nothing surfaces. I can imagine nothing worse.

I know how people can be single-issue voters. There are some who care about nothing except abortion, or gun rights. For me, the need to improve public mental-health care outweighs other political issues. A champion of funding for the mentally ill could trash a few rivers and still have my vote. I can’t say that better funding would’ve prevented my brother’s suicide. But it might improve the day-to-day lives of others.

If I were in charge, my program for crazy people would include a decent apartment, a good burrito, movies, hikes. And cats and dogs and whores, so the crazy people can touch and be touched physically, without judgment. And a place for hammering things to smithereens, without endangering other people.

My thoughts will not be welcomed by all who are touched by mental illness and suicide. But maybe this story will resonate in your life, offer you some support for decisions you’ve made, both good and bad. I hope it will also raise awareness. That’s all I can offer. I can’t talk about it any more than this.

When we were boys together in Illinois, John and I played in the muddy, slow-flowing creeks and sought out slithering black leeches and the crawdads lurking under rocks. We also had a big swamp behind our house, and we tramped around there looking for snakes and rabbits. John always liked animals. He found little birds that had fallen from their nests, brought them into the house, and we tried to feed them. Sometimes he discovered nests of rabbits where the maintenance crews were cutting tall grass. He brought the tiny rabbit babies to the house, and we fed them with little doll bottles of milk. He also brought in snakes, concerned that they might not survive the coming winter.

One of John’s childhood projects was building a clubhouse in our backyard. He put all kinds of work into it, and all of us neighborhood boys used the clubhouse to hide from grownups and fool around. Then a tornado came along and smashed the clubhouse flat, spreading the old lumber across several yards. That didn’t discourage John. He gathered some of the scuffed boards and torn roofing paper and nails, and made a flat-bottomed boat. Of course it leaked, but he made the joints tight enough that it floated, or sank slowly. We took that boat to the high-school pond and it kept us just out of reach of snapping turtles. We took it into the mysterious swamp, poling through the black waters and muck and thickets of cattails and brush. We used that boat for years, exploring and re-exploring the swamp. That’s how I think of John’s life: A tornado came through, and he did his best to make something of the wreckage.

Ray Ring is HCN senior editor

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My Crazy Brother

by Ray Ring, High Country News
March 31, 2008

<h1>My Crazy Brother</h1> <p class="byline">by Ray Ring, High Country News <br />March 31, 2008</p> <div class="wp-block-jetpack-slideshow aligncenter" data-effect="slide"> <div class="wp-block-jetpack-slideshow_container swiper-container"> <ul class="wp-block-jetpack-slideshow_swiper-wrapper swiper-wrapper"> <li class="wp-block-jetpack-slideshow_slide swiper-slide"> <figure> <img alt="https://www.hcn.org/external_files/allimages/2008/mar31/graphics/080331-026.jpg" class="wp-block-jetpack-slideshow_image wp-image-22905" data-id="22905" src="https://www.hcn.org/wp-content/uploads/2023/03/080331-026.jpg" /><figcaption class="wp-block-jetpack-slideshow_caption gallery-caption">John and Ray Ring at Ray's October 1993 birthday party.<br /> John, who struggled with mental illness most of his life, committed<br /> suicide a year and a half later at age 47. COURTESY RING<br /> FAMILY</figcaption></figure> </li> <li class="wp-block-jetpack-slideshow_slide swiper-slide"> <figure> <img alt="https://www.hcn.org/external_files/allimages/2008/mar31/graphics/080331-027.jpg" class="wp-block-jetpack-slideshow_image wp-image-22906" data-id="22906" src="https://www.hcn.org/wp-content/uploads/2023/03/080331-027.jpg" /><figcaption class="wp-block-jetpack-slideshow_caption gallery-caption">Dotti Ray (far left), gunshot wound to the head, 1995<br /> Shown here with children Tisha and TJ Thomson, Dotti Ray struggled<br /> with depression and migraine headaches for 12 years before she<br /> committed suicide in 1995. She had been an artist, and was selected<br /> to do a portrait of President Ronald Reagan, which she delivered to<br /> Reagan in the White House in 1987. "Eventually, she just crossed<br /> the line. I didn't recognize the signs, didn't expect it," TJ says.<br /> He was home in Idaho on leave from the Air Force when it happened;<br /> she shot herself the day before he was to go back to work. PHOTO<br /> COURTESY TJ THOMSON</figcaption></figure> </li> <li class="wp-block-jetpack-slideshow_slide swiper-slide"> <figure> <img alt="https://www.hcn.org/external_files/allimages/2008/mar31/graphics/080331-028.jpg" class="wp-block-jetpack-slideshow_image wp-image-22908" data-id="22908" src="https://www.hcn.org/wp-content/uploads/2023/03/080331-028.jpg" /><figcaption class="wp-block-jetpack-slideshow_caption gallery-caption">"They're both doing pretty well, now ..." Twin brothers<br /> Robert and Richard Encinas were normal, popular high school<br /> students in Southern California until the summer after their<br /> sophomore year. "One minute they're playing football, and the next<br /> minute they're in a psychiatric hospital," says brother Tony<br /> Pelais, who after that summer returned to the high school and<br /> questions like, "What happened to your brothers? I hear they<br /> freaked out." Ricky Encinas says, "My wife and I actually had no<br /> idea what mental illness was. We hadn't even heard about<br /> schizophrenia." After years of turmoil, "(the twins) finally<br /> learned to take medication continuously, and everything kind of<br /> leveled off." Robert now has his own apartment and Richard has a<br /> job, is married and has a child. ENCINAS FAMILY, LEFT, FROM NOTHING<br /> TO HIDE: MENTAL ILLNESS IN THE FAMILY. GIGI KAESER PHOTO.</figcaption></figure> </li> <li class="wp-block-jetpack-slideshow_slide swiper-slide"> <figure> <img alt="https://www.hcn.org/external_files/allimages/2008/mar31/graphics/080331-029.jpg" class="wp-block-jetpack-slideshow_image wp-image-22910" data-id="22910" src="https://www.hcn.org/wp-content/uploads/2023/03/080331-029.jpg" /><figcaption class="wp-block-jetpack-slideshow_caption gallery-caption">Kevin Graham (right), hanged, 2003 Major General Mark<br /> Graham, at Fort Carson, Colo., and his wife, Carol, highlight their<br /> story in TV and newspaper interviews. One of their sons, Kevin,<br /> suffered depression and hanged himself when he was 21. (Their other<br /> son, Jeff, was killed in the Iraq War; they also have a daughter,<br /> Melanie.) The Grahams work with the national Suicide Prevention<br /> Action Network, trying to lessen the stigma of mental illness and<br /> suicide. On their Web site, they say of Kevin, "Our son died on his<br /> own battlefield. ... He fought against adversaries that were as<br /> real to him as his casket is real to us. They were powerful<br /> adversaries. ... At last these adversaries overwhelmed him and it<br /> appeared he had lost the war. But did he? ... (He) has won our<br /> admiration because even if he lost the war, we give him credit for<br /> his bravery on the battlefield." COURTESY GRAHAM FAMILY,<br /> WWW.GRAHAMMEMORIAL.COM</figcaption></figure> </li> <li class="wp-block-jetpack-slideshow_slide swiper-slide"> <figure> <img alt="https://www.hcn.org/external_files/allimages/2008/mar31/graphics/080331-030.jpg" class="wp-block-jetpack-slideshow_image wp-image-22911" data-id="22911" src="https://www.hcn.org/wp-content/uploads/2023/03/080331-030.jpg" /><figcaption class="wp-block-jetpack-slideshow_caption gallery-caption">"I think that maybe someday there will be a cure for<br /> mental illness ..." Trinidad Esparza sailed through high school as<br /> student body president and a star athlete, and went on to college<br /> and then a job as a tax auditor. But then he started feeling<br /> paranoid and thought voices in the television were talking to him.<br /> He stopped eating and even stopped drinking water. He had to resign<br /> from his job, and eventually was hospitalized and diagnosed with<br /> schizo-affective disorder. His mother, Bartola, says of her son's<br /> illness, "We didn't hide it ... Some people won't tell anyone that<br /> a family member has a mental illness. They keep it to themselves<br /> and hibernate in the closet. I tell people to open up and let the<br /> world know." Trini, as he's known, now volunteers and is waiting<br /> for a cure for mental illness. "It's just a matter of time and<br /> research." ESPARZA FAMILY, LEFT, FROM NOTHING TO HIDE: MENTAL<br /> ILLNESS IN THE FAMILY. GIGI KAESER PHOTO.</figcaption></figure> </li> <li class="wp-block-jetpack-slideshow_slide swiper-slide"> <figure> <img alt="https://www.hcn.org/external_files/allimages/2008/mar31/graphics/080331-031.jpg" class="wp-block-jetpack-slideshow_image wp-image-22915" data-id="22915" src="https://www.hcn.org/wp-content/uploads/2023/03/080331-031.jpg" /><figcaption class="wp-block-jetpack-slideshow_caption gallery-caption">Harry Reid, self-inflicted gunshot wound, 1972 Nevada Sen.<br /> Harry Reid's father, also named Harry, a gold miner, committed<br /> suicide in 1972. Reid revealed the suicide in a Senate hearing in<br /> 1997. "For many years it was just one of those unpleasant memories<br /> that I didn't allow to surface and I've found that's very typical,"<br /> Reid told the Associated Press in February 2008, when he introduced<br /> the Stop Senior Suicide Act, which would allocate federal money to<br /> help prevent suicide. Other Western congressmen also have shared<br /> their stories: Oregon Sen. Gordon Smith's son, Garrett, suffered<br /> depression and committed suicide in 2003. Smith is also a champion<br /> for better funding for mental health care. Oregon Sen. Ron Wyden<br /> had a schizophrenic brother who died. New Mexico Sen. Pete Domenici<br /> has a schizophrenic daughter. Domenici is also a champion on the<br /> issue. A SQUARE FROM A SPAN USA LIFEKEEPER MEMORY QUILT, (COURTESY<br /> SPAN USA)</figcaption></figure> </li> <li class="wp-block-jetpack-slideshow_slide swiper-slide"> <figure> <img alt="https://www.hcn.org/external_files/allimages/2008/mar31/graphics/080331-032.jpg" class="wp-block-jetpack-slideshow_image wp-image-22916" data-id="22916" src="https://www.hcn.org/wp-content/uploads/2023/03/080331-032.jpg" /><figcaption class="wp-block-jetpack-slideshow_caption gallery-caption">"We want to do the same things you do." Juan Ineguez says<br /> the media has a lot to do with creating the stigma around mental<br /> illness. When mentally ill John Hinckley shot President Reagan,<br /> "The media made it sound like everybody with a mental illness was<br /> going to go out there and shoot people ... (it) can't conceive that<br /> anyone who has a mental illness can have a healthy relationship or<br /> even a normal conversation with someone else." NOTHING TO HIDE/GIGI<br /> KAESER</figcaption></figure> </li> </ul> <p> <a class="wp-block-jetpack-slideshow_button-prev swiper-button-prev swiper-button-white" role="button"></a><br /> <a class="wp-block-jetpack-slideshow_button-next swiper-button-next swiper-button-white" role="button"></a><br /> <a aria-label="Pause Slideshow" class="wp-block-jetpack-slideshow_button-pause" role="button"></a></p> <div class="wp-block-jetpack-slideshow_pagination swiper-pagination swiper-pagination-white"></div> </p></div> </p></div> <p>I used to get mad at my brother for being crazy.</p> <p>Because some of the time, he wasn't crazy. Or he didn't act crazy. In those good spells, he could be the together older brother, a guy who was good with tools, had a precise pool shot and a talent for massaging brown clay into sculptures of beautiful women. He could take apart the engine of a car or motorcycle, lay out the pieces in neatly labeled envelopes, fix what was broken and put it all back together so it worked. He could talk physics and chemistry and make a good spaghetti. He could see into people and make perceptive remarks.</p> <p>Most of the time, though, he could barely function. He would hang from a cigarette as if it alone sustained him, and pace back and forth because he couldn't be still and couldn't figure out where to go. He would stare at people and things too long and not answer when spoken to.</p> <p>In his worst times, he acted completely crazy. Hallucinating, he lined his walls with crinkled aluminum foil to try to block out the voices only he could hear. His movements grew stiff and jerky. His stare seethed with anger.</p> <p>Or even worse, he would soar on optimism, exuberantly telling me he'd finally cured himself and would be all right from now on - that look lighting his eyes.</p> <p>I would look at him acting so crazy, and sometimes I thought: Come on, John, knock it off.</p> <p>You're probably also involved in craziness somehow. The issue cascades through communities and families. Most of us don't talk about it much, because it's too personal. Too burdened with despair and desperate hopes, guilt, blame, feeling sorry for others and ourselves. We're not even supposed to use the word "crazy." It's politically incorrect, but it's the most succinct description I know.</p> <p>This story needs to be aired because it has meanings beyond vicious fate and one family struggling to cope. It's about people needing help in general, and how that isn't much in fashion these days. And it illuminates dark aspects of Western culture that we prefer to keep hidden.</p> <p> </p> <p><strong>One out of every six people</strong> in this country will suffer a diagnosable episode of mental illness this year. One out of every 17 is seriously mentally ill, a category of disasters that includes bipolar disorder, major depression and schizophrenia.</p> <p>The National Alliance on Mental Illness, an advocacy group founded in 1979, gives the United States the grade of "D" for our systems of mental-health awareness and care - nearly complete failure. Nationwide, we spend more than $100 billion per year on it. The total keeps rising, and the number of people being treated keeps rising. The wider impacts on society - the annual costs of untreated mental illness - total another $100 billion.</p> <p>The only feel-good rush on this issue came during the 1950s to the 1970s, when nationwide reforms freed many people from long-term warehousing in mental hospitals. Now we have one-tenth the number of hospitalized crazies we had back then. But we traded one set of failures for another - we have more mentally ill people in jails and prisons than in hospitals. And in our communities and on the streets, the billions of dollars have fallen short, and mostly we've chosen to look away from the sick rather than set up adequate treatment and support.</p> <p>I'm focusing on the deficiencies in our systems of public care, for those who can't afford private psychiatrists and thus fall onto the ragged safety nets. Even for the wealthy, though, there are no easy answers, if there are any answers at all.</p> <p>For my brother, it worked like this: John was born in 1947 in Tucson, Ariz., where our parents had moved for the healthy, dry air. Then they moved to California, where I was born in an ambulance, and then Indiana, then Illinois, where my younger brother, Mike, was born. Our father, Ray Sr., was an entrepreneur who chased opportunity while suffering physical illnesses and subtle symptoms of craziness, including unpredictable moods and an inability to stay in one place. As Ray Sr. failed in business, he aimed his demand for perfection and his angry frustration at his first seed - John. In his eyes, John could never do anything right.</p> <p>Like many crazy people, John probably had his illness encoded into his genes, and childhood stress activated it. From the time he was an infant he rarely smiled. By fourth grade, he had trouble concentrating. He was hearing his own thoughts. Our mother, Kate, took him to his first psychiatrist. More clouds emerged. When John was 13, Ray Sr. went into the hospital for an operation for symptoms that turned out to be cancer, and John punished himself: He took a baseball bat into his bedroom, locked the door and began smashing his toys. Kate and I stood outside the door listening to the breakage, calling to him, getting no response. Kate didn't know what to do and phoned an Episcopal priest, who came in his black outfit and called through the door, "John, do you know who this is?" John's voice came through the door, "Santa Claus?" and he kept on with the bat. I remember grinning at his crazy humor. Smiling was my nature, and I did it so much that Kate thought something might be wrong with me.</p> <p>Our father finally killed himself with cigarettes and lung cancer when John was 15, I was 13 and my younger brother was 10. Kate finished raising us, taking a series of jobs, including elementary school teacher, editor of educational materials, real estate agent, and finally an adjunct English teacher at a community college. All of this has been toughest on her.</p> <p>----</p> <p>John's path alternated between periods of lucidity and paranoia and hallucinations. He made a few unsuccessful attempts at college, then enlisted for four years in the Army, hoping the structure would straighten him out, serving in the South and Germany as a radar technician. Then he had a few brief civilian jobs. He tried enlisting a second time, but by then he had been diagnosed as schizophrenic, so the Army had no more use for him. He began what would eventually become hundreds of sessions with psychiatrists and counselors. He tried outpatient treatment and hospitals run by universities, counties, private businesses, and the Veterans Administration, the long grind of antipsychotic medications, even shock treatments. At times he wandered the streets incoherently, or landed in jail.</p> <p>The first years of John's intermittent care were in the Illinois system. Then he and my mother returned to Tucson, where he spent 17 years in the Arizona system. I left Illinois for Colorado, but wound up in Tucson for most of John's crazy years there. I was old enough to be a better witness, and I saw how the Arizona system was itself crazy and sad.</p> <p>Our family didn't have a lot of money for treatment. John got by mostly on small disability payments from Social Security and the Veterans Administration, and whatever the public mental-health care system could do for him. Arizona's system, like those of the other Western states, is a complicated array of dozens of agencies and companies, some of which operate to make a profit on craziness. The federal government provides some money through programs such as Medicaid and Social Security disability, but state governments are in the driver's seat. Every year, the legislatures and governors allocate state money for the systems, and it doesn't have much to do with what's needed. The principle is called "managed care," which really means managing costs.</p> <p>"It's an oxymoron approach," says Chick Arnold, a lawyer who has pressed a class-action suit against Arizona's system since the 1980s, demanding a series of improvements. "The companies (and agencies) get a finite amount of money to provide an open-ended commitment for service for a growing population. They can't do it. ... The system is designed to screen people out, not in. It's all about cost containment."</p> <p>At most, John would see a psychiatrist for one 15-minute visit per month. Most of his interactions with the system came through his case managers and counselors, each of whom juggled many dozens of patients. Much of the treatment is based on medications that try to soothe or dampen the brain chemistry. John would get his meds in pills, liquid potions or injections. All the meds had bad side effects, such as tardive dyskinesia - uncontrollable pacing, stiffness of posture, facial grimacing.</p> <p>John would take his meds for a while, stabilize, and then stop taking them. He would fly without meds for weeks or months, then crash. Sometimes when he had bad spells, my mother and I would ally with local prosecutors and go to court, testifying against him, saying he was a danger to himself or others, the legal standard for court-ordered commitment to treatment. The commitment would last for a week or so in a locked hospital ward, then longer periods of follow-up and mandatory meds outside the hospital, sometimes for as long as a year. Always the commitment would end, and then the cycle would begin again. All this is familiar to people who pay attention to crazy people.</p> <p>John tried taking megavitamins and nutritional powders. He paid to consult with psychics. Once, he drove to California to try to talk to the guy who wrote a popular book on primal scream therapy. The guy refused to see him.</p> <p>When he wasn't in hospitals, John lived wherever Tucson landlords would rent to a crazy person, usually cockroach-infested dives. In one big apartment complex that was filled with various losers, one of his neighbors got stabbed, and the police helicopter regularly flew over with its glaring spotlight and warlike noise. The wait for federal subsidized housing stretched out for years, and he could rarely take advantage of it.</p> <p>In the bad spells, he forgot to eat and grew extremely thin. Or he got mad at everything and everyone, sometimes attracting the cops. The busts I know about were for leaping out of bushes and threatening strangers with a hammer, for taking the hammer into a convenience store and causing a disturbance, for tearing the windshield wipers off a parked car, throwing rock salt into the swimming pool in his apartment complex, and for forgetting to show up in court. Landlords evicted him for hurling rocks through his windows and breaking his door. During visits to our mother's house he broke dishes, threw a hammer through the wall, broke furniture, or pounded on the front door demanding to be let in. One time when they were driving together, he became agitated and told her, "Pull over or I'll put your face through that windshield." Sometimes the cops took him to hospitals, and sometimes to jail. At least once he set a fire in his cell.</p> <p>He had a series of troubled cars - a Ford Falcon, a Mercury Comet, a Ford Pinto, and then an old International Harvester Scout. He worked on them constantly to keep them going. During bad spells, he caused a few car wrecks.</p> <p>Most of the world had no sympathy for him. Banks dunned him with extra charges for bounced checks, and he would struggle to keep track of all his bills, especially the ones from ambulances and other mental-health providers, with their complicated deductibles and formulas for benefits. Bills from the phone company, other utilities, car insurance and the dentist often came faster than he could afford.</p> <p>In desert heat above 100 degrees, he went around in a long-sleeved shirt with a T-shirt under it, and long pants. He wore down the heels of his shoes with his pacing. He loaned money to "friends" and never got it back. He was incapable of bargaining and often got rooked. Now and then, he picked fights with strangers and put up no resistance as the blows began to fall - punishing himself like that. One of the times I talked him into going to a hospital, we sat on chairs in the waiting room, and suddenly he curled down onto the floor, a catatonic escape.</p> <p>Music could soothe him. In his lucid spells, he liked a good joke. He could talk Arizona Wildcats basketball. He had a persistent hope of creating something special and lasting, a breakthrough in physics or some other wild dream. One time I asked him what he was up to, and he said, "The never-ending battle against entropy." I had to look it up: the natural tendency of all things in the universe to fly apart.</p> <p>I would get angry at him, wanting him to take his meds, regardless of their side effects, because the alternative seemed worse to me. Now and then he threatened to commit suicide. I got tired of hearing it. Sometimes I secretly wished for him to die, thinking it was the only way for him to find relief, and also because it would end my duty.</p> <p>Then in 1995 at the age of 47, he bought a pistol from a guy he found in the classified ads, took it home to his latest one-room apartment in Tucson, lay down on his bed, and, sometime during the night, shot himself in the head. I do not know the exact date of his death - only that it was sometime in late April or early May - because it took a while for his body to be found. He was that alone at the end.</p> <p>I know there are many dedicated professionals in Arizona's mental-health care system. But sometimes it seems as if the system mostly amounts to passing out guns. Maybe for some crazy people that's the only effective treatment.</p> <p> ----</p> <p><strong>"No one knows"</strong> exactly what leads up to any person committing suicide, says John McIntosh, a psychology professor at Indiana University South Bend who has studied 50 years of nationwide statistics. But he's one of the experts who've noticed that, collectively, Westerners lead the nation in suicide rates.</p> <p>No other measurement of mental illness distinguishes the West so clearly - not rates of depression and "serious psychological distress," not the shortages of money for treatment. In public spending on mental-health care, for instance, some Western states are below average, with New Mexico and Idaho nearly last, while some Western states are above average.</p> <p>For suicide, nine of the top 11 states are in the West, a trend that holds year after year and decade after decade. And the degree of the lethal regional difference is stunning: Nevada, Montana, New Mexico, Wyoming, Idaho, Utah, Colorado, Arizona and Oregon range from 19 to 15 suicides per 100,000 people - more than twice as high as New York and Washington, D.C., the healthy end of the scale. The rate in Washington state is nearly as high as its neighbors in the region, and even mellow California ranks 50 percent higher than New York and D.C.</p> <p>Some 8,000 Westerners will kill themselves this year, a hefty portion of the national total of more than 30,000 suicides. Much of the cause, McIntosh suspects, is embedded in our Western culture. "Potential contributors," he says carefully, "include the personality or attitudinal or world-view differences across the country." Patty Limerick, a prominent Western historian at the University of Colorado, frames it more frankly: In the West, "we won't admit our sorrows until they become cataclysmic."</p> <p>Wallace Stegner is considered the Shakespeare of the West, one of our most important writers and thinkers. He wrote of the region's "geography of hope," and the inevitable poisonous disappointments that blossom from that hope. His life fits the pattern. "Stegner experienced a hardscrabble childhood. His father, George, a failed farmer and career bootlegger, dragged long-suffering wife Hilda and their two boys to remote locations," says Carlin Romano, in a review of a new biography of Stegner. "The Stegners lived in 20 different residences over 10 years to avoid raids on George's bootlegging. ... At one point, Hilda deposited Stegner and his brother in a Seattle orphanage, one of the writer's most painful memories. ... He came to hate his abusive father ..."</p> <p>Wallace Stegner's father committed suicide (and killed his mistress) in a Salt Lake City hotel in 1939. Four years later, Stegner published an autobiographical novel, <em>Big Rock Candy Mountain</em>, which "yields insights into the origins of the most important themes of his life and writings - how man relates to his family and to his surrounding environment," according to Patricia Rowe Willrich, a literary critic who profiled Stegner shortly before his death in 1993. In <em>Big Rock Candy Mountain</em>, Stegner described a character, Bo Mason, based on his father:</p> <p><em>"He was born with the itch in his bones. ... He was always telling stories of men who had gone over the hills to some new place and found a land of Canaan, made their pile, got to be big men in the communities they fathered. But the Canaans toward which Bo's feet had turned had not lived up to their promise. People had been before him. The cream, he said, was gone. He should have lived a hundred years earlier.</em></p> <p><em>"Yet he would never quite grant that all the good places were filled up. There was somewhere, if you knew where to find it, some place where money could be made like drawing water from a well, some Big Rock Candy Mountain where life was effortless and rich and unrestricted and full of adventure and action, where something could be had for nothing."</em></p> <p>Stegner's themes echo. Westerners by nature tend towards transience. The early white settlers came here to escape or find something new and better - that Big Rock Candy Mountain - and the same urge continues today. Waves of migration come from other regions. People bounce from California to Montana to Arizona, thinking nicer scenery will somehow solve their problems, or that they'll find a fresh start in a booming city, or forge deep connections in some small rural town. When nothing is solved, the beautiful mountains or rivers or deserts become a taunt. And guns - the most popular method of suicide - are easily available.</p> <p>"We encourage people to move here and lie to them about it being paradise," says Arnold, the Arizona mental-health lawyer. Western states, exploding with population growth, have flimsy communities. Families are strained or fragmented by the churning. Our frontier mentality makes us suspicious of government and public services. We expect people to tough it out on their own. "The dream of a freer life, independence, that kind of individualism, works against community and familiar structure," says Bill Handley, an associate professor at the University of Southern California who studies how Western writers deal with these themes. "There's a whole literature of loneliness in the West."</p> <p>Among the other cultural factors linked to suicide: Westerners are the least likely to attend church. We're more likely to abuse alcohol and prescription drugs. We have high rates of divorce. A 1992 study even found that country music, with its refrains of loneliness and failure, could contribute to suicide rates.</p> <p>Sheila Linwood, who runs a suicide-prevention group in Grand Junction, Colo., sees high rates of suicide among the young men who work far from their families in the booming construction and oil and gas fields. "It's huge isolation," she says. When they suffer depression and other mental illness, she says, "They really do feel like no one else in the world can understand, no one is going to help them out. It's not a healthy atmosphere." Some suicides never make it into the statistics, she says. "If you're putting up an oil derrick, it's dangerous work, and if you have a mental-health condition, you may not take the precautions you need to take."</p> <p> </p> <p><strong>I don't know whether my brother would've fared better</strong> if he'd stayed in the Illinois system. I do know that when he moved back to the West, his chances worsened. But he was a Westerner, in his origin, his conclusion and his transience. He lived in at least six states, two countries, and more than a dozen apartments and houses in Tucson alone, not including hospitals. Sometimes he was willing to seek help, but often he was reluctant. He was also a victim. All the very crazy ones are born into it, or hit with it, regardless of the choices they make or how they try to live their lives.</p> <p>I go around with thoughts that I should've done more for John. In Tucson, I saw him roughly once a week. On holidays and other special occasions, he came over to the house where I lived with my wife and kids. He tried to interact, but sometimes was too far gone. The kids called him Uncle John, and he was sweet to them, but generally he wasn't good in groups. So most of the times I was with John in the desert, it was just the two of us (my younger brother took his own path, to New Mexico, Europe and California). We had our routines: I took John out for burritos, or we went to a bar to shoot pool. We went to movies, where he could lose himself in the big screen. He helped me work on my cars.</p> <p>The hikes were the best times we shared. We liked to go at sunset. One trail meandered through washes in the Tucson Mountains to a pioneer's homestead that had fallen into decay. The roof and windows were gone, and just stone walls remained on a concrete pad. Sometimes we hiked up the canyons of a bigger range, the Santa Catalinas, where we often found the magic of water flowing in the desert. Or I would drive us up to the summit of that range for hikes in the cool pines. John would sit on the passenger seat next to me, refusing to look at the panoramic views out his side window. He just stared straight ahead, but I know the scenes outside registered in him and helped him.</p> <p>Our favorite hike was Tanque Verde, a canyon between two ranges, where we almost always found water. I would take off my shoes and persuade him to take off his, and we would wade on the sandy bottoms as the sunset flared into dusk and bats emerged on fluttering wings.</p> <p>I always said goodbye to John with a hug. He liked that, too. He rarely felt the touch of other people. Over the years he had a few girlfriends who valued his intellect, his intensity and his struggle, but they all ultimately gave up on him. At least one was a fellow crazy, and two were counselors with their own troubles. Counselors aren't supposed to lie down with people like John because it's considered unprofessional and unhealthy. But I saw them as heroic.</p> <p>He was so alone that sometimes he would call me and say nothing, just looking for a voice. Sometimes I got angry at the long pauses, when his calls interrupted my life. I felt I was expected to carry him, but I had competing duties to my wife, my kids, and myself. "Family members feel badgered," says Clarke Romans, director of the National Alliance on Mental Illness's Tucson chapter. "The mentally ill person sucks the attention of most of the family. Others in the family feel shortchanged. Families walk around with this aggravated sense of rage, because they're not getting the services they deserve."</p> <p>----</p> <p>When I decided to leave Tucson, fleeing the sun-baked urban mess - chasing my Big Rock Candy Mountain, headed north to the Rockies - I thought about taking John with me. It seemed close to impossible, on top of moving the wife and kids and facing who knows what changes ahead. My wife thought I was crazy to consider it. When I told him we would move soon, he took off driving his old Scout, heading north, fully crazy and somehow imagining, I think, that he could prove he could relocate himself. He drove about 120 miles and ended up out of gas and with a dead battery in an old mining community, walking beside the road for hours, hungry and hallucinating. The cops there scooped him up, thank you, and called me, and my wife and I drove up and brought the Scout back to Tucson. They committed him to a hospital and long-term outpatient meds, again. And we left without him.</p> <p>The last time he and I talked, about nine months after I moved away from Tucson, it was a long-distance call. My life still felt shaky from the move and I was under more than the usual stress. I picked a fight with him about his driving. He spent too much of his paltry income on gas, insurance and repairs, and for too long I had lived with the fear that he would hurt someone else by driving when he was crazy or acting out his anger. I told him angrily that he should sell that old truck. Within a few weeks, he did sell it. He used some of the money to buy the gun.</p> <p>There was a lot of turnover, and his case manager changed four times during his last year. He ended up amid strangers and without wheels, trapped in one place with only his madness. Tucson had a lousy bus system, like many Western cities, and that also helped kill him. He lost his last shreds of hope.</p> <p>He pulled the trigger in the springtime, the season of suicide. A few days later, a comedy videotape arrived in my mailbox. He had ordered it for my kids.</p> <p> </p> <p><strong>In the 13 years since John killed himself,</strong> there have been some improvements in the system. New medications have fewer side effects. But still there are no cures, and horror stories are legion.</p> <p>Prodded by many lawsuits, Arizona has increased its spending on mental health. Now, it's eighth in the nation - but that still works out to $136 per capita, about half the price of a small iPod. Tucson has a few more services for crazy people, but case managers still suffer burnout. "The ratio is way up in the 70 to 100 clients per case manager," says Romans. "That kind of ratio makes it impossible for case managers to actually do their jobs. It contributes to a high turnover rate - people quit because they can't help people like they thought they could."</p> <p>"The Arizona system is not particularly good," says Bob Hess, director of the National Alliance on Mental Illness' Arizona chapter. "But as a nation we're not good - basically everyone stinks together."</p> <p>For 12 years, I've lived in Bozeman, Mont., a prosperous New West college town. If you're crazy in Bozeman and having a serious breakdown, you'll probably be hauled more than 100 miles, to the nearest hospital psych ward. On some nights every psychiatric bed in Montana is full. Then the Bozeman hospital (which has no psych unit) might admit you to spend the night under watch of a security guard.</p> <p>Recent scandals in Western states include physical and sexual abuse, even suicides, right inside hospitals. More changes are needed, but they must be cataclysmic, not just incremental. We must change the way we think about mental health. As Dr. Bruce Kahn, with the nonprofit Valley Mental Health in Salt Lake City, says, "We need a health-care policy that would not discriminate based on which organ of the body is afflicted."</p> <p> </p> <p><strong>I think back to how John would get frustrated</strong> and smash things he cared about. Sometime in the 1970s, when he was living in Illinois with Kate, I came from Colorado for a visit. Somehow he got pissed off at the car he had at the time, the old Falcon. He took a hammer and began beating on it in the driveway.</p> <p>From inside the house, I could hear the kawack of the hammer blows on steel and the tinkling broken glass. I went out, thinking I might be able to handle it. When I confronted John in the driveway, though, he didn't seem to know me. He walked around the crumpled machine, selected another spot and smashed it. I asked him to move the car down the street, telling him he was disturbing the neighbors - grasping for sanity. Wild-eyed, he said he wanted to do it here. He held the hammer over his head and glared at me, scaring me. I grabbed his wrist and punched him on the forehead. He punched me and ripped my shirt as I took the hammer and pulled away. We faced each other, panting for air and bleeding onto the blacktop. Then I thought, What the hell? I handed him back the hammer and went back into the house. The hammer blows began anew.</p> <p>Now my only regret about that scene is that I didn't appreciate the statement he was making. I should have built a bonfire, eased back in a lawn chair and shouted encouragement: "You missed a spot, John! There's a piece of chrome trim sneering indifference! Go get 'em, crazy John!"</p> <p>When I returned to Tucson for his funeral, I went hiking in Tanque Verde Canyon at sunset. I found water and went barefoot into it. Walking up the trail out of the canyon, alone in the dusk, I heard a great horned owl hooting. The huge bird was perched atop a tall saguaro cactus silhouetted against the full moon. I watched the owl for a long time. The owl tipped forward to let loose each hoo-hooo-hooo-hooo! with all the volume and force in its body. Hoot after hoot.</p> <p>On that trip, I also went to the apartment where John killed himself. I felt the terribleness there. Then another strange thing happened: The feeling changed to something golden, like a sunrise coming into the room and into me. I am not a religious person, but I could feel John in it, telling me he had finally found a better place. I have never felt that feeling again. It is not enough to put my turmoil to rest. But I am proud of how he bore his burden, and I understand that he needed to find a way out.</p> <p>I inherited John's toolboxes, including that ball-peen hammer. And I have a cardboard box with a few things I gathered from his last apartment: a little plastic trophy he won in a pool tournament, triangles for his mechanical drawing, the classified ads where he shopped for the gun. And notebooks in which he kept meticulous journals at times. March 16, 1987: "Just when you think you have an upper hand ..."</p> <p>I remember him most vividly when I'm driving by myself, no one there to distract me, and a song comes on the car stereo. There are many sad songs that honor outlaws, victims of crashes and other tragedies. There are no songs for the mentally ill. But a few of Bruce Springsteen's ballads remind me of John, like "Philadelphia," about a gay man wandering the streets as he dies of AIDS, and "Highway Patrolman," about the bond between brothers. And there's Steve Earle's ballad with the line: "Even Jesus couldn't save me, though I know He did His very best ... Swing low, swing low, swing low and carry me home."</p> <p>I'll look over, and there he is, sitting on the passenger seat just like he used to. "Hey, <em>Juaaan</em>," I say, drawling the amusing nickname only he and I knew. He doesn't turn, just sits stiffly and stares straight ahead, like he did in life. Or I'll see him in the corner of my eye, standing in the corner of a room in my house, stiff with his hands shoved in his pockets. If I look directly, he vanishes. Many people have ghosts like this. We don't talk about it to anyone.</p> <p>I watch my children for any signs of the craziness, hope to hell nothing surfaces. I can imagine nothing worse.</p> <p> </p> <p><strong>I know how people can be single-issue voters.</strong> There are some who care about nothing except abortion, or gun rights. For me, the need to improve public mental-health care outweighs other political issues. A champion of funding for the mentally ill could trash a few rivers and still have my vote. I can't say that better funding would've prevented my brother's suicide. But it might improve the day-to-day lives of others.</p> <p>If I were in charge, my program for crazy people would include a decent apartment, a good burrito, movies, hikes. And cats and dogs and whores, so the crazy people can touch and be touched physically, without judgment. And a place for hammering things to smithereens, without endangering other people.</p> <p>My thoughts will not be welcomed by all who are touched by mental illness and suicide. But maybe this story will resonate in your life, offer you some support for decisions you've made, both good and bad. I hope it will also raise awareness. That's all I can offer. I can't talk about it any more than this.</p> <p>When we were boys together in Illinois, John and I played in the muddy, slow-flowing creeks and sought out slithering black leeches and the crawdads lurking under rocks. We also had a big swamp behind our house, and we tramped around there looking for snakes and rabbits. John always liked animals. He found little birds that had fallen from their nests, brought them into the house, and we tried to feed them. Sometimes he discovered nests of rabbits where the maintenance crews were cutting tall grass. He brought the tiny rabbit babies to the house, and we fed them with little doll bottles of milk. He also brought in snakes, concerned that they might not survive the coming winter.</p> <p>One of John's childhood projects was building a clubhouse in our backyard. He put all kinds of work into it, and all of us neighborhood boys used the clubhouse to hide from grownups and fool around. Then a tornado came along and smashed the clubhouse flat, spreading the old lumber across several yards. That didn't discourage John. He gathered some of the scuffed boards and torn roofing paper and nails, and made a flat-bottomed boat. Of course it leaked, but he made the joints tight enough that it floated, or sank slowly. We took that boat to the high-school pond and it kept us just out of reach of snapping turtles. We took it into the mysterious swamp, poling through the black waters and muck and thickets of cattails and brush. We used that boat for years, exploring and re-exploring the swamp. That's how I think of John's life: A tornado came through, and he did his best to make something of the wreckage.</p> <p><em>Ray Ring is </em>HCN <em>senior editor</em></p> <p> </p> <p><em><br /></em></p> <div class="wp-block-group hcn-print-edition-box"> <p>This article appeared in the <a href="/?p=189168">print edition of the magazine</a> with the headline <span class="hcn-magtitle">My Crazy Brother</span>.</p> </p></div> <p>This <a target="_blank" href="https://www.hcn.org/issues/issue-367/my-crazy-brother/">article</a> first appeared on <a target="_blank" href="https://www.hcn.org">High Country News</a> and is republished here under a Creative Commons license.<img src="https://i0.wp.com/www.hcn.org/wp-content/uploads/2023/05/cropped-HCN_Logo-Monogram_White_Sq-2.png?fit=150%2C150&amp;ssl=1" style="width:1em;height:1em;margin-left:10px;"><img id="republication-tracker-tool-source" src="https://www.hcn.org/?republication-pixel=true&post=113500&amp;ga4=G-0NS3WVPPTN" style="width:1px;height:1px;"></p> Copy to Clipboard

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