The Best Minds: A Story of Friendship, Madness, and the Tragedy of Good Intentions

In The Best of Minds, the story of Michael Laudor is placed in the wider context of the history of mental healthcare in the United States. The 20th century brought about significant changes in mental health treatment and legislation, reflecting evolving societal attitudes toward mental illness, individual rights, and the role of the state.

In the first half of the 20th century, mental illness was often met with ignorance and fear, leading to the widespread stigmatization of individuals with such conditions. Many Americans viewed mental illness as a shameful secret, and those affected often faced social isolation and discrimination. This era was marked by the prevalence of large, state-run psychiatric hospitals, where patients were often subjected to inhumane treatment, including overcrowding, electroconvulsive therapy, and lobotomies. These institutions further perpetuated the stigma surrounding mental health, as they were isolated from mainstream society.

In the 1950s, the mental health landscape began to change with the advent of psychotropic medications such as chlorpromazine (brand name Thorazine), which offered a more effective means of treating mental illness. At the same time, a backlash against the inhumane treatment associated with psychiatric hospitals occurred. The deinstitutionalization movement played a crucial role in shifting the focus from long-term hospitalization to community-based care for people with mental illnesses, leading to the Community Mental Health Act (1963). In Rosen’s text, this well-intentioned ideology is embodied by “the Network”—a group of individuals who perceive enforced hospitalization as the last resort of psychiatric care.

In The Best of Minds, the author explains how other prevailing ideologies contributed to deinstitutionalization during this era. Members of the civil rights movement perceived psychiatric institutions as another form of segregation. Meanwhile, the counterculture of the 1960s increasingly celebrated “madness” as a non-conformist response to societal oppression. Even literary theory participated in the dialogue about mental health, as post-structuralists like Michel Foucault presented “madness” as a social construct. Rosen points out that while these concepts destigmatized mental illness, they also largely ignored medical facts and the need for treatment. This disregard for the practical needs of patients with mental illness was reflected in the inherent flaws of deinstitutionalization. While many psychiatric hospitals were closed, insufficient community-based mental health centers opened in their place. As the deinstitutionalization movement progressed, it became apparent that many individuals with severe mental illnesses were not receiving adequate care in the community.

Concerns surrounding liberty and the violation of human rights also led to legal reforms that transformed involuntary hospitalization laws. The case of O’Connor v. Donaldson (1975) was pivotal in establishing that the involuntary commitment of an individual required a determination of dangerousness to themselves or others. This legal precedent aimed to protect the civil liberties of individuals with mental illnesses. However, the legislation also left the assessment of dangerousness open to flawed decision-making. In many cases, it also led to inadequate treatment for those in need of medication or hospitalization. Rosen vividly illustrates this point with the example of Michael Laudor. Despite refusing to take his medication and experiencing paranoid delusions, Michael was not considered a danger before killing his girlfriend. The memoir highlights the irony that many people with mental illnesses only receive the support they need once they have committed a violent crime.