That Way Madness Lies... | Kathleen M. Pike, PhD |

Shakespeare was the master of tragedy. And King Lear is the quintessential tragic hero. Driven to madness by a cosmic collision of errors and misfortune, King Lear laments, “O, that way madness lies; let me shun that; No more of that.”

Yes, noble men can succumb to insanity. So can noble institutions. And so it is that our psychiatric hospitals, mental health policies, and legal systems can seem downright insane at times. That Way Madness Lies… is a documentary by filmmaker Sandra Luckow that portrays the descent of her brother, Duanne, into psychosis. It also captures the crazy, broken mental health system that the family encounters in their desperate efforts to help Duanne.

On May 11, 2017 That Way Madness Lies… premiered in Portland, Oregon as part of the Northwest Tracking series at the NW Film Center. The film is a tragic story about a singular family. It is also the story of anyone in America who had to deal with serious mental illness. And the greatest tragedy of all is that there are no bad guys. Everyone – well almost everyone – is trying to do right by Duanne, but the system has gone mad.

1. The patient, Duanne Luckow. “I’ve been through a lot,” Duanne says, summarizing years of involuntary admissions to mental hospitals, treatments he didn’t want, and discharges to the streets. The healthcare system for those with serious mental illness has become a complex web that is knotted up in bureaucracy, inefficiency and conflicting policies. Duanne and many like him wind up disenfranchised, voiceless, and unsupported. The system doesn’t operate as if it is on their side.

2. The rest of the Luckow family. Early in That Way Madness Lies…, Sandra, Duanne’s sister and the filmmaker, calls the hospital where Duanne is a resident. Because of patient privacy laws, no one can give her any information, not even to confirm he’s there. Patient privacy is paramount, and Duanne is an adult. But when individuals with serious mental illness go missing, and the flair up of their disorder specifically and directly interferes with their judgment or ability to notify family members, the standard privacy laws don’t work in these not-so-rare cases. When families are prohibited access to information about their loved one’s whereabouts, they are unable to provide essential supports that we know aid in recovery. Clearly, at times like this, families do not experience the system as being on their side.

3. The police officers. “Can you take your hands out of your pockets just so we can make sure you don’t have any weapons?,” the police officers ask Duanne as they enter his house. Police officers have little training in dealing with mental health crises, yet they are frequently our first responders – and the number of mental health related encounters has skyrocketed in recent years. To make matters worse, their hands are tied. They can only act if individuals are in imminent danger of hurting themselves or someone else or if a crime has been committed. Thus, individuals with serious mental illness are not getting care early, even though early intervention leads to better outcomes. Instead, they often become criminals in our justice system first and then get mandated mental health care – which is limited to restoring them to trial competency so that their case can proceed within the judicial system. It’s clear that the system is not on the side of police officers.

4. The nurse. Involuntarily committed at the Western State Hospital in Tacoma, Washington, Duanne Luckow is lauded by a young nurse as a model patient – always polite, never causing problems. In the unfolding parallel stories of Duanne’s mental illness and the insanity of the system, her hope and optimism are refreshing but painfully naïve. Staff at inpatient mental health facilities dedicate their lives to serving people with serious mental illness, but their work is difficult, sometimes dangerous, and the system frequently thwarts their best intentions. Limits to inpatient stays because of insurance coverage, lack of continuing care, and a heavy focus on legal risk management undermine the effectiveness of the care that hospitals can provide. Often it seems mental health professionals are doing their best in spite of the system.

5. The judge. King Lear descends into madness in Act 3. It’s about Act 3 of Duanne’s story when a judge determined that Duanne was an imminent danger to himself and others and ordered that he be involuntarily committed. The legal system was meant to be a last resort to provide guidance in exceptional cases of individuals with mental illness. Instead, lawyers and judges frequently find themselves at the center of decision making about care and services for people with serious mental illness. The laws governing incarceration, involuntary treatment, and mandated care are guided primarily by considerations of safety – necessary but not sufficient in these terribly complex situations where lives are at risk.

That Way Madness Lies… is a must see. There are no bad guys. But the system is broken. It is the essence of tragedy. The film raises many questions, and instead of answers, we – like King Lear – find ourselves in a quagmire of conflicting interests, policies, and despair.