Many of the stories Earley investigates are influenced by, or are the result of, deinstitutionalization movements decades earlier. Deinstitutionalization began in the 1960s, partly in recognition of the poor and often abusive conditions at psychiatric hospitals; over the following decades, adults with mental illnesses or developmental disabilities were released from institutions without proper support systems. Earley views this movement as merely shifting where people with mental illnesses are put away: “[O]ur jails and prisons have become our nation’s asylums because there is nowhere else for the mentally ill to go” (354).

Part of the problem with deinstitutionalization, Earley suggests, is that it occurred at a time when the medical understanding of mental illness was more limited than it is today. Theories of mental illness often stressed environment—e.g., an individual’s upbringing—rather than potential biological causes. Earley argues that mental illness is a form of chronic illness without a cure, meaning it often persists throughout an individual’s life. For example, Gilbert, Jackson, and Hernandez each relapse several times. They struggle to take their medication and stay off the streets even though they know their mental illness will spiral again. However, the virtual inevitability of relapse is most pointedly brought home in Earley’s discussion of his son.