August 6, 1999

Noel Drury, M.D., a psychiatrist, recently complained in a letter to Garrison Keillor, National Public Radio's best known humorist and observer of life in small-town America, about how one of Keillor's sketches that aired earlier this summer stigmatized the mentally ill.

Dear Mr. Keillor:

I really looked forward to listening in tonight on your broadcast of "Prairie Home Companion" on National Public Radio, especially since it was originating in Butte, in my home state of Montana. And you started out right away at your hayseedy-hip best, and I was having the predictably enjoyable time I have when I listen to your show, until the "Lake Wobegon" segment came on. As that part of your show unfolded, I began to see red, and I'm writing to tell you why.

You described in detail in that segment a character who was a 200-pound woman, seriously mentally ill, off her psychiatric medications, walking down the street in her neighborhood in the nude, with a fishing pole in hand, talking gibberish. Her behavior was quite shocking to her neighbors in the piece, but her behavior and their reactions to it were what was meant to be funny, and apparently was taken as such by the Butte audience, judging from their reaction to your narrative. She liked "knock-knock" jokes, and this was also thought to be funny, in an endearing sort of way.

The key fact that you and your scriptwriters don't get in allowing this portrayal to air, Mr. Keillor, is that mental illnesses cause anguish and are not funny-if you understand them. They cause anguish to the people suffering from them, to their families and friends, and, in those sad infrequent occasions of destructive acts, to victims and victims' families. They are decidedly not funny, if you understand them, just like there's nothing funny about cancer, high blood pressure, or Alzheimer's disease. It hurts to have a mental illness. Ask Mike Wallace or Tipper Gore.

Mental illnesses are also quite costly in many other ways. But due to such stigmatizing portrayals, especially by a nationally revered person (namely you), the costs are far greater than you might imagine. Your cheap shots at those with mental illnesses have the effect of driving people who desperately need treatment further underground. Can you guess, Mr. Keillor, what the outcomes are when people postpone, refuse, or are refused treatment for their serious mental illness? Next time you walk downtown in any city, you'll see a little bit of what I mean, although there's much more to the story, if you're interested.

The person you described on your show in many ways reminds me of someone who was once my patient. In her lifetime, she had to be hospitalized more than 20 times for her mental illness. She was quite accustomed to the kind of stigmatizing portrayal witnessed on your show-she experienced it all her life-but she didn't let that drive her away from getting treatment. Her family and neighbors dearly loved her. But just as we were starting to get a handle on better treatment for her illness, with the more advanced treatment approaches we have today, she suddenly died. I think her body just wore out from decades of stress. She is one of the most courageous and determined people I've ever known. She could have given Steve McQueen in "The Great Escape" lessons. You would have liked her-she had a great sense of humor. It is in her memory I write this letter.

From your position of influence, please help turn back the tide of stigma and ignorance that is drowning millions of Americans, many of whom may be your listeners. It can start with an understanding of the anguish caused by mental illnesses.

NOEL DRURY, M.D.

Dr. Drury is president of the Montana Psychiatric Association.

Garrison Keiller responds:

Dr. Drury refers to a story on "The News From Lake Wobegon" about Mrs. Schrupps, who went off her medications and had a psychotic episode and was taken to the hospital by the town constables, Gary and LeRoy, after she appeared in the nude waving a fishing pole at a backyard picnic and then entered the Lutheran church, where she terrified an organist.

The story was based on a conversation with a former county sheriff who responded to many such calls and who found that the mentally ill responded to ordinary friendly conversation and to the telling of jokes. That was the point of the story, I guess, insofar as it had one.

In the story, Mrs. Schrupps is not belittled or ridiculed; she is depicted as a person doing battle with immense and nameless invisible forces arrayed against her, and she becomes something of a natural force herself, a rampaging fury, though she never harms a soul.

The objects of ridicule, if there are any, are the girls in the identical blue cardigan sweaters practicing [the song] "Will You Still Love Me Tomorrow?" at the picnic, who are horrified by Mrs. Schrupps's appearance and the arrogant young organist who is rehearsing his recital and whose organ playing Mrs. Schrupps recognizes as the voice of the beast that is after her. She confronts this voice in the choir loft, and then the constables arrive.

They treat her with kindness. They talk to her as one would talk to a friend and put a blanket around her and lead her to the squad car, telling her jokes. Though she is not able to focus on the literal meaning of the jokes, she recognizes them by their cadence as being jokes and being a basic component of sociability in this culture, and she relaxes and allows herself to be cared for.

I felt at the time that there was some wisdom in the deputies' finding about jokes, some wisdom that mental health professionals might heed, but then came an angry letter from this distinguished leader in the field, who was so distressed as to feel the need to phone news media in the Twin Cities and alert them to the monster in their midst. So I ran his letter by another professional in the field who listens regularly to the show and who replied:

"My own mother was what is referred to as a 'serious and persistent mentally ill' person (we in the business refer to these poor folk as just SPMT), and to me, your comments hardly qualify as offensive. To some people, perhaps, but they really need to get a life. In our field, much of what we have to deal with is not very pretty, and we sometimes use humor to relieve stress. But we do, above all, have a profound respect for those we are entrusted to care for, and your story was respectful."

But I am not a crusader, merely an entertainer, out to amuse people for a couple of hours on Saturday night, and I realize that now our show will be monitored by people who have their angry letter all drafted and are simply waiting to fill in the blanks, and it isn't worth it to get them cranked up. It really isn't. They will have to wait many, many years before they ever hear me refer to anyone suffering from mental illness. This is a niggardly solution, and I think that silence and invisibility are the worse stigma, but it is not possible for an American humorist to deal with mental illness today without serious risk to his career. And that's my last word on the subject, and now I am going to turn my attention to lawn care.