The Best Minds opens on a green lawn in a Westchester suburb in 1973. It’s here that the book’s author, Jonathan Rosen, meets his new best friend, Michael Laudor. They are 10 years old. Rosen’s memoir ends 50 years later with Michael confined to a hospital for the criminally insane. The interim years, so full of promise and crisis, are rendered with deep humility, wisdom, and erudition in a book that is nothing less than an American masterpiece.

Raised by Jewish intellectual parents, the boys loved books and music as well as board games, politics, and pickup basketball—but their crowning compatibility was “the belief that your brain is your rocket ship and that simply as a matter of course you are going to climb inside and blast off,” Rosen says. “We would outsoar the shadow of ordinary existence and think our way into stratospheric success.”

With his photographic memory and personal charm, Michael dazzled anyone who met him, including Rosen, who regarded his mind as a subset of Michael’s. “I’d always been the tortoise to Michael’s hare,” Rosen writes. Competition would flare between them, but the cerebral rocket ship had room for both, and they blasted off to Yale College. There, the friendship cooled, owing to different majors, different friends, and Michael’s stinging view, expressed openly, that his friend wouldn’t be able to keep up with him. But their bond endured: “We carried the world of each other’s childhood in our pockets like a kryptonite pebble, a fragment of the home planet.”

After Yale, Rosen headed to Berkeley for a Ph.D. in English. Michael, the hare, graduated a year early summa cum laude (“summa cum Laudor,” Rosen quips) and took a consulting job at Bain and Company. The plan was to make a lot of money over the next decade and then turn to a life of writing.

But the pressure of Bain’s 100-hour work week combined with familial fate—psychotic illness ran in his father’s line—caused Michael to crack. Bosses were tapping his phone, he thought, and colleagues were spying on him. Once, he watched his secretary morph into a creature with claws and bloody fangs.

Within a year, Michael, then 24, was back home in New Rochelle where his psychosis blossomed further. Convinced that his mother and father had been replaced by surgically altered Nazis who had killed his real parents and now wanted to kill him, he slept with a baseball bat and carried a knife around the house.

The Best Minds is haunted by Nazis. They terrorized Rosen’s father, a professor of German literature who spoke with a soft Viennese accent—the country from which he was rescued as a teen and before he came by himself to America. Rosen and his older sister, Anna, are named for his father’s parents, murdered in the Holocaust. Nazis followed Michael into the locked psychiatric ward at Columbia Presbyterian Medical Center where he battled fears that Mengele himself was planning to remove part of his brain without anesthesia.

After eight months as an inpatient, the medications for his newly diagnosed schizophrenia worked well enough for Michael to be discharged to a halfway house. But instead of adopting the role of infantilized mental patient that social workers seemed to envision for him, he enrolled in Yale Law School.

Before his hospitalization, Michael had applied successfully to the top law schools. He chose Yale and was forthright about his mental illness with the dean, who welcomed him warmly, comparing his psychosis to an “invisible wheelchair” and promising to provide the “ramps.”

Despite delusions of monkeys eating his brain, Michael did well enough in class. Professors accommodated him when he could not do the work, and fellow students read to him when his eyes blurred from medication side effects. He began dating Carrie Costello, a shy, petite computer whiz interested in education reform. Michael graduated on time but could not find a job, so the faculty created a special postgraduate fellowship for him.

“I went to the most supportive mental health care facility that exists in America: the Yale Law School,” Michael would tell a New York Times reporter who wrote a profile of him three years later. In the Times article, Michael, then 32, described his advocacy for people with serious mental illness. “People with schizophrenia are negated constantly,” he said, “and I can be a role model.”

Titled “A Voyage to Bedlam and Part Way Back,” the Times article sparked interest from publishers. Michael’s subsequent 80-page proposal for a memoir incited a bidding war, culminating in a $600,000 contract. Soon, director Ron Howard was offering $1.5 million for the film rights with actor Brad Pitt signed to play Michael.

Michael was held aloft by the media and Hollywood as a symbol of how people with schizophrenia can succeed. But he would soon demonstrate that genius is no bulwark against unmedicated madness. Engaged to Carrie, Michael was alone in their apartment all day. As he struggled with writer’s block and fended off his nervous publisher and the Hollywood writers, his medications appeared to lose their effectiveness. Eventually, he stopped taking them. No one could compel him to resume them, especially as his delusions intensified. When Carrie, then pregnant, tried to talk him into going back on his medications, she began to look like the enemy.

On the morning of June 17, 1998, Carrie alerted her colleagues that she would be late to due to a personal emergency. That evening, police found her body on the kitchen floor, stabbed multiple times. Michael had already fled to Cornell, where he’d once been a student in a summer program, and flagged down a campus security officer. Still covered in blood, he told her he might have killed his girlfriend or maybe it was a space alien or a mechanical look-alike doll that was planning to kill him. In the next day’s New York Post, the headline was “Psycho.”

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The “best minds” in Rosen’s book belong not only to the author and Michael. They include the 1960s poets, postmodernists, public-health experts, legal theorists, and judges who put their utopian visions ahead of the vulnerable to create a system of laws and mental-health institutions whose failures continue to reverberate.

The Beats saw the mentally ill as misunderstood geniuses straining against societal norms. One of them, Allen Ginsberg, gave Rosen’s book its name. “I saw the best minds of my generation destroyed by madness,” reads the first line of his 1956 poem, Howl. Michel Foucault, whose Madness and Civilization Rosen read at Berkeley, fashioned schizophrenia as a social construct. It was a designation, not a diagnosis—a way to punish one’s ideological enemies. Asylums, it followed, were meant to keep the bad ideas contained, as well as the people who held them. But when the author visited Michael during his hospitalization at Columbia, he writes, “I found it impossible to pretend that he was suffering from a ‘social construct.’”

Policies were also misguided. President Kennedy signed a bill in 1963 designed to build a system of community-based care in place of mental hospitals. Intentions were good, but outcomes were bad. The sickest could not thrive in the community; they needed structure and a social network. Not only were there few hospital beds in case of a crisis, but the new clinics were set up to treat neurotics and the socially deprived, not those needing medication and heavy doses of benign paternalism.

At the level of federally funded research, the head of the National Institute of Mental Health at the time was a psychoanalyst who viewed all social problems as his agency’s legitimate province, so severe conditions took a distant back seat. The safety net was in tatters, too. Medicaid requirements “did not create a caring community or even an indifferent one,” Rosen observes. “Checks and pills are what remain of a grand promise, the ingredients of a mental health care system that had never been baked but were handed out like flour and yeast in separate packets to starving people.”

In the legal domain, the civil-liberties bar and state laws made it nearly impossible to intervene when a person stopped taking medication and became delusional and unstable. Families’ hands are still tied today; they can only watch their loved ones unravel, unable to get help until danger is imminent. In most states, a person must be about to kill himself or someone else before involuntary treatment can take place.

Meanwhile, efforts to destigmatize mental illness were, and still are, largely based on a misbegotten 1998 MacArthur Foundation report that was issued just weeks before Michael killed Carrie. Its press headline: “Mentally Ill, Not Especially Violent.” In truth, people with schizophrenia who are not taking medication are four to seven times more likely to commit violent crimes, such as assault and homicide.

In Michael’s case, another blow was dealt by the family friends and professors who were blinded by the glare of his genius. “Brilliance was so highly prized in our world that it seemed to guarantee all the other brain functions,” Rosen writes. Michael’s professors and supporters reflexively underplayed his vulnerability and rejected the idea that hospital containment served a vital purpose, and they thereby lost perspective on the depth of his problem.

The Best Minds makes us ask how we let these things happen—things ranging from Michael’s escalating madness to the proliferation of psychotic souls in urban encampments, roaming the streets with their “right” to liberty intact. Of course, the freedom to be crazy is no freedom at all, as many of these people—once treated—will usually attest.

Rosen shows the power of ideology and romanticization to distort the truth about both mental illness and genius. Absent a realistic and pragmatic vision, society is unlikely to agree on what we owe to people with disabling mental illness. At the personal level, the author grapples with what he owes a friend who remains so deeply estranged from reality. Michael remains confined to the Mid-Hudson Forensic Psychiatric Center, a maximum-security hospital for those judged not guilty by reason of insanity. Michael is too ill to be released.

In the quarter century since Michael’s terrible act, not a lot has changed for the most vulnerable. We can neither predict nor prevent severe mental illnesses such as schizophrenia and bipolar illness. The treatment and social-welfare systems are still full of gaps. Jail cells in many cities still hold more severely mentally ill people than do hospitals, and the threshold for involuntary care is still too high.

The Best Minds is one of the best books about mental illness I have ever read. Its grand sweep takes in the nuanced cultural history of ideas and policies regarding people with severe illness. Andrew Solomon’s The Noonday Demon did this for depression, and Scott Stossel’s My Age of Anxiety for anxiety. Those books, both superb, are grounded in memoir as well, but the specific horror of Rosen’s makes it especially unforgettable.

Reflecting upon a rare, painful visit to his still-institutionalized friend, Rosen pronounces schizophrenia to be “the most human of disorders, a reminder of how remarkable our minds are. It’s like the Tin Man realizing he has a heart because it’s breaking.”

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