In 1860, Mrs. Elizabeth Packard had a conversation with a traveling sewing machine salesman. Her husband, a Calvinist minister named Theophilus Packard, was on her mind. Elizabeth had recently caused quite a ruckus when she stood up in the middle of one of her husband's sermons, and announced that she was crossing the street to the Presbyterian church, whose religious views aligned better with hers.

"She found fault that Mr. Packard would not discuss their points of difference in religion in an open manly way instead of going around and denouncing her as crazy to her friends and to the church," the salesman later testified. He pointed out that she "had a great aversion to being called insane. Before I got through the conversation she exhibited a great dislike to me."

The dislike was earned. The salesman was, in fact, a physician, Dr. Knott, who was secretly examining her at the behest of her husband. "Her mind appeared to be excited on the subject of religion…. I would say she was insane."

During that time in Illinois a public hearing was required before a person could be committed against their will, with the exception of a husband committing his wife. This is what happened to Elizabeth Packard after her conversation with the undercover Dr. Knott. She spent three years in an asylum before managing to sue her husband. She was found sane by a jury and set free.

When she returned home, Theophilus had sold their house, and taken the children to Massachusetts, leaving her with nothing.

With mental illness being so poorly understood then, let alone now, the model of involuntary incarceration was ever a tricky proposition. Even for those with diagnosable mental issues, the medications of the day proved substandard.

Drs. Megan Testa and Sara G. West wrote a 2010 paper called Civil Commitment in the United States that covered this:

Most persons who ended up in American asylums were patients suffering from dementia, seizure disorders, diseases involving paralysis, or advanced neurosyphilis. These individuals were incurable by the available treatments of the day. Asylums thus became long-term homes for chronic patients whose care consisted of restraint, sedation with medications, such as bromides and chloral hydrate, or experimental treatment with opium, camphor, and cathartics. These treatments were neither effective in curing patients nor did they affect a level of improvement that could render patients able to survive outside the facilities.

In 1953, the population in asylums peaked at 559,000. Two years before this, a breakthrough drug Chlorpromazine — better known by the trade name Thorazine — was discovered. The drug was so effective at treating previously unmanageable psychosis that the idea of out-patient treatment became feasible as it began to grow in application during the 50s.

Ten years after that population peak, John F. Kennedy signed the Community Mental Health Centers Act, with the idea of transitioning asylum patients into communities, where they would have a web of support. By the 1990s, the number of psychiatric inpatients was down to 30,000.

Today, the chronic underfunding of community mental health programs and courts has made prisons into default mental health care facilities. One study estimates that 20 to 30 percent of Washington’s 16,700 inmates are suffering from some kind of mental illness.

Which leads us to a particularly nasty fact of our modern world: a mentally ill person who denies their illness needs to be accused of a crime before they can get help. The families of the mentally ill are powerless as they witness the escalation of erratic and dangerous behaviors escalating, without a way to invoke intervention. Dangerous, but not criminal, behavior, then, is not treated as a marker. It is as if there is no life before a crime, at least, not in the eyes of the state.

On July 19, 2009, Isaiah Kalebu entered the South Park home of Teresa Butz and Jennifer Hopper while they were sleeping, and subjected them to a nightmare in real life. At the end of the ordeal, Teresa Butz was dead from knife wounds, Hopper was badly wounded, and Kalebu had escaped.

Eli Sanders has been watching this story since the beginning. At the Stranger, crime and the city were his beat. Though that work, he developed a specific interest around crimes committed by mentally ill people who had fallen the through the cracks of the system. He was there when Kalebu was arrested, and he was there for every step of each trial.

His reporting of Hopper's court testimony of the attack (while she was still maintaining public anonymity) “The Bravest Woman in Seattle” won him a well-deserved Pulitzer Prize, and convinced that very brave woman to come forward and attach her own name to the story.

While the City Slept is his book-length investigation of the crime, the lives behind it, and the system that, he artfully shows, allowed it to happen.

It is not an easy book to read, in the sense that every aspect of it is heartbreaking. Certainly, foremost, the attack itself is heartbreaking. It is difficult to read about Teresa Butz and not lament her death. It is difficult to read about Jennifer Hopper, who suffered so greatly in the attack herself, and then struggled with the added burden of mourning her fiancée — Teresa Butz's memorial service was held in the venue they rented for their commitment ceremony (at the time of her death, gay marriage was not legal in Washington State).

But it is also heartbreaking to hear the story of the man who committed these crimes. Sanders lays the evidence before you of the many, many times over a difficult life that the state was not only involved in the life of Isaiah Kalebu, but with dire outcome, was repeatedly unwilling or unable to help him.

Sanders has a deft hand, and a sensitive approach and avoids the sensational. While never shirking from the hard facts of the story, he presents an artful narrative that adds context and consideration every step of the way.

For example, the start of the book gives a quick detail of the attack, as seen from the neighborhood and outside the house. But when the time comes to describe what happened in that room he presents it through Hopper's court testimony. This allows her dominion over the narrative. She is the one who takes us inside, and tells us what happened. In the courtroom, as she testified:

The horror of what happened next made the court reporters's eyes well up, made the bailiff cry. The jury handed around a box of tissues. The prosecutor took long pauses to collect himself. The family and friends in the courtroom cried (although, truth be told, they had been crying throughout). The Seattle Times reporter seated next to me cried. I cried. The camerawoman who was shooting video for all of the television stations in town cried, and later hugged Jennifer as she left the courtroom for a mid-morning break.

If you have second thoughts about reading this book because your heart may break, well, that's a fair consideration — although, my feeling is that since Jennifer Hopper is strong enough to stand up and tell her story, the least I can do is be strong enough to hear it.

Teresa Butz's brother Norbert, an award-winning Broadway actor and singer, is quoted in the book as saying:

“You know, people say 'Breathe, take a breath' when someone is in distress. 'Breathe, take a breath.' Well, you know, singing is breath. It's breath. It's taking breath after breath after breath. You can't sing unless there's been a breath taken, and that feels — for me, that was a natural — is a natural way to get back into my body. I have not died. I have not been flung off the face of the earth. The universe is not crashing.

But if you're concerned that the book will be insensitive to either the victims, or to the reader, you should be reassured. If you are concerned whether the book is exploitative, then you should be reassured. The book is wholly remarkable, and the heartbreak it delivers is a heartbreak we all share responsibility for.

One of the heroes of this story is Dr. Maria T. Lymberis, who was hired by the court to create a forensic psychological workup of Kalebu. Her clear-eyed reasoning, bright prose, and unflinching assessment shows exactly the straight approach so badly needed in addressing mental health issues.

Sanders relies heavily on her report, and also interviews her (although, she cannot speak of Kalebu outside of the context of her report, she does offer other thoughts).

Through research and interviews, Dr. Lymberis illuminated Kalebu’s history: failed by the system when he was a boy suffering abuse from his father; failed by the system as a teenager when he had his first run-ins with the police; failed by the courts when he was a pawn in a vicious divorce; failed by the courts when he first showed signs of a mental disorder; failed by the courts when his family was begging them to help with his mental illness.

“And here we go,” said Dr. Lymberis. “When the family turned to the system, the system had the same dynamic as the family.” The system was under financial stress. It was under time pressures. It had dysfunctions and limitations. No one could pay enough attention. Which was all well-known to people within this system. For decades, commissions at the state level, just like their counterparts at the federal level, had presented papers urging change, action, bigger fixes, more funds. “But, you know, everybody’s too busy with their own narcissism, and with the narcissism of the country, to really address problems,” Dr. Lymberis said. “So here we are.”

Kalebu is intelligent, and this intelligence made his prosecution difficult. Various doctors disagreed on whether or not he was faking symptoms of mental illness to derail his own trial. But he was certainly delusional, and was obviously unable to act in his own best interest.

What emerges, in sharp contrast to so many true-crime stories, is not one of a systematic failure, after his arrest — that failure comes in the twenty-three years before his crime (and, potentially, another double murder he is implicated in, but has never been charged with, that left his aunt and another gentleman dead in Tacoma a few days before the attack on July 19).

But the judge, defense, and prosecutors all seemed single-minded on making sure that not only that Kalebu got a fair trial, but that justice was ably served. It's a slow process, mired by the chaos Kalebu continually attempted to interject into the plodding proceedings. His sentencing took place over two years after the original attack.

When we look back on the injustices inflicted on women such as Elizabeth Packard — all evidence points to a three-year sentence for standing up to her bully of a husband — we have no choice but to assure that innocent people are not institutionalized without an opportunity to prove themselves sane. Packard spent the rest of her life working to make sure what happened to her would not happen to other women, both in terms of being forcibly committed, but also in terms of women being able to retain property and access to their children.

Surely there is a stopping point between Packard's experience, and the complete lack of support we have now? Sanders says that some were trying to work on this exact problem:

Over the decades that passed after President Kennedy signed his 1963 Community Mental Health Act, whenever crises arrived, whenever budgets had to be cut, expensive programs designed to help a marginalized and stigmatized population, now dispersed throughout many communities and possessing little political clout, tended to the be first to get the knife. Dreams of widespread education about psychological instability did not materialize, either. Nor did dreams of services capable of responding rapidly to any individual in crisis. By 2008, when Isaiah found himself in crisis, multiple presidents had been warned that the system put in place by President Kennedy was failing because of neglect and was riddled with disparities and limitations. The same presidential commission that had described America's "patchwork relic" of a mental health care system had, in its final report in 2003, called for a "fundamental transformation" of the country's entire approach to people in psychological distress. It imagined a system in which, "at the first sign of difficulties, preventative interventions will be started to keep problems from escalating." This commission was called the New Freedom Commission on Mental Health, and it reported to the then president, George W. Bush, who created it intending to fulfill a campaign promise. However the commission had the misfortune of competing for attention with the aftermath of September 11, 2001.

It's not the metaphor Sanders chooses, but health care in this country is akin to the Arctic Ice Sheet. Whereas once it was frozen solid, allowing nobody to fall through, even if they were equipped to swim, it fractured to icebergs broken from any mooring, and then dwindling small chunks free floating in a warming sea.

But unlike global warming, mental health is an issue both sides of the aisle in American politics like to rally around, at least until the specter of actually funding programs is raised.

Perhaps we can send a few copies of While the City Slept to the other Washington. Perhaps you reading it, and talking about it, will convince some of your friends to do the same. Sanders has given us the tools for a needed conversation, and it is high time that we started it.