Madmen Die Alone is one of the better detective novels set in a mental institution. Never once are we given a variety of cartoon nut cases. Each patient is presented with compassion; their diagnoses don't label them. Often Prescott thinks the patients are perfectly normal and wonders why someone as friendly and lucid as Mrs. Windowmore is in the place at all. Greene seems to be using the novel as a primer in humane understanding and a less clinical approach to the treatment and care of the mentally ill. Dr. Sylvester, frequently described as a genius by his co-workers, is someone who in this day and age might be said to have an exceptionally high emotional intelligence. Sylvester is talked about as someone with great empathy, who often knows what someone wants better than the person himself knows. He treats everyone with amazing equanimity whether they were a patient, co-worker or friend. As Johnny Dennis explains to Prescott Sylvester never thought lesser of someone if they exhibited what might be seen as negative traits such as being lazy, unambitious, moody or sullen. But Sylvester was also unconventional in his treatment methods and tended to use the patients as guinea pigs in a variety of unusual psychological experiments. A rumor begins to circulate that he intentionally let Parisi free and that it backfired on him leading to his grisly death.
Prescott learns that Parisi was criminally insane and that he came from a family of con artists and thieves. His interrogation of the family reveals that they all seem a little bit off and D.r Richards even suggests that there is a genetic tendency towards mental illness in the Parisi family. Further investigation shows that they have ties to some mob activity and Parisi's father was seeking revenge on a rival businessman and a fellow Italian immigrant. When the rival also turns up dead the same night Prescott begins to think that an elaborate vendetta was put into action with the escaped madman part of the plan and the intent of using Joseph as a scapegoat.
However, the two storylines don't mesh all that well. When the plot is focused on the Exeter hospital, it's staff and patients the book is both engaging and informative, often enlightening in Greene's ideas about how to better understand mentally ill people. When the plot travels outside of the hospital into the city and we are dealing with the Parisi family, a couple of teenage thugs and a posse of stereotyped Italian American gangsters the book devolves into the netherworld of pulp magazine cliches. Much of the plot becomes too predictable and a final twist in the revelation of Sylvester's murderer comes not as the intended surprise but as an anticlimax.
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Reading Challenge update: Golden Age card, space D6- "Author has name with initial same as me"
Josiah and John both start with J.