E. Fuller Torrey

In psychiatry, “serious mental illness” is substitute language for bipolar disorder and schizophrenia. These two difficult diseases account for much of the homelessness that American cities see. Thus, these two diseases also account for much of where tax dollars go. The utterly tragic part, however, is that decent biomedical treatments exist for these diseases; in America, the infrastructure to treat them does not. Why? And what can be improved? This book, originally published in 1988 show more but readapted to 2025 in a second edition, attempts to answer those questions.

The author Dr. E. Fuller Torrey spent a lot of his career at the National Institute for Mental Health (NIMH), a part of the National Institutes of Health (NIH). Thus, he had a high-level view of America’s mental healthcare system. He’s spent most of his professional life advocating that serious mental illness receive a larger share of the mental healthcare financial pie. He does so not by tugging at one’s heart strings but rather by presenting overwhelming data that we’ve misappropriated governmental spending going back to JFK’s time.

We indeed can combat homelessness, he maintains, by building a better mental healthcare system that addresses these difficult, yet treatable, conditions. We might even be able to save money in the long run! Starting with Great Society reforms in the 1960s, attempts to create a mental healthcare system shut down state mental institutions. Most of those “freed” were unable to keep a steady job and simply entered the trap of homelessness. He argues that freedom from mental institutions without “freedom from psychosis” is a mirage.

Homelessness continues to tax urban infrastructures, but few politicians offer any real solutions other than sweeping them under the rug. To his credit, Torrey offers two handfuls of specific ways to improve our policy. He shows how mental health expenditures went to surface-level psychological topics instead of research to address the most difficult of problems.

Policy wonks and mental health workers will benefit the most from this work. Its offerings focus on systemic answers rather than individual ones. It offers a deep history of how we got here and why we got here. It also begs the question of when will we get the collective will to confront these problems. I’m concerned that the stigma of mental illness – still so pervasive – limits constructive conversations. If we’d only be able to fund treating serious mental illness as much as we fund other serious but common diseases, we might be able to build a better society and a more productive country. show less

In the 1960s there were two big things happening in US society. First, there were civil rights movements, and second, states and the government needed money. There began one of the largest problems seen on the streets of America today. Though most experts at the time believed that deinstitutionalization was the right way to go, no one seemed to think of the long term consequences this movement might have. Civil rights advocates argued that involuntary commitment was inhumane and that the show more laws should be changed, and so they were. Thousands of state funded hospitals for those with serious mental illnesses were closed, and most of the individuals living in them were left with no where to go.

The Insanity Offense is an accounting of the deinstitutionalization of America and the profound effect it has had on society. E. Fuller Torrey, a research psychiatrist, has followed many cases of mentally ill individuals that have been left without proper care only to cause harm. He puts a light on the real picture of what’s happening. The mentally ill have no where to turn, those who need treatment the most cannot get it because the laws say that an involuntary commitment to a facility cannot happen until the individual has actually acted in violence, not just threatened it. In many cases even if someone is taken in, they will be released after a few days, and chances are they will repeat the cycle again.

Mentally ill peoples are being left homeless, they turn violent and hurt themselves and others, they are victimized because other criminals think of them as weak and defenseless, and they are being incarcerated at higher rates than ever before, left in prisons that don’t have the resources to treat them as needed. Is that more inhumane than involuntarily committing them to get the treatment they need?

Reading this book broke my heart and infuriated me at the same time. The blindness of those with the power to change the circumstances is inexcusable. This book is a true eye-opener and it is something I can see myself referring back to in the future. Honestly, I would have to call it a “must read” because everyone should know what is really happening to the mentally ill of America. show less

This book, written in part by a psychiatrist with expert knowledge of schizophrenia, addresses the question of why mental illness has become increasingly pervasive since 1750. Starting with this date and proceeding towards the present, Torrey and Miller make a commanding case that the prevalence of mental illness has increased steadily since the age of Enlightenment, at least in English-speaking countries. The argument is forceful.

They argue against the common argument - pushed forward by show more many in prominence like Michel Foucault - that the diagnosis of insanity/psychosis is merely a way of pushing away societal nonconformists into asylums. The finding of MRI changes in those with bipolar disorder or schizophrenia, for one, argues for some kind of biology of disease, not merely a sociology. Further, the contention that genetics provides a key does not answer the question: What in modernity has led to the spread of mental diseases? Why did we not see this prior to 1750?

The authors propose a wide variety of possible (but unconfirmed) causes, all centered around the hypothesis that urbanization plays a key role. This case is well-argued and deserves attention and research. show less

A long history of malignant neglect

American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System by E. Fuller Torry, M.D. (Oxford University Press, $27.95).

Torrey, who is a psychiatrist with an impeccable reputation, has written previously on the subject of the way we treat—or fail to treat, or mistreat—the mentally ill. This book is an historical overview of the recent (last half of the 20th century) history of American treatment of people with mental show more illness, and it’s only slightly better than the snakepits that Dorothea Dix exposed in the 19th century.

Torrey’s premise is familiar to readers who have followed mental health and treatment issues: First, we created a network for mental health care, starting with the Kennedy Administration. Then, we defunded it. Then, we killed it completely by making it easier for people with mental health issues to choose not to accept treatment.

And it’s clear that Torrey is most definitely not in favor of allowing people with mental illness to “opt out” of treatment. Current law—at least in most states—limits involuntary commitment and treatment to those who exhibit symptoms that may pose a danger to themselves or others. Torrey would raise that bar considerably.

The reality is every bit as bad as he paints it, though—and part of the problem with allowing mentally ill people to refuse treatment is the agony they endure is often public, with social services at best and the police and jails at worse left to provide some sort of care.

But making it harder for people with mental illness to refuse treatment is only partially helpful, for without increased services—and even a return to institutional care settings for some—there will still be no place for them to get treatment.

This is a dose of hard truth, and Torrey is clear that the failure has been a public, bipartisan one. We have simply closed our eyes and allowed vulnerable, mentally ill people to become chronically homeless, increasingly desperate, and in dire need.

He’s right. It’s high time we took some concrete steps to remedy the situation.

(Published on Lit/Rant on 1/30/2014: http://litrant.tumblr.com/post/75040534321/a-long-history-of-malignant-neglect-a... show less