American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System

“Throughout history the problem of the mentally ill has been dodged. We have continually avoided mentally ill patients—we have segregated them, ostracized them, turned our back on them, tried to forget about them. We have allowed intolerable conditions to exist for the mentally ill through our ignorance and indifference. We can no longer afford to ignore their needs, to turn a deaf ear to their calls for help. We must come face to face with the facts.”

This one is tough. I'm going to just split up evenly into positive and negative.

POSITIVE: While some might have felt the author spent too long on JFK, I thought it was incredibly interesting. It helped create historical depth and context for a book that is largely about analysis of show more modern policy. While I'm not necessarily a Kennedy fanatic, I had never heard of Rosemary Kennedy and found her story profound. I'm not sure how much relevancy all of the details had (I really don't need to know how hard the Kennedys tried to keep her from having sex), but all in all it was a compelling section.

In general, the message of the book is concise and positive. As shown by the quote I shared above, the author feels that this country has a system (or lack thereof) for mental healthcare based on a simple ideology: keep them out of our view. In the name of this mission, we have allowed our mentally ill to rot on the streets and in our prisons. People die very day from suicide, and immeasurable suffering is caused by psychiatric disorders, especially among today's youth. Talking about how damaged our mental healthcare is must continue, it's not only important but it's literally a matter of life and death(s). So good on that.

NEGATIVE: The approach to the book can be questionable. The consequences of deinstitutionalization are often outlined by listing off violent crimes perpetuated by the mentally unstable, which perpetuates stigma and stereotypes that the author himself refutes later on. The author looks down his nose on certain existing programs, and in general he doesn't seem to be super on board with the idea of casual, low-level treatment such as in-home help and community programs. These might not stop someone in severe need of help, but they do provide plenty of good to society and I thought it was strange how he would talk about them sometime. Just in general, you can tell this book was written by a Psychiatrist and not a therapist, or for that matter an actual person with mental illness.

It's the classic trope that I've complained about on here before: Stories of the mentally ill and how they need our help, Written by Concerned Parent, or Concerned Expert, or Anyone Besides A Person With An Actual Illness. Those that live with mental disorders are not given a platform to talk, instead they must allow people to speak on their behalf through whatever lens their "ally" might prefer.

The book was frustrating at times, and insightful at times. I learned a lot but also kind of got mad at the author a lot. Solid 3 stars. 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 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, show more 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

In this strongly stated book, Torrey describes how the formation of the National Institute of Mental Health (NIMH) was formed, accompanied by well-meaning, but ill-planned federal programs for the out-patient care of mental ill patients and the emptying of state-funded mental hospitals. Due to terrible conditions in state hospitals and to the discovery of antipsychotics, many well-intended people wanted to improve the condition of mentally ill people by giving them independence and better living conditions through outpatient treatment. So the founders of NIMH, with the help of President Kennedy, began a federal program intended to care for patients on an outpatient basis, as well as providing resources which were intended on reducing show more the onset of mental illness in future generations. Unfortunately, as the state hospitals closed en masse, these federal programs didn't do their job as intended. The federal programs focused too much on trying (and failing) to reduce the new onset of mental illness, and not enough on taking care of people who were released from hospitals. Many people from the hospitals had nowhere to go and/or stopped taking their meds (for various reasons). The populations of homeless and jailed/imprisoned mentally ill people skyrocketed. Violence by and against people with mental illness skyrocketed. Chaos ensued.

Torrey provided convincing background and evidence that the federal program has failed and that the en masse emptying of state hospitals was a huge mistake. It did a fantastic job of laying out the problems as they stand as well as some of the history as to how we got to the failed mental healthcare system of today. However, he did not provide adequate solutions to the problems presented. Even the chapter whose title was dedicated to solutions was only a recap of the problems with few real solutions presented. And those that were presented were not argued in-depth. I'm still giving the book 4 stars, though, because it was interesting and informative. show less

I walk a lot - always have - so I observe the world from the pedestrian's point of view. Streets, businesses, people - everything is at eye level and throughout my life I've seen more and more people on the streets who are very ill. There's the girl who wanders about downtown - half naked, barefoot, talking to herself, occasionally screaming at passersby. There's the guy I've watched go from mildly eccentric - hanging out in front of the Walgreen's with his boombox powered by a car radio - to almost catatonic - huddled in the corner of a building, covered in filth, unable to move or speak. I haven't seen him in awhile. Variations of these scenarios play out all over - these are the more dramatic examples.

Then there are the people who show more are high-functioning, but who occasionally need a little extra help and quickly learn the strict limitations their health insurance imposes on this kind of help. More and more people are steered toward classes and group therapy (whether or not these are indicated for their disorder). Fewer and fewer people have a real care team, anything resembling coordinated care. Psychiatric medications are staggeringly expensive and most have side effects. It takes time to find the right combination of medications for any individual and even more time for the effects to truly kick in. Most anti-depressants don't make themselves felt until six weeks after a patient begins taking them. People give up, can't muster the energy to be active consumers, can't afford their medications, can't get the help they need. This is a scandal and American Psychosis walks its reader through the history of the failed experiment. show less

This book tells the story of the American mental health system, starting with JFK's "reforms" and ending with the Affordable Care Act. JFK, whose sister suffered from mental retardation and a failed partial lobotomy, assuaged his family's "guilt" by reforming the system to close the state-run mental hospital system. This step federalized the system and took away state responsibility for these actions. In its place, no one - especially a partisan, semi-dysfunctional Congress - takes full responsibility for those struggling with serious mental issues.

In particular, it points out the problems our country has faced with serious mental illness (e.g., schizophrenia and bipolar disorder). For these, deinstitutionalization does not pose a show more permanent solution as they require inpatient watching, sometimes for the rest of the patient's life.

Dr. Torrey overlooks the positive steps JFK's system took towards those with easier-to-tackle mental issues (e.g., Post-Traumatic Stress Disorder and Major Depression). He also fails to fully acknowledge the problems with the prior system of state-run hospitals. Living herded together like cattle is not really a functioning system to begin with. Getting rid of a dysfunctional system for another dysfunctional system is a relatively even-sum game. The remaining question is what steps ought one take towards assuaging these problems.

Dr. Torrey ends with a chapter of policy analysis and proposals which are frankly the best part of this book. He frames these in ten summarized points which will surely tantalize the policy wonks who live among him in Washington, D.C. One can hope that the true knowledge in this book will speak to our Congress and action can be taken for the most difficult psychiatric cases, for whom very few people know about or care about. These patients cannot lobby for themselves, but we can act for them. show less

Torrey has been a voice in the wilderness advocating for better treatment of the mentally ill for years. This was especially interesting to me as I was briefly a caseworker for the chronically mentally ill in a city with a large number of deinstitutionalized patients; I learned about the policies that resulted in the conditions I saw on the street. A passionate and well-researched analysis; at times a bit academic and statistic-heavy. The book I wish Torrey would write is his personal experiences of growing up with a mentally ill sister, and how that has influenced his career.

Found it to be a very interesting read. Well written and flows nicely for a non-fiction book. Thoughtful look about how mostly decent intentions went very awry.