American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment Systemby E. Torrey
In 1963, President John F. Kennedy delivered an historic speech on mental illness and retardation. He described sweeping new programs to replace "the shabby treatment of the many millions of the mentally disabled in custodial institutions" with treatment in community mental health centers. This movement, later referred to as "deinstitutionalization," continues to… See more details below
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In 1963, President John F. Kennedy delivered an historic speech on mental illness and retardation. He described sweeping new programs to replace "the shabby treatment of the many millions of the mentally disabled in custodial institutions" with treatment in community mental health centers. This movement, later referred to as "deinstitutionalization," continues to impact mental health care. Though he never publicly acknowledged it, the program was a tribute to Kennedy's sister Rosemary, who was born mildly retarded and developed a schizophrenia-like illness. Terrified she'd become pregnant, Joseph Kennedy arranged for his daughter to receive a lobotomy, which was a disaster and left her severely retarded. Fifty years after Kennedy's speech, E. Fuller Torrey's book provides an inside perspective on the birth of the federal mental health program. On staff at the National Institute of Mental Health when the program was being developed and implemented, Torrey draws on his own first-hand account of the creation and launch of the program, extensive research, one-on-one interviews with people involved, and recently unearthed audiotapes of interviews with major figures involved in the legislation. As such, this book provides historical material previously unavailable to the public. Torrey examines the Kennedys' involvement in the policy, the role of major players, the responsibility of the state versus the federal government in caring for the mentally ill, the political maneuverings required to pass the legislation, and how closing institutions resulted not in better care - as was the aim - but in underfunded programs, neglect, and higher rates of community violence. Many now wonder why public mental illness services are so ineffective. At least one-third of the homeless are seriously mentally ill, jails and prisons are grossly overcrowded, largely because the seriously mentally ill constitute 20 percent of prisoners, and public facilities are overrun by untreated individuals. As Torrey argues, it is imperative to understand how we got here in order to move forward towards providing better care for the most vulnerable.
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I'm usually one who defends the government and roots for federal policies that help the poor and middle class, so it's embarrassing and infuriating to read about the mental health policies of the last 50 years. I lived through the times Torrey writes of, as a state mental health social worker in the state of Georgia for fifteen years 1967-1978. Then I began teaching. My experience of mental health programs in the beginning of my career there is all positive, with Lester Maddox heroically bringing the state up to date. I know we wasted money, but things were going well until we began cutting out state programs, and stopping progress of some that were just getting started. Torrey was at NIMH when this was happening and he details that end of what was going on. It's really even worse than I thought. Torrey writes of federal policy from the 1940s to the present in a fast and interesting way. I liked the part where he listed 13 innovative programs in 13 separate states that could have given direction to the planners of federal policy; but they paid no attention to these programs. One was Fountain House, which is one of the best. At the end of the book Torrey cites the clubhouse model and the one that would probably best meet the needs of seriously mentally ill people in the community. I wished he had said more about the Recovery Model, which is in vogue. He mentions it but it would have been good to get a more in depth analysis of the New Freedom Commission and its aftermath since 2003. Torrey has little hope for anything useful coming out of Washington. That's depressing.
The author has chronicled the development and dismantling of the modern American public mental health "system" in a work with ample criticisms of the ambitions and abilities of the would be designers' concepts and competencies. The author's ideological biases seem obvious enough, and I may not agree with all of his analysis and conclusions, but feel that it is a useful and essentially accurate story about how the modern mental health "system" started out and how it got to where it is today -but it is also somewhat incomplete in its review of how it is being dismantled and corrupted bit by bit on the state and local level.