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

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

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by E. Fuller Torrey
     
 

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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

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Overview

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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Editorial Reviews

From the Publisher
"For a few days in September—after a psychotic gunman killed 12 people in Washington's Navy Yard—we were forced to ask ourselves, yet again, how we treat the seriously mentally ill in America and whether we need to rethink our policies and assumptions. No one is better equipped to address those questions than E. Fuller Torrey." —Sally Satel, Wall Street Journal

"This is a powerful book on how to prevent the high profile tragedies that galvanize national attention, and the thousands of other tragedies that pass under the radar. I highly recommend it to all advocates and policymakers who care about mental illness."
—Huffington Post

"This wise and unflinching book is an object lesson in good intentions gone awry on a grand scale. It should be widely read." —New York Times

"An important book by a refreshingly candid author who shares his vast knowledge in the interests of the needy." —Kirkus Reviews, starred review

"Torrey is the conscience of the country and its most articulate spokesperson when it comes to public mental health care. His latest installment, American Psychosis, is a scathing analysis of the abject failure of U.S. mental health care policy written in his usual lucid and compelling style. Torrey is the Dorthea Dix of our time." — Jeffrey A. Lieberman, MD, President Elect, American Psychiatric Association; Lawrence C. Kolb Professor and Chairman of Psychiatry, Columbia University College of Physicians and Surgeons; and Director, New York State Psychiatric Institute

"The first time I heard Torrey speak at a meeting of psychiatrists I was so offended I got up and left. Five years later I realized that everything he had said was true. This book will, I believe, offend many people; hopefully it will take them less time to recognize the truth of what Torrey has written." — Alan A. Stone, MD, Former President of the American Psychiatric Association, Touroff-Glueck Professor of Law and Psychiatry in the Faculty of Law and the Faculty of Medicine, Harvard University

"Torrey's superb new book is a devastating indictment of America's mental health 'system,' a story of good intentions gone disastrously awry. Torrey combines a deep professional knowledge of severe mental illness with an unparalleled understanding of the politics and policy of mental health. His lively writing weaves together powerful and poignant examples of the problem with hard-headed and yet compassionate solutions to one of America's greatest public policy tragedies." — Stuart M. Butler, PhD, Distinguished Fellow and Director, Center for Policy Innovation, The Heritage Foundation

"With persuasive facts and gripping, tragic examples, Torrey documents what state psychiatric hospitals, community mental health centers, and jails have in common: millions of seriously mentally ill people treated inhumanely and inadequately, causing deterioration in the care of the most vulnerable. He examines the lessons learned from mental illness service programs over the past 50 years and concludes that we should greatly expand the best, such as proven programs in Wisconsin and New York City, and eliminate the worst, such as for-profit mental illness providers like nursing and board and care homes. American Psychosis is an unprecedented, invaluable elaboration of how to alter a national tragedy." — Sidney M. Wolfe, MD, Public Citizen Health Research Group, Co-author of Worst Pills, Best Pills, and Editor, WorstPills.org

"Vintage Torrey: Comprehensive, deep, and thoughtful; biting and to the point; yet hopeful and hoping for change." — John A. Talbott, MD, Professor of Psychiatry, University of Maryland School of Medicine

"The author successfully weaves in political, social, and medical influences of the time, permitting readers to comprehend the challenges faced during this period. It is clear the author has a passion for this subject, and he provides solid conclusions that should leave readers wondering when, if not now, is the appropriate time to overhaul the system once again." -Steven T. Herron, MD, Doody's Health Sciences Book Review

Doody's Review Service
Reviewer: Steven T. Herron, MD (Assurance Health and Wellness)
Description: Most of those familiar with the mental health system in the United States are aware of the challenges faced when working with those with psychiatric illnesses. In order to appreciate where we are now, it is important to understand where we came from.
Purpose: Given the half-century that has passed since President Kennedy signed the Mental Retardation Facilities and Community Mental Health Centers Construction Act in 1963, the author explores the reasoning behind the law, its intention, and its unfortunate consequences.
Audience: Though intended for individuals in the field of mental health, this work is potentially useful for anyone interested in the state of the current mental health system and how those responsible for its inception envisioned it would develop in the wake of significantly reducing state psychiatric hospital populations.
Features: Reading more as a narrative than a textbook, this work initially provides some history regarding the Kennedy family and travels fluidly to the architects of the "new" system to its conclusion with the author's 10 "solutions" for the current troubled mental health system. Additionally, there are some interesting black-and-white photographs that allow readers to associate names with faces.
Assessment: This book provides interesting insights into the reasoning behind the push to revamp the mental health system in the late 1950s and early 1960s. Since many of the players who were heavily involved in this decision making process are no longer living, this book allows us to appreciate the process through the eyes of those working tirelessly to overhaul the outdated system. Though the book is brief, the author successfully weaves in political, social, and medical influences of the time, permitting readers to comprehend the challenges faced during this period. It is clear the author has a passion for this subject, and he provides solid conclusions that should leave readers wondering when, if not now, is the appropriate time to overhaul the system once again.
Library Journal
11/15/2013
Torrey (executive director, Stanley Medical Research Inst.; psychiatry, Uniformed Services Univ. of the Health Sciences) continues to argue that deinstitutionalization of mental patients has precipitated the deterioration in U.S. psychiatric care, simultaneously flooding communities with untreated and/or homeless populations of the mentally ill. This is not a new argument for Torrey (The Insanity Offense: How America's Failure To Treat the Seriously Mentally Ill Endangers Its Citizens; Out of the Shadows: Confronting America's Mental Illness Crisis), who has spoken out about the issue for years. The book does provide additional historical background on the genesis and collapse of the community mental health movement. The author traces the beginnings of the movement to President John F. Kennedy and his family's guilt about Rosemary Kennedy's lobotomy. Kennedy wrested control of psychiatric institutions from the states, instead creating federal programs that were bound to fail because they were virtually unenforceable and provided no backup support systems for patients who were cast out of hospitals. The leading luminaries at the National Institute of Mental Health successfully lobbied for federalization, thereby leaving the mental health treatment system in shambles. Torrey helpfully offers solutions, maintaining that successful care can come through community mental illness centers, not community mental health centers. In the end, his argument is convincing. VERDICT This powerful polemic presents a compelling case for the reform of the mental illness treatment system.—Lynne Maxwell, West Virginia Univ. Coll. of Law Lib., Morgantown
Kirkus Reviews
Psychiatrist Torrey (The Insanity Offense: How America's Failure to Treat the Seriously Mentally Ill Endangers Its Citizens, 2008, etc.) returns to the battleground of reform with another book about the inability of government agencies and private institutions to care well for the severely mentally ill. The author names individuals who, in his opinion, are responsible for the disaster of mental health care across the United States. Here, Torrey focuses more on the historical reasons for the sad situation, with special emphasis on the family of President John F. Kennedy. Since Kennedy's sister Rosemary was developmentally disabled and increasingly unstable as she aged, the new president had a high awareness of hidden mental illness problems. But his push for federal mental illness legislation, however well-intended, dismantled the state-based mental hospital system without sensible alternatives in place. As a result, Torrey explains, what became known as "deinstitutionalization" placed tens of thousands of severely mentally ill patients in communities entirely unprepared to care for them. Torrey excoriates the leadership at the National Institute for Mental Health for their inability to anticipate the disaster and subsequent failure to admit their mistakes and take corrective action. After devoting about two-thirds of the text to the historical record, Torrey offers a chapter titled "Dimensions of the Present Disaster, 2000-2013," in which he lucidly explains how community jails and state prisons have become the new centers for warehousing severely mentally ill individuals. The final chapter is filled with sensible recommendations that could be funded by current misguided expenditures that Torrey estimates at about $140 billion annually. The author makes clear that the solutions will require not only vast funding, but also a long-term commitment by trained caregivers, plus family members who insist that their mentally ill relatives be committed to institutions when dangerous to themselves and innocent bystanders. An important book by a refreshingly candid author who shares his vast knowledge in the interests of the needy.

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Product Details

ISBN-13:
9780199988716
Publisher:
Oxford University Press
Publication date:
10/01/2013
Pages:
224
Product dimensions:
6.20(w) x 9.30(h) x 0.80(d)

Meet the Author

E. Fuller Torrey is Executive Director of the Stanley Medical Research Institute in Chevy Chase, MD, founder of the Treatment Advocacy Center, and Professor of Psychiatry at the Uniformed Services University of the Health Sciences.

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American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System 4.5 out of 5 based on 0 ratings. 2 reviews.
LKurtz More than 1 year ago
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.
Anonymous More than 1 year ago
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.