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American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System 1st Edition

by E. Fuller Torrey (Author)
4.6 4.6 out of 5 stars 173 ratings
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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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  1. ISBN-10
    0199988714
  2. ISBN-13
    978-0199988716
  3. Edition
    1st
  4. Publisher
    Oxford University Press
  5. Publication date
    October 1, 2013
  6. Language
    English
  7. Dimensions
    6.2 x 0.9 x 9.3 inches
  8. Print length
    224 pages
  9. See all details
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Editorial Reviews

Review

"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

Book Description

E. Fuller Torrey's book provides an insider's perspective on the birth of the federal mental health program

Product details

  • Publisher ‏ : ‎ Oxford University Press; 1st edition (October 1, 2013)
  • Language ‏ : ‎ English
  • Hardcover ‏ : ‎ 224 pages
  • ISBN-10 ‏ : ‎ 0199988714
  • ISBN-13 ‏ : ‎ 978-0199988716
  • Item Weight ‏ : ‎ 1.05 pounds
  • Dimensions ‏ : ‎ 6.2 x 0.9 x 9.3 inches
  • Customer Reviews:
    4.6 4.6 out of 5 stars 173 ratings

About the author

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E. Fuller Torrey

E. Fuller Torrey

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E. Fuller Torrey, M.D., is a research psychiatrist specializing in schizophrenia and bipolar disorder. He is the executive director of the Stanley Medical Research Institute, the founder of the Treatment Advocacy Center, a professor of psychiatry at the Uniformed Services University of the Health Sciences, and the author of twenty books. He lives in Bethesda, Maryland.

Customer reviews

4.6 out of 5 stars
173 global ratings

Customers say

Customers find the book very informative and well-documented. They describe it as an excellent, important, and impressive work. Readers also praise the writing style as wonderful and easy to read. Opinions are mixed on the clarity, with some finding it good and sensible, while others say the conclusions are flawed and hasty.

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InformativeReadabilityWriting styleClarity
18 customers mention "Informative"18 positive0 negative

Customers find the book informative, well-documented, and fascinating on many levels. They say it's a comprehensive history of mental health policy in the U.S. and the author makes wonderful recommendations in the conclusions.

"...It is fascinating on so many levels: the imperfections of human decision making laid bare...." Read more

"...He is thorough and well documented in each book, and his writing style is very readable...." Read more

"There’s a decent amount of good information in here, but the author misdiagnoses and otherwise misses the point for a few key areas...." Read more

"This book did a phenomenal job outlining the sad history the federal/state mental health institutions and gave a dark and relevant picture of how..." Read more

13 customers mention "Readability"13 positive0 negative

Customers find the book excellent, important, and impressive. They say it's a good primer on what's wrong with mental health care in America. Readers also mention the book is worth the time and a wonderful library addition.

"This is a very important book...." Read more

"...the UNBELIEVABLE aspects of "American Psychosis" and is well worth the read on it's own...." Read more

"...Truly impressive work here and a must-read for all concerned citizens." Read more

"An amazing review and analysis of the care for the mentally ill in the US.He writes very clearly and well supported by facts...." Read more

6 customers mention "Writing style"6 positive0 negative

Customers find the writing style wonderful, well-written, and interesting. They also say it's an easy read.

"...This book is also wonderfully well written...." Read more

"...He is thorough and well documented in each book, and his writing style is very readable...." Read more

"...Dr. Torrey gives a lucid and realistic analysis of all this, very well-written too, and makes important suggestions as to how to fix our collective..." Read more

"Torrey's book as an interesting and easy read...." Read more

8 customers mention "Clarity"4 positive4 negative

Customers have mixed opinions about the book's clarity. Some mention it provides a good summary of the problem and sensible recommendations for reform. However, others say the conclusions are flawed and too hasty.

"...resultant harm done to so many innocent people, finished with sensible recommendations for reform...." Read more

"...the community mental health care program was due to more than just poor planning and lack of funding...." Read more

"Very imformative. A must read for anyone really wanting to understand why our broken mental health care system is the way it is...." Read more

"...from the shocking fate of Rose Kennedy to the massive lack of coordination between agencies...." Read more

Top reviews from the United States

T E 23
5.0 out of 5 stars An incredibly important book, about a very complex problem
Reviewed in the United States on January 17, 2014
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If I could give this book 10 stars, I would. It treats an extremely important problem in a very sensible manner, making a compelling case for essential reforms. It is fascinating on so many levels: the imperfections of human decision making laid bare. the resultant harm done to so many innocent people, finished with sensible recommendations for reform. In reading this book, one cannot help but wonder, how much more?: how many more innocent lives will be taken by untreated mentally ill persons? how much more suffering, on the part of the mentally ill and their families, will we tolerate? how many more mentally ill homeless women will be forcibly raped? how much longer will our lives be degraded by the sad sight of untreated mentally ill homeless persons? how much more will we spend on the intermittent hospitalization of the mentally ill homeless? How many mentally ill people will die in board and care facilities, because their conditions go untreated? What will it take for us to take some real action?!?!

This book is also wonderfully well written. It is actually quite entertaining in many places, especially in describing the quaint views formerly held by many psychiatrists about the promise of early detection and treatment of mental illness.

I can only hope that our political leaders will pay attention and act with courage.
6 people found this helpful
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Kathy Brandt
5.0 out of 5 stars A Must Read for Anyone Concerned about Our Mental Health Care "System"
Reviewed in the United States on October 28, 2013
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Walks on the Margins, a Story of Bipolar Illness

I've been talking and writing about our broken mental health care system and the need for change since shortly after our son was diagnosed with mental illness in 1999 and we began battling to find good treatment in that "system." It's been well over a decade now, yet nothing has changed. That we dare to call mental health care a "system" is laughable. After all "system" implies organization of services, coordination of care, and oversight. In too many cases, there are no services at all. And instead of care, there is only chaos. I've never understood how this could have happened--how we could be failing the mentally ill among us so completely.

E Fuller Torrey, in his recently released book, American Psychosis, has made it painfully clear. With uncompromising and fierce analysis and insight, he has explained how things went so wrong after JFK signed the community mental health act in 1963. The motivation for legislation was laudable, the outcome, however, was a disaster. Fifty years since, the mental health care system is in shambles.

Mental health hospitals had already begun closing in the 50's and continued to do for many reasons--exposure of the horrible conditions and lack of treatment in some, new medications that brought the worst symptoms under control, changes in Medicare and Medicaid that disallowed coverage for psychiatric hospital care, lawsuits and changes in commitment criteria, and the feeling that there were better ways to treat those who live with mental illness. With the closings and the new law came a hopeful paradigm- community mental health centers would provide care in outpatient settings where those with mental illness could reengage as members of their families and communities.

Why was the plan such a failure? The legislation, says Torrey was fatally flawed. "It encouraged the closing of state mental hospitals without any realistic plan regarding what would happen to the discharged patients, especially those who refused to take medication they needed to remain well. It included no plan for the future funding of mental health centers. It focused resources on prevention when nobody understood enough about mental illnesses to know how to prevent them. And by bypassing the states, it guaranteed that future services would not be coordinated."

The failure of the community mental health care program was due to more than just poor planning and lack of funding. For me, the most troubling was the changing philosophy of those who were charged with leading the program. As plans were being formulated, their focus shifted from the care for those with severe mental illness to one of prevention, which in turn became a movement to address our social and cultural ills in order to promote mental health. Admirable perhaps, but such grandiose notions were far beyond the scope of community mental health centers that were supposed to serve those with mental illness. The change in thinking, Torrey says, altered the essential function of community treatment.

Many of those who were released from hospitals were severely ill, didn't have family support, had chronic long-term needs, and had no place to go. Says Torrey, "Our failure to protect such mentally ill people by insuring they receive treatment is a major miscarriage of our mental health care system and a blot on our claims to be civilized." So many ended up homeless and in jail and the travesty continues to this day. The result? The largest mental health providers in the nation are our prisons and jails: Cook County in Illinois, Los Angeles County, and Rikers Island in New York among them. The complete failure of mental health care in this country is a sad commentary on how personal biases and ambitions, wrong headedness, and political aspirations can shape policy and impact people in such devastating ways.

In the last chapter Torrey acknowledges that change does not come easily. Progress is impeded by the lack of understanding of serious mental illness, failure to understand the magnitude of the problem, economic and political interests, and the lack of leadership. However, "the fact that we know what to do to correct the existing mental illness diaster is the good news," he says. He explains how we can incorporate what we've learned into successful programs. When we know how and why the system fails and when we look at what successful treatment looks like, as Torrey does, then we can begin to work to achieve it.

Torrey concludes his book with a 1947 quote from Out of Sight, Out of Mind by Frank Wright:

"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."

"Isn't it time to finally do so?" Torrey asks.

I urge anyone who is concerned about the current state of mental health care to read this book. And I thank Dr. Torrey for writing it.
38 people found this helpful
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Albert P. Bensimon
5.0 out of 5 stars A Brilliant Report on Another Failed Government Initiative
Reviewed in the United States on November 2, 2013
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E. Fuller Torrey knows this subject, mental illness and state v. federal efforts to ameliorate it, better than anyone. As a Psychiatrist, he has been involved in mental illness for decades and has written about it - and various subsets such as Paranoid Schizophrenia - with brilliance. He is thorough and well documented in each book, and his writing style is very readable. American Psychosis is a history of how first states, then the federal government, and now jails and homeless-on-the-streets, handle our growing public health problem; and more important, perhaps, he offers tangible solutions for these problems. Is it a coincidence that mental health problems, and specifically Paranoid Schizophrenia, have afflicted many/most of the past few years' shooters, both mass and only one or two souls? I think not. Every political office holder should be required to read this book as well as every American concerned about mental health; it is both a history of how we came to this troubling mess and a blueprint for immediately dealing with it and particularly the poor souls afflicted with mental illness, their families and friends, and potential victims...
8 people found this helpful
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Carpe Diem
4.0 out of 5 stars Excellent chronology of what happened to mess up American care of the seriously mentally ill
Reviewed in the United States on January 5, 2014
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This is a very important book. As someone who deals with many mentally ill on a professional level, and one who was very familiar with the old and now destroyed system of state hospitals, I found this book to be particularly powerful, distressing, and heartbreaking. The government has indeed made a mess of things by forcing implementation of untested policies, leading to great suffering and death on the part of the mentally ill themselves, their families, and their victims, due to flawed theoretical premises conceived by politicians, influential mental health technocrats and psychiatrists who conducted a giant social experiment without consent of those it would impact. However, bizarrely, despite recognizing that the all-knowing government of experts was not so expert after all, the author presses forward with a recommendation that private board and care or nursing facilities should be banned from providing lodging and care of the mentally ill. What makes him think that this all-out prohibition, without exception or review, will be better than government provided care? Perhaps a plan for a foundation of reopened state hospitals, public and private in competition, and a recommendation to tackle the "freedom to be psychotic" laws would be alternatives to consider.
4 people found this helpful
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Top reviews from other countries

José Manuel Jara
5.0 out of 5 stars A very good essay on the evolution of mental health policy in ...
Reviewed in the United Kingdom on May 8, 2015
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A very good essay on the evolution of mental health policy in USA since the sixties, mainly on the difficulties with cronic mental patients assistence
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Susan Inman
5.0 out of 5 stars This should be required reading for anyone wanting to understand the politics of mental health care.
Reviewed in Canada on October 13, 2013
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After Her Brain Broke: Helping My Daughter Recover Her Sanity

This book should be required reading for anyone who has any power to influence mental health policies or anyone who works with people living with severe mental illnesses. Also people in the criminal justice system will discover why prisons have become the new mental institutions. And certainly families will finally have a chance to understand the origins of the shockingly dysfunctional mental health system they confront. And people with schizophrenia and bipolar disorder who have learned to manage their illnesses will learn a lot about the social forces in the last fifty years that have made it less likely that many people with the most severe brain disorders have a chance to recover.

Fuller Torrey's Book Surviving Schizophrenia provided the foundation I needed to help my daughter recover from the hell of psychosis; this book helps me understand the obstacles that continue to be in the way of families like mine who want to see excellent mental health care available for everyone.

Susan Inman
author, After Her Brain Broke, Helping My Daughter Recover Her Sanity
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Susan Miller
5.0 out of 5 stars Wow - who knew JFK caused so many problems
Reviewed in Canada on November 25, 2013
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Thorough and interesting analysis of the impact of JFK and his family on the mental health system. Who knew such good intentions could lead to such bad outcomes?
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