The Insanity Offense: How America's Failure to Treat the Seriously Mentally Ill Endangers Its Citizens

Picture a small county in Texas, 25,000 population, with only one special confinement cell and no specially trained sheriff's deputies. Picture a severely bipolar young man, with other mental health diagnoses as well, such as PTSD, on parole from a manslaughter convictioon (he may or may not have committed) assaulting his mother and stepfather. Picture him now locked away here, literally trying to bash his head against the walls. Add to the fact that the PTSD was prison induced, in part through prison rape, just as Dr. Torrey describes. Picture a relatively sympathetic DA, and very sympathetic sheriff, hands tied do to lack of resources. I don't have to "picture" it. I've reported on it. What Dr. Fuller Torrey says is all so true. Add in the Texas mental health system, which is one of the worst in the nation, as Torrey notes. A system lacking mental health beds in both the "outside" world and inside the criminal justice system. We CAN do better, without going back to stereotyped days of the 1950s. We don't need hyper-civil libertarians (I am a card-carrying ACLU member myself), or Scientologists, telling us mental illness doesn't exist, or the severely mentally ill have freedom of choice when they don't even know who they are. Somehow, some way, we must change our laws.

Dr. Fuller Torrey provides us with another sane plea to help "the insane" - those whom society has abandoned to homelessness and jail rather than to the medical treatment they so deserve. The US is not alone in its treatment of the victims of serious mental illness. What is seen in the US is repeated in most western countries with only a few exceptions. A policy of deinstitutionalization has emptied our psychiatric hospitals while the actions of civil libertarian lawyers has allowed them to remain in the community even though they are too ill to make a rational decision. They are given the authority to refuse treatment when they do not have the capacity to understand that they are ill. These are the two main reasons for the situation we see today. Torrey points out that in 1955, the US population was 164 million and there were about 560,000 patients in psychiatric facilities. By 2006, the US population grew to 300 million. If the proportion of the population in mental institutions was the same as in 1955, there would be over one million hospitalized. Instead, the number is only 40,000. The emptying of hospitals was initially done for humanitarian reasons and coincided with the development of better medication. Unfortunately, the medication was not as effective as initially hoped and those discharged were not provided with support or services in the community. Getting someone psychiatric care and into hospital was described by D. J Jaffe as more difficult than getting into Harvard Law School. That was in 1991 and Jaffe was a spokesperson for the New York City Friends and Advocates for the Mentally Ill. That same situation exists today. Lawyers and civil libertarians quote John Stuart Mill's On Liberty for their reasons for allowing the mentally non competent to make treatment decisions. Mill said that "the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not sufficient warrant." At the time Mill wrote that, there were few effective medical treatments for anything let alone schizophrenia. However, in the very next paragraph, Mill offers an exception for the above quoted assertion used by so many of the so called friends of the mentally ill. He says that "those who are still in a state to require being taken care of by others must be protected against their own actions as well as against personal injury." Let us hope that Dr. Torrey's book and his activity to change the laws through the Treatment Advocacy Center will win out in the end. Marvin Ross Author of Schizophrenia: Medicine's Mystery - Society's Shame

E. Fuller Torrey has been one of the most astute commentators on the deinstitutionalization charade for decades. This is his best book. He takes the key states (California and Wisconsin) which contributed to the legislative and court changes to the involuntary commitment laws for people with mental disorders and traces them from their original passing (late 1960s and early 1970s) to the present. He uses case vignettes and journal articles to convey the consequences of the new legislation and court decisions respectively. The result is deeply disturbing and powerful. Torrey has been controversial for years but he is right on target. The solutions to this very problematic reality are extremely difficult. But talking about it is the beginning. This book is an excellent place to start.

I am a psychiatric social worker and have been in the field for years. I think anyone who works in behavioral health should read this book. It clearly explores the relationship between the "deinstitutionalization" of the 1950s and 1960s and the relationship as those in mental hospitals were set free to fend for themselves in the community. The relationship unfolkds as the author explains how the population decline in state mental hospitals has been off-set by the soaring number of mentally ill men and women who are wandering the streets homeless, or are locked away in jails and prisons with little to no treatment. By now, 50 or so years on, it's obvious shutting down mental hospitals was not the solution -- rather, improving conditions and quality of life in the hospitals was what was needed. The author cites hundreds of specific cases in which institutionalized men and women are set free -- to become victims, or to victimize. The community mental health clinic concept works for a certain segment of the mentally ill population. But, as I have seen and experienced on an almost daily basis, there are far too many chronically mentally ill people who have no insight into their illness and the need to take medication consistently, and thus suffer in poverty, filth, and psychic ghettos in the inner cities of America. The once-hospitalized men and women have achieved the "freedom" lawyers and psychiatrists a generation ago sought. Sadly, to quote from "Me and Bobby McGee" -- freedom's just another word for nothing left to lose. Those of you who work with the men and women who live in run-down housing, eat out of trash cans, are a revolving door in emergency rooms and jail cells will know what I talking about. This book paints a grave picture of the state of public behavioral health's state of the union in the early part of the 21st Century. It's not an easy book to read, but perhaps it will inspire a few people to push for some changes, because the system's broken and it needs fixing -- bad!

This author is not kidding...he really tells it as it is, but with a light touch that may miss the mark. State legislators need to be slammed up side the head to get their attention and I fear he is a little too politically correct. As the father of a middle-aged bi-polar daughter, I was blindsided by the impact of her disease. She is one of the lucky ones who found a qualified psychiatrist and medications that are working to keep her off the streets, but barely. Unless you experience the family impact of mental illness most people just walk on by. The civil rights lawyers and courts who curtailed mandatory treatment are the real criminals in this crisis and the author is too easy on them. Mental illness still is a great social taboo in this culture of control and cure. When neither are possible our government seems paralized to respond. Unfortunately, I fear that it will take a lot more homeless people and mentally ill criminal behavior to get the needed attention and reforms. But, hey, never forget that a few highly dedicated people can change things. Meantime, you suffer and hope. Read this book and get involved.