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The Insanity Offense: How America's Failure to Treat the Seriously Mentally Ill Endangers Its Citizens
"Vital for all working in the mental health field . . . . Fascinating reading for anyone." ― Choice E. Fuller Torrey, the author of the definitive guides to schizophrenia and manic depression, chronicles a disastrous swing in the balance of civil rights that has resulted in numerous violent episodes and left a vulnerable population of mentally ill people homeless and victimized. Interweaving in-depth accounts of landmark cases in California, Wisconsin, and North Carolina with a history of legislation and changes in the mental health care system, Torrey gives shape to the magnitude of our failure and outlines what needs to be done to reverse this ongoing―and accelerating―disaster. A new epilogue on the 2011 shooting in Tucson, Arizona, brings this tragic story up to date.
306 pages, Paperback
First published June 16, 2008
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Displaying 1 - 30 of 35 reviews
April 24, 2015
I need to talk about this book.
I got about halfway through before I got too annoyed to finish. Initially, I picked up the book because it's something I'm interested in and support. I don't think people with mental disorders get enough help and are stigmatized; so hey there's this book! Well, let me tell you, I was constantly making this face :| Not only was the author NOT discussing how treatments would improve society at large and the individuals receiving better and affordable (and let's be honest, in most cases it would be ANY treatment to begin with since it's not very accessible), he was also using schizophrenia as a threat.
He mentioned bipolar TWICE (and I was halfway through the book!) and the rest of the book was talking about cases where people who have untreated schizophrenia have murdered or severely injured people. Also without differentiating between types of schizophrenia. (Paranoid schizophrenia was mentioned twice but without definition). If you're going to write a book advocating for mental health treatment, using only one type of mental health and using it as a fear tactic is not helpful. It just stigmatizes it more. (And don't give me that bullshit that people who are picking up this book should already know or have a background in mental illness. No. When it's research like this, you give even a BRIEF description of what you are discussing).
/fin/
I got about halfway through before I got too annoyed to finish. Initially, I picked up the book because it's something I'm interested in and support. I don't think people with mental disorders get enough help and are stigmatized; so hey there's this book! Well, let me tell you, I was constantly making this face :| Not only was the author NOT discussing how treatments would improve society at large and the individuals receiving better and affordable (and let's be honest, in most cases it would be ANY treatment to begin with since it's not very accessible), he was also using schizophrenia as a threat.
He mentioned bipolar TWICE (and I was halfway through the book!) and the rest of the book was talking about cases where people who have untreated schizophrenia have murdered or severely injured people. Also without differentiating between types of schizophrenia. (Paranoid schizophrenia was mentioned twice but without definition). If you're going to write a book advocating for mental health treatment, using only one type of mental health and using it as a fear tactic is not helpful. It just stigmatizes it more. (And don't give me that bullshit that people who are picking up this book should already know or have a background in mental illness. No. When it's research like this, you give even a BRIEF description of what you are discussing).
/fin/
September 21, 2008
An interesting book - and on a topic with which I regularly deal in my work. I am often frustrated by the limitations on involuntary treatment, especially here in Seattle where the laws are very stringent and lean in favor of individual liberties as opposed to treatment - and in my work with the most severely ill folks, many of whom have a history of violence toward themselves or others. So I certainly agree with the bulk of Torrey's assertion that this is a serious problem. However, I was troubled by his reliance on anecdotal evidence and some of his extrapolations on the little scientific evidence that does exist. I also feel that he relies a bit too much on simply changing the laws to make committment more available - while this may be the solution for a very small subset of those people with mental illness, I think we fail far more people by simply not funding and offering sufficent services for care. In outpatient mental health, our hands are tied far far more by financial constraints and federal regulations regarding funding for care than they are by a lack of involuntary treatment laws. Even when people are committed to involuntary treatment, it typically fails because of a lack of resources to truly implement it. So in the end, I found this an interesting read in large part because of my work. His use of anecdotes (while not the best scientific evidence) does make this an interesting and engaging read, despite the grim topic.
December 15, 2012
More than 50% of “rampage killers,” men (they are almost always men) like the one who killed more than 30 people at Virginia Tech a few years ago and the one who recently killed five people and grievously wounded Representative Gabrielle Giffords and several others in Arizona, are seriously mentally ill. More than 60% of men who kill their own children and 75% - that’s three out of four – women who kill their children are seriously mentally ill. More than 10% of the prisoners in American jails and a larger percentage of people arrested for non-family violence are seriously mentally ill. Between a third and half of the people who are homeless and living on the streets and eating out of garbage cans, as best can be determined, are mentally ill and untreated.
Yet we have stringent state laws in the US that prevents involuntary hospitalization and treatment of people even with extremely serious paranoid schizophrenia and bipolar disorder, even if they are delusional and violent. A few such people who have been treated against their will have been awarded millions of dollars when represented by civil liberties lawyers to make certain they continue to go untreated – and in all too many cases remain on the street, eating garbage, threatening and attacking their families and others. The laws require a person to be threatening “imminent” violence – which means with a knife in hand and moving forward, which also means years of increasingly frequent and threatening incidents and a history of assault, even with a baseball bat, knife, gun, or other weapon, is not enough to allow a judge to force the mentally ill person to remain in treatment and to continue to take medication.
In The Insanity Offense, E Fuller Torrey, makes a plea for more sensible and humane treatment of these people who are, by the nature of their illness, unable to make a sane decision whether to be treated or not. Before the middle of the 19th century people who were insane were kept imprisoned and chained. Today we are doing much the same thing, because leaving such people untreated leads to staggering numbers of the mentally ill residing in our jails and prisons. In the more than 3,000 counties in the United States there is not one with a hospital housing more mentally ill people than the county jail. The jails are our new mental hospitals.
Torrey’s case for sensible laws that allow involuntary hospitalization and treatment of the most seriously ill is convincing. Sick people who are released from hospitals without further treatment are alarmingly vulnerable – they are attacked, raped, murdered in much higher percentages than the general population. They fill our jails and take up the time and resources of our police system. They are now a large percentage of the people who attack police and are killed by them. And the very seriously mentally ill are found in disconcertingly high percentages among those who attack and murder their families, neighbors, and complete stranger.
We used to have mental asylums, places where, ideally, the sick and vulnerable could be protected from themselves and others. But deinstitutionalization from the late 1960s through the late 1990s has put most of these people at the mercy of themselves and others.
We cannot call ourselves a civilized nation and continue to treat the most vulnerable among us in this way.
Yet we have stringent state laws in the US that prevents involuntary hospitalization and treatment of people even with extremely serious paranoid schizophrenia and bipolar disorder, even if they are delusional and violent. A few such people who have been treated against their will have been awarded millions of dollars when represented by civil liberties lawyers to make certain they continue to go untreated – and in all too many cases remain on the street, eating garbage, threatening and attacking their families and others. The laws require a person to be threatening “imminent” violence – which means with a knife in hand and moving forward, which also means years of increasingly frequent and threatening incidents and a history of assault, even with a baseball bat, knife, gun, or other weapon, is not enough to allow a judge to force the mentally ill person to remain in treatment and to continue to take medication.
In The Insanity Offense, E Fuller Torrey, makes a plea for more sensible and humane treatment of these people who are, by the nature of their illness, unable to make a sane decision whether to be treated or not. Before the middle of the 19th century people who were insane were kept imprisoned and chained. Today we are doing much the same thing, because leaving such people untreated leads to staggering numbers of the mentally ill residing in our jails and prisons. In the more than 3,000 counties in the United States there is not one with a hospital housing more mentally ill people than the county jail. The jails are our new mental hospitals.
Torrey’s case for sensible laws that allow involuntary hospitalization and treatment of the most seriously ill is convincing. Sick people who are released from hospitals without further treatment are alarmingly vulnerable – they are attacked, raped, murdered in much higher percentages than the general population. They fill our jails and take up the time and resources of our police system. They are now a large percentage of the people who attack police and are killed by them. And the very seriously mentally ill are found in disconcertingly high percentages among those who attack and murder their families, neighbors, and complete stranger.
We used to have mental asylums, places where, ideally, the sick and vulnerable could be protected from themselves and others. But deinstitutionalization from the late 1960s through the late 1990s has put most of these people at the mercy of themselves and others.
We cannot call ourselves a civilized nation and continue to treat the most vulnerable among us in this way.
November 19, 2013
This book is horseshit. The only good thing it does is point out how difficult it is for people with severe mental illness to receive services. More importantly, it also takes the asinine stance that all people with severe mental illness are dangerous, homicidal time bombs waiting to go off. The author presents numerous stories of individuals who have committed terrible acts, such as killing, at times in response to delusional thinking. Unfortunately, he then uses these anecdotal stories to suggest that all people with mental illness are capable of such acts and should thus be locked up and given forced medication. In actuality, people with severe mental illness are in much greater danger of harm due to an inability to care for self. This book is offensive, misleading, and contributes to the ongoing stigmatization and vilification of people with mental illness. To be fair, I only read the first 210 pages or so. I guess it's conceivable that it gets better, but I threw the book away from me in disgust one too many times to continue reading.
February 5, 2009
I had to read 5 chapters of this book for a class and I have no desire to finish. The author makes the valid point that people with severe mental illness cannot get the mental health care they need, which often results in them becoming homeless or put in jail. However, he seems to be arguing that forced medication is the answer in order to protect the general public. Several of his chapters focus on violence perpetrated by people with severe mental illness, buttressed by newspaper headlines and questionable uses of data. Apparently, Torrey is an advocate for people with SMI, although this does not come through in his book. Granted, I did not read the whole book, but thus far his book does more to promote stigmatizing attitudes toward people with SMI than to promote a balanced view.
I concur with the review by Paul Appelbaum in the American Journal of Psychiatry (Am J Psychiatry 165:1493-a-1494, November 2008. doi: 10.1176/appi.ajp.2008.08060938)
I concur with the review by Paul Appelbaum in the American Journal of Psychiatry (Am J Psychiatry 165:1493-a-1494, November 2008. doi: 10.1176/appi.ajp.2008.08060938)
February 6, 2016
This was a very exciting read. The author makes it seem as if there were an untreated schizophrenic lurking behind every tree, armed with a loaded gun or at least a board with a nail through it, waiting to kill me if I leave my house. The book focuses almost entirely on homicides committed by people who have refused treatment for schizophrenia, as if the plague of suicides, property crimes and miscellaneous domestic violence exacerbated by mental illness were not much bigger and more pressing problems for all of us. He makes many good points about the gaps in mental-health treatment in this country, but inexplicably ignores the noxiousness of the drugs given to psychotic patients and the critical shortage of psychiatrists in this country. He totally skips over the questionable claims of mental illness as a criminal defense that have stood in the way of the needs of the truly mentally ill. He even cites Ed Kemper as an example of the way the system fails the mentally ill, when Kemper not only was getting regular psychiatric attention through his entire killing spree, but he probably was never mentally ill in the first place. That glaring mistake makes me wonder what else he got wrong in the course of this book. Above all, one never quite sees what he wants done about all this. He seems to imply that he wants every mental patient out there being forcibly treated under an Assisted Treatment Order, and he comes within about half an inch of saying that anyone with a mental-health diagnosis is incapable of deciding whether to pursue treatment, which is ridiculous. He appears to scoff at psychotherapy and skill-building and seems to feel that only meds and clubhouses (!) are needed to make a difference. And where, exactly, is all the money for this supposed to come from? His ideas are intriguing but I don't see any useful answers here. I have to say overall that this is a pretty flawed work, though not as laughable as his SURVIVING SCHIZOPHRENIA.
November 30, 2012
A welcome corrective to overly libertarian public policy toward the mentally ill
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.
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.
January 4, 2009
My experience growing up with a bipolar foster sister confirms the author's thesis that our failure to treat the seriously mentally ill hurts everyone in our society. According to the author (and confirmed by my sister's life), the three most frequent outcomes for mentally ill people today are: 1) homelessness, 2) criminal activity/incarceration, 3) homicide/suicide. My question remains: if our judicial system acquits mentally ill people of egregious crimes based on the fact that their mental state renders them incapable of taking responsibility for their actions, how can the same judicial system place the responsibility of seeking/accepting treatment for their illness on the same mentally ill people? I'm not saying I approve 100% in involuntary commitment to mental institutions, but I do know that what we're doing now isn't working.
December 14, 2009
really a 3.5/5
Torrey makes excellent points about how the closing of so many state mental institutions in the 70s, due to misguidedness by both right and left (the right believed that mental illness didn't exist and the left felt that people had the right to be crazy if they wanted to...somewhat simplified...), has led to the huge increase in homelessness and imprisonment of the mentally ill. What he had to say would have made a very effective magazine of journal article, but in a 200 page book there was way too much repetition and lists and lists of anecdotes.
Torrey makes excellent points about how the closing of so many state mental institutions in the 70s, due to misguidedness by both right and left (the right believed that mental illness didn't exist and the left felt that people had the right to be crazy if they wanted to...somewhat simplified...), has led to the huge increase in homelessness and imprisonment of the mentally ill. What he had to say would have made a very effective magazine of journal article, but in a 200 page book there was way too much repetition and lists and lists of anecdotes.
April 3, 2019
I have to say that when I started reading this book, I was a little sickened by his approach, mostly because I read this from the perspective of somebody with a serious mental health illness who has been part of the treatment system for many years of my life. However, I decided to give it a chance and set aside my feelings to see if there were any good points.
Things I agree with: I do agree that there is a small subset of people with serious mental illness who do cause the most issues and he is advocating for reform for that group, not the majority of people with mental illness. The best point I found in the book was that we all, regardless of a mental illness do have the right to live our lives as we choose and make decisions about our care, but we also have the responsibility to not infringe on the rights of others. I think the point he is trying to make is that if people are going to lose their rights anyway because of their mental illness by committing crimes and being incarcerated, maybe it is more compassionate and humane to intervene earlier and treat them medically.
Things I disagreed with: his only solution to this problem was lesser restrictions on involuntarily commitment and forced medication. He barely offered other solutions or even discussed the reason psychiatric hospitals were closed in the first place, because they were, and still are in many cases, inhumane and poorly run. I was a patient at a state run hospital for three months and I can honestly say it wasn't a treatment facility, it was a warehouse. It was understaffed, underfunded, and offered almost nothing in the way of actual treatment aside from forcing medications. On top of that, the place was filthy, infested with vermin and bugs, and patients were hungry and eating out of trash cans because they didn't provide enough food. Most patients I saw being discharged were still just as sick if not in worse condition than when they were admitted. Is this what he calls humane treatment?
He also doesn't offer any solutions to the lack of community funding for adequate housing, rehabilitation services, and protections for people with mental illnesses. He just says it's a problem over and over again
My biggest complaint is his advocacy for forced medication as the only option. There are many options for treatment and one of the most promising things I've seen is treatment involving things like art therapy, music, movement therapy, recreational therapy, etc. I've seen even people who have a history of violence benefit far more from programs like these because they find an outlet and sense of purpose, while still retaining their right to not be medicated. Maybe instead of forcing hospitalization and medication on people as an only option for serious mental illness, we can meet them halfway and find more creative strategies that still help them while being less restrictive.
Things I agree with: I do agree that there is a small subset of people with serious mental illness who do cause the most issues and he is advocating for reform for that group, not the majority of people with mental illness. The best point I found in the book was that we all, regardless of a mental illness do have the right to live our lives as we choose and make decisions about our care, but we also have the responsibility to not infringe on the rights of others. I think the point he is trying to make is that if people are going to lose their rights anyway because of their mental illness by committing crimes and being incarcerated, maybe it is more compassionate and humane to intervene earlier and treat them medically.
Things I disagreed with: his only solution to this problem was lesser restrictions on involuntarily commitment and forced medication. He barely offered other solutions or even discussed the reason psychiatric hospitals were closed in the first place, because they were, and still are in many cases, inhumane and poorly run. I was a patient at a state run hospital for three months and I can honestly say it wasn't a treatment facility, it was a warehouse. It was understaffed, underfunded, and offered almost nothing in the way of actual treatment aside from forcing medications. On top of that, the place was filthy, infested with vermin and bugs, and patients were hungry and eating out of trash cans because they didn't provide enough food. Most patients I saw being discharged were still just as sick if not in worse condition than when they were admitted. Is this what he calls humane treatment?
He also doesn't offer any solutions to the lack of community funding for adequate housing, rehabilitation services, and protections for people with mental illnesses. He just says it's a problem over and over again
My biggest complaint is his advocacy for forced medication as the only option. There are many options for treatment and one of the most promising things I've seen is treatment involving things like art therapy, music, movement therapy, recreational therapy, etc. I've seen even people who have a history of violence benefit far more from programs like these because they find an outlet and sense of purpose, while still retaining their right to not be medicated. Maybe instead of forcing hospitalization and medication on people as an only option for serious mental illness, we can meet them halfway and find more creative strategies that still help them while being less restrictive.
December 8, 2014
In the 1960s there were two big things happening in US society. First, there were civil rights movements, and second, states and the government needed money. There began one of the largest problems seen on the streets of America today. Though most experts at the time believed that deinstitutionalization was the right way to go, no one seemed to think of the long term consequences this movement might have. Civil rights advocates argued that involuntary commitment was inhumane and that the laws should be changed, and so they were. Thousands of state funded hospitals for those with serious mental illnesses were closed, and most of the individuals living in them were left with no where to go.
The Insanity Offense is an accounting of the deinstitutionalization of America and the profound effect it has had on society. E. Fuller Torrey, a research psychiatrist, has followed many cases of mentally ill individuals that have been left without proper care only to cause harm. He puts a light on the real picture of what’s happening. The mentally ill have no where to turn, those who need treatment the most cannot get it because the laws say that an involuntary commitment to a facility cannot happen until the individual has actually acted in violence, not just threatened it. In many cases even if someone is taken in, they will be released after a few days, and chances are they will repeat the cycle again.
Mentally ill peoples are being left homeless, they turn violent and hurt themselves and others, they are victimized because other criminals think of them as weak and defenseless, and they are being incarcerated at higher rates than ever before, left in prisons that don’t have the resources to treat them as needed. Is that more inhumane than involuntarily committing them to get the treatment they need?
Reading this book broke my heart and infuriated me at the same time. The blindness of those with the power to change the circumstances is inexcusable. This book is a true eye-opener and it is something I can see myself referring back to in the future. Honestly, I would have to call it a “must read” because everyone should know what is really happening to the mentally ill of America.
The Insanity Offense is an accounting of the deinstitutionalization of America and the profound effect it has had on society. E. Fuller Torrey, a research psychiatrist, has followed many cases of mentally ill individuals that have been left without proper care only to cause harm. He puts a light on the real picture of what’s happening. The mentally ill have no where to turn, those who need treatment the most cannot get it because the laws say that an involuntary commitment to a facility cannot happen until the individual has actually acted in violence, not just threatened it. In many cases even if someone is taken in, they will be released after a few days, and chances are they will repeat the cycle again.
Mentally ill peoples are being left homeless, they turn violent and hurt themselves and others, they are victimized because other criminals think of them as weak and defenseless, and they are being incarcerated at higher rates than ever before, left in prisons that don’t have the resources to treat them as needed. Is that more inhumane than involuntarily committing them to get the treatment they need?
Reading this book broke my heart and infuriated me at the same time. The blindness of those with the power to change the circumstances is inexcusable. This book is a true eye-opener and it is something I can see myself referring back to in the future. Honestly, I would have to call it a “must read” because everyone should know what is really happening to the mentally ill of America.
August 20, 2008
In the mid 1960s, America began emptying and closing its mental hospitals, all in the name of civil rights. California was the first state to do so and by the mid 1980s, the other 49 states had followed suit.
The author calls this "one of the great social disasters in recent American history." It has created at least 175,000 homeless mentally ill men and women in this country, many of whom become victims of violence -- muggings, rapes, murders. Many of these same mentally ill are responsible for an increased number of violent crimes against their own family members and other hapless citizens.
Let's look at some statistics from California:
* California has 38,000 sverely mentally ill homeless living on its streets on any given day -- mostly in LA and San Francisco.
* About 9,000 severely mentally ill individuals who are in dire need of treatment are incarcerated in California's county jails. That's about 11% of the total jail population.
* Worse, about 32,000 severely mentally ill inhabit California's state prisons. That's about 20% of the total of state prisoners.
* Between 1970 and 2004, severely mentally ill individuals who were not receiving treatment were responsible for 4700 California homocides. Each year they commit some 120 more murders.
Each state has its own mental illness statistics that when added to California's paint a grim picture indeed. Our concern for the civil rights of the mentally ill have caused tens and thousands of innocent American citizens to lose one of their most precious rights -- The right to life!
Torrey uses statistics, court records, news reports and other sources to hammer home the seriousness of this problem. If cold statistics are n ot enough, the book also contains poignant interviews the author had with the mentally ill, their families and their victims. One only needs to read this troublesome book to realize the system isn't working and needs to be replaced before it creates even more victims.
The author calls this "one of the great social disasters in recent American history." It has created at least 175,000 homeless mentally ill men and women in this country, many of whom become victims of violence -- muggings, rapes, murders. Many of these same mentally ill are responsible for an increased number of violent crimes against their own family members and other hapless citizens.
Let's look at some statistics from California:
* California has 38,000 sverely mentally ill homeless living on its streets on any given day -- mostly in LA and San Francisco.
* About 9,000 severely mentally ill individuals who are in dire need of treatment are incarcerated in California's county jails. That's about 11% of the total jail population.
* Worse, about 32,000 severely mentally ill inhabit California's state prisons. That's about 20% of the total of state prisoners.
* Between 1970 and 2004, severely mentally ill individuals who were not receiving treatment were responsible for 4700 California homocides. Each year they commit some 120 more murders.
Each state has its own mental illness statistics that when added to California's paint a grim picture indeed. Our concern for the civil rights of the mentally ill have caused tens and thousands of innocent American citizens to lose one of their most precious rights -- The right to life!
Torrey uses statistics, court records, news reports and other sources to hammer home the seriousness of this problem. If cold statistics are n ot enough, the book also contains poignant interviews the author had with the mentally ill, their families and their victims. One only needs to read this troublesome book to realize the system isn't working and needs to be replaced before it creates even more victims.
September 28, 2013
This is a well documented -- but heartbreaking -- book about the history of health care and legal protections for criminally insane individuals in the United States.
It is a well written book with chapter notes and a thorough index; the author makes a complicated topic easy to understand. But he also provides example (after example, after example) of individuals and families whose lives have been devastated, firstly by mental illness and secondly by a legal system that insists on protecting the insane person’s individual “rights” above and beyond what is prudent for society in general. This is a book that is discouraging to read (so much change is needed, so little seems to be happening) and just plain numbing – the stories are heartbreaking and unending.
I found one of the author’s quote to be quite sobering because the quote was written in 1975 – almost 40 years ago:
The humane approach to serious impairment of mental functioning demands that the suffering of the patient be relieved. He must be helped to take his place in society comfortably. …this right is more fundamental than, and therefore takes precedence over, that of liberty…. without appropriate therapy what do we offer the patient? It is true that he is free to come and go as he pleases, but what about the quality of his life? Can we really call it “liberty” if someone walks the streets in terror because of paranoid delusions or threatening hallucinations?” (p. 162)
This quote is quickly followed by the author’s point of view, which I whole heartedly concur:
Family members, law enforcement officers, media personalities, religious leaders and mental health professionals are all frequent victims (of mentally ill persons). By not affording protection to these individuals, we are depriving them of their civil liberties and sometimes their lives. (p. 166)
It is a well written book with chapter notes and a thorough index; the author makes a complicated topic easy to understand. But he also provides example (after example, after example) of individuals and families whose lives have been devastated, firstly by mental illness and secondly by a legal system that insists on protecting the insane person’s individual “rights” above and beyond what is prudent for society in general. This is a book that is discouraging to read (so much change is needed, so little seems to be happening) and just plain numbing – the stories are heartbreaking and unending.
I found one of the author’s quote to be quite sobering because the quote was written in 1975 – almost 40 years ago:
The humane approach to serious impairment of mental functioning demands that the suffering of the patient be relieved. He must be helped to take his place in society comfortably. …this right is more fundamental than, and therefore takes precedence over, that of liberty…. without appropriate therapy what do we offer the patient? It is true that he is free to come and go as he pleases, but what about the quality of his life? Can we really call it “liberty” if someone walks the streets in terror because of paranoid delusions or threatening hallucinations?” (p. 162)
This quote is quickly followed by the author’s point of view, which I whole heartedly concur:
Family members, law enforcement officers, media personalities, religious leaders and mental health professionals are all frequent victims (of mentally ill persons). By not affording protection to these individuals, we are depriving them of their civil liberties and sometimes their lives. (p. 166)
May 30, 2018
Although I believe this book was well-intentioned in nature, it was nevertheless woefully irresponsible. Based on the blurb, I had expected Torrey to focus on the history of deinstitutionalization and the lack of public resources devoted to the mentally ill. Although he did devote an entire chapter to discussing the increase in homelessness, victimization and incarceration as a result of deinstitutionalization, the vast majority of the book focused on violence perpetrated by the mentally ill. Although I acknowledge the need to discuss the dangers sometimes posed by individuals experiencing psychosis, such acknowledgement needs to be balanced with an effort to emphasize the fact that the vast majority of the mentally ill pose no threat to anyone but themselves. Rather than attempting such a balance, Torrey actively mocks efforts to put violence committed by the mentally ill into statistical perspective. In addition, much of his book is populated by case studies and anecdotes about violent acts, typically those perpetrated by unmedicated paranoid schizophrenics. The zeal with which he details their crimes leaves the reader with the impression that they were reading a true crime novel rather than a plea for a public investment in the care and safety of our most vulnerable citizens. Despite giving lip service to the need to reduce stigma, Torrey has managed to write a book that appears specifically designed to convince its readers that such stigma is well-deserved. He makes every effort to detail the dangers posed by the mentally ill and primarily argues that the solution is strengthening involuntary commitment laws, as if safety can only be found by caging them away from the community rather than investing public services. Portraying the mentally ill as an undifferentiated mass of homicidal maniacs is exactly what advocates have been fighting against for decades, and Torrey should have known better than to perpetuate such harmful stereotypes.
June 18, 2017
The sad thing about the mental health problem is that people don't admit to having one.
In this book, E Fuller Torrey discusses the situation that people with severe mental illness go through, and it is infuriating. In many cases, all of the signs were there for someone to be hospitalized, but since so many bleeding hearts in the 1960s and 70s wanted to close state-run mental health facilities, many people were left with no place else to go but the streets and low-income housing. Not only were the hospitals and facilities closed, but they also went and changed the laws, making it difficult to institutionalize someone for being a danger to society. Basically, in order to be committed, you have to realize that you have a problem and commit yourself. This is a serious issue when you aren't working with a full deck. Most of the patients in this book have some form of anosognosia; a condition where you don't feel you have a problem. This is a very real condition and can even happen to people with paralysis. For example, they might come up with excuses for why they don't use a paralyzed arm.
Dr. Torrey mostly talks about people with severely debilitating psychosis that makes them a danger to themselves and others. Using statistics and the story of several families, Dr. Torrey argues ardently for a system that would aid the mentally ill or disabled. He does a good job at this since it does tug at my heartstrings to see so many capable people with promise and dreams lose themselves to mental illness. In that sense, Torrey numbers a few of them and gives them a story. In making them people and not merely another number, it adds a human element to the book.
In this book, E Fuller Torrey discusses the situation that people with severe mental illness go through, and it is infuriating. In many cases, all of the signs were there for someone to be hospitalized, but since so many bleeding hearts in the 1960s and 70s wanted to close state-run mental health facilities, many people were left with no place else to go but the streets and low-income housing. Not only were the hospitals and facilities closed, but they also went and changed the laws, making it difficult to institutionalize someone for being a danger to society. Basically, in order to be committed, you have to realize that you have a problem and commit yourself. This is a serious issue when you aren't working with a full deck. Most of the patients in this book have some form of anosognosia; a condition where you don't feel you have a problem. This is a very real condition and can even happen to people with paralysis. For example, they might come up with excuses for why they don't use a paralyzed arm.
Dr. Torrey mostly talks about people with severely debilitating psychosis that makes them a danger to themselves and others. Using statistics and the story of several families, Dr. Torrey argues ardently for a system that would aid the mentally ill or disabled. He does a good job at this since it does tug at my heartstrings to see so many capable people with promise and dreams lose themselves to mental illness. In that sense, Torrey numbers a few of them and gives them a story. In making them people and not merely another number, it adds a human element to the book.
October 11, 2012
Torrey, a renowned expert on schizophrenia and bipolar disorder, poses an extremely controversial question that few will say out loud: Is it ethical to allow people who are actively psychotic to simply deteriorate because they will not seek treatment willingly? This book's answer is a resounding No, but despite your own answer, it's a necessary read for anyone engaged in the debate over that question. Though it weighs heavy on what Torrey terms "preventable tragedies" (the murders of others by actively psychotic people who refuse treatment), this question is just as much about stopping the severely mentally ill from being victimized as it is about them victimizing others. Made readable to laypersons by Torrey's simplified prose (though it drags later on when studies are discussed, if that's not your interest) and heartbreaking stories, The Insanity Offense is a must-read.
January 9, 2013
I had requested this book at my library before the school shootings in Connecticut. We should all read it to better understand why this type of shootings/killings are taking place in the United States.
Torrey begins with the history of deinstitutionalization of mentally ill patients that began in California in the 1950s. There are stories about specific people and events illustrating the laws and statistics presented in the book. The thesis of the book is that potentially violent, diagnosed, mentally ill people go untreated because of the difficulty of getting involuntary committments. Some people who are paranoid schizophrenics or bipolar deny they are ill and refuse to take their medicine. Apparently, the legal philosophy when these laws were passed was that people have a right to be insane - but what about their family members and other people they hurt?
Good read.
Torrey begins with the history of deinstitutionalization of mentally ill patients that began in California in the 1950s. There are stories about specific people and events illustrating the laws and statistics presented in the book. The thesis of the book is that potentially violent, diagnosed, mentally ill people go untreated because of the difficulty of getting involuntary committments. Some people who are paranoid schizophrenics or bipolar deny they are ill and refuse to take their medicine. Apparently, the legal philosophy when these laws were passed was that people have a right to be insane - but what about their family members and other people they hurt?
Good read.
Read
July 12, 2011I have a profession where I must believe that people have the capacity to change their behaviors. Do all people have the capacity to control their behaviors? No. This book outlines the scary changes that occured since mentally ill were taken out of institutions. The focus is on the legislative and follow-up social changes in the state of California.
A summer 2009 study of 8000 schizophrenic people between 1793 and 2006 showed no significant relationship between violent crime and mental illness. The side of the argument that this book depicts is real, but it is only one slice of the whole picture.
Who is a risk to general safety? And what can we do to help those suffering from mental illness?
A summer 2009 study of 8000 schizophrenic people between 1793 and 2006 showed no significant relationship between violent crime and mental illness. The side of the argument that this book depicts is real, but it is only one slice of the whole picture.
Who is a risk to general safety? And what can we do to help those suffering from mental illness?
September 13, 2015
A well written and shocking exposé on the failure of the deinstitutionalization movement of the 60's that left our country's mental health system in shambles under the guise of "civil liberties." Really illustrates the importance of mental healthcare. This line from the book sums it up perfectly: "Uninformed calls to protect civil liberties betray a profound misunderstanding of that term. There is nothing "civil" about leaving people lost to disease to live homeless on the streets suffering rape, and victimization. There is nothing "right" about leaving someone untreated and psychotic, rendering them incapable of discerning whether they are attacking a CIA operative or their own mother."
January 26, 2010
This was a pretty wild read... It's a collection of vignettes about individuals with severe mental illness who have committed crimes. It's a bit scary for me as a future intern, but alas, many of the stories reflect failures of the mental health system to medicate individuals and to commit them when necessary. I still feel that client's rights are central and even after just two weeks of internship, I can see how these tragedies occur. Sigh - tricky business.
December 3, 2009
I was born as a result of the upheaval that took place as it was described in this book. My biological mother was a patient at Agnew Insane Asylym during the period of deinstitutionalization, I was fascinated to learn the details of what took p;ace around my birth and adoption.
November 23, 2009
Why are there so many insane people living on the street? Because Reagan closed down most of the long-term psych hospitals in the 80's.
There are also remarkable stories included of families who tried to get their relatives help, to no avail, and the tragedies that resulted.
There are also remarkable stories included of families who tried to get their relatives help, to no avail, and the tragedies that resulted.
January 27, 2010
Shhhh... it's a secret. This is the truth. So, shhhh...
I wish I could mandate every polititian and every screen writer, every journalist and every mental health care worker to read this. You all are welcome, too.
I wish I could mandate every polititian and every screen writer, every journalist and every mental health care worker to read this. You all are welcome, too.
February 4, 2012
Okay, the author founded my employer, and I needed to read the book for work. But, along with former WashPost reporter Pete Earley's "Crazy," this is essential reading for anyone interested in how America has replaced its mental hospitals with jail and prison cells.
June 1, 2012
Although the author makes a cogent argument for involuntary commitment, it was difficult to finish. I found myself bored after the 5th chapter but forced myself to finish the remainder of the book.
January 24, 2016
If you wondered why there are so many untreated mentally ill roaming America's streets, filling America's jails, and living lives of untreated hell for themselves and others, this book provides the answer. It also suggests a solution. Well worth reading.
March 4, 2018
"A rock doesn't make a decision while it's falling. It just falls." Proper treatment can free people from their illness and restore their dignity, their free will and the meaningful exercise of their liberties.
February 18, 2018
Very interesting!
June 3, 2024
An important warning call about deinstitutionalization and resultant mental health crises (psychotic violence, homelessness, prisons becoming de facto psychiatric centers, etc.) plaguing communities. Although the author relies a bit too heavily on case studies to prove his point, the information is nonetheless critical.
March 21, 2025
frustrating on multiple levels, especially as someone w StPD
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