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

by E. Fuller Torrey

In 1963, President John F. Kennedy delivered an historic speech on mental illness and retardation. He described sweeping new programs to replace "the shabby treatment of the many millions of the mentally disabled in custodial institutions" with treatment in community mental health centers. This movement, later referred to as "deinstitutionalization," continues to 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.

Genres: Nonfiction, History, Psychology, Mental Health, Politics, Mental Illness, Psychiatry

224 pages, Hardcover

First published January 1, 2013

Reviews

[Caitlin · Rating 4 out of 5]

I walk a lot - always have - so I observe the world from the pedestrian's point of view. Streets, businesses, people - everything is at eye level and throughout my life I've seen more and more people on the streets who are very ill. There's the girl who wanders about downtown - half naked, barefoot, talking to herself, occasionally screaming at passersby. There's the guy I've watched go from mildly eccentric - hanging out in front of the Walgreen's with his boombox powered by a car radio - to almost catatonic - huddled in the corner of a building, covered in filth, unable to move or speak. I haven't seen him in awhile. Variations of these scenarios play out all over - these are the more dramatic examples.

Then there are the people who are high-functioning, but who occasionally need a little extra help and quickly learn the strict limitations their health insurance imposes on this kind of help. More and more people are steered toward classes and group therapy (whether or not these are indicated for their disorder). Fewer and fewer people have a real care team, anything resembling coordinated care. Psychiatric medications are staggeringly expensive and most have side effects. It takes time to find the right combination of medications for any individual and even more time for the effects to truly kick in. Most anti-depressants don't make themselves felt until six weeks after a patient begins taking them. People give up, can't muster the energy to be active consumers, can't afford their medications, can't get the help they need. This is a scandal and American Psychosis walks its reader through the history of the failed experiment.

[E. Dade · Rating 2 out of 5]

I devoured this book reading of the dangers of A Freudian influenced psychiatric community, tales of lobotomies, individuals doped up on Thorazine, and treatment of the mentally ill catering to family members frustrated with dealing with their children or embarrassed of their maladies, so institutions and procedures to make the afflicted family member docile. Later, government corruption, money misused by CMHC's, the complacency of the NIMH, and Reagan’s laissez-faire attitude of funds appropriated for mental hospitals (which were often pocketed by crooked administers) ended up shuttering the hospitals Ronald Reagan's abysmal handling of mental health (and the AIDS crisis that he viewed without humanity, actually laughing at the subject*) wasn't even mentioned (sus). Dr. Keith Ablow (a horrific splicing of Alex Jones and Dr. Phil) can often be seen on Fox news diagnosing political figures with personality disorders {This review was originally written pre-Trump}🤷‍♂️) is cited as a valid source of information for this emetic disguised as a text.The author also expresses an affinity for “The Clubhouse Model” which consists of "counselors" in charge of people with several pathologies. They're sole purpose is to get every schizophrenic working at a McDonald's. Patients are referred to as "members", and to reiterate the facilities are run by Junior College graduates and no professional presence to deal with this pressure cooker are on the premises.) This book accumulated into a lack of mentioning the success of CBT, DBT, Talk-Therapy (one-on-one or group), and a cynical view of in-home care. The political slant tainted any validity I may have had in it before questionable passages were just subverting a certain ideology within a book I had been reading with a reasonable expectation of learning the history of our mental health system and didn't expect the author to attempt to manipulate my political stance regarding behavioral health care.

* http://nymag.com/daily/intelligencer/...

[Kathy Brandt · Rating 5 out of 5]

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.

[MBP · Rating 4 out of 5]

Torrey has been a voice in the wilderness advocating for better treatment of the mentally ill for years. This was especially interesting to me as I was briefly a caseworker for the chronically mentally ill in a city with a large number of deinstitutionalized patients; I learned about the policies that resulted in the conditions I saw on the street. A passionate and well-researched analysis; at times a bit academic and statistic-heavy. The book I wish Torrey would write is his personal experiences of growing up with a mentally ill sister, and how that has influenced his career.

[Kyle Nicholas · Rating 2 out of 5]

No real review, just a few thoughts:

1. I am sick and tired of the word "hospital" and its derivatives (hospitals, hospitalization, hospitalized, etc.) For god's sake, it's called a THESAURUS. Pronouns are acceptable in the English language, too.

2. The audiobook version stinks because the narrator obviously doesn't know how to open his mouth while speaking. He sounds like what Sylvester the cat would sound like after Tweety pours alum into his mouth... after smoking a joint or two. He sounds like the type of man who actually lifts his pinkie finger when he sips his afternoon tea. If you're going to narrate, learn how to SPEAK.

3. So, richy-rich writer, you think SSI (Supplemental Security Income) is a problem because a few for-profit care homes and nursing facilities are corrupt and just screw the government and the patients... and so you want to get rid of SSI for mental disability? No, no, no. You SUCK. This is why the poor hate the rich right now! The problem isn't SSI or SSDI. The problem is the greedy farts who take the money from the patients and screw the government for profit! You don't blame the fire in an arson; you blame the arsonist, idiot!

[Britt · Rating 3 out of 5]

This book broke down into three sections to me. The first was way too much focus on the Kennedy family. We all know about Rosemary Kennedy and her cognitive and mental health functioning compared to her siblings. I get that this likely played a part in JFK’s mental health policies and approach, but we could have had one page on that and not a whole section. The second part is about policy along with many many many stats. The goal is to show you the sheer high number of flaws in mental health care. However, there was almost a dramatic framing of information to instill fear. For example, the author lists off all the people with mental illness that committed heinous crimes in certain timeframes. If you are just reading and see lists of people that tried to chew a baby’s arm off or decapitate someone, you think people with mental illness are super dangerous and should be locked away. It’s misleading, but then he later backtracks and says the fact of how mental illness is not likely to make you more violent but usually a victim of violence. It’s only 1% of people with mental illness that become violent. The third piece is all his recommendations for improving mental health treatment. Some of them you might agree with and some of them you might not. He takes a big picture view and does not really mention any therapy services (he’s a psychiatrist versus psychologist). The author skipped important pieces of treatment and then bashed some people too much. Either way, the book had some interesting facts and made me think differently on a couple topics. The author says we spend $140 billion on mental health care and another $193 billion on indirect costs yearly. I don’t doubt these numbers and they are likely an underestimation as they are old now. There are always way to improve our mental health system as it has definitely failed many people, so I think the author brings up good data points to have deeper conversations on.

[Amy Armstrong · Rating 4 out of 5]

American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System is a must-read for anyone who is a consumer of behavioral health services or working in the field because it is such an eye-opening read about the complexities of why our current mental healthcare system (if you call it that) is totally useless. I am probably a bit more invested in the future of funding and the provision of mental health services because I am working in the field and often have to make referrals only to find that most of the referral resources are overburdened and under-funded, and we have yet to see a push that has any teeth to it to change that. I have even started to believe it's impossible to ever get people in power to take the need for comprehensive behavioral health care seriously, but, according to E. Fuller Torrey, that was not always the case.
Thanks to progressive ideals in the 1940s and 50s, mental illness briefly went from being a state-funded issue handled in asylums to a federal-funded issue to be handled by community clinics. In theory, much of the original proposal sounded Utopian. Entire communities would be molded in such a way to prevent anxiety and eventually, we would have a great society free of mental illness. We just needed to focus on mental health.
That type of model works fine for the "low pathology" populations dealing with the normal stresses brought on by transitions through life stages. Unfortunately, for many patients struggling with chronic psychiatric disorders that require intensive treatment, community treatment does not work very well in large part because the patient needs to be proactive in obtaining, continuing and actively participating in his or her treatment. While all of that sounds nice, in many psychotic illnesses like schizophrenia, patients often do not realize that they are sick and need medication. Also, the ideal low-stress community (assuming will power and a clinic were enough to create that) would not bring someone with delusions and hallucinations the same sort of solace it would to a slightly anxious young woman who just had a bad day at work.
American Psychosis is a bit information heavy and repetitive at times, but definitely worth the read. Also, it's worth noting that this review is based upon a digital ARC, so some of the repetitive sections could have been edited out since.

[Laura · Rating 4 out of 5]

Torrey's brief history of psychiatric care in the United States from the early 1960's to the present is illuminating. He pulls together the events and advances that led to the closing of our country's mental hospitals in a short, cohesive book. However, this is not just a history text. Torrey is an advocate for change and his opinions pervade the book. Unfortunately, as he points out, certain statistics just haven't been kept; therefore, much of the book relies on small studies and inferences gleaned from the available stats.

It is not surprising that Kennedy's Camelot was the birthplace for the community health concept. It was a heady time for America, and American's could do the formerly impossible; social ills and poverty would soon be relegated to the past. No more would states inter hapless individuals to the morass of state mental hospitals. Rather the federal government would create community based mental health centers focused on preventing mental illness and providing resources for the mentally ill and their families. This grand idea, combined with emerging drug therapy and the new federal programs (medicare and medicaid), led to an emptying of the hospitals. New laws prevented individuals from being involuntarily committed or medicated. It was a grand new era for mental healthcare, until it became apparent that the community health centers weren't working and that preventing mental illness was a little harder than previously thought.

As the states learned to shift the cost of caring for the mentally ill to the federal government, profiteers learned how to make big bucks off nursing homes and board-and-care facilities that received many of the former hospital patients, homelessness increased among the most ill, and police departments became overwhelmed with problems caused by the untreated. Mental healthcare had devolved from the imperfect hospital system to no system at all, leaving patients with uncoordinated, inconsistent treatment. We currently struggle with piecemeal solutions that are more costly than ever to the taxpayer. Privatization has been a fiasco for the patients but a political and monetary boon for certain politicians, lobby groups, and businesses. As an aside, the problems with privatization of mental health care should be a canary in the mine for the privatization of our public schools.

Torrey leaves us with some thoughts on what has gone wrong and potential solutions. Sadly, we seem to be moving farther away from any kind of fix especially since it involves one of the most vulnerable, voiceless segments of our population.

[Kerry · Rating 4 out of 5]

This book is a well-structured, succinct report on the state of governmental mental health systems since the 1940s and an argument about where they went wrong--and continue to go wrong--in the United States. The long path to abandoning mentally ill people to homelessness and lack of care began with policy makers who had agendas, big egos, a lack of responsibility, and a lack of understanding or concern about the consequences of their actions. Though a complex issue, Torrey untangles its elements and presents them logically, following up with recommendations and suggestions about how to fix the issue.

Because it affects us today, perhaps most poignant is the discussion about the number of mentally ill inmates in prison, how mentally ill citizens become homeless, and the danger these people may cause to themselves and to others. Torrey also emphasizes how some mentally ill people, not realizing they are affected by their disease, stop their medication or do not seek treatment because they aren't aware of their problem.

Torrey doesn't get overly emotional about the topic, letting the facts instead speak for themselves. He attempts to correct myths and misunderstandings that have arisen out of this situation--that the most severely mentally ill "choose" to be homeless and refuse help, that all mentally ill people have families to help them, or that all mentally ill people who use public spaces are "harmless." While he does spend a significant portion of the latter chapters of the book presenting cases of dangerously mentally ill people, he does not suggest that we should be afraid of them, but rather that government responsibility must be taken to get these individuals the necessary care to protect themselves and others and to help them live productive lives.

Torrey does a good job of criticizing decades of people in government turning a blind eye, passing the buck, and making decisions without having the necessary expertise or knowledge to do so without creating problems that nobody, in turn, wants to fix. Again, though, he does so without being too strident about it, presenting a chronology and the opinions of policy makers to show the process of a decades-old debacle that continues to ignore a segment of the population who can't always help themselves effectively.

[Jules Ray · Rating 5 out of 5]

Thank you to NetGalley and Dr. Torrey for this free ARC in exchange for an honest review.

Where do I start? I have a background in mental health/mental retardation having earned my first undergraduate degree in developmental psychology and working in the field for many years until I made a shift into something else. So this book appealed to me in a big way but I had no idea what was in store for me. Not only did my classes in college not go over the history of MHMR in detail, they left out some of the most important aspects that Dr Torrey explains very well.

To start off with, Dr. Torrey describes the Kennedy family and their big secret, Rosemary. The Kennedy family did everything they could to hide her from the press, going so far as to lie about her circumstances. Then, they did a most horrific act that was done all in the name of being public figures and pursuing their idea of the American dream.

Needless to say, this started the federal government's imposition on the mental health services in this country. Granted, the plan slowed down and shut down many of the "snake pit" psychiatric facilities but it also created a number of other issues outlined in the book.

Facts and details are well outlined in this book. At some points it seems a little tedious but this is a work of non-fiction so the reader has to keep this in mind and absorb all the information. So from the early 20th century up until the present moment, American Psychosis details the creation of the new system, the people responsible for the direction it went in, and how it has blossomed into today's problem.

I can't praise this book any more than I have without going into too many points brought up in the book. However, I highly recommend this to anyone interested in the history of our country's mentally ill. Whether you work in the field or not, this will open your eyes and enlighten your world in what was started 50 years ago and what it is now.

[Debbie · Rating 4 out of 5]

Startling how a country as vast and great as the Unites States has such a disjointed and ineffective strategy for addressing mental illness. The author covers the history of mental health policy and programs revealing the gaps and loopholes for caring for those in most need of care. Though depressing and disturbing, the book finishes by outlining a plan of what is needed to bring care standards up to at least an acceptable level. Though given the history, and current challenges with the implementation of the affordable health care act, it's a daunting task to say the least.

[Ben · Rating 2 out of 5]

Basically a retread of The Insanity Offense: How America's Failure to Treat the Seriously Mentally Ill Endangers Its Citizens by the same author, which is a far better book. The newer book offers some historical background, but is otherwise empty of any original content.

[Tess · Rating 4 out of 5]

This is an informational book about the past and present treatments for the mentally ill in America. It carries its course through time, beginning with the tragedy of Rosemary Kennedy, and ending in modern day. It points out the many flaws of the mental health system, and begs for reform. It has few personal connections to the topic and contains its own work cited in the back of the book. I enjoyed the way it was written, and would consider reading other works by the author.

[Erica Ross · Rating 5 out of 5]

“Americans highly value our civil rights to live as we please and not have government tell us what to do. Many people thus defend the rights of mentally ill persons to be “free” to not take needed medication, to live on the sidewalk, or under a bridge. What they don’t realize is that most such people are not “free”; rather, their actions are dictated by their delusions and auditory hallucinations, however irrational those may be. They are in fact enslaved by their illness.”

[Anna Nowinski · Rating 1 out of 5]

Pop-policy. And not even good pop?

[Maddie · Rating 2 out of 5]

Lost me in the middle. I wouldn’t recommend this book. The beginning was interesting with the history and ideologies behind deinstitutionalization. The middle was full of stigmatizing language and stories that seemed to be included just for the shock value. I feel like this book lacks nuance and further stigmatizes an already vulnerable population.

[Alex MacMillan · Rating 3 out of 5]

This expose of a silent and ongoing humanitarian disaster in the United States is one part Kennedy family biography and another part bureaucratic nightmare inflicted on the nation's mentally ill. A book ultimately about the dry topic of why emptying state mental hospitals was a bad idea draws the reader in by creating empathy with the conflicted feelings families have when the personality and behavior of somebody you love and want to share your live with unravels. The country's neglect of the crisis is clearly analogous to the Kennedy family's anguished detachment from daughter Rosemary's illness.

I repeatedly associated common themes in American Psychosis to other books about competing strands of political theory that inform public policy. Ever since Aristotle first criticized Plato's utopian City as unimaginable in practice, Western philosophy has divided between rationalists who believe in the perfectibility of mankind as engineered by an elite of central planners, and empiricists who support gradual organic trial and error to mitigate our inherently self-centered human nature (see [A Conflict Of Visions). On issues of mental health treatment, E. Fuller Torrey and the evidence of the past five decades clearly aligns with the empiricists. Many tombstones ended up filled by civil liberties lawyers who tied the hands of law enforcement by placing abstract notions of individual liberty above protecting the severely ill from violence to themselves and their communities. Crafters of the legislation signed by Kennedy and administered without effective opposition for twenty years by the rationalist/Democratic Party made assumptions about the efficacy of community treatment and preventative care that were without real-world evidence.

To end the exploitation and abandonment of citizens who are psychologically incapacitated through no fault of their own, legislators should reverse funding disincentives that prevent federalism (mental health treatment should be exclusively a state/local job) and Americans should speak out and bring the force of our vibrant civil society to bear to provide better conditions. Unlike the Kennedys, we can relearn the simple lesson that proper care starts at home.

[Ken · Rating 3 out of 5]

If you work with people in the public sphere--as counselor, social worker or psychologist--you probably already know this book. Its relevance to you is obvious. But it is equally relevant, and perhaps more needed, by those of us who do not think of ourselves as dedicated to working with those afflicted with mental illness. I include my own profession (clergy) in this category, but also police, emergency responders of all types, those who provide open services to the public such as librarians. For us, this book details how it came about that we often feel like we're living in a huge open-air psychiatric ward. Answer: We Are. Since 1962, the Mental Illness treatment system in the USA hsas been demolished and replaced with a haphazard array of procedures inadequate to the needs of our fellow Americans afflicted with mental illness. All this was "accomplished" with Good Intentions. Apparently there were plenty of Good Intentions left over after the Road to Hell was paved. Combinations of extremist psychiatric theories and the family traumas of the Kennedys were major interlocking causes initiating the closing of state psychiatric hospitals. The assassination of JFK with weeks of legislation federalizing care meant that no adequate follow-up was provided for those patients evacuated from closed hospitals. Well-intentioned bans on involuntary psychiatric care imposed upon many mentally ill folks the burden of properly discerning and choosing appropriate care when the nature of their affliction made such choice nearly impossible. They were caught in a classic Catch-22. Dumping those suffering mentally ill patients into communities meant that police and other non-trained folks were the ones confronting the needs. The result is that we currently spend many times the money as we did in 1960, but with arguably far worse results. It's a short book. It's important. I recommend it.

[Meg - A Bookish Affair · Rating 3 out of 5]

"American Psychosis" covers an incredibly important subject. It seems all too often that I come across a story of someone struggling with a mental illness and not being able to get the help that they need. It's really sad. It used to be that we had mental hospitals in this country that would take in patients. Unfortunately this system did not seem to work well since the people in the hospital were not cared for well at all! This book covers how in the 1960s, President Kennedy tried to reform the mental healthcare system of this country and how the system eventually failed. It's a very sad tale that definitely could use some attention.

There were some sections of this book that were very good. I really liked the beginning section about President Kennedy and his own dealing with mental illness in his family. His sister, Rosemary, was mentally ill and had a lobotomy as a young woman so Kennedy was well aware of the plight of families that had to deal with this difficult matter.

The more narrative parts of this book were fascinating to me. There were other parts of the book where Torrey had so much information that it was almost overwhelming as there wasn't a whole lot of narrative to break it up.

One thing that I didn't care for is that the book used the word, "retarded" over and over again. While that word has been used in the past to describe those with intellectual disabilities and/or mental illnesses, the word is now sort of offensive and I was disappointed that the word was used so much in this book.

I also wish that the conclusion had been a little more actionable or at least more concrete. It seemed to end very quickly.

Overall, I really liked this book. Torrey makes some incredibly good points and definitely gave me a lot to think about. I know that this is an issue that I will be thinking about long after finishing this book.

[Hank Pharis · Rating 2 out of 5]

This is an interesting history of the treatment of the mentally ill in the U.S. since the Sixties by a well known and respected Psychiatrist. The book begins with the tragic story of Rosemary Kennedy. The family, and especially her father, were humiliated by her mental illness. She had about a 4th-5th grade level of intelligence and maturity and they had her institutionalized. However she was beautiful and they feared she would get pregnant. Therefore her father Joseph chose for her to have one of the first prefrontal lobotomies. Thus she spent the next 64 years of her life with the abilities of a 2 year old. All this had a big impact on the rest of her family. Not only did they all have a lot of guilt and shame but they also attempted good things as a result. For example, her sister Eunice, was inspired to begin the Special Olympics. And her brother, President John, fought for and brought sweeping changes for the care of the mentally ill.

The primary change certainly had good intentions. Many of the state mental institutions were awful places. Thus community mental health centers were developed to replace them as better, kinder facilities. However Torrey argues that decades later things have not improved. For example, at least 1/3 of the homeless are mentally ill as are 1/5 of those imprisoned. He further tells the story of numerous mentally individuals and the havoc they have wrought.

Torrey concludes the books with some proposals for a better future.

(I'm stingy with stars. For me 2 stars means a good book. 3 = Very good; 4 = Outstanding; 5 = All time favorites.)

[Christopher Prosser · Rating 3 out of 5]

The overall narrative of this book is fantastic. The author covers many of the key ingredients that went into the deconstruction of the state-run mental health system. It's very educational to see how blind optimism; a lack of oversight; and unintended side effects of other policies at up to the travesty of how we currently care for our severely mentally ill citizens.

I would have given the book 4 stars, but the author is incredibly fond of quoting statistics; but does nothing to normalize, or contextualize the numbers within our greater society. For example the author cites a study that shows the incidence of psychotropic medication use in the prison population is 40%. But without the context of what the incidence of medication use is in a control population, you can't draw the conclusions the author makes. You can't really draw any conclusions, other than the fact that 40% of people in that population on medication.

At another point when he's discussing the cost of treatment, he cites three different studies. One study provides the cost of treatment per month; another provides a range of values for annual treatment; and a third provides a point estimate for annual treatment. At that point it wasn't clear to me if these even covered the same definition of treatment, and I had to manually calculate the annual cost for that first study.

Read the book, skim all the numbers.

[Richard · Rating 3 out of 5]

You would think this a libertarian book by the title but you'd be wrong. He states the mental health treatment's failure at the federal level, and the state level before that, and the privatized system before that. In fact he spends so much time going over the history of failures that at the end when he asks rhetorically which level should lead it and answers his question with "It's unclear, but obviously not at the federal level due to its failures over the last fifty years, probably at the state level or counties," it's not clear at all how he picked one failing system over the other.

While his solutions are wispy ideas that do not inspire confidence that he has a good enough idea of what to do prior to writing, the book as history fails on certain levels too. It doesn't go chronologically, starting with a thorough storytelling of Rosemary Kennedy and working up, but then yo-yoing all over the place. Working forward to 1980, then back to 1962, then forward to 1987 then backward to 1982, over and over.

So while he doesn't succeed at the history of the problem nor in the later sections of the proposed solutions, should you read/listen to it?

Yes? If you like jigsaw puzzles of the word kind, you will find pieces of value.

[Maggie Hesseling · Rating 4 out of 5]

An incredibly interesting and shocking text regarding the situation of mental health care in the United States during the twentieth century on. With the human element attached to it (mostly in the form of the Kennedy Family) this text is not only accessible for a wide audience, but is engadging as well. The statistics are also interesting and not overwhelming, meaning that though the text contains them, it is not driven by numbers and is therefore anything but dry. You'll laugh at some of the absurdity:

"A large billboard in LA carried the following message in the 1950s: It is amazing and appalling how many supposedly intelligent people have been duped by such COMMUNIST SCHEMES as FLUORIDATION and 'mental health' especially since both the AMERICAN LEGION and the D.A.R have publicly branded 'mental health' as a COMMUNIST PLOT to take over our country"

And sigh at the rediculousness of notions such as that mental illness can be caused by the relationships you keep. Some of it seems crazy and bizar, but it's all brought together in an elegant way, so that at the end you're left with an indication that things are changing for the better. Especially thanks to people such as Torrey.

[Dana · Rating 2 out of 5]

Torrey makes many accurate conclusions about the state of mental health care in our country and the sad consequences of the deinstitutionalization movement, I just wish he hadn't done it in such a superficial manner. His conclusions are too quick and neatly packaged - barely glancing over the hugely complex social, religious, political, and artistic influences of the era. He makes it seem as though the past 50 years of mental health treatment in America is a direct result of money (ok, what isn't?) and Rosemary Kennedy. I just think this is too simple of a perspective and leaves much un-discussed in the periphery.

Also, he states that the failed community mental health centers interrupted whatever progress that the "emerging" state programs of the 1950's where making. What evidence is there that had state control of mental health treatment continued, the outcome would have been any better?

From a quality of writing perspective, the ratio of quotations and case examples to his actual text was too lopsided for me.

[Andria Morningstar-Gray · Rating 4 out of 5]

A fascinating look at the history of mental health treatment in our country. I learned so much reading this one. I had no idea that trying to improve the system actually led to disastrous results. You sort of get the idea that we are always moving forward, progressing, as the years pass, but this book reminds the reader that not all changes are for the good. A few parts of this book were a bit dry and repeated info from chapter to chapter, but I still think it was worth the read. It really shed light on how we got into the mess we are in with the lack of a good system for helping those who suffer with a mental illness.

[Támara]

Dr E Fuller Torrey is a wonderful advocate for the severely mentally ill and those who are untreated within our society. He methodically draws attention to the homeless, the incarcerated, the victimized, and thee violent tendencies of those too ill to make proper decisions. American Psychosis is a different type of book for Dr Torrey. He focuses on the Federal Government and the errors within our system that have led to poor mental health treatment. Although I wasn't pulled in at the beginning, the book continues and makes great points that deserve much thought.

[Andy White · Rating 4 out of 5]

This is a very good, brief overview of the sad state of mental health care in the US. The sad fact that many people STILL don't believe mental illness is a real thing, (Oh, just snap out of it!) is the first stumbling block. Having worked in mental health care in the 80s, during the deinstitutionalism era, this title really interested me. It provides a history of the treatment of the mentally ill in the US. Torrey ends the book with the things we need to do about the lack of mental health care in the US. Ignorance and money are the two great hurdles we face.

[Marik Casmon]

I enjoyed this book a great deal. It demonstrates how government programs get traction and come into being. Among several factors are the influence of money and political power in getting something started, the importance of having experts who have beliefs unsubstantiated by evidence, the failure of intelligent people to consider the possible consequences of their actions, the power of denial in public policy, and the immoral behavior of private businesses. All valuable lessons.

[Jackie · Rating 4 out of 5]

I wanted a history of asylums and ended up with this book. It wasn't exactly what I was looking for (although it did go into history of asylums), but I read it anyway and found it thought-provoking. Of the intertwining of history, politics, and how we look upon mental illness.

I did not like how hard it was to keep my attention. Definitely written by a Dr. I had to motivate myself to finish, even though I was interested in what he had to say.

[Elizabeth Chadsey · Rating 2 out of 5]

I'm not exactly a stranger to non-fiction and I know psych/science/cultural studies aren't always thrilling start-to-finish but this one was notably boring for substantial stretches throughout. Less of a psychology study and more of an American governmental history lesson, I can't say I learned very much after the first chapters illuminated the Kennedy Family's handling (or not) the care and treatment of their mentally ill daughter/sister.