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Bedlam: An Intimate Journey Into America's Mental Health Crisis
A psychiatrist and award-winning documentarian sheds light on the mental health care crisis in the U.S.
When Dr. Kenneth Rosenberg trained as a psychiatrist in the late 1980s, the state mental hospitals, which had reached peak occupancy in the '50s, were being closed at an alarming rate, with many patients having nowhere to go. There has never been a more important time for this conversation, as one in five adults — 40 million Americans — experiences mental illness each year. Today, the largest mental institution in the U.S. is the LA County Jail, and the last refuge for many of the 20,000 mentally ill people living on the streets of Los Angeles is LA County Hospital. There, Dr. Rosenberg begins his chronicle of what it means to be mentally ill in America today, integrating his own moving story of how the system failed his sister, Merle, who had schizophrenia. As he says, "I have to come to see that my family's tragedy is an American tragedy. My family's shame is America's great secret."
When Dr. Kenneth Rosenberg trained as a psychiatrist in the late 1980s, the state mental hospitals, which had reached peak occupancy in the '50s, were being closed at an alarming rate, with many patients having nowhere to go. There has never been a more important time for this conversation, as one in five adults — 40 million Americans — experiences mental illness each year. Today, the largest mental institution in the U.S. is the LA County Jail, and the last refuge for many of the 20,000 mentally ill people living on the streets of Los Angeles is LA County Hospital. There, Dr. Rosenberg begins his chronicle of what it means to be mentally ill in America today, integrating his own moving story of how the system failed his sister, Merle, who had schizophrenia. As he says, "I have to come to see that my family's tragedy is an American tragedy. My family's shame is America's great secret."
256 pages, Hardcover
First published October 1, 2019
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December 6, 2021
Dr. Kenneth Paul Rosenberg’s impassioned plea for better mental health care in America.
He chose the Los Angeles county emergency psych system as a case study in dysfunction.
I’m a mental health worker in the Los Angeles area. I have worked at every level of the system. Homeless heroin addicted populations. County funded foster care for girls (children) involved in human trafficking. Insurance based dual diagnosis treatment where I saw addiction kill dozens (more than 20) bright, wonderful young people.
I can say from first hand experience, that the emergency psychiatric care system in LA county is so grossly insufficient, that it defies words.
The people who work in those systems are the best in the world. USC and UCLA are incredibly good hospitals. But there simply aren’t enough resources, and thousands are discharged too early, or turned away altogether, for no good reason. The most unfortunate of which end up in jail, prison or dumped on skid row. Which if you haven’t been to skid row in LA. Trust me. It’s the worst one of those in the developed world. Absolutely tragic abject misery.
This is an important book on an urgently important topic.
It’s reasonable.
Well written.
And accurate.
5/5 Stars.
He chose the Los Angeles county emergency psych system as a case study in dysfunction.
I’m a mental health worker in the Los Angeles area. I have worked at every level of the system. Homeless heroin addicted populations. County funded foster care for girls (children) involved in human trafficking. Insurance based dual diagnosis treatment where I saw addiction kill dozens (more than 20) bright, wonderful young people.
I can say from first hand experience, that the emergency psychiatric care system in LA county is so grossly insufficient, that it defies words.
The people who work in those systems are the best in the world. USC and UCLA are incredibly good hospitals. But there simply aren’t enough resources, and thousands are discharged too early, or turned away altogether, for no good reason. The most unfortunate of which end up in jail, prison or dumped on skid row. Which if you haven’t been to skid row in LA. Trust me. It’s the worst one of those in the developed world. Absolutely tragic abject misery.
This is an important book on an urgently important topic.
It’s reasonable.
Well written.
And accurate.
5/5 Stars.
September 21, 2019
“Asylums never went away, they just grew into two varieties: posh for the wealthy... and prisons for the poor” - Cheryl Roberts, quoted in Bedlam
“truly quality psychiatric care will emerge only with the establishment of a universal, single-payer insurance system of the sort used in every other industrialized country in the world” - Bedlam
I received a free ARC of this book in exchange for an honest review.
Kenneth Rosenberg, MD, provides an always timely, poignant, and intimate description of the state of mental healthcare in the United States. Using his insight as a psychiatrist and as a sibling to a seriously mentally ill woman (deceased), he reinvigorates the call for more responsible treatment. His tone is both compassionate, historically & currently relevent and, as needed, empirically unforgiving. He also takes care, however, to highlight where progress continues to be made in mental health treatment, and he does not leave the reader mired in cynicism.
The structure of the book is similar to Tacking on the Styx in so far as it interweaves personal story telling with empirical social & scientific discourse. However, the former is strictly about epilepsy and incorporates intimate historical fiction. The latter is much more inclusive of all (serious) mental illnesses, and it seeks the attention not only of medical professionals but of government agencies and the public at large. Biographical discussion of Rosenberg's mentally ill sister and his own experiences surrounding her treatment are vividly humanizing.
Rosenberg's take away points are too numerous for a book review, but some that stick out include the need to vigilantly protect the Mental Health Parity and Addiction Equity Act. That act protects patients from attempts by insurance companies seeking to discount a patient's mental health coverage relative to other medical needs. Rosenberg carefully avoids saying that an ill concealed elephant in the room is the exceptionally pro-business state of present American government, so I have said it for him. Parity cannot be taken for granted. Contrary to my cynicism, however, he introduces the reader to our current 'mental health czar', Dr. Elinore McCance-Katz and describes her very progressive agenda with optimism and respect.
Highlighting a need to fight stigma, Rosenberg also quotes Bruce Schwartz as saying that insurance companies considered the stigma of mental illness to be a first line of defense against monetary claims for treatment ultimately never sought or never fought for. Fighting stigma is a powerful message within the book insofar as the text confronts the fiasco of using the prison system as a fundamental, yet doomed, care-giver. He points out that one big - city jail has mentally ill prisoners filling about 1,500 beds. By contrast, he then describes the great results of a multipronged approach to care in Italy where in-patient (and by extension, inmate) care transforms into out-patient care with great effectiveness. Insurance companies must be brought to this approach.
Bedlam provides a great informational resource, but one of Rosenberg's greatest gifts to the reader comes at the end of the book in “Practical advice for persons with SMI and their families.” He lays out the hands-on measures to take under particular circumstances, giving contact and website information for the National Alliance on Mental Illness and lists some of the services and information provided there. He suggests and describes making a crisis plan for the household. He discusses Dr. Xavier Amador's Listen-Empathize-Agree-Partner method of constructively connecting to someone with an SMI.
Even more importantly, his “Tips and tricks to help a loved one with chronic, debilitating SMI” is an essential, practical mini-manual of coping which touches on everything from paying bills online to limit stress, to pet ownership, to legal prodding (he also suggests visiting https://mentalillnesspolicy.org/coping). He offers important advice relevant to situations requiring law and law enforcement.
Bedlam is an essential resource to both everyone who has a loved one with a serious mental illness and everyone planning a career in mental healthcare.
February 15, 2020
What an engrossing little read this was! Not technical at all, very relatable with the many personal stories included, and filled with empathy.
Some of the surprising things I learned from this book are that the longer a person suffers with an episode from a serious mental illness, the harder it is to treat in a meaningful way and the harder it is to return the person to normal thoughts and behaviors.
I learned about how many times people suffering from serious mental illness only receive treatment in jail, and that usually is not long enough to see actual improvement, only stabilization.
I learned about a new model of justice called mental health court where a judge can work with the offender in getting them the help they need in order to avoid jail and homelessness.
This was a very short and informative read, and it was not nearly as bleak as you may think. While there is a long way to go in terms of treatment and providing meaningful societal assistance, the book does end on an optimistic note. I thoroughly enjoyed reading this and I feel that it is an important book for everyone to read.
Some of the surprising things I learned from this book are that the longer a person suffers with an episode from a serious mental illness, the harder it is to treat in a meaningful way and the harder it is to return the person to normal thoughts and behaviors.
I learned about how many times people suffering from serious mental illness only receive treatment in jail, and that usually is not long enough to see actual improvement, only stabilization.
I learned about a new model of justice called mental health court where a judge can work with the offender in getting them the help they need in order to avoid jail and homelessness.
This was a very short and informative read, and it was not nearly as bleak as you may think. While there is a long way to go in terms of treatment and providing meaningful societal assistance, the book does end on an optimistic note. I thoroughly enjoyed reading this and I feel that it is an important book for everyone to read.
Read
July 4, 2022I kinda already knew how fucked our mental health system is but there’s some interesting stuff here, particularly about how the capitalist influence on the psychiatric pharmaceutical industry has meant that very little research goes into finding drugs to treat severe mental health issues.
February 24, 2020
I would have given this five stars if I had any immediate or extended family suffering with psychosis. At it was, it gave me a scare as to how badly the United States has treated people having a psychotic episode or perhaps multiple ones. Prisons now house a substantial number of people experiencing schizophrenic or bipolar 1 episodes. This should not be. The author suggests several approaches for both families and institutions to deal humanely with people experiencing these unique and misunderstood mental illnesses.
The book has profuse notes and sources, and lists agencies that can help.
The book has profuse notes and sources, and lists agencies that can help.
August 11, 2025
”’Why is this okay? Where is the outrage? The ribbons, the races, and the ice bucket challenges?’”
It started with his sister.
Before Kenneth Paul Rosenberg became a respected psychiatrist and lauded documentary filmmaker, he was just Ken, living with his family in Philadelphia. He had two older sisters and lived a nice, middle-class existence. But he also had a secret: his older sister Merle had schizophrenia. Her lapses into mania, paranoia, and violence were a source of shame for the family, but also a source of endless frustration trying to get her treatment in a time when preventive treatment wasn’t available. Inspired and propelled forward by his sister’s experience, Rosenberg decided to become a psychiatrist. Throughout his career, he has gotten a deeper insight into how broken America’s treatment of the severely mentally ill is, and that insight has inspired advocacy. In a five year quest to further understand how and why we got here he takes himself and the reader on a seven year journey into a quest of what it truly means to be mentally ill in the United States and how it seems to be an endless cycle of tragedy in the amount of people it has failed, including Merle.
As a person living in the United States of America and who works with the mentally ill fairly often, I knew that our mental healthcare system was not that great, but I had no idea how bad the actual extent of the problem was. After reading this intense, riveting, and heartbreaking study of the past and present state of mental health treatment in the United States, I have learned that our mental healthcare system is, quite simply put, a disaster. A shitshow. A garbage fire. A long smoldering fire on the verge of an implosion. It’s laughable how little people with power seem to care about the mentally ill here in the United States. As The Fiancé puts it, “the mentally ill aren’t the people. It’s the people running the system that are the problem.”
Reading this book was a revelation. It opened my eyes to so many things I had suspected were true and so many things I never knew about. Honestly, if I listed all of them, this review would be about the size of an academic thesis.
This book proved my mother right when she always said that the almighty dollar is responsible for the decisions we make, whether right or wrong. I found out that due to the amount of time it takes to research mental illness and human psychology in general, the major drug companies aren’t willing to take the risk to fund research for new advances in medication, leaving doctors and patients to rely on antiquated medicine that has no effect on relieving mental health systems. I was aghast to discover that the largest healthcare providers for mentally ill patients aren’t hospitals or treatment centers, but jails and prisons. It was no surprise to me to discover that people of color get disproportionately diagnosed with mental illness compared to their white counterparts, and yet nothing has been done to solve this problem. I was appalled to discover that after the closing of American asylums in the 1950s and 1960s, there has been no solution or better places built to house these mentally ill individuals, with many of them left to fend for themselves out on the streets. And it made me so sad to realize that the stigma and shame when it comes to people with severe mental disorders prevents them from getting the help they need, and our outdated methods of treatment often dissuade them from seeking any assistance at all. As an American, I was outraged at how horribly our government has failed the most vulnerable in our society. It’s been happening right under our noses and yet it’s the giant elephant in the room that no one wants to acknowledge. The good old philosophy of if we ignore the problem, it will go away, is alive and well.
With an endless amount of research, care, compassion, and knowledge. Dr. Kenneth Paul Rosenberg not only identifies the numerous problems with the system and how we got here, but he also offers solutions on what we can do to improve our treatment of the mentally ill. He intersperses his own memories of his sister Merle with carefully researched facts and personal stories from people with mental illness and their families. Oftentimes when it comes to nonfiction, academic type books, there tends to be a disconnect between the author and what they’re writing about that leaves the writing style very dry and distant. Thankfully, that’s not the case here. Due to his own experiences I’m sure, Rosenberg has written a case study that is as riveting as it is informative. I simply couldn’t put this book down. He truly made me want to learn more about what he was talking about. Further, instead of this book being all gloom and doom like one might expect, he also offers solutions and an abundance of resources for people with mental illness and those who have loved ones with mental illness to get the help they need and offer the love, compassion, and care that so many mentally ill people, including his sister, never got the chance to get.
This book is an absolute must-read for anyone who has a loved one dealing with a mental illness, works with people who are mentally ill, or has a mental illness themselves.
And for those who might be reading this, you are not alone. You are not the problem. It is not your fault.
There is hope.
It started with his sister.
Before Kenneth Paul Rosenberg became a respected psychiatrist and lauded documentary filmmaker, he was just Ken, living with his family in Philadelphia. He had two older sisters and lived a nice, middle-class existence. But he also had a secret: his older sister Merle had schizophrenia. Her lapses into mania, paranoia, and violence were a source of shame for the family, but also a source of endless frustration trying to get her treatment in a time when preventive treatment wasn’t available. Inspired and propelled forward by his sister’s experience, Rosenberg decided to become a psychiatrist. Throughout his career, he has gotten a deeper insight into how broken America’s treatment of the severely mentally ill is, and that insight has inspired advocacy. In a five year quest to further understand how and why we got here he takes himself and the reader on a seven year journey into a quest of what it truly means to be mentally ill in the United States and how it seems to be an endless cycle of tragedy in the amount of people it has failed, including Merle.
As a person living in the United States of America and who works with the mentally ill fairly often, I knew that our mental healthcare system was not that great, but I had no idea how bad the actual extent of the problem was. After reading this intense, riveting, and heartbreaking study of the past and present state of mental health treatment in the United States, I have learned that our mental healthcare system is, quite simply put, a disaster. A shitshow. A garbage fire. A long smoldering fire on the verge of an implosion. It’s laughable how little people with power seem to care about the mentally ill here in the United States. As The Fiancé puts it, “the mentally ill aren’t the people. It’s the people running the system that are the problem.”
Reading this book was a revelation. It opened my eyes to so many things I had suspected were true and so many things I never knew about. Honestly, if I listed all of them, this review would be about the size of an academic thesis.
This book proved my mother right when she always said that the almighty dollar is responsible for the decisions we make, whether right or wrong. I found out that due to the amount of time it takes to research mental illness and human psychology in general, the major drug companies aren’t willing to take the risk to fund research for new advances in medication, leaving doctors and patients to rely on antiquated medicine that has no effect on relieving mental health systems. I was aghast to discover that the largest healthcare providers for mentally ill patients aren’t hospitals or treatment centers, but jails and prisons. It was no surprise to me to discover that people of color get disproportionately diagnosed with mental illness compared to their white counterparts, and yet nothing has been done to solve this problem. I was appalled to discover that after the closing of American asylums in the 1950s and 1960s, there has been no solution or better places built to house these mentally ill individuals, with many of them left to fend for themselves out on the streets. And it made me so sad to realize that the stigma and shame when it comes to people with severe mental disorders prevents them from getting the help they need, and our outdated methods of treatment often dissuade them from seeking any assistance at all. As an American, I was outraged at how horribly our government has failed the most vulnerable in our society. It’s been happening right under our noses and yet it’s the giant elephant in the room that no one wants to acknowledge. The good old philosophy of if we ignore the problem, it will go away, is alive and well.
With an endless amount of research, care, compassion, and knowledge. Dr. Kenneth Paul Rosenberg not only identifies the numerous problems with the system and how we got here, but he also offers solutions on what we can do to improve our treatment of the mentally ill. He intersperses his own memories of his sister Merle with carefully researched facts and personal stories from people with mental illness and their families. Oftentimes when it comes to nonfiction, academic type books, there tends to be a disconnect between the author and what they’re writing about that leaves the writing style very dry and distant. Thankfully, that’s not the case here. Due to his own experiences I’m sure, Rosenberg has written a case study that is as riveting as it is informative. I simply couldn’t put this book down. He truly made me want to learn more about what he was talking about. Further, instead of this book being all gloom and doom like one might expect, he also offers solutions and an abundance of resources for people with mental illness and those who have loved ones with mental illness to get the help they need and offer the love, compassion, and care that so many mentally ill people, including his sister, never got the chance to get.
This book is an absolute must-read for anyone who has a loved one dealing with a mental illness, works with people who are mentally ill, or has a mental illness themselves.
And for those who might be reading this, you are not alone. You are not the problem. It is not your fault.
There is hope.
December 6, 2021
The primary content of the book comes in at under 200 pages, but it covers an incredible amount. The issues surrounding the crisis of mental health is something everyone has their own opinion on, usually terrible and asinine, but Rosenberg's take is definitely worthwhile. He covers the history of it, what is working today and what isn't working, provides plenty of firsthand examples, all from an experienced perspective.
Myself being a party to who the topic of this book is about I would say this is one of the better books you could pick up about this. If you are looking for a place to start when it comes to the topic of mental health, this is it.
Myself being a party to who the topic of this book is about I would say this is one of the better books you could pick up about this. If you are looking for a place to start when it comes to the topic of mental health, this is it.
Read
June 18, 2019In a time that we desperately need to focus in on mental health - from a professional, personal, and historical perspectives - this books is brilliantly effective :D
This well researched focus on mental illness, and how if its storyand modern views effect millions of lives, is timely and compelling.
There has never been a more important time for this conversation. Today, one in four families in the United States has a member with a severe mental illness. Approximately one in five adults, or 43.8 million people, experiences mental illness in a given year.
Galley borrowed from the publisher.
This well researched focus on mental illness, and how if its storyand modern views effect millions of lives, is timely and compelling.
There has never been a more important time for this conversation. Today, one in four families in the United States has a member with a severe mental illness. Approximately one in five adults, or 43.8 million people, experiences mental illness in a given year.
Galley borrowed from the publisher.
July 18, 2020
Excellent book! I especially like the author's personal story and the other personal stories he includes that connect the facts in a way families like mine can relate to. The successful activism in California by young, diverse people is incredible, inspiring to us all. I also highly recommend the corollary television documentary.
December 21, 2020
All in all a fascinating and personal look at America's mental health crisis through the eyes of a psychologist whose sister was diagnosed with schizophrenia. Rosenberg weaves stories of his personal experiences with those of some of the people that he has treated throughout the years to discuss the deeply dysfunctional state of mental health care in the United States. His book is both intimate and formal; both a look at some of the most personal moments in the author's life while also discussing the facts and statistics of the mental health community at large. He deftly discusses the intersection of mental health, poverty, and race in a way that is sure to appeal to progressive readers interested in learning more about how the mental health crisis disproportionately affects disadvantaged communities.
December 2, 2021
The topic of this book is extremely relevant to my interests and (hopefully) future career, since I hope to work at a prison/forensic hospital as a psychologist. I actually knew a lot of what the author was talking about already, but it was nice to have a general review of the topic and to hear about individuals in the criminal justice system who have mental illness. I definitely thought about some of the patients that I've seen at Kirby Forensic Psychiatric Center and how we can best serve them, and how so many people there are super jaded, which obviously doesn't serve them very well. At the same time, this problem seems so overwhelming and so hopeless. There needs to be deep societal changes if we are going to fix this problem. As it is, most individual doctors can only help one or two people, but not the general societal problem - and as the author stated, doctors may not even have the resources to help individual patients.
August 23, 2019
I was a Goodreads giveaway winner and received an early release copy of this book.
Overall, I feel this book was a great and quick read. It read like a documentary, which made sense to me later when I read that Dr. Rosenberg also made documentaries. I’m a huge fan of documentaries so I found his style very welcoming, for lack of a better word.
I have a background in psychology and work in a government position where I regularly inadvertently work with people with severe mental illnesses (SMI’s). I am not a doctor , nor a mental health professional. I say this, because often, I notice medical professionals either write everything in layman’s terms which often dumbs down, or loses focus , on the concept they’re trying to get across. Or, they write overly intellectually as if they assume everyone is a doctor or are trying to impress people with their large medical vocabulary. Dr. Rosenberg did a great job of using language, terms and ideas that any layman can understand, without causing more subject-familiar readers to feel bored or patronized. Additionally, the writing is very much scientific/medical , political, historical, as well as heartwarming. While the book is clearly discussing what’s wrong with our “fractured “ system when it comes to mental illness, it also provides real people of reference who are living with SMI’s and/or fighting to improve the system and telling their stories. This humanizes the situation and really brings in readers. Again, very much written like a documentary.
One thing I noticed right away that was a little frustrating for me personally was the references are all at the back of the book. I enjoy being able to see reference notes at the bottom of the page so I can get the greater understanding of the situation immediately and then continue with my reading without getting distracted and losing focus on the main topic at hand. However, I’m sure the average reader doesn’t enjoy the story being interrupted by large margins with references and thus won’t bother them as it did me.
I found towards the end of the book I used post-its to mark certain ideas that I wanted to discuss in my review specifically and wished I had started reading with that premise. There are certainly many opportunities for further discussion and hashing out ideas. This somehow brought me back to my college days where I read something that really excited me and I wanted to remember it to bring up in discussion later. I ended up only using two post-its:
1) In chapter 7 (Early and Effective Intervention), Dr. Rosenberg mentions the DSM (specifically, III) and how he knew “all the while that these categorizations were crude and the DSM is always in flux.” He goes on to say: “Most psychiatrists would prefer if diagnoses were not solely phenomenological—determined by clusters of symptoms...but instead based on biological markers such as brain scans, blood tests, or genetic chromosomal studies.” I loved that this was included, especially as the newest DSM-V has such seemingly low criteria that it appears to me and many other critics that people are often not just misdiagnosed, but also over-diagnosed. I would have loved to have him flush this idea out more, especially as much of the book is discussing the high rates of SMI’s and using very specific representative numbers. It would be interesting to know if there was any correlation and if so, how that affects the numbers.
2) In chapter 8 (Strength in (Small) Numbers, or America is Waking Up), there is some discussion regarding a city in Italy and how they have reformed their mental healthcare. Dr. Rosenberg goes on to say: “Making treatment more inviting will require a cultural shift toward more respectful and welcoming care.” This statement hit the crux of what I personally wanted to know more about while reading this book. After all, the book is titled, “...America’s Mental Health Crisis.” And while this book definitely does delve us deep into the many layers affecting mental healthcare in America, I definitely wanted to read about Dr. Rosenberg’s thoughts on why our system is so broken compared to many other developed countries. Is it simply public policy and lack of universal healthcare, or is it more of a cultural issue? The book has a strong theme of shame throughout, but is this why we seem to be failing in America? Is there something else culturally that we in America are doing overall that is causing us to have such high numbers of afflicted people to begin with? Is it family structures, environmental, etc.? I found myself highly intrigued in the potential stark difference between America and other countries. I would love to read another book of his where he went more into detail on this idea.
Again, overall, fantastically written. Very thought-provoking. I’ve been made to want to delve into deeper research. But I was also very touched to hear the personal stories of those in the book, including Dr. Rosenberg. I highly recommend this book to others so as to bring greater understanding to the masses regarding this epidemic and crisis we’re having in this country. The end of the book includes tips, as well as visual examples of documents that loved ones of people with SMI should be familiar with, making this book not only informative, but a useful tool. The book is scheduled for release in October 2019 -make sure to pick up a copy!!!
Overall, I feel this book was a great and quick read. It read like a documentary, which made sense to me later when I read that Dr. Rosenberg also made documentaries. I’m a huge fan of documentaries so I found his style very welcoming, for lack of a better word.
I have a background in psychology and work in a government position where I regularly inadvertently work with people with severe mental illnesses (SMI’s). I am not a doctor , nor a mental health professional. I say this, because often, I notice medical professionals either write everything in layman’s terms which often dumbs down, or loses focus , on the concept they’re trying to get across. Or, they write overly intellectually as if they assume everyone is a doctor or are trying to impress people with their large medical vocabulary. Dr. Rosenberg did a great job of using language, terms and ideas that any layman can understand, without causing more subject-familiar readers to feel bored or patronized. Additionally, the writing is very much scientific/medical , political, historical, as well as heartwarming. While the book is clearly discussing what’s wrong with our “fractured “ system when it comes to mental illness, it also provides real people of reference who are living with SMI’s and/or fighting to improve the system and telling their stories. This humanizes the situation and really brings in readers. Again, very much written like a documentary.
One thing I noticed right away that was a little frustrating for me personally was the references are all at the back of the book. I enjoy being able to see reference notes at the bottom of the page so I can get the greater understanding of the situation immediately and then continue with my reading without getting distracted and losing focus on the main topic at hand. However, I’m sure the average reader doesn’t enjoy the story being interrupted by large margins with references and thus won’t bother them as it did me.
I found towards the end of the book I used post-its to mark certain ideas that I wanted to discuss in my review specifically and wished I had started reading with that premise. There are certainly many opportunities for further discussion and hashing out ideas. This somehow brought me back to my college days where I read something that really excited me and I wanted to remember it to bring up in discussion later. I ended up only using two post-its:
1) In chapter 7 (Early and Effective Intervention), Dr. Rosenberg mentions the DSM (specifically, III) and how he knew “all the while that these categorizations were crude and the DSM is always in flux.” He goes on to say: “Most psychiatrists would prefer if diagnoses were not solely phenomenological—determined by clusters of symptoms...but instead based on biological markers such as brain scans, blood tests, or genetic chromosomal studies.” I loved that this was included, especially as the newest DSM-V has such seemingly low criteria that it appears to me and many other critics that people are often not just misdiagnosed, but also over-diagnosed. I would have loved to have him flush this idea out more, especially as much of the book is discussing the high rates of SMI’s and using very specific representative numbers. It would be interesting to know if there was any correlation and if so, how that affects the numbers.
2) In chapter 8 (Strength in (Small) Numbers, or America is Waking Up), there is some discussion regarding a city in Italy and how they have reformed their mental healthcare. Dr. Rosenberg goes on to say: “Making treatment more inviting will require a cultural shift toward more respectful and welcoming care.” This statement hit the crux of what I personally wanted to know more about while reading this book. After all, the book is titled, “...America’s Mental Health Crisis.” And while this book definitely does delve us deep into the many layers affecting mental healthcare in America, I definitely wanted to read about Dr. Rosenberg’s thoughts on why our system is so broken compared to many other developed countries. Is it simply public policy and lack of universal healthcare, or is it more of a cultural issue? The book has a strong theme of shame throughout, but is this why we seem to be failing in America? Is there something else culturally that we in America are doing overall that is causing us to have such high numbers of afflicted people to begin with? Is it family structures, environmental, etc.? I found myself highly intrigued in the potential stark difference between America and other countries. I would love to read another book of his where he went more into detail on this idea.
Again, overall, fantastically written. Very thought-provoking. I’ve been made to want to delve into deeper research. But I was also very touched to hear the personal stories of those in the book, including Dr. Rosenberg. I highly recommend this book to others so as to bring greater understanding to the masses regarding this epidemic and crisis we’re having in this country. The end of the book includes tips, as well as visual examples of documents that loved ones of people with SMI should be familiar with, making this book not only informative, but a useful tool. The book is scheduled for release in October 2019 -make sure to pick up a copy!!!
October 13, 2019
There were aspects of the book that I admired and respected- Dr. Rosenberg’s personal self-disclosure and self-reflection, his practical advice for helping someone with a serious mental illness (SMI), and his reliance on facts to give the reader a sense of urgency. He also stayed relatively unbiased in his discussion of controversial legal and ethical questions. However, his book ended up perpetuating some of the very stereotypes he wanted to disassemble. He focused primarily on schizophrenia, a serious and life-threatening mental illness, yet still a generally uncommon one compared to depression and anxiety. The book jumped around and the specific audience to whom he was writing seemed unclear. Doctors? Therapists? Family members? I would have rather had a more tailored analysis.
March 9, 2023
I wanted an overview and this fit the bill. The author is a psychiatrist coming from a background of living with a sister diagnosed with schizophrenia. Lots of good nuggets in here regarding SMI. He's an advocate of involuntary treatment fyi. Still thinking a lot about that complicated topic. This book definitely did not make me more hopeful about the efficacy of treatment options and how we treat/traumatize people seeking care but I found it valuable to understanding the predicament. Lots of tie ins with housing.
August 21, 2019
I received a free ARC of this book from Avery books and was asked to give an honest review.
When I first received this book I was thinking of placing it on the bottom of my To Read pile but then I glanced through it and saw some of the stories of actual patients. It turned out to be quite an interesting read. It got a bit too statistical for me, but the personal stories, especially about the author's own sister, were really good.
When I first received this book I was thinking of placing it on the bottom of my To Read pile but then I glanced through it and saw some of the stories of actual patients. It turned out to be quite an interesting read. It got a bit too statistical for me, but the personal stories, especially about the author's own sister, were really good.
April 13, 2025
4.5 stars. Short, but dense. Heartbreaking how we fail this vulnerable population.
”Asylums never went away, they just grew into two varieties: posh for the wealthy (in the form of a handful of fancy $100,000-plus a year mental institutions) and prisons for the poor.”
”Asylums never went away, they just grew into two varieties: posh for the wealthy (in the form of a handful of fancy $100,000-plus a year mental institutions) and prisons for the poor.”
June 5, 2023
Ugh and wow and this book motivates me to want to do more to help.
August 17, 2021
Super interesting, some practical info for families at the end.
February 13, 2022
A brief history of the mental health care system in the US, interspersed with the stories of individuals suffering from serious mental illness, including the author’s sister. Not much of the broader history is particularly detailed or revelatory, but the personal stories are compelling, heart-breaking and show clearly the mess that is today’s mental health care system.
February 24, 2020
This book is apparently to accompany a documentary by the author called Bedlam. I haven't seen the film so I do not know if it's the same as the film.
Although this book reads quickly, once it starts rolling, it's suddenly over. This is just a surfce look at the problems mentally ill Americans have in getting any sort of meaningful treatment. It focuses only on SMIs (serious mental illnesses) such as schizophrenia and bipolar disorder. Just the regular ol' OCDs or anxiety sufferers are not mentioned.
I'll let you know up front that I have an SMI, although it's considered a "mild" SMI: endogenous recurring depression, aka major depression aka sucidal depression aka serious depression aka no-one-gives-a rat's-ass-about-you depression and whatever else the mental health community has, in its wisdom, decided to call it this week. I was not represented in this book.
I'm currently trying to get on Medicaid and have found it a soul-shattering experience. It's taken months to try to get a doctor to prescibe me drugs to keep me from killing myself and it looks like that by the time I get one, my benefits for the year (which I told started in December even though I still do not have a doctor) will happen the day my benefits run out for the year -- and then I'll have to start all over again. Right now, I'm stealing drugs from my Mom to keep me more or less sane. And I have NO plans to kill myself.
Speaking of SMIs, this book is crammed with abbreviations and acronyms. It would have been nice if there had been a glossary of these bastards so I could keep them straight. Or hey -- here's a radical idea -- how about just spelling out the entire words or phrases instead of using mental doc speech?
That being ranted, this is a highly readable book because it almost entirely consists of individual cases of people even crazier than I am (and I am so glad they exist.) The author spends considerable time talking about his crazy sister, but only in drips and drabs here and there. It's as if he could only stand to let us peep through the keyhole to life with his crazy sister and so does not give us the whole story of just what went on.
There is also a long section of activists stopping the construction of a "Mental health jail" in California. Just how a mental health jail and jail differs is never discussed.
Despite its problems, it's still an easy to read book about a complex problem in America. Personally, I think that if access to mental health care was easy, there would be a lot fewer crazy people in America. Then again, I have an SMI, so what do I know?
Although this book reads quickly, once it starts rolling, it's suddenly over. This is just a surfce look at the problems mentally ill Americans have in getting any sort of meaningful treatment. It focuses only on SMIs (serious mental illnesses) such as schizophrenia and bipolar disorder. Just the regular ol' OCDs or anxiety sufferers are not mentioned.
I'll let you know up front that I have an SMI, although it's considered a "mild" SMI: endogenous recurring depression, aka major depression aka sucidal depression aka serious depression aka no-one-gives-a rat's-ass-about-you depression and whatever else the mental health community has, in its wisdom, decided to call it this week. I was not represented in this book.
I'm currently trying to get on Medicaid and have found it a soul-shattering experience. It's taken months to try to get a doctor to prescibe me drugs to keep me from killing myself and it looks like that by the time I get one, my benefits for the year (which I told started in December even though I still do not have a doctor) will happen the day my benefits run out for the year -- and then I'll have to start all over again. Right now, I'm stealing drugs from my Mom to keep me more or less sane. And I have NO plans to kill myself.
Speaking of SMIs, this book is crammed with abbreviations and acronyms. It would have been nice if there had been a glossary of these bastards so I could keep them straight. Or hey -- here's a radical idea -- how about just spelling out the entire words or phrases instead of using mental doc speech?
That being ranted, this is a highly readable book because it almost entirely consists of individual cases of people even crazier than I am (and I am so glad they exist.) The author spends considerable time talking about his crazy sister, but only in drips and drabs here and there. It's as if he could only stand to let us peep through the keyhole to life with his crazy sister and so does not give us the whole story of just what went on.
There is also a long section of activists stopping the construction of a "Mental health jail" in California. Just how a mental health jail and jail differs is never discussed.
Despite its problems, it's still an easy to read book about a complex problem in America. Personally, I think that if access to mental health care was easy, there would be a lot fewer crazy people in America. Then again, I have an SMI, so what do I know?
November 6, 2019
I picked this one up hoping that I would be able to suggest it for my book club at work. Unfortunately, I don't believe that it will be a good fit for us.
The things I enjoyed about this overview:
The stories of the actual patients that were shared throughout, especially the author's own experiences with his sister who suffered from schizophrenia.
The last section of the book that contained "practical advice"
The points made about research into mental health conditions, what approach other countries take to helping those with SMIs and the damage caused by not having mental health first responders.
__________________________________________________________
While this was a good overview, it didn't do a deep enough dive on any of the topics covered and the practical advice section was too short, in my opinion. It was a good, engaging read, but not exactly what I was expecting. 2.5 stars
The things I enjoyed about this overview:
The stories of the actual patients that were shared throughout, especially the author's own experiences with his sister who suffered from schizophrenia.
The last section of the book that contained "practical advice"
The points made about research into mental health conditions, what approach other countries take to helping those with SMIs and the damage caused by not having mental health first responders.
__________________________________________________________
While this was a good overview, it didn't do a deep enough dive on any of the topics covered and the practical advice section was too short, in my opinion. It was a good, engaging read, but not exactly what I was expecting. 2.5 stars
January 19, 2020
I started reading this for work, but read the whole thing because it was so well written and so informative. Rosenberg take you through a short history of how mental health has been dealt with in the US, with special emphasis on how catastrophic the move to deinstitutionalize has been for people living with serious mental illness. He shares his family’s own story, which he finds is a common element of why many of his colleagues also entered the field of psychiatry. Rosenberg looks at the lack of resources devoted to developing and testing new psychiatric drugs, how policies meant to protect people with mental illness have in fact hurt them, and what hope there is to be found in reforms being tried here and in other countries. An excellent book with a lot of very specific examples to help illuminate the problems. A PBS documentary based on the book and his work will be out in April 2020 — I hope it reaches a large audience!
April 8, 2020
I really enjoyed this brief overview of healthcare and mental illness. It is liberally sprinkled with anecdotes making it highly readable while still addressing the problems faced by families and individual affected by mental illness. Rosenberg covers drugs, mental healthcare and the judicial system especially regarding prisons, laws that affect payments, etc. He ends the book with a section on navigating the system along with examples of how to fill out forms you may run into. I think this is a good resource for people struggling to understand the system, but it is just a general survey and a jumping off point for further study. It is not in-depth and will not answer all your questions, but it may get you asking some questions. It's main thrust is advocacy and I'm sure Rosenberg would be thrilled if he found out he created even just one activist.
March 4, 2020
As a social worker who works on an ACT team with people with psychotic spectrum disorders, this book seems like a wonderful and respectful overview of the crisis of mental health care in the US and how we got here. It wasn't primarily new information to me, but I enjoyed Rosenberg's empathetic story telling throughout. He sets himself apart by focusing on possible solutions - emphasizing shifting away from treatment through incarceration (our current default), increasing hospital beds, and building up intensive community care using models like ACT. He ends the book with suggestions for people who have a psychotic diagnosis and their families. Highly recommended for anyone curious about the deficit of mental health care for the seriously ill and what we can do about it.
November 22, 2020
An examination of the current state of mental health care in the U.S.
Dr. Rosenberg became a psychiatrist because his older sister was schizophrenic. In this book he tells the stories of several patients with mental health problems and describes their treatments. He also discusses the current practices and practitioners in the area of mental health, concluding that, as a society, we are not doing enough to help those diagnosed with serious mental diseases. After reading this book, I have to agree with him. A complete reevaluation and overhaul of our mental health system is needed, and quickly.
Dr. Rosenberg became a psychiatrist because his older sister was schizophrenic. In this book he tells the stories of several patients with mental health problems and describes their treatments. He also discusses the current practices and practitioners in the area of mental health, concluding that, as a society, we are not doing enough to help those diagnosed with serious mental diseases. After reading this book, I have to agree with him. A complete reevaluation and overhaul of our mental health system is needed, and quickly.
May 21, 2024
Bedlam covers the lack of care for those with SMI, serious mental illnesses, and how the courts and streets are becoming home to those with mental illnesses.
The book was not marked with heavy jargon nor was it difficult to read in the context of grasping the who framework of systems that mental illnesses are being tossed into.
I really liked it and would recommend it to anyone who wants to get since this is where the mental health system really is. Unlucky for many, deadly for some, and most of all broken.
The book was not marked with heavy jargon nor was it difficult to read in the context of grasping the who framework of systems that mental illnesses are being tossed into.
I really liked it and would recommend it to anyone who wants to get since this is where the mental health system really is. Unlucky for many, deadly for some, and most of all broken.
May 10, 2020
One of the best nonfiction books I have ever read. It's about how, in the US, people with Serious Mental Illness frequently end up homeless or in jails, rather than getting treatment to allow them to live their lives. Author is a prominent psychiatrist who had a sibling with SMI. As someone who works in mental health and also has a loved one with SMI who currently sits in a jail cell and isn't likely to be released, I can't recommend this one enough
May 23, 2020
Wonderful, inspiring, and a message of hope for those who suffer from and know someone who suffers from mental illness. A historical view of the changes we have seen in the realm of mental health treatment, and a personal view of what it’s like to know and love someone who suffers from these often misunderstood and under treated disorders. Rosenberg writes in a way that is easy for the average person to understand. Very informative and and a great read!
December 9, 2019
A great book, highly recommended. Bedlam is both one families journey through the mental health care system and a shocking indictment of the way we treat those with a Serious Mental Illness in this country. The system is broken and only by working collaboratively with individuals, family and professionals can we hope to change the system for the better.
January 27, 2020
Interesting book that is definitely more intimate than most. Rosenberg interweaves his and others personal experiences with those suffering from mental health issues. Writing from this more personal view Rosenberg offers some new ideas on preventing or minimizing some of the interaction with the criminal justice system when the issue is clearly stemming from mental health.
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