So often we forget the plight of the severely mentally ill, even though we are in the mental health profession. But then again, that probably is the problem. We work with those who are already mentally healthy, or at least almost. Like the world, we enjoy working with college students or high-functioning adults who are good conversationalists. The severely mentally ill are relegated to the streets.
Isaac and Armat hit us with our own neglect. The severely mentally ill compose between one-third and one-half of the homeless population. Why? The authors blame the anti-psychiatry movement, specifically R. D. Laing, Thomas Szasz, and the ex-patient movement. Government, and the rest of our culture, has been heavily influenced by their philosophy and political rhetoric, while ignoring the scientific evidence and humanitarian compassion. Irving Goffman and others joined forces to defame state hospitals, and then to defund them. Community mental health centers were to replace them, but as Torrey points out in his Nowhere to Go, the CMHs almost exclusively treat the non-severely mentally ill.
There is much rhetoric about preventing mental illness, but the trouble is that no one really knows how to prevent it, since science really hasn't determined its source. Instead, the federal and state governments pour their resources into programs designed to treat the severely mentally ill, but don't actually provide such treatment.
The stories of broken families, suicides, and people thrown out on the street break your heart. Families are caught between a rock and a hard place. Patients are allowed to refuse treatment even though their minds are "ill," while family members watch their loved ones destroy themselves or be raped or killed on the street. "The effect was to deprive many of life in the name of liberty" (p. 127). If you work with the severely mentally ill, this book is a must. Historians of psychology will find their discussion of the roots of anti-psychiatry, the ex-patient movement, and the rise of the mental health bar highly informative. And clinical psychologists or psychiatrists will find their discussion about the effectiveness of psychosurgery, ECT, and psychoactive drugs not only informative and well-documented, but stimulating (electifying? shocking?). In contrast to most of the psychological and psychiatric community, the authors endorse all three modes of treatment!
In their analysis, Isaac and Armat demonstrate that the science of clinical psychology is so clouded with rhetoric on all sides of every treatment issue, it is often difficult to discern the truth. Consequently, insurance companies and the helping professions become political conservatives, not wanting to make waves and wanting to appear socially and politically correct, rather than acting in the best interest of the severely mentally ill.
Isaac and Armat don't merely criticize the present system. Almost a quarter of their book outlines practical guidelines to help the severely mentally ill. They encourage voluntary community programs, and give several examples. Yet they point out the necessity of state hospitals and involuntary treatment backed up through the courts. In sum, if you are concerned about the homeless and you are in the mental health profession, this book is a definite must.