Out of the Shadows: Confronting America's Mental Illness Crisis (Hardcover)

by E. Fuller Torrey (Author) "In the shadows of mental illness there are many faces..." (more)
Key Phrases: mental health lawyers, patient care indicators, mental illness crisis, New York, United States, Los Angeles (more...)

Editorial Reviews

Amazon.com Review
E. Fuller Torrey excoriates the way the mentally ill are treated in this country. His polemic against the concept of "deinstitutionalization" takes us on a grim tour of the lives led by the mentally ill: untreated, homeless, jobless, and helpless against street violence. Torrey argues that the criteria for involuntary commitment should include the need for treatment.

From Kirkus Reviews
The crisis, simply put, is that 2.2 million of the estimated 5.6 million Americans with serious mental illness are not being treated. Instead, these ``walking time bombs'' are often homeless in the community or incarcerated in prisons. Torrey, a clinical research psychiatrist, explores how this situation came to be and offers some radical proposals for remedying it. Torrey (Nowhere To Go, 1988; Freudian Fraud, 1992, etc.) notes that for the majority of people with severe mental disorders treatments to effectively control their symptoms are already available, and with research, better ones would surely be found. To that end, he urges formation of a National Brain Research Institute. Meanwhile, however, Torrey sees much that can be done to provide humane and cost-effective services for the severely mentally ill. With numerous anecdotes and impressive statistics, he builds a dismaying picture of society's failure to care for the mentally ill. He then argues for major ideological, economic, and legal changes, as well as a change in how we think about serious mental illnesses. Too often they are seen as occupying one end of the spectrum of mental health, linked to social reform and liberal causes and thus highly politicized. Torrey asserts that when serious mental illnesses are properly viewed as neurological disorders of the brain, research funding, treatment resources, and professional expertise can be more readily obtained. To eliminate cost-shifting between levels of government, which he sees as the primary cause of the present situation, he would make the states responsible for providing services and accountable for treatment outcomes, with the federal government providing block grants. While these proposals may arouse polite debate, the legal remedies he calls for- -changing the laws to permit involuntary treatment, including involuntary commitment to hospitals--raise some very troubling images and are likely to elicit loud objections. Controversial ideas, forcefully presented. -- Copyright ©1996, Kirkus Associates, LP. All rights reserved.

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Product Details

• Hardcover: 244 pages
• Publisher: John Wiley & Sons; 1 edition (November 1996)
• Language: English
• ISBN-10: 0471161616
• ISBN-13: 978-0471161615
• Product Dimensions: 9.3 x 6.2 x 1.1 inches
• Shipping Weight: 1.3 pounds
• Average Customer Review: 3.8 out of 5 stars See all reviews (5 customer reviews)
• Amazon.com Sales Rank: #1,510,084 in Books (See Bestsellers in Books)

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Customer Reviews

Most Helpful Customer Reviews

32 of 36 people found the following review helpful:

5.0 out of 5 stars This is Must Reading!, April 22, 1998

By A Customer

This book is one of Dr. Torrey's best. He demonstrates how Americans have allowed their government and medical profession to immorally ignore and degrade the people who need our help the most--those with serious mental illness. Mental health workers would rather treat relatively healthy people going through ordinary life crises. Indeed, a sign of sucess in psychiatry and psychology is having a comfortable office practice where you don't have to see many manic depressives and almost no psychotics. The DSM (Psychiatry's diagnostic manual) is written so that any problem in a normal human life can be considered a "mental illness," so talking to a millionare who is disappointed that he only has $3 million instead of $10 million qualifies as providing mental health care. Meanwhile, those with serious depression kill themselves and people who are disabled because of dangerous hallucinations and delusions live in their own filth on the streets. This is all the more tragic because we have the means to treat the vast majority of mental/brain diseases. Very few people cannot be helped by the hundreds of medications that exist, but many are deprived of treatment because of absurd social and political policy. Torrey implicates several different political groups and movements as playing a big part in the problem. Liberals, civil libertarians, mainstream consrevatives and the far right have all had their reasons for closing mental hospitals and depriving psychiatrists of the ability to effectively treat their patients. Torrey points out that most of this opposition to psychiatry is done out of ignorance and hopes that as more and more people know the facts, society will demand that poeple with life threatening mental diseases be given the treatment they need to live health productive lives, and that the limited mental health resources our nation has will be spent wisely; giving those with the greates need the highest priority.

11 of 12 people found the following review helpful:

5.0 out of 5 stars Documents the Stuggle Among Mental Health Professionals, October 1, 2000

By A Customer

Dr. Torrey once again published a book that highlighted a critical issue among mental health professionals. He once again tries to prod the American public into becoming aware of what is happening among the mentally ill in this country. He wants his profession to take a hard look at how they are responding to the crisis of mental illness. He desperately wants them to evaluate how they are responding. And he wants the system changed.

1 of 2 people found the following review helpful:

3.0 out of 5 stars Passionate but poorly argued, February 8, 2008

By	David Ross "Cook, Chemist, Nurse" (Rochester, NY USA) - See all my reviews (REAL NAME)

This review is from: Out of the Shadows: Confronting America's Mental Illness Crisis (Paperback)

Torrey is certainly correct that the large number of mentally ill persons who are homeless or jailed rather than receiving effective treatment is yet another shameful failure of the US health system. While he has some interesting suggestions, his arguments are effective only on an emotional level. Torrey organizes this book around horrific and certainly true anecdotes of the untreated mentally ill. His arguments are passionate to the extent of loosing perspective so that the book is both poorly argued and poorly organized. For example he includes a curious but largely irrelevant account of the conservative opposition to the first mental hospital in Alaska in the 1950s.

Torrey argues among other things that the right of the mentally ill to refuse treatment has been extended too far; he blames the lawyers. He proposes that required or forced outpatient or inpatient treatment should be more widely reinstituted in cases where people with mental illness lack the competence to refuse treatment. This is clearly a controversial suggestion that would need to be very cautionsly implemented though it has factual merit. His ideas for such "assisted care" arrangements are more clearly described in Surviving Manic Depression: A Manual on Bipolar Disorder for Patients, Families, and Providers. Other suggestions include financial guardianship arrangements particularly for drug and alcohol abusing mentally ill persons and a vague though reasonable suggestion for better coordination of services at state and federal levels. Unfortunately Torrey is overly focused on assigning blame for the historic cost cutting and cost shifting motivations for the systematic deinstitutionalization and lack of treament of the mentally ill. On the other hand he largely ignores the subtle and currently prevailing undereimbursement and non-reimbursement of mental health services by insurance which characterizes today's health system. This question of insurance reimbursement is a key underlying public policy issue today.

This book stands up poorly compared to Torrey's excellent works such as Surviving Manic Depression and Surviving Schizophrenia: A Manual for Families, Patients, and Providers.