Customer Reviews

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

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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.

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.

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.

Backed with a wealth of peer-reviewed studies, official government statistics, and personal anecdotal exprience over decades of specialty medical practice, Dr. Torrey presents a blistering attack upon our current ideology and approach to seriously mentally ill patients. The data presented is at times somewhat dated, much from 1995, but Dr. Torrey has shown considerable prescience in his evaluation and recommendations. My personal "updating" of his predictions shows he has only underestimated the nature and degree of the problems our nation faces in failing to treat the needy. This book is not concerned with lesser forms of mental such as the neuroses. Rather, "serious mental illness", including crippling pathologies such as the schizophrenias, are the focus of the text.

Our current mental health crisis appears to have two principal origins: (1) increased medical costs and (2) the concept and practice of "deinstitutionalization"--defined as including (a) pushing needy patients out of the clinical setting and (b) closing facilities and programs capable of dealing with the seriously mentally ill.

A complete state-by-state listing of key mental health laws is provided. A detailed review of 1990s-early 2000 state of the art is insightful.

One of the principal theses of the text is that we now have abundant methodologies to deal with psychotic patients, but we lack the will or commitment to use them. Because the statistical data is dated, the principal value of this text is as an overview of a national disgrace--a failure to provide needed treatment rationalized by the claim of "freedom from unwanted care."

This book speaks to the heart of the latest mental health issues...homelessness being one of them.

I have much respect for this professional who is not afraid to get his hands wet. God bless him.

In his earlier book, The Death of Psychiatry, Torrey wrote this:

"A mental "disease" is said to be a 'disease' of the mind... But a mind is not a thing and so technically it cannot have a disease... There are many known diseases of the brain ... But these diseases are considered to be in the province of neurology rather than psychiatry... None of the conditions that we now call mental 'diseases' have any know structural or functional changes in the brain..."

Now in his days of infamy Torrey says the very opposite. In this book, despite his painfully transparent attempts to explain away the reality he earlier acknowledged, he is unsuccessful. We are still left with the fact that genuine brain diseases are treated not by psychiatrists like Torrey, but by neurologists. Psychiatrists "treat" non-existent diseases in a non-existent location called the mind. The metaphor of "the mind" didn't change, but Torrey did. And we are left bewildered as to why he now embraces views that he once blasted. It deserves a clear explanation that he doesn't offer.

This book, and Torrey's other popular titles, can be read as an extended attempt to justify his devotion to something he formerly identified as useless pseudoscience. It's a clear case of cognitive dissonance.