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The Insanity Offense: How America's Failure to Treat the Seriously Mentally Ill Endangers Its Citizens Hardcover – June 17, 2008

ISBN-13: 978-0393066586 ISBN-10: 9780393066586 Edition: 1st

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Editorial Reviews

From Publishers Weekly

Starred Review. The ill effects of not providing proper treatment for people with serious mental disorders has become all too apparent in recent years, writes research psychiatrist and treatment advocate Torrey (Surviving Manic-Depression). Released en masse from institutions beginning in the 1960s, the most severely ill are most likely to become homeless, incarcerated, victimized, and/or violent. Torrey details how civil liberties suits have prevented such people from being involuntarily institutionalized, leaving them a danger both to themselves and to others. Confronting these issues head on, Torrey offers both the clinical and the anecdotal, citing several tragic examples: in the case of Cho Seung-Hui, the 2007 Virginia Tech killer, he faults both the university and stringent state laws regarding involuntary commitment for neglecting to treat a clearly very ill young man. This reform-minded book calls for a change in laws affecting how mentally ill people are treated, keeping close track of those with a history of violent behavior and creating a more comprehensive treatment approach. Chilling and well documented, this text has many no-nonsense solutions to protect the mentally ill themselves as well as society as a whole. (July)
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From Booklist

Research psychiatrist Torrey says that what began in the 1960s as an unlikely marriage between civil liberties advocates, who saw mandatory institutionalization of the mentally ill as a civil rights violation, and cost-conscious conservatives has resulted in a national catastrophe. That was when state governments decided they could save money by deinstitutionalizing mental patients, shuttering mental hospitals, and turning thousands of schizophrenics and manic-depressives out onto the streets. Ever since then, Torrey has been tallying instances in which severe mental illness has contributed to an escalating number of violent attacks, murders, and suicides and counting the number of severely mentally ill who are either homeless or incarcerated. Though he admits some of his numbers are estimates—most public officials like to pretend the mentally ill are invisible and thus fail to keep an accounting—they speak volumes about the dire need for public institutions equipped to help the severely mentally ill regain control over their destructive behaviors. His cry is loud and clear, but his solutions, alas, are necessarily complicated. --Donna Chavez

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Product Details

  • Hardcover: 288 pages
  • Publisher: W. W. Norton & Company; 1 edition (June 17, 2008)
  • Language: English
  • ISBN-10: 9780393066586
  • ISBN-13: 978-0393066586
  • ASIN: 0393066584
  • Product Dimensions: 0.6 x 0.1 x 1 inches
  • Shipping Weight: 1.2 pounds
  • Average Customer Review: 4.5 out of 5 stars  See all reviews (28 customer reviews)
  • Amazon Best Sellers Rank: #205,917 in Books (See Top 100 in Books)

More About the Author

E. Fuller Torrey, M.D., is a research psychiatrist specializing in schizophrenia and bipolar disorder. He is the executive director of the Stanley Medical Research Institute, the founder of the Treatment Advocacy Center, a professor of psychiatry at the Uniformed Services University of the Health Sciences, and the author of twenty books. He lives in Bethesda, Maryland.

Customer Reviews

It is within this group that exists a subset that creates most of the problems.
This book important for not only mental health and law enforcement professionals to read ,but also governments officials, family members and the public in general.
Jenine L. Yannucciello, LCSW
An Illinois study found 30% of mental health patients discharged are re-hospitalized within one month.
Leon Czikowsky

Most Helpful Customer Reviews

48 of 54 people found the following review helpful By Lewis Tagliaferre on June 23, 2008
Format: Hardcover Verified Purchase
This author is not kidding...he really tells it as it is, but with a light touch that may miss the mark. State legislators need to be slammed up side the head to get their attention and I fear he is a little too politically correct. As the father of a middle-aged bi-polar daughter, I was blindsided by the impact of her disease. She is one of the lucky ones who found a qualified psychiatrist and medications that are working to keep her off the streets, but barely. Unless you experience the family impact of mental illness most people just walk on by. The civil rights lawyers and courts who curtailed mandatory treatment are the real criminals in this crisis and the author is too easy on them. Mental illness still is a great social taboo in this culture of control and cure. When neither are possible our government seems paralized to respond. Unfortunately, I fear that it will take a lot more homeless people and mentally ill criminal behavior to get the needed attention and reforms. But, hey, never forget that a few highly dedicated people can change things. Meantime, you suffer and hope. Read this book and get involved. Contact the National Alliance for Mental Illness in your area.
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12 of 12 people found the following review helpful By Hermes on November 30, 2008
Format: Hardcover
E. Fuller Torrey has been one of the most astute commentators on the deinstitutionalization charade for decades. This is his best book. He takes the key states (California and Wisconsin) which contributed to the legislative and court changes to the involuntary commitment laws for people with mental disorders and traces them from their original passing (late 1960s and early 1970s) to the present. He uses case vignettes and journal articles to convey the consequences of the new legislation and court decisions respectively. The result is deeply disturbing and powerful. Torrey has been controversial for years but he is right on target. The solutions to this very problematic reality are extremely difficult. But talking about it is the beginning. This book is an excellent place to start.
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14 of 15 people found the following review helpful By S. J. Snyder on February 12, 2009
Format: Hardcover
Picture a small county in Texas, 25,000 population, with only one special confinement cell and no specially trained sheriff's deputies.

Picture a severely bipolar young man, with other mental health diagnoses as well, such as PTSD, on parole from a manslaughter convictioon (he may or may not have committed) assaulting his mother and stepfather.

Picture him now locked away here, literally trying to bash his head against the walls. Add to the fact that the PTSD was prison induced, in part through prison rape, just as Dr. Torrey describes.

Picture a relatively sympathetic DA, and very sympathetic sheriff, hands tied do to lack of resources.

I don't have to "picture" it. I've reported on it.

What Dr. Fuller Torrey says is all so true.

Add in the Texas mental health system, which is one of the worst in the nation, as Torrey notes. A system lacking mental health beds in both the "outside" world and inside the criminal justice system.

We CAN do better, without going back to stereotyped days of the 1950s. We don't need hyper-civil libertarians (I am a card-carrying ACLU member myself), or Scientologists, telling us mental illness doesn't exist, or the severely mentally ill have freedom of choice when they don't even know who they are.

Somehow, some way, we must change our laws.
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7 of 7 people found the following review helpful By Loyd E. Eskildson HALL OF FAME on January 21, 2009
Format: Hardcover
At least one-third of America's homeless persons are severely mentally ill, while another one-tenth the population of jails and prisons are as well. About 25% of all severely mentally ill individuals living in the community are victims of violent crimes each year; this same group is responsible for at least 5% of all homicides.

Deinstitutionalization was a policy to move psychiatric patients out of public mental hospitals and place them in the community. The trend began after WWII, sparked by a series of exposes of dreadful conditions in state psychiatric hospitals and aided by the discovery of effective anti-psychotic drugs in the early 1950s. Unfortunately, essential after care in most places varied from inadequate to invisible.

Additional impetus came from the legal profession via logic that civil liberties were violated when patients were involuntarily treated in most cases, including refusing to take medications.

An estimated 4 million American adults have the most severe forms of psychiatric disorders - schizophrenia, bipolar disorder, and sever depression. The most severe 1% are the ones most in need of enforced treatment.

Relatively simple solutions that Torrey recommends include direct observation of medication-taking (backed up by required inpatient commitment if not complied with), the use of longer-lasting medications (eg. single injections that provide treatment over 3-4 weeks), and compilation of local statistics that reveal the true cost of untreated mental illnesses.
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8 of 9 people found the following review helpful By Marvin Ross on January 13, 2009
Format: Hardcover
Dr. Fuller Torrey provides us with another sane plea to help "the insane" - those whom society has abandoned to homelessness and jail rather than to the medical treatment they so deserve. The US is not alone in its treatment of the victims of serious mental illness. What is seen in the US is repeated in most western countries with only a few exceptions.

A policy of deinstitutionalization has emptied our psychiatric hospitals while the actions of civil libertarian lawyers has allowed them to remain in the community even though they are too ill to make a rational decision. They are given the authority to refuse treatment when they do not have the capacity to understand that they are ill. These are the two main reasons for the situation we see today. Torrey points out that in 1955, the US population was 164 million and there were about 560,000 patients in psychiatric facilities. By 2006, the US population grew to 300 million. If the proportion of the population in mental institutions was the same as in 1955, there would be over one million hospitalized. Instead, the number is only 40,000.

The emptying of hospitals was initially done for humanitarian reasons and coincided with the development of better medication. Unfortunately, the medication was not as effective as initially hoped and those discharged were not provided with support or services in the community. Getting someone psychiatric care and into hospital was described by D. J Jaffe as more difficult than getting into Harvard Law School. That was in 1991 and Jaffe was a spokesperson for the New York City Friends and Advocates for the Mentally Ill. That same situation exists today.
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