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The Insanity Offense: How America's Failure to Treat the Seriously Mentally Ill Endangers Its Citizens [Hardcover]

by E. Fuller Torrey
4.3 out of 5 stars  See all reviews (18 customer reviews)


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Book Description

June 17, 2008 9780393066586 978-0393066586 1

A leading expert on mental illness outlines the tragic consequences of deinstitutionalization and sounds the call for reform.

Beginning in the 1960s in the United States, scores of patients with severe psychiatric disorders were discharged from public mental hospitals. At the same time, activists forced changes in commitment laws that made it impossible to treat half of the patients that left the hospital. The combined effect was profoundly destructive. Today, among homeless persons, at least one-third are severely mentally ill; among the incarcerated, at least one-tenth. Of those individuals living in our communities, many are the victims of violent crime. Other untreated individuals commit crimes, including murder and assault. In The Insanity Offense, E. Fuller Torrey takes full stock of this phenomenon, exploring the causes and consequences as he weaves together narratives of individual tragedies in three states with sobering national data on our failure to treat the mentally ill. In the book's final chapters, Torrey outlines what needs to be done to reverse this ongoing—and accelerating—disaster.


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)
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

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

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: 9.2 x 6.6 x 1 inches
  • Shipping Weight: 1.2 pounds
  • Average Customer Review: 4.3 out of 5 stars  See all reviews (18 customer reviews)
  • Amazon Best Sellers Rank: #775,945 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

Most Helpful Customer Reviews
45 of 51 people found the following review helpful
5.0 out of 5 stars Long ovedue and too nice... 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
5.0 out of 5 stars Torrey,s Best Book November 30, 2008
By Hermes
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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11 of 12 people found the following review helpful
5.0 out of 5 stars Torrey is dead-on, newspaper editor says 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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6 of 6 people found the following review helpful
5.0 out of 5 stars Important Reading! 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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7 of 8 people found the following review helpful
5.0 out of 5 stars Another Gem from Dr. Torrey 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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Most Recent Customer Reviews
5.0 out of 5 stars psychiatric social worker
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. Dr. Read more
Published 2 months ago by Jenine L. Yannucciello, LCSW
5.0 out of 5 stars Great book!
Because I have a 44+ year Prison Ministry AND have a daughter who has Bi-polar Affective Disorder - and is doing GREAT! Read more
Published 5 months ago by Jeanette
4.0 out of 5 stars A scary story
This book is frightening, but right here is the answer to what is going on with the mass murders. Psychotic control, not gun control, is the answer, and this author is armed with... Read more
Published 6 months ago by LadyDoc
5.0 out of 5 stars Review of The Insanity Offense
The book rates five stars, but I can't say I loved it. It is depressing that our inexcusable treatment of the mentally ill has continued for so long without correction. Read more
Published 9 months ago by E. Cresswell
5.0 out of 5 stars Need more of this
While this book is filled with reactionary and sensational argument, i believe it is entirely necessary. Read more
Published 13 months ago by Lilo
4.0 out of 5 stars Great Insight
With so much going on in the news about world of mental illness and gun laws, etc. - he gives you a lot of documentation to base your beliefs on.
Published 14 months ago by CarolyninDallas
5.0 out of 5 stars Long Overdue
Torrey's eye-opening expose' about all that is wrong with our mental health system is a long overdue discussion. Read more
Published 15 months ago by Nancy C Brown
5.0 out of 5 stars An examination of policies regarding severe intellectual disabilities
The author seeks hope for people with severe mental illnesses and their families. He is troubled that the deinstitutionalization of people with such illnesses such as severe... Read more
Published on February 28, 2012 by LEON L CZIKOWSKY
2.0 out of 5 stars Long on polemic, short on facts
This is more of the same tired, emotional diatribe that has made Fuller Torrey a hit with the many families whose members have been failed by the mental health system. Read more
Published on January 25, 2012 by Hobbes
3.0 out of 5 stars Good call-to-alarm but few solutions offered
The Tuscon shootings have spurred serious questions about why the mentally-ill shooter was free. After 40 pages or so of alarming anecdotes, this book becomes a highly repetitive... Read more
Published on January 17, 2011 by Wayne
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Topic From this Discussion
Torrey is a liar
I really wish people like you, who rant about what you don't understand, had to deal with those suffering from the diseases. That schizophrenia is brain-based is solidly fact. That people with it can be helped by neuroleptics is also fact, and I have experience with seeing people helped by it.... Read more
Jan 9, 2009 by M. Bast |  See all 5 posts
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