Out of the Shadows: Confronting America's Mental Illness Crisis Paperback – February 26, 1998

I am writing my dissertation on this topic; I have used this book as a source. If you really want to understand the absolute "truth" about what ails our mental health system, read this. Torrey is an expert in this field, yet his work is quite readable. He seems to be a down to earth type of advocate. Our mental illness crisis will continue until the "system" listens to people like this author.

prompt delivery, pleased.

While the problems are real, the use of a handful of situations and cases to represent the totality of the problem is lacking. Where are hard statistics in these books? When presenting information to change a flawed system readers need more stats to explain the real impact on the system in the representation of numbers not just a handful of individual sad stories.

Interesting and thorough history of deinstitutionalisation.

Just as described

Edwin Fuller Torrey (born 1937), is an American psychiatrist, who has written many books, such as Freudian Fraud The Malignant Effect of Freud's Theory on American Thought and Culture,Surviving Schizophrenia: A Manual for Families, Patients, and Providers,Surviving Manic Depression, etc. He wrote in the Preface of this 1997 book, "I have written this book for anyone who has wondered why there are so many severely mentally ill men and women living on the streets of our cities and towns. And why there are so many severely mentally ill people in jails and prisons. And why there are so many episodes of violence by sufferers of mental illnesses, especially since we know that when such people are treated they are not more violent than the general population... I believe we know how to solve our mental illness problems, but for a variety of reasons we do not do so. This book is about those reasons." (Pg. vii)

He says, "The mental illness crisis, then, has not occurred because we do not have effective treatments. Rather, it exists because we do not use these treatments." (Pg. 6) He explains, "What percentage of the total homeless population is mentally ill? If the definition of 'mentally ill' includes alcohol and drug addictions, then ... 75 percent or more of the homeless are mentally ill. If, however, only severe mental illness is the criterion... approximately 35 percent of homeless persons qualify." (Pg. 17) He adds, "studies following up on patients discharged from psychiatric hospitals strongly suggest that homelessness is a consequence of severe mental illness." (Pg. 23)

He then discusses a related problem: the incarceration in jails and prisons of the mentally ill: "A 1973 study in Santa Clara County indicated that the jail population had risen 300 percent in the four years after the closing of Agnews State Psychiatric Hospital, located in the same county. In 1975, a study of five California jails... reported that the number of mentally ill inmates also rose sharply in the 1970s." (Pg. 36) He adds, "Sometimes, 'mercy bookings' are initiated by mentally ill persons themselves to get into jail for shelter or food... The mentally ill also are sometimes jailed because their families find it is the most expedient means of getting the person into needed treatment." (Pg. 40)

He laments, "Since 92 percent of the patients who were in public psychiatric hospitals have been deinstituionalized, we have therefore discharged thousands of patients who should have remained in hospitals. These are, presumably, the people who have ended up homeless, who are in jails or prisons, who are responsible for acts of violence, and who have contributed heavily to the deterioration of life in communities and within their families." (Pg. 87) He comments, "Cost-shifting has been the primary reason for the inappropriate discharge of many patients." (Pg. 99) He adds, "Federal dollars have moved psychiatric inpatient care from public psychiatric hospitals to general hospitals. Because Medicaid pays for psychiatric care in general hospitals but not in psychiatric hospitals, there has been a massive shift in psychiatric inpatient care from public psychitric hospitals to general hospitals." (Pg. 103)

This is an extremely informative, heartfelt (the author's sister has schizophrenia, by the way) book, that is virtually "must reading" for anyone concerned with the mentally ill, the homeless, or similar social problems.

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.