Insanity Offense: How Americas Failure To Treat The Seriously Mentally Ill Endange Hardcover – May 27 2008
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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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Torrey's book describes a nation that has been unable to come up with a humane mental health policy—one that protects the ill from their own demons and society from their rare but deadly outbursts. — David Brooks (New York Times) --This text refers to the Paperback edition.See all Product Description
Most Helpful Customer Reviews on Amazon.com (beta)
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.
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.
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.
Lawyers and civil libertarians quote John Stuart Mill's On Liberty for their reasons for allowing the mentally non competent to make treatment decisions. Mill said that "the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not sufficient warrant."
At the time Mill wrote that, there were few effective medical treatments for anything let alone schizophrenia.
However, in the very next paragraph, Mill offers an exception for the above quoted assertion used by so many of the so called friends of the mentally ill. He says that "those who are still in a state to require being taken care of by others must be protected against their own actions as well as against personal injury."
Let us hope that Dr. Torrey's book and his activity to change the laws through the Treatment Advocacy Center will win out in the end.
Marvin Ross Author of Schizophrenia: Medicine's Mystery - Society's Shame
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