Friday Reads: American Psychosis

This week's Friday Reads is a Covid edition; Kelly finally succumbed to the virus and had a bit more time to read than usual. This week she tells us about American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System by E. Fuller Torrey.

For various reasons, I've had an interest for years in how the United States cares for (or does not care for) people with severe mental illness. On a visit to the Trans-Allegheny Lunatic Asylum in Weston, WV on vacation years ago, I was impressed with how much historical information was presented in their small museum area and at how compassionate the guides were when speaking of the former patients. We also learned a great deal about how the closure of the hospital in the '90s impacted the surrounding community as well as the former inhabitants and staff. 

American Psychosis explains how America went from an all-time high number of mental illness inpatients in the 1950s to our current situation, where often people with severe mental illness are shuttled from the streets to the emergency room or jail and back again. 

Well-intentioned figures such as JFK and Robert Felix (the first director of the National Institute of Mental Health - NIMH) set in motion a program that would close the hospitals in favor of community treatment. Torrey, who worked at NIMH as the changes were taking place, contends that the community treatment centers were incentivized to focus on community "wellness" measures rather than on treating discharged people with severe illnesses such as schizophrenia or bipolar disorder.

Torrey traces the changes of the mental health program from the 1960s to the 2010s, showing how funding sources were shifted, resulting in less oversight and coordination of care and allowing huge numbers of people to fall through the cracks. He considers the legal "right to be insane" and how this can harm both the individuals with severe mental illness and those in their communities. He examines the abuses and neglect that take place in many community living arrangements for people with mental illnesses. Finally, he presents suggestions for steps that could be tested and/or implemented to improve the quality of life for people with mental illness and the community as a whole. 

Nobody wants to go back to a time when someone could be institutionalized against their will for a vague diagnosis like "hysteria," but it is clear that much suffering has been shifted from the hospital ward to the jail cell or park bench rather than eliminated. I was particularly taken with a quote on page 125: "Our failure to protect such mentally ill people by ensuring that they receive treatment is a major miscarriage of our medical care system and a blot on our claims to be civilized."