American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System
E. Fuller Torrey
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In 1963, President John F. Kennedy delivered an historic speech on mental illness and retardation. He described sweeping new programs to replace "the shabby treatment of the many millions of the mentally disabled in custodial institutions" with treatment in community mental health centers. This movement, later referred to as "deinstitutionalization," continues to impact mental health care. Though he never publicly acknowledged it, the program was a tribute to Kennedy's sister Rosemary, who was born mildly retarded and developed a schizophrenia-like illness. Terrified she'd become pregnant, Joseph Kennedy arranged for his daughter to receive a lobotomy, which was a disaster and left her severely retarded.
Fifty years after Kennedy's speech, E. Fuller Torrey's book provides an inside perspective on the birth of the federal mental health program. On staff at the National Institute of Mental Health when the program was being developed and implemented, Torrey draws on his own first-hand account of the creation and launch of the program, extensive research, one-on-one interviews with people involved, and recently unearthed audiotapes of interviews with major figures involved in the legislation. As such, this book provides historical material previously unavailable to the public. Torrey examines the Kennedys' involvement in the policy, the role of major players, the responsibility of the state versus the federal government in caring for the mentally ill, the political maneuverings required to pass the legislation, and how closing institutions resulted not in better care - as was the aim - but in underfunded programs, neglect, and higher rates of community violence. Many now wonder why public mental illness services are so ineffective. At least one-third of the homeless are seriously mentally ill, jails and prisons are grossly overcrowded, largely because the seriously mentally ill constitute 20 percent of prisoners, and public facilities are overrun by untreated individuals. As Torrey argues, it is imperative to understand how we got here in order to move forward towards providing better care for the most vulnerable.
Violent and Illegal Behavior of Mental Patients Reconsidered,” American Sociological Review 57, no. 3 (1992): 275–292; J. Monahan, “Mental Disorder and Violent Behavior,” American Psychologist 47, no. 4 (1992): 511–521. 40. Keith Ablow, The Strange Case of Dr. Kappler: The Doctor Who Became a Killer (New York: Free Press, 1994); B. Miller, “Woman Freed on Insanity Plea Held in New Slaying,” Washington Post, July 10, 1993, and P. Davis and B. Miller, “Police Had Warning of Violence,” Washington
Hygiene American Psychosis 1 JOE KENNEDY: A MAN WITH PROBLEMS September 1, 1939: Ambassador Joseph P. Kennedy was preoccupied with two deeply distressing problems. The first had become apparent at dawn that day, when German tanks rolled into Poland. This was a clear invitation for Britain to declare war, as Britain had publicly guaranteed Poland’s independence. Two days later Parliament obliged, and Kennedy immediately telephoned the president. According to Michael Beschloss’s
of the state of our medical and scientific knowledge. Whatever difficulties we shall face in the future cannot be more difficult than those of the past—and the seeds of the future which we have sown and are now nurturing give every promise of bearing good fruit.52 Unfortunately, the mental health centers legislation passed by Congress was fatally flawed. It encouraged the closing of state mental hospitals without any realistic plan regarding what would happen to the discharged patients,
compliance. The report concluded: The main point of this report is not how ineffective these particular Centers are, but that because of the present system of non-accountability all Centers could be this ineffective. Those Centers which are doing a better job are doing so because of their leadership, not because NIMH has required them to do so. The lack of accountability of the Centers means that all Centers, no matter what they are doing, continue to receive public money from NIMH. If a Center
with the Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) payments. These are federal entitlement programs intended to provide living support for the aged, blind, and disabled. As noted previously, SSI is the product of President Nixon’s decision in 1972 to standardize and federalize welfare and disability payments that previously had been the responsibility of the states. Nixon had no intention of making SSI into a major mental health program, but over the years