American Psychosis: A Mental Health Advocate Reviews Fuller Torrey's Contoversial New Book
When my good friend Kathy Flaherty informed me she had picked up E Fuller Torrey's latest book, "American Psychosis," at her local library, I asked her to send me a book report. Kathy is a legal aid attorney and mental health advocate living in Connecticut.
The outspoken Dr Torrey is simultaneously the most loved and hated person in the mental health movement. Way way back, he championed the cause of the first generation of NAMI advocates – moms and dads - against the psychiatric establishment of the day. He was also a pioneer in researching the biological causes of schizophrenia and remains a staunch advocate for increased funding of mental illness research.
But Dr Torrey also assumes that just about everyone with schizophrenia and a good many with bipolar lack insight concerning their illness and may need to be treated against their will. Inevitably, he will state this views in the wake of a high-profile shooting tragedy. For this, he has earned the enduring wrath of many mental health advocates, my friend Kathy included.
Following is her review:
About the only view that Dr Torrey and I have in common is that the present mental health system in the US is broken. Reading his “American Psychosis” was one of the most frustrating experiences I have had.
Dr Torrey starts his book with the hypothesis that Rosemary Kennedy’s mental condition was the impetus for President Kennedy’s establishment of the federal mental health program. He states on page 9 that “it is not possible to give a definitive diagnosis of Rosemary’s illness without access to her files," but then proceeds to contradict himself (in the same paragraph, no less) by giving a definitive diagnosis.
Why I even continued to read this book after this I am not entirely sure.
Dr Torrey - together with the Treatment Advocacy Center he founded - views as the major problem acts of violence committed by the “seriously mentally ill.” At the same time, both he and the Treatment Advocacy Center conveniently ignore the studies that show that rather than being the perpetrators of violence, people living with mental illness are far more likely to be its victims. Torrey's proposals for “fixing” the problem involve stripping fundamental rights from vulnerable people.
Let's look at his top three arguments:
First argument: Public psychiatric hospitals cannot be completely abolished.
Dr Torrey’s number one priority is to increase inpatient psychiatric hospital beds by 500%. There is no question that the mental health system needs more resources, but the law requires that services be provided in the least restrictive setting.
The large, state-run institution model has already been tried and rejected. The money that was saved from closing the old state hospitals was supposed to have been invested in community-based services. This didn’t happen. As a result, we have a shortage of mental health treatment options. The problem is not going to be solved by returning the delivery system to the old model of inpatient services. It can be solved by keeping the promise of delivering community-based services.
Second argument: Lack of awareness of illness (anosognosia) must be considered when planning any treatment system and therefore "assisted outpatient treatment" must be an option.
Let's call it what it actually is – forced outpatient treatment. What fascinates me about the people who want to impose psychiatric treatment on others is their fundamental disconnect when it comes to every other freedom.
People – in general – are incredibly “non-compliant” with recommended treatment. We don’t eat right, we drink too much, we smoke, we don’t exercise enough, we don’t sleep as much as we should, we ask for antibiotics when they aren’t necessary, when they are prescribed we don’t finish them – but it is ONLY when psychiatric treatment is recommended and ignored that this need to force it on us is so distinct.
The argument is risk of harm to self or others. Again, existing laws of civil commitment already provide a means of restricting liberty when a person poses a risk of imminent danger to self or others or is gravely disabled. Adding another level of restrictions on one’s rights in the community, as a justification of protecting safety, when in every other context people clamor to protect their freedom, is really thinly veiled discrimination against people with psychiatric disabilities, and is a prejudice based on fear. It needs to stop.
Third argument: Community treatment will only be successful if carried out by community mental illness centers, not community mental health centers.
It makes me profoundly sad that a doctor, of all people, feels this way. If he wants patients to recover, why would he want them to focus on their illness and not on getting well? Since most of society, including the medical profession seems to be in an orientation of focusing on wellness and recovery and not focusing on illness, I’m not going to spend more time on this.
Some stuff we can agree on …
Dr Torrey lists more proposals - such as continuity of care, access to housing and a raft of services (centered around clubhouses), protecting the vulnerable, and acknowledging the failure of the for-profit funding – each of which is hard to find fault with.
Mixed feelings …
Dr Torrey would prioritize services for those who are the sickest, pose the greatest risk to themselves and others, and incur the greatest cost.
Yes, those with the most need should be served first. But if those whose care is the most expensive are treated first, it would seem that fewer people would receive care, including those with the most need. Dr Torrey appears to be presenting conflicting arguments simultaneously. He needs to decide what he truly wants.
Dr Torrey also wants, in selected instances, to put private personal information in the hands of law enforcement personnel, our de facto frontline mental health workers. This would apply to those with mental illness who have a history of dangerousness
But there is already a law enforcement exception under HIPAA and FERPA, so I’m not really sure what Dr Torrey (or any other person who talks about the need to “reform” disclosure laws) is talking about. As a mental health advocate and an attorney, it is particularly frustrating for me when someone argues that existing law needs to be changed when the very thing that the person is complaining about is already allowed to be done under existing law.
A mental health czar?
I would not be averse to trying this, but I imagine that Dr Torrey and I would have very different opinions on who should be selected. What is most important is that all members of the mental health community have input on the selection of this individual, including people living in recovery.
End note …
Dr Torrey has his legion of supporters, and certainly the media always seem to go to him for a sound bite. It’s important for us as advocates to know where he is coming from. To that extent, this book was worth the time investment. I’m glad my local library had it.
Disclosure: Dr Torrey wrote a glowing back cover blurb to my 2006 book, "Living Well with Depression and Bipolar Disorder." My views accord with Kathy's review, and I have put them on record years before my book came out. But I also acknowledge Dr Torrey's other contributions. Life is complicated …