American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System
(from Easy Browser)
E. Fuller Torrey has written a new book, “American Psychosis.” Contrary to the oplnion expressed by a sarcastic friend it is not an autobiographical piece. Up front let me say I have not read the book. I have read the review written by DJ Jaffe linked above. In a very real sense this is a review of that review and thus is by no means the final word on Dr. Torrey’s book. I plan to read it and suggest you do to.
One friend asked me why I have written so much in the last couple of weeks on topics relating either directly or indirectly to Dr. Torrey. My answer was simple. With the coming of the Murphy Bill he goes from a loud opinion to possibly a very bad national law. Torrey loud is a nuisance. Torrey legal is past a nuisance.
I was struck by the subtitle of the book, “How the federal government destroyed the mental illness treatment system.” Dr. Torrey like most people seems to know that if something was messed up the federal government messed it up. It’s a popular opinion, but the rest of the subtitle is more important: “the mental illness treatment system…” My first response when I read that phrase was, “What in the world is he talking about?” What is the “mental illness treatment system”?
I tried to figure out logically what that was and found out that logic had little to do with it. You had to know the code.
Dr. Torrey, in the most ironic of ironic twists, is a victim of the success of psychiatry. The defender of the “severely mentally ill” has found himself drowning in a veritable sea of “the merely mentally ill.” And he is trying to put the genie back in the bottle. He thinks too much money is being spent on people who dont need or deserve the help. If you strip away the rhettoric that is what he is saying. If you spend “too much money” on people who dont need psychiatric hospitals in the end there will be less money for psychiatric hospitals. There is an intrinsic competition for money between the hospital and community system. There is too much money tied up in the provision of community services. Despite Dr. Torrey’s hysterics I dont think this genie is ever going back in the bottle.
His biggest problem in the end is that he costs too much money. His prize interventions- psychiatric hospitalization and outpatient commitment- are big ticket items. Despite what Jaffe claims they are the least cost efficient ways to do things. In the end what will always leave them short, is not just that it is bad treatment. They are bad business and that is evident in states trying to cope with Dr Torrey’s wisdom.
Psychiatric hospitals are dinosaurs that are pricing themselves out of existence. To my knowledge, I know of no study, no data– nothing that even shows that past a brief crisis stabilization period they even work. And I strongly question whether or not that hospitalization is the only, or even the best method of that. Torrey wages a war of anecdotes, but anecdotes are like noses….Everyone has one.
In Tennessee there is a hospital system and a community system. The hospital system serves less than 10% of the people the community system serves for about the same money. The result is a penny poor community system which lets people fall through the cracks to a hospital system that doesnt work which feeds them back into a community system that doesnt work and the cycle continues.
I was reading about the “success” of AOT in New York and found one statement (it was not the only one) that truly amazed me. The success of New York’s AOT was that it decreased expenditures from $100,000 per person to $50,000. No wonder most states that have AOT basically dont use it. It matters what you commit people to and if you have a skeletal system all the coercion in the world is not going to put meat on bones that has none.
Two more statements in Jaffe’s opening paragraph caught my eye. He says that media and government come to Dr. Torrey for advice with every tragedy. My impression is that Dr. Torrey is perpetually in line and that no one has ever had to twist his arm to accept some publicity. I might be very wrong and if so I certainly apologize to Dr Torrey but I really wonder who calls who.
The second item was the remark about Dr. Torrey’s advice preventing further “mental illness tragedy.” There is simply no evidence that is even remotely true. To say that Newtown happened because of the lack of AOT or because too much money was spent on “mental health” instead of “mental illness” is simple minded, manipulative and basically not very honest.
In fairness to Mr. Jaffe his review touches on much more than I have talked about in this brief post. I strongly suggest that you read his review and judge it for yourself. And like I said I recommend you read the book. Its a shame that it is important what Dr. Torrey says but it is.
I have one more comment or perhaps a question. If the major problem according to Dr. Torrey is that the federal government has taken control of the mental “illness” system then why has he tried so strongly to advocate for a bill (the murphy bill) that basically puts the federal government more in charge of the mental “illness” system than ever before? Just wondering?