In American Psychosis: How The Federal Government Destroyed The Mental Illness Treatment System E. Fuller Torrey argues that the transfer of responsibility for individuals with serious mental illnesses from state to federal government destroyed the mental illness treatment system, through deinstitutionalization, and led to a disastrous change in how mentally ill individuals are treated today. Fuller Torrey argues that the change began in 1962 with plans for President Kennedy’s Interagency Task Force on Mental Health and federally funded community mental health centers (CMHCs).

Fuller Torrey opens with a historical overview of how the mental health system worked at the time before the shift, focusing on the Kennedy family and the mental illness of Rosemary Kennedy before moving on to the politics of deinstitutionalization of state hospitals and the “death of asylums”, while arguing that none of the experts called in to work on this shift had any experience with mental hospitals.  

Fuller Torrey state that yes, the previous system with state responsibility was flawed but at least there was a system in place. The new shift in responsibility actually led to a lack of leadership, the closing of many hospitals and a severe lack of hospital beds and the move of individuals with severe mental illness from hospitals to prisons, jails, boarding homes and nursing homes, to name a few consequences.

The CMHCs put strong emphasis on the prevention of mental illness, without any studies demonstrating that the type of prevention they were advocating actually worked and without definite knowledge of how to prevent mental illness or what was causing mental illness. Fuller Torrey writes that: “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, especially those who refused to take medication they needed to remain well. It included no plan for the future funding of the mental health centers. It focused resources on prevention when nobody understood enough about mental illnesses to know how to prevent them” (p. 58).

The author, in the coming chapters, discusses the impact of deinstitutionalization on individuals with mental illnesses, the prison system and the public, providing plenty of examples on how dangerous and flawed the current system is. In the last chapters, Fuller Torrey mentions “good news”, giving examples of some of the few upsides and successes of the mental health system. Thereafter the author provides a list of solutions and lessons to be learned. 

I appreciate how Fuller Torrey offers example after example to make his points. Thereby, statements and arguments are clearly backed up and the author shows his authority on the subject at hand. It also makes it difficult to argue with Fuller Torrey because the reader is almost overwhelmed by evidence of how the shift in responsibility has damaged the care of individuals with mental illness. I also appreciate how the author touches upon a subject in an earlier chapter and then revisits the subject in a later chapter, providing more evidence and backup to his claims.  

On the down side, the first few chapters are quite a difficult read as they contain numerous names, organizations and information that the reader needs to deal with. The introduction, although mainly necessary, also becomes somewhat tedious in comparison to later chapters since the reading simply gets better and better as I move through the chapters.

This book would be of use to anyone who is interested in the politics and care of individuals with mental illness. It provides a critical view of how mentally ill individuals are cared for in the United States and how key individuals have viewed mental illness throughout the last few decades. It would especially be of use to psychology students and to those who work in the field. This is a book that I would highly recommend.

© 2014 Elin Weiss

Elin Weiss has a Bachelor’s Degree in Psychology and a Master’s Degree in Women’s Studies from University College Dublin, Ireland.