Welcome E. Fuller Torrey (Treatment Advocacy Center) (Salon.com), and Host Gregory Dober (PrisonLegalNews.org) (co-author, Against Their Will)

American Psychosis: How The Federal Government Destroyed The Mental Illness Treatment System

There is a saying:

“The definition of insanity is doing the same thing over and over again and expecting different results.”

American Psychosis reveals how, for decades, governmental policy makers of mental illness programs have expected different outcomes despite utilizing the same failed past policies.

E. Fuller Torrey’s insightful book, American Psychosis: How the Federal Government Destroyed The Mental Health Treatment System, is confirmation to what many people suspect of the current mental illness system and policies: This system is broken and current disjointed polices will make it forever difficult to correct.

Dr. Torrey takes us through the history of state and federal governments involvement with mental health care in the U.S. He details how the vision and eventual policy mandates of a few individuals shaped federal and state governmental policy for decades. Psychiatrists, with varying and competing theories on mental health and illness, would be appointed top directors at the National Institute of Mental Health (NIHM) and guided these policies for decades.

Despite the flawed NIMH policies, the directors and administrators used politically opportune times for the advancement of their flawed agendas. The election of JFK and the Kennedy family guilt over a mentally ill and lobotomized Rosemary Kennedy gave NIHM officials the opportunity to realize the creation of community mental health centers (CMHC). The LBJ vision of the “Great Society” and creation of Medicare and Medicaid would provide the states with the ability to release more institutionalized patients to the community. Though Nixon despised psychiatry and wanted to defund many NIMH programs, he would have his own problems with Vietnam, Watergate and a Democratic Congress. Nixon’s problems would spare the NIHM and many of its programs from extinction.

The CMHC’s, during the 1960s and 70’s, were encouraged to become more involved in political and social activism than the treatment of seriously mental ill individuals. The “new patient” would be the less severe, “worried well,” rather than the country’s most seriously mentally ill citizens. The NIMH’s “grand experiment” was comprised of one part “social engineering” and one part “political activism.”

Policymakers at NIMH despised state hospitals and encouraged social and political activism. State mental hospitals were eliminating beds at an alarming rate. Hundreds of thousands of beds have been eliminated since the 1950’s. resulting in an increase of homelessness for mentally ill individuals. Jail and prisons would eventually become the “after-care” for many of these untreated Americans. Cost shifting was taking place. With the advent of Medicaid and Medicare, states were provided a disincentive to care for the mentally ill. Operators of private homes flourished and encouraged those ill to seek help at their facilities. Many for-profit facilities motivated by profits and cost containment would replace the state institutional system. However, without adequate oversight and protection, these facilities would become what the early administrators bemoaned; inhumane warehouses of mentally ill individuals.

Dr. Torrey is a leading researcher on schizophrenia and executive director of Stanley Medical Research Institute. He is the founder of the Treatment Advocacy Center and has published numerous books on mental illness. In addition, Dr. Torrey h as worked for the NIMH and was a principal investigator of a NIMH Schizophrenia/Bipolar Disorder Twin Study. His years of experience and knowledge are used well in American Psychosis.

 

[As a courtesy to our guests, please keep comments to the book and be respectful of dissenting opinions.  Please take other conversations to a previous thread. - bev]

130 Responses to “FDL Book Salon Welcomes E. Fuller Torrey, American Psychosis: How The Federal Government Destroyed The Mental Illness Treatment System”

BevW December 1st, 2013 at 1:46 pm

Fuller, Welcome to the Lake.

Gregory, Welcome back to the Lake.

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Gregory J. Dober December 1st, 2013 at 1:51 pm
In response to BevW @ 1

Hi Bev, I’m here. I’ll wait to you get Fuller logged in.

dakine01 December 1st, 2013 at 2:00 pm

Good afternoon Fuller and welcome to Firedoglake this afternoon. Greg, welcome back

Fuller, I have not had an opportunity to read your book but do have a question for you. It seems the short-shrift provided to mental health services at all levels of government is part and parcel with all the continued squeezing of the middle-class and poor. Is it a case of the powers that be not seeing the need (out of sight, out of mind) or are they purposefully obtuse and refusing to see people they perceive as other/lesser for whatever reasons?

Gregory J. Dober December 1st, 2013 at 2:00 pm

Welcome Fuller to FDL book salon. The book was very insightful for me into the mental illness problem. From my work at Prison Legal News, I knew that the mentally ill incarcerated was high, but did not realize the history of this problem.

So again, welcome and thank you for taking time and being here.

E. Fuller Torrey December 1st, 2013 at 2:03 pm
In response to BevW @ 1

Hi everybody. glad to be with you. Fuller Torrey

Gregory J. Dober December 1st, 2013 at 2:04 pm

Good afternoon Fuller

Gregory J. Dober December 1st, 2013 at 2:04 pm

When did you decide to write a book such as American Psychosis and what was the motivation?

E. Fuller Torrey December 1st, 2013 at 2:06 pm
In response to dakine01 @ 3

This is actuaally an equal opportinity disaster. The poor and the rich are all getting very poor mental health services.

eCAHNomics December 1st, 2013 at 2:08 pm

Disclosure: My bias against medical mental industry deep, with theoretical, personal, institutional aspects.

With that in mind, one part is that the minute government gets involved in an industry that fails on its own lack of merits, it is a license to manipulate, blackmail, otherwise malhandle patients.

Comments?

E. Fuller Torrey December 1st, 2013 at 2:08 pm

I have followed the ongoing and worsening disaster for 30 years. I decided to write the book to explain how we got into this mess over 50 years.

Gregory J. Dober December 1st, 2013 at 2:09 pm

Can you tell us the feedback from colleagues and other professionals in mental health that you may be receiving since the books release?

Gregory J. Dober December 1st, 2013 at 2:10 pm
In response to eCAHNomics @ 9

That can create a perfect storm.

E. Fuller Torrey December 1st, 2013 at 2:11 pm
In response to eCAHNomics @ 9

Govt has a responsibility to provide care for the most disabled. In this instance the mistake was having the feds get involved. For 150 years this was a state ressponsibility and we would be better off if the reponsibility was returned to the states.

Gregory J. Dober December 1st, 2013 at 2:13 pm
In response to eCAHNomics @ 9

The book does a great job at explaining this transition from state to fed and the problems that went with it.

E. Fuller Torrey December 1st, 2013 at 2:13 pm

The feedback has been remarkably positive, even frm many of the professionals involved. I think there is now a wide agreement that emptying the hospitals without providing treatment has been a disaster.n

BevW December 1st, 2013 at 2:13 pm

This is actuaally an equal opportinity disaster. The poor and the rich are all getting very poor mental health services.

Fuller, that is an amazing statement considering the rich have access to the full services available in health care. Can you explain why everyone is not getting quality mental health services?

Gregory J. Dober December 1st, 2013 at 2:13 pm

Did your experience working at NIMH shape your opinion on the country’s overall mental health and illness policy?

spocko December 1st, 2013 at 2:14 pm

Interesting topic.
I haven’t read the book and I’m not sure if you address this, but what are some of your suggestions for reform and more importantly, which lobbying firm-backed by which industry-will be pushing for them?

Gregory J. Dober December 1st, 2013 at 2:15 pm
In response to BevW @ 16

The book terms people that can afford it, not seriously ill and know they need it the “worried well.”

E. Fuller Torrey December 1st, 2013 at 2:16 pm

Yes, I could not have written the book without having worked there from 1970 to 76. I saw well meaning professionals making in retrosspect major mistakes which led us to the current problems.

Gregory J. Dober December 1st, 2013 at 2:17 pm

Fuller, you note that an impediment to change in the current policy is the public mistrust of psychiatrists. How do you see that trust being obtained?

Gregory J. Dober December 1st, 2013 at 2:18 pm

Also, just a thought to my reply to Bev…can you define who the “worried well” are these days?

eCAHNomics December 1st, 2013 at 2:18 pm

I’ve noticed.

Once asked (in innocence) Senator Domenici if he had mandated any medical payments by employers (who could also manipulate, blackmail, otherwise manhandle employees). I didn’t know that he had a child with mental problems.

He lashed out at me. It was a group meeting. I wondered at his bad behavior in response to normal question (trying to figure out how much of what payment was going to whom, for what reason, & what agendas might be) and learned later of his problems.

Gregory J. Dober December 1st, 2013 at 2:19 pm
In response to eCAHNomics @ 23

Very interesting anecdote.

E. Fuller Torrey December 1st, 2013 at 2:19 pm
In response to BevW @ 16

Mental health is the one area of medicine where more money will not necessarily buy you better services. Very few psychiatrists specialize in the difficult patients, eg schizophrenia and bipolar.

spocko December 1st, 2013 at 2:20 pm

Well speaking of state responsibility. I was working in a day treatment center in San Jose in the ’80s after Reagan was shutting down the state hospitals and turning patients out into “board and care” facilities. So my clients were people were the chronic mentally ill. People how had multiple psychotic breaks. Many had been in hospitals for years. (Side note, we had two clients with Masters degrees and one with a Ph.D. they weren’t mentally deficient, but mentally ill)

I’ll never forget the day one of my clients got a letter from the social security suggesting he get a job. I mean he’s not hospitalized, what’s the problem?

His parents couldn’t care for him, he couldn’t work, “Welcome to McDonald’s [talks to self'No I will NOT put my hands in the fryer!'] Can I take your order? Yet from the point of view of the California government he was a freeloader and needed to get off the state dole.

eCAHNomics December 1st, 2013 at 2:21 pm

NYS here. I remember, from way-back-machine, some horrific treatment of mentally ill in state institutions (Creedmore?). Then the patients were released onto the streets to become homeless.

Gregory J. Dober December 1st, 2013 at 2:22 pm

Spocko, this book is for you! Your story resonates in a few chapters.

E. Fuller Torrey December 1st, 2013 at 2:22 pm

I have focused my work and this book on the most seriously mentally ill. By worried well I mean people with relationship problems or existential angst. I have argued that resources should go to the sickest forst.

eCAHNomics December 1st, 2013 at 2:23 pm

U.S. spends 1-1/2 to 2X per capita on medical bills than any other country and gets worse outcomes. Problem is not confined to mental health.

eCAHNomics December 1st, 2013 at 2:24 pm

What are the “resources”? Haven’t kept up with technology, but last I knew, psychiatrists were pill pushers, and patients hated side effects. What has changed?

Gregory J. Dober December 1st, 2013 at 2:24 pm
In response to eCAHNomics @ 30

Just to address this….find the statistic for the amount of money spent on patients 30 days prior to death. We have a cultural issue as well.

BevW December 1st, 2013 at 2:25 pm

How many of the US population would be considered the seriously mentally ill? This treatment would require 24/7 care?

E. Fuller Torrey December 1st, 2013 at 2:25 pm
In response to spocko @ 26

As President Reagan made a big mistake when he tried to cut the SSI roles. But in fact none of the presidents since Kennedy, and including all 5 Dems and all 5 rep. have exhibited any real understanding of this problem.

Gregory J. Dober December 1st, 2013 at 2:25 pm

Fuller, you wrote about the plight of a homeless, mentally ill man in Reno who was referred to as “Million Dollar Murray.” His nickname derived by the amount of money that may have been spent in community services for his care. Is this a more common problem than one man in Reno and will their be an increase in “Million Dollar Murray’s’ in the future?

spocko December 1st, 2013 at 2:26 pm

That was another problem that I saw. The psychiatrists would rather treat people with schizophrenia and bipolar but people with depression and anxiety or other illnesses where people could function in society (and have health insurance.)
One of the issues that I had to deal with is that when I started working with these people they were schizophrenia or bipolar and a year later they still were. They weren’t going to get better. We could only hope they didn’t get worse (or de-compensate as they termed it then.)

It was frustrating for me not to feel I was having any impact, I can imagine it would feel the same with some psychiatrists.

E. Fuller Torrey December 1st, 2013 at 2:27 pm
In response to eCAHNomics @ 31

The medications we have are much better than in the past but some cannot take because of side effect. In that regard the meds are about the same as we use for heart disease or arthritis.

Gregory J. Dober December 1st, 2013 at 2:28 pm

This is providing that a mental health patient will be compliant taking them too. Sorry-forgot to hit reply on this one.

E. Fuller Torrey December 1st, 2013 at 2:31 pm

Greg, million dollar Murray, whose ER costs in the Reno hospitals accumulated over only 10 years, is famous only because the New yorker wrotte about him. Every city in the US has similar people, usually combining Schiz. or Bipolar with substance abuse. If we would focus our efforts on this small group alone we would save a lot of money if we made sure they were being treated.

spocko December 1st, 2013 at 2:31 pm

Good suggestion. Which lobbying group is going to push for this? Which lobbying group is going to want to block it?

I’m sorry I seem overly focused on lobbying, but until money is out of the government I’m trying to get one lobby to fight another to get something done.

So, who “wins” when the really mentally ill are cared for better? Who “loses” what are the financial loses or other kind of losses?

Gregory J. Dober December 1st, 2013 at 2:32 pm

or I assume that many may have ended up incarcerated as well?

Gregory J. Dober December 1st, 2013 at 2:32 pm

How important is a change in Medicaid and Medicare rules, specifically, allowing more flexibility on payment for mental health treatments, to the overall mental illness policy in this country?

Gregory J. Dober December 1st, 2013 at 2:34 pm

This is just an fyi for all readers to check out later. This tragic situation was in my local paper last week. This story addresses many of the issues in American Psychosis. http://www.post-gazette.com/news/2013/11/24/Murder-reflects-plight-of-ex-Mayview-patients.html

eCAHNomics December 1st, 2013 at 2:35 pm

Read recently that heart disease meds are not different from placebos.

Also read a long time ago (NYT annual Sunday issue on medical industry) that half of what doctors know is wrong. The trouble is, they don’t know which half.

Also read that non-compliance in taking meds is high, regardless. In the day when HRT was the rage, roughly 1/3 did not fulfill prescriptions.

E. Fuller Torrey December 1st, 2013 at 2:35 pm

Compliance with medication is a huge problem. About half of people with schiz. and 40 % of bipolars have little or no awareness of their illness because of the effect of the disease on their brain. Thus they will not take meds because they think they are not sick.

spocko December 1st, 2013 at 2:38 pm

SF has had to deal with this exact issue. One of the interesting complications have to do with patient’s rights.
Intended to protect people from being committed for all the wrong reasons, they are used by people who should be committed because they are a danger to themselves or others. And of course the whole, providing beds for them once they are in custody.

I work on issues of gun safety and you will note after every shooting that the NRA tried to dodge any role in the death, they use the “He’s just a lone crazy person.” But what they don’t tell you is that the NRA blocked things like the National Mental Health Register where this “lone crazy person” had a history of Violent mental illness and should have gone into that database which is referenced by the database that is used on a background check for weapons.

After Virginia Tech their were some more effort put into getting people into this system, but the NRA (and others at the state level blocked efforts “Just because I told my Dr. that I had a gun and I was thinking of killing myself shouldn’t mean he should tell the government and put me in a database where I can never get a gun again! This is America I have my 2nd Amendment rights! I got over my depression. I want more guns!”)

E. Fuller Torrey December 1st, 2013 at 2:38 pm

Spocko, We all lose when these folks are not treated as I descrice in my book. At least 30% of the homeless, at least 20% of inmates in jails and prisons, and at least 10 % of homicides are done by untreated seriously mentally ill individuals.

Gregory J. Dober December 1st, 2013 at 2:39 pm

That is amazingly high. We focus on getting the treatments to market but not getting the treatment to patients

spocko December 1st, 2013 at 2:40 pm

What do you mean, “To market” vs. to patients?

E. Fuller Torrey December 1st, 2013 at 2:41 pm
In response to spocko @ 46

Yes, our gun issues are crazy but so is our failure to treat seriously mentally ill people. Controlling guns is a worthy goal but it willl not solve the mental illness issue,

Gregory J. Dober December 1st, 2013 at 2:41 pm

Since spocko noted this subject.

Fuller, his is not a political question of advocacy or opposition to gun control but more of an insight on media and mental health issues. When a rampage killing, such as Newtown, Aurora or Columbine, occurs in the United States, the media tends to focus on the political battle of gun control. Is the focus on gun control by the media taking away from the debate for improvement and intervention of mental illness?

Please everyone, try to refrain from the 2nd amendment debate today.

Gregory J. Dober December 1st, 2013 at 2:42 pm
In response to spocko @ 49

We spend millions developing new cures but we can’t get seriously mental ill patients to comply. We are choosing to spend very little on their management which would include compliance.

E. Fuller Torrey December 1st, 2013 at 2:45 pm

Greg, No question that the focus on guns detracts from addressing the mental illness issue. For example, in Tucson the media completely missed the issue that the state legislature had severly cut funds for the program which could have treated Jared Loughner just 6 months before the tragedy.

Gregory J. Dober December 1st, 2013 at 2:47 pm

How does our current policy effect mental illness treatment for children and
teenagers? Are we missing early signs of illness because of this policy?

BevW December 1st, 2013 at 2:48 pm

In contrast, how are other countries (England, France, Germany, etc.) set up to treat the seriously mentally ill?

E. Fuller Torrey December 1st, 2013 at 2:48 pm

People with schiz. etc who don`t take meds most often do so because the do not think they are sick. This is because of damage to their brain. There are programs to encourage them to take meds, such as assisted outpatient treatment which I describe in the book, but most states do not use them.

Gregory J. Dober December 1st, 2013 at 2:49 pm
In response to BevW @ 55

Good question

spocko December 1st, 2013 at 2:50 pm

“Spocko, We all lose when these folks are not treated as I descrice in my book. At least 30% of the homeless, at least 20% of inmates in jails and prisons, and at least 10 % of homicides are done by untreated seriously mentally ill individuals.”

Sorry Doc. I need you to be more specific. Which industry is going to lobby to deal with these people when the pay off is less homelessness? Is it going to be city governments going to states saying, ‘if we fix the mental ill problem we will have fewer homeless, less homicides and that will look better to business people’

I only am pushing you on this because of the sick state of our current government. Maybe prisons LIKE having mentally ill (more beds to fill) Are there companies that benefit from homicides? Which ones benefit from fewer homicides?
Which benefit from less mentally ill homeless?

Note I say Companies it could also mean industries. Who makes money with less severe mentally ill? Who saves money with less severe ill? Who wants the problem fixed so bad they will spend money on bills to fix the problems?

E. Fuller Torrey December 1st, 2013 at 2:50 pm
In response to BevW @ 55

Bev, In general the European countries do better, esp. Netherlands and the Scand. countries.

Gregory J. Dober December 1st, 2013 at 2:52 pm
In response to spocko @ 58

Yes, there are companies that benefit from crime…publicly held companies are now on the NYSE that run prisons. GEO and CCA come to mind as well as a other companies that provide prioner health care (if u call it that) such as Corizon and Wexford health. Many towns in rural areas beg for prisons as a way to create jobs too.

Gregory J. Dober December 1st, 2013 at 2:53 pm

Is it the amount of GDP spent on mental health or better processes from their governments that make these countries work?

E. Fuller Torrey December 1st, 2013 at 2:54 pm
In response to spocko @ 58

Spocko, You are right on target. The for profit nursing home industry, for example, has profited nicely by taking the patients who used to be in the state hospitals. And you are right that there is no strong group pusing for change. There is a small group, which I started 15 years ago, see http://www.treatmentadvocacycenter.org.

dakine01 December 1st, 2013 at 2:56 pm

Building prisons was one of Mario Cuomo’s lasting legacy, especially in central upstate New York. I lived in Rome, NY (Oneida County) and there were I think 3 medium security prisons plus a Psychiatric Prison (Marcy Correctional) in the county

Dearie December 1st, 2013 at 2:56 pm

Do you have a citation for this? My experience with seriously mentally ill is that the side effects of the drugs deaden the client’s feelings to such an extent that they don’t feel “real” and stop taking the meds to get back to themselves.

spocko December 1st, 2013 at 2:57 pm

the media completely missed the issue that the state legislature had severely cut funds for the program which could have treated Jared Loughner just 6 months before the tragedy.

This is what I was referring too.

E. Fuller Torrey December 1st, 2013 at 2:57 pm

GDP is part of it but more important is their coherent natl health plan. They assume that the govt, not health insurance companies, should coordinate it.

Gregory J. Dober December 1st, 2013 at 2:57 pm

Interesting point about Marcy. In AP you note that in Raleigh, NC, the correctional system has developed a 216 bed hospital for those being sent to central prison. Can we expect more of these innovative programs across the country in the future?

Gregory J. Dober December 1st, 2013 at 2:59 pm
In response to Dearie @ 64

Interesting point.

E. Fuller Torrey December 1st, 2013 at 3:00 pm
In response to dakine01 @ 63

Dakine, I know the area well since I came from there. Remember Marcy used to be a state hospital, now it is a state prison specializing in mentally ill inmates. We have transferred many of the same people from hospitals to jails and prisons.

E. Fuller Torrey December 1st, 2013 at 3:02 pm

Yes, in NC they closed Dorothea Dix state hospital and are opening a prison hospital for mentally ill inmates RIGHT ACROSS THE STREET in Raleigh. Is this crazy or what?

dakine01 December 1st, 2013 at 3:02 pm

(I had to become far more familiar with the prisons than I wanted as my phone number had previously belonged to Oneida Correctional and the entire 5 plus years I lived there, I was getting calls for the prison)

Gregory J. Dober December 1st, 2013 at 3:04 pm

Yet they believed the hospital wasn’t needed. It probably is easier for the Department of Prisons to get funding than many state health and welfare departments. An irony since many of the people that prisons are getting should be under a state health and welfare department.

E. Fuller Torrey December 1st, 2013 at 3:06 pm

Dearie, Citation for use of antipsychotic meds: Surviving Schizophrenis, 6th edition to be publisshed this month, HarperCollins, I am the author.

Gregory J. Dober December 1st, 2013 at 3:06 pm

Statistics note that anywhere between 10-15% of inmates are arrested on marijuana related charges. In addition, mandatory sentences, for drugs like crack-cocaine and heroin, have incarcerated people longer than some other felonies. Has our drug policy, “war on drugs”, chose to jail many addicts rather than to treat them? What are the alternatives?

ThingsComeUndone December 1st, 2013 at 3:07 pm

How many homeless people would or should be in mental hospitals.

spocko December 1st, 2013 at 3:07 pm

“and you are right that there is no strong group pushing for change. “

As I suspected, so, from a political advocacy activism point of view, how can we show already entrenched powerful groups how change can benefit them?

Quality of life for the mentally ill is only an issue for Conservatives if it is happening to someone in their family. Their empathy doesn’t extend to mentally ill homeless (in fact they think that homeless are conning people to get free money- See John Stossel disgusting video John Stossel Poses as Homeless to Get People to Stop ‘Enabling’ Their ‘Drug and Alcohol Habit’

However in their world they can understand how having homeless around can bring down the atmosphere or property value of a business district. And that fewer “lone crazy person attacking tax paying community members” would be good for business.

So they can see the benefit of that, And they can see the waste in millions of tax dollars going to pick up a mental ill substance abuser, but only if it is made clear that it will lead to real savings and fewer personal encounters.

Gregory J. Dober December 1st, 2013 at 3:08 pm

Another good publication was Fuller’s, “Criminalizing the Serious Mentally Ill.”

Dearie December 1st, 2013 at 3:09 pm

Thanks for the information. And congrats on the publication. Is it something that someone dealing with mentally ill would find readable? I’ll look for it.

BevW December 1st, 2013 at 3:09 pm

What is the history of severely mental health care in the US? Did it start as a warehousing / separation for the population – or real care for the ill? What has there been the time patients received the best care?

E. Fuller Torrey December 1st, 2013 at 3:09 pm

Greg, Our drug policies are almost as thought disordered as our mental illness policies. We have filled up th prisons with them without providing treatment. This is the major reason for the overcrowding. I am not an expert on this but the Eurpoean countries do much bettter on this.

Tammany Tiger December 1st, 2013 at 3:11 pm

Regarding the “worried well,” I recently read Allen Frances’ book Saving Normal, which is about the controversy surrounding DSM-5, the diagnostic manual for mental disorders. Dr. Frances argues that the psychiatric profession is engaging in “diagnostic inflation” that could end up with millions of Americans being diagnosed with new mental disorders and being given powerful drugs they don’t need and that could cause nasty side effects.

The rich get pills, the poor get prison.

E. Fuller Torrey December 1st, 2013 at 3:12 pm

Things: Very few of the homeless need to be in the hospital except for brief stabilization on meds. i volunteered in homeless shelters for 16 years and if they are on medication, and take the meds, our homeless peoulation would decrease by one third nest week.

Gregory J. Dober December 1st, 2013 at 3:14 pm
In response to Tammany Tiger @ 81

What’s interesting is that in American Psychosis, Fuller notes that an impediment to reform is distrust in psychiatry.

E. Fuller Torrey December 1st, 2013 at 3:16 pm

Bev, We started moving mentally ill patients from jails and alms houses to hospitals in the 1830s. We then warehoused them until the 1950s because we did not have any effective meds. Then once we got the meds we moved the patients into the community but neglected to make sure that they continued to recieve treatmen. It is a long sad story.

Gregory J. Dober December 1st, 2013 at 3:17 pm

ironically back into the jails and prisons as well.

spocko December 1st, 2013 at 3:17 pm

I think we know where the source of that is. Tom Cruise. “Matt you don’t know the history of psychiatry, I do.”

Gregory J. Dober December 1st, 2013 at 3:18 pm
In response to spocko @ 86

He doesn’t help the case.

Gregory J. Dober December 1st, 2013 at 3:19 pm

A subject that is controversial is involuntary treatment for the mentally ill. It is my understanding that an individual, under law, can be quarantined/confined for public health necessity as long as we use reasonable means, proportionality and harm avoidance to that individual. Why hasn’t our society deemed this as a public health threat warranting involuntary treatments?

RevBev December 1st, 2013 at 3:19 pm

Does the VA do any better? Mostly all I hear about its service is the over-crowding? How good is what they are able to do?

E. Fuller Torrey December 1st, 2013 at 3:19 pm

Yes, the distrust of psychiatry is widespread, some of it deserved. American psychistry has overtreated many children and undertreated many severly mentally ill adults. And the DSM official diagnostic system has overdiagnosed many people.

spocko December 1st, 2013 at 3:21 pm

That is because he is backing the Scientology drug “treatment” programs.

Gregory J. Dober December 1st, 2013 at 3:22 pm

what’s interesting about this is that big pharma has the sales pitch for parents of children but they obviously feel that pitching to severely mentally ill patients is not a worthwhile endeavor. It shows by the sales of many of its products.

E. Fuller Torrey December 1st, 2013 at 3:23 pm

Greg, Invol. treatment is very controversial because it interferes with civil liberties. But if I develop schizzophrenia next week, have no awareness of my illness becuuse of the effect of the disease on my brain. and am living on the street, I hope someone will interfere with my civil liberties and make sure I get treated.

Gregory J. Dober December 1st, 2013 at 3:23 pm
In response to spocko @ 91

seems everyone has an agenda when it comes to vying for dollars from mental health.

bluewombat December 1st, 2013 at 3:24 pm

the distrust of psychiatry is widespread, some of it deserved.

That’s true, but at least they mean well (many of them, at least). I contrast the psychiatric profession with the Scientologists, who cynically attack psychiatry not because they’re concerned about threats to public welfare, but because they see it as an opportunity to increase their market share among disturbed people — not to help those people, but to line their own coffers.

Gregory J. Dober December 1st, 2013 at 3:25 pm

So, if I have TB, they can quarantine me but if i am a violent threat to society, they allow me to have my liberty until I take action. I must be missing something on this policy.

E. Fuller Torrey December 1st, 2013 at 3:25 pm

Spocko, Scientology is a big reason why people distrust psychiatry, For years the have had a well financed campaign to discredit psychiartry.

Tammany Tiger December 1st, 2013 at 3:26 pm

In 2005 my home state of Michigan passed a law that expands the courts’ authority to order someone with a mental illness to participate in outpatient treatment, including taking medication, if failing to treat the illness poses a threat to self or others.

A noble idea on paper, but there are serious practical difficulties, starting with finding the money to treat the mentally ill. When John Engler was governor during the 1990s, state mental health services too a big budgetary hit.

RevBev December 1st, 2013 at 3:27 pm

Well, I think that again depends on the state.

spocko December 1st, 2013 at 3:28 pm

Of course! How can they be expected to make money on a drug that they can’t sell to millions? They are much more excited about “Focusin,” a new drug touted to boost academic attention spans in children.

And this of course is another one of the drug company lies. “We need all this profit to make new drugs to cure people.”

So my question is, since the government does all the major work in new drug development (even if it doesn’t help millions) are their any new drugs on the horizon that they are working on that will help deal better with schiz, bi-polar or other ailments with fewer side effects?

Gregory J. Dober December 1st, 2013 at 3:28 pm

Is their a distrust because psychiatry is relatively new compared to clinical medicine? Also, its easy to prove “germ theory” exists from years of research. Is it a problem that psychiatry deals with something you can’t necessarily see under a microscope?

(Sidenote: enhanced brain imaging, the above thought may be a thing of the past)

E. Fuller Torrey December 1st, 2013 at 3:29 pm

Greg, You are not missing aanything. In NYC until a few years ago you could invol. hospitalize and invol treat a patient with TB if he/she was non compliant with meds but if the samy person also had schizophrenia and a history of dangerousness you could not necessarily treat.

Gregory J. Dober December 1st, 2013 at 3:29 pm
In response to RevBev @ 99

I believe you are correct as the individual state courts are responsible for many of those laws.

E. Fuller Torrey December 1st, 2013 at 3:32 pm

Tammany, I believe in Mich. it is called Kevin`s law, named after a young man killed by an untreated man with schiz. The law is a good one but grossly underused because of underfunding and civil rights activists.

E. Fuller Torrey December 1st, 2013 at 3:33 pm

Greg, Yes, these are all state laws and differ somewhat by state. But good laws are useless unless they are used.

Gregory J. Dober December 1st, 2013 at 3:34 pm

Want to make this a general comment as well.

Is their a distrust because psychiatry is relatively new compared to clinical medicine? Also, its easy to prove “germ theory” exists from years of research. Is it a problem that psychiatry deals with something you can’t necessarily see under a microscope?

(Sidenote: enhanced brain imaging, the above thought may be a thing of the past)

Gregory J. Dober December 1st, 2013 at 3:36 pm

Since it has been in the headlines so often lately: Do you feel that the Affordable Care Act, “Obamacare” , will provide those in most serious need help or will it be just another program for the “worried well.”

spocko December 1st, 2013 at 3:36 pm

I ran into this in a case recently where the parent was concerned and didn’t know who to turn to. History of violence, mental illness. No one to call to get him committed. Police said, “Can’t do anything unless he does something.” He shot up a cafe. In another case history of violence and mental illness, started talking about planning a Aurora type shooting. Mother called the Sheriff, he went out and talked to him, he told them what he was planning and they got him committed.

Part of the difference was who was entrusted /funded to do enforcement.

RevBev December 1st, 2013 at 3:36 pm

A question above: How effective is the VA with mental problems & care?

E. Fuller Torrey December 1st, 2013 at 3:37 pm

Greg, Yes, it is difficult for people to understand mental illness. The new brain imaging has helped a lot – you can actually see the difference in scans of many, but not all, patients with schiz. and BP, even in patients who have never been treated with meds.

Gregory J. Dober December 1st, 2013 at 3:39 pm
In response to spocko @ 108

I believe a landmark case was Tarasoff V Board of regents of UCAL. An identifiable versus a general threat must be noted before the psychiatrist is obliged to warn.

Gregory J. Dober December 1st, 2013 at 3:40 pm
In response to RevBev @ 109

Thank you RevBev

E. Fuller Torrey December 1st, 2013 at 3:41 pm

I wish I could be more hopeful that Obamacare will help this problem. It will put more of the patients onto Medicaid but even now it is difficult to find psychiatrists who will accept Medicaid. So I don`t expect much to change.

E. Fuller Torrey December 1st, 2013 at 3:44 pm

The VA is a mixed bag. There are a few good VA hospitals that do a pretty good job of treating seriously mentally ill, but many others do not. Compared to the non VA public sector, however, they are better but that is a pretty low bar.

Gregory J. Dober December 1st, 2013 at 3:45 pm

Since we are nearing the end, two more here.

1) A question above: How effective is the VA with mental problems & care?

2) What kind of political or social catalyst will be needed to implement many of your recommendations, such as more institutional beds, closer scrutiny or abolition of for-profit long-term facilities etc., to provide better services for the mentally ill?

Gregory J. Dober December 1st, 2013 at 3:46 pm

is it only going to get worse from the last decades conflicts with many post traumatic stress disorders?

E. Fuller Torrey December 1st, 2013 at 3:49 pm

Spocko, Re new drugs, the drug companies hve cut way back on their research on psych drugs. They had hoped that the new genetics would open things up but it has not so, as always, they are moving to potentially more lucrative markets.

BevW December 1st, 2013 at 3:50 pm

As we come to the last minutes of this great Book Salon discussion. Any last thoughts?

Fuller, Thank you for stopping by the Lake and spending the afternoon with us discussing your new book, and discussing the needed treatment for the severely mentally ill.

Gregory, Thank you very much for Hosting this great Book Salon.

Everyone, if you would like more information:

Fuller’s website and book

Gregory’s website and book

Thanks all, Have a great week.

If you would like to contact the FDL Book Salon: FiredoglakeBookSalon@gmail.com

Gregory J. Dober December 1st, 2013 at 3:51 pm

The book really was an interesting perspective on this subject. I enjoyed reading it.

Dearie December 1st, 2013 at 3:52 pm

I had a Medicare provider number, but the reimbursement rate was so low that I never used it. An individual provider couldn’t pay the rent for a place to see elders in need of talk therapy. Oh, well………

RevBev December 1st, 2013 at 3:52 pm

Thank you…very interesting discussion. We can hope for progress.

bigbrother December 1st, 2013 at 3:53 pm

Healthy diet and exercise might help a little too.

Gregory J. Dober December 1st, 2013 at 3:54 pm
In response to RevBev @ 121

Seems like miles away too!

Gregory J. Dober December 1st, 2013 at 3:54 pm
In response to bigbrother @ 122

Is that you Mayor Bloomberg? lol I

E. Fuller Torrey December 1st, 2013 at 3:54 pm

Greg, I think I just answered the VA question. RE how to get out of this mess, the first priority is leadership which is bdly missing. At the frderal level Rep. Tim Murphy in the House is taking it on and wil introduce legislation this month. What I am waiting for is for some govenor to take this on and show how to do this is one state. It can be done and we know how. LEADERSHIP is the answer and it can`t come fast enough.

Gregory J. Dober December 1st, 2013 at 3:55 pm
In response to Dearie @ 120

Until it becomes lucrative it will hardly be a priority.

E. Fuller Torrey December 1st, 2013 at 3:55 pm
In response to BevW @ 118

Thank you for inviting me. Fuller

Gregory J. Dober December 1st, 2013 at 3:56 pm

I can say that Murphy is my districts congressman. I will look forward to seeing his initiatives.

Gregory J. Dober December 1st, 2013 at 3:57 pm

Bev, thank you as well.

easyrider1969 December 2nd, 2013 at 9:10 am
In response to eCAHNomics @ 31

Psychiatry is the last residencey. Usually the “creme de la crap.” After that, the pills don’t work any better than their side effects, i.e. the main effect is a side effect or no better than placebo. Other than the organically based disorders schizophrenia and true bipolar (most are really borderlines), peolpe are screwed up because of bad luck of varing degrees. Pills can’t fix your life when it is otherwise falling apart because of real stuff.

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