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Out of the Shadows: Confronting America's Mental Illness Crisis Paperback – 11 Mar 1998


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Product details

  • Paperback: 256 pages
  • Publisher: Jossey Bass; New Ed edition (11 Mar. 1998)
  • Language: English
  • ISBN-10: 0471245321
  • ISBN-13: 978-0471245322
  • Product Dimensions: 15.7 x 1.9 x 23.6 cm
  • Average Customer Review: 5.0 out of 5 stars  See all reviews (1 customer review)
  • Amazon Bestsellers Rank: 2,584,407 in Books (See Top 100 in Books)
  • See Complete Table of Contents

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Product Description

From the Inside Flap

out of the shadows "E. Fuller Torrey is a brilliant writer. There is no one writing on psychology whom I would rather read." &151;Jack Miles, Los Angeles Times There are the ones we try not to notice. Filthy and disoriented, they wander the streets and back alleys of America, a danger to themselves and often to the communities they haunt. Then there are the millions more we don’t see, the ones who suffer behind closed doors for years, a burden only to themselves and their loved ones. Many of these end up committing suicide, or worse. There are also the tens of thousands who are currently being "warehoused" in our jails, and because of their inability to comply with even the most rudimentary codes of conduct, many receive cruel, sometimes fatal, treatment from other inmates and exasperated jail officials. And, finally, there are those who, because they are not being treated, explode with senseless violence, destroying lives, and leaving the rest of us angry, perplexed, and a little less certain about our own safety. They are our five million mentally ill, and try as we might to sweep them under the rug, they represent human tragedies and a major social problem that continues to grow in magnitude. Now, in this hard–hitting and humane exploration of the mental illness crisis in America, psychiatrist E. Fuller Torrey reveals how we have failed our mentally ill and offers a viable, provocative blueprint for change. Torrey begins by examining the consequences of our current mental illness policies on homelessness, our penal system, and the spread of violence in America. He then explores the economic, ideological, and legal reasons why, even though billions of tax dollars are spent each year on the mentally ill, they continue to receive less–than–adequate care. And finally, he proposes a three–phase approach to correcting the situation, including: cost–shifting to states as single–responsibility funders of treatment programs; commitment and involuntary treatment for those deemed incapable of making decisions for themselves; and divorcing, both ideologically and economically, serious mental illness (schizophrenia, manic–depressive illness, and other brain–based disorders) from mental health (the "worried well," and people suffering from quality–of–life and emotional problems). Out of the Shadows is a fact–filled, compellingly argued, and compassionate assessment of mental illness in America: where we are, how we got there, and where we should be going. It is essential reading for healers, policymakers, and the millions of families whose lives have been touched by serious mental illness. --This text refers to an out of print or unavailable edition of this title.

From the Back Cover

"Powerful. . . . The crisis [Torrey] delineates should stir any halfway sensitive human being to anger."—The New York Times Book Review "Brilliant and remarkably detailed. . . . Dr. Torrey, our clearest and most informed voice for the mentally ill, offers his own insightful plan for a way out . . . of a healthcare scandal that remains one of America′s most enduring shames."—Phil Donahue. "If President Clinton is looking for a worthy goal to accomplish in his second term, here′s one: Rescue the homeless mentally ill. It can be done. . . . Dr. E. Fuller Torrey . . . provides a five–year road map in Out of the Shadows."—New York Daily News. "An important book . . . timely and very well written."—The New England Journal of Medicine. "Controversial ideas, forcefully presented."—Kirkus Reviews "Moving and vivid. . . . Torrey′s powerful prescription for change challenges conventional wisdom and political correctness. His searing case examples will haunt the reader."—Laurie Flynn Executive Director National Alliance for the Mentally Ill

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In the shadows of mental illness there are many faces. Read the first page
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1 of 2 people found the following review helpful By A Customer on 22 April 1998
Format: Hardcover
This book is one of Dr. Torrey's best. He demonstrates how Americans have allowed their government and medical profession to immorally ignore and degrade the people who need our help the most--those with serious mental illness. Mental health workers would rather treat relatively healthy people going through ordinary life crises. Indeed, a sign of sucess in psychiatry and psychology is having a comfortable office practice where you don't have to see many manic depressives and almost no psychotics. The DSM (Psychiatry's diagnostic manual) is written so that any problem in a normal human life can be considered a "mental illness," so talking to a millionare who is disappointed that he only has $3 million instead of $10 million qualifies as providing mental health care. Meanwhile, those with serious depression kill themselves and people who are disabled because of dangerous hallucinations and delusions live in their own filth on the streets. This is all the more tragic because we have the means to treat the vast majority of mental/brain diseases. Very few people cannot be helped by the hundreds of medications that exist, but many are deprived of treatment because of absurd social and political policy. Torrey implicates several different political groups and movements as playing a big part in the problem. Liberals, civil libertarians, mainstream consrevatives and the far right have all had their reasons for closing mental hospitals and depriving psychiatrists of the ability to effectively treat their patients. Torrey points out that most of this opposition to psychiatry is done out of ignorance and hopes that as more and more people know the facts, society will demand that poeple with life threatening mental diseases be given the treatment they need to live health productive lives, and that the limited mental health resources our nation has will be spent wisely; giving those with the greates need the highest priority.
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Most Helpful Customer Reviews on Amazon.com (beta)

Amazon.com: 9 reviews
36 of 40 people found the following review helpful
This is Must Reading! 22 April 1998
By A Customer - Published on Amazon.com
Format: Hardcover
This book is one of Dr. Torrey's best. He demonstrates how Americans have allowed their government and medical profession to immorally ignore and degrade the people who need our help the most--those with serious mental illness. Mental health workers would rather treat relatively healthy people going through ordinary life crises. Indeed, a sign of sucess in psychiatry and psychology is having a comfortable office practice where you don't have to see many manic depressives and almost no psychotics. The DSM (Psychiatry's diagnostic manual) is written so that any problem in a normal human life can be considered a "mental illness," so talking to a millionare who is disappointed that he only has $3 million instead of $10 million qualifies as providing mental health care. Meanwhile, those with serious depression kill themselves and people who are disabled because of dangerous hallucinations and delusions live in their own filth on the streets. This is all the more tragic because we have the means to treat the vast majority of mental/brain diseases. Very few people cannot be helped by the hundreds of medications that exist, but many are deprived of treatment because of absurd social and political policy. Torrey implicates several different political groups and movements as playing a big part in the problem. Liberals, civil libertarians, mainstream consrevatives and the far right have all had their reasons for closing mental hospitals and depriving psychiatrists of the ability to effectively treat their patients. Torrey points out that most of this opposition to psychiatry is done out of ignorance and hopes that as more and more people know the facts, society will demand that poeple with life threatening mental diseases be given the treatment they need to live health productive lives, and that the limited mental health resources our nation has will be spent wisely; giving those with the greates need the highest priority.
12 of 13 people found the following review helpful
Documents the Stuggle Among Mental Health Professionals 1 Oct. 2000
By A Customer - Published on Amazon.com
Format: Hardcover
Dr. Torrey once again published a book that highlighted a critical issue among mental health professionals. He once again tries to prod the American public into becoming aware of what is happening among the mentally ill in this country. He wants his profession to take a hard look at how they are responding to the crisis of mental illness. He desperately wants them to evaluate how they are responding. And he wants the system changed.
1 of 1 people found the following review helpful
The Absolute Defining Book on understanding our mental health system 15 Feb. 2014
By Sue - Published on Amazon.com
Format: Paperback Verified Purchase
I am writing my dissertation on this topic; I have used this book as a source. If you really want to understand the absolute "truth" about what ails our mental health system, read this. Torrey is an expert in this field, yet his work is quite readable. He seems to be a down to earth type of advocate. Our mental illness crisis will continue until the "system" listens to people like this author.
WHY ARE THERE SO MANY MENTALLY ILL HOMELESS PERSONS ON THE STREETS? 11 Jun. 2013
By Steven H Propp - Published on Amazon.com
Format: Paperback
Edwin Fuller Torrey (born 1937), is an American psychiatrist, who has written many books, such as Freudian Fraud The Malignant Effect of Freud's Theory on American Thought and Culture, Surviving Schizophrenia: A Manual for Families, Patients, and Providers, Surviving Manic Depression, etc. He wrote in the Preface of this 1997 book, "I have written this book for anyone who has wondered why there are so many severely mentally ill men and women living on the streets of our cities and towns. And why there are so many severely mentally ill people in jails and prisons. And why there are so many episodes of violence by sufferers of mental illnesses, especially since we know that when such people are treated they are not more violent than the general population... I believe we know how to solve our mental illness problems, but for a variety of reasons we do not do so. This book is about those reasons." (Pg. vii)

He says, "The mental illness crisis, then, has not occurred because we do not have effective treatments. Rather, it exists because we do not use these treatments." (Pg. 6) He explains, "What percentage of the total homeless population is mentally ill? If the definition of 'mentally ill' includes alcohol and drug addictions, then ... 75 percent or more of the homeless are mentally ill. If, however, only severe mental illness is the criterion... approximately 35 percent of homeless persons qualify." (Pg. 17) He adds, "studies following up on patients discharged from psychiatric hospitals strongly suggest that homelessness is a consequence of severe mental illness." (Pg. 23)

He then discusses a related problem: the incarceration in jails and prisons of the mentally ill: "A 1973 study in Santa Clara County indicated that the jail population had risen 300 percent in the four years after the closing of Agnews State Psychiatric Hospital, located in the same county. In 1975, a study of five California jails... reported that the number of mentally ill inmates also rose sharply in the 1970s." (Pg. 36) He adds, "Sometimes, 'mercy bookings' are initiated by mentally ill persons themselves to get into jail for shelter or food... The mentally ill also are sometimes jailed because their families find it is the most expedient means of getting the person into needed treatment." (Pg. 40)

He laments, "Since 92 percent of the patients who were in public psychiatric hospitals have been deinstituionalized, we have therefore discharged thousands of patients who should have remained in hospitals. These are, presumably, the people who have ended up homeless, who are in jails or prisons, who are responsible for acts of violence, and who have contributed heavily to the deterioration of life in communities and within their families." (Pg. 87) He comments, "Cost-shifting has been the primary reason for the inappropriate discharge of many patients." (Pg. 99) He adds, "Federal dollars have moved psychiatric inpatient care from public psychiatric hospitals to general hospitals. Because Medicaid pays for psychiatric care in general hospitals but not in psychiatric hospitals, there has been a massive shift in psychiatric inpatient care from public psychitric hospitals to general hospitals." (Pg. 103)

This is an extremely informative, heartfelt (the author's sister has schizophrenia, by the way) book, that is virtually "must reading" for anyone concerned with the mentally ill, the homeless, or similar social problems.
1 of 2 people found the following review helpful
WHY ARE THERE SO MANY MENTALLY ILL HOMELESS PERSONS ON THE STREETS? 11 Jun. 2013
By Steven H Propp - Published on Amazon.com
Format: Paperback
Edwin Fuller Torrey (born 1937), is an American psychiatrist, who has written many books, such as Nowhere to Go: The Tragic Odyssey of the Homeless Mentally Ill, Surviving Schizophrenia: A Manual for Families, Patients, and Providers, Surviving Manic Depression, etc. He wrote in the Preface of this 1997 book, "I have written this book for anyone who has wondered why there are so many severely mentally ill men and women living on the streets of our cities and towns. And why there are so many severely mentally ill people in jails and prisons. And why there are so many episodes of violence by sufferers of mental illnesses, especially since we know that when such people are treated they are not more violent than the general population... I believe we know how to solve our mental illness problems, but for a variety of reasons we do not do so. This book is about those reasons." (Pg. vii)

He says, "The mental illness crisis, then, has not occurred because we do not have effective treatments. Rather, it exists because we do not use these treatments." (Pg. 6) He explains, "What percentage of the total homeless population is mentally ill? If the definition of 'mentally ill' includes alcohol and drug addictions, then ... 75 percent or more of the homeless are mentally ill. If, however, only severe mental illness is the criterion... approximately 35 percent of homeless persons qualify." (Pg. 17) He adds, "studies following up on patients discharged from psychiatric hospitals strongly suggest that homelessness is a consequence of severe mental illness." (Pg. 23)

He then discusses a related problem: the incarceration in jails and prisons of the mentally ill: "A 1973 study in Santa Clara County indicated that the jail population had risen 300 percent in the four years after the closing of Agnews State Psychiatric Hospital, located in the same county. In 1975, a study of five California jails... reported that the number of mentally ill inmates also rose sharply in the 1970s." (Pg. 36) He adds, "Sometimes, 'mercy bookings' are initiated by mentally ill persons themselves to get into jail for shelter or food... The mentally ill also are sometimes jailed because their families find it is the most expedient means of getting the person into needed treatment." (Pg. 40)

He laments, "Since 92 percent of the patients who were in public psychiatric hospitals have been deinstituionalized, we have therefore discharged thousands of patients who should have remained in hospitals. These are, presumably, the people who have ended up homeless, who are in jails or prisons, who are responsible for acts of violence, and who have contributed heavily to the deterioration of life in communities and within their families." (Pg. 87) He comments, "Cost-shifting has been the primary reason for the inappropriate discharge of many patients." (Pg. 99) He adds, "Federal dollars have moved psychiatric inpatient care from public psychiatric hospitals to general hospitals. Because Medicaid pays for psychiatric care in general hospitals but not in psychiatric hospitals, there has been a massive shift in psychiatric inpatient care from public psychitric hospitals to general hospitals." (Pg. 103)

This is an extremely informative, heartfelt (the author's sister has schizophrenia, by the way) book, that is virtually "must reading" for anyone concerned with the mentally ill, the homeless, or similar social problems.
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