Out of the Shadows: Confronting America's Mental Health Crisis

By Goldberg, Carl | American Journal of Psychotherapy, Spring 1999 | Go to article overview

Out of the Shadows: Confronting America's Mental Health Crisis


Goldberg, Carl, American Journal of Psychotherapy


E. FULLER ToRREY: Out of the Shadows: Confronting America's Mental Health Crisis. John Wiley, New York, 1997, 244 pp, $16.95, ISBN 0-471-24532-1.

Deinstitutionalization of the "mentally ill" in the United States began in earnest a couple of decades ago. The force that compelled this movement came from unlikely "allies": one, a humanitarian concern that the severely "mentally ill" were neglected and abused in state hospital systems; the other, public sentiment that large hospitals that warehoused psychiatric patients was extremely costly to the tax payer. A profusion of briefs brought to the courts by some of the best legal minds in the nation resulted in the closing or the drastic down-sizing of state hospitals throughout the country.

According to Torrey, little or no concern was given to the effect that deinstitutionalization would have on the lives of the patients discharged or of those of their families and that of the community. For example, no research was conducted prior to deinstitutionalization. This state of affairs "helped create the mental illness crisis by discharging people from public psychiatric hospitals without ensuring that they received the medication and rehabilitation services necessary for them to live successfully in the community" (p. 10). As a result, Torrey indicates, there are an "estimated 2.2 million Americans with untreated severe mental illness. On any given day, approximately 150,000 of them are homeless, living on the streets or in public shelters. Another 159,000 are incarcerated in jails and prisons, mostly for crimes committed because they were not being treated. Some of them become violent and may terrorize their families, towns or urban neighborhoods. A very large number have died prematurely as a result of accidents and suicides" (p. 3).

Out of the Shadows is an excellent critique of the reasons for our present "mental illness" crisis. Torrey offers a plethora of insightful recommendations for dealing with this complex problem. I was disappointed, however, that he did not discuss what I regard as the core issue concerning the "mentally ill": the problem is really about what we value in American society. Our society readily shuns those who are unable to get on with their lives without assistance-and bridles at the idea that we must pay for their care for the rest of their lives. …

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