American Psychosis

American Psychosis

American Psychosis

How the Federal Government Destroyed
the Mental Illness Treatment System

E. Fuller Torrey, MD

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© E. Fuller Torrey 2014

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Library of Congress Cataloging-in-Publication Data

Torrey, E. Fuller (Edwin Fuller), 1937-
American psychosis : how the federal government destroyed the mental illness treatment system /
E. Fuller Torrey, MD.

pages cm
Includes bibliographical references and index.

ISBN 978–0–19–998871–6
1. Mentally ill—Care—United States—History. 2. Mentally ill—Services for—United
States. 3. Mental health policy—United States. 4. Mental health services—United

States—Evaluation. I. Title.

RC443.T66 2014
362.1968900973—dc23
2013017565

1 3 5 7 9 8 6 4 2
Printed in the United States of America
on acid-free paper

For the ineffable women of my life

—Barbara, Martha, Torrey, and Olivia

All royalties have been assigned to the Treatment Advocacy Center in Arlington, Virginia.

CONTENTS

Preface

Acknowledgments

1. Joe Kennedy: A Man with Problems

2. Robert Felix: A Man with Plans

3. The Birth of the Federal Mental Health Program: 1960–1963

4. The Short, Unhappy Life of the Federal Mental Health Program: 1964–1970

5. The Death of the Federal Mental Health Program: 1971–1980

6. The Perfect Storm: 1981–1999

7. Dimensions of the Present Disaster: 2000–2013

8. Solutions: What Have We Learned and What Should We Do?

Notes

Index

PREFACE

I don’t know why other people write books, but for me, it is a selfish enterprise. I write to answer questions that are bothering me. For many years I have been appalled to watch the unfolding disaster of services for people with serious mental illnesses. The fact that my sister suffered from severe schizophrenia has certainly accounted for part of my interest. Year after year, I observed the consequences as public mental hospitals were being emptied. It was like watching the effects of a tsunami or a Category 5 hurricane in slow motion; although I knew what would happen next, I have re-run the tape in my mind, again and again.

I worked at the National Institute of Mental Health (NIMH) from 1970 to 1976, in the midst of the events described herein. Bertram Brown, then NIMH director, was my supervisor. Although I had no formal responsibilities for the federal community mental health centers program, I interested myself in it and visited some centers. Thus, I personally was acquainted with many of the players who were responsible for the program. With few exceptions, these people were intelligent, public-spirited, well-meaning, and dedicated individuals. That fact elicited the question that bothered me: How could so many well-meaning professionals have been so wrong and been complicit in creating such a disaster? This book attempts to answer that question.

I do not pretend to be a dispassionate observer. During my years of working in a public psychiatric hospital, I observed with increasing anger the effects on my patients of inadequate community services. I continue to become choleric when I read accounts like that of Charles Furry, diagnosed with schizophrenia and Lou Gehrig’s disease, living by himself in suburban Virginia and dependent on Medicaid-funded home health aides:

When we removed his socks maggots fell out. Hundreds fell out initially. There were some between his toes and under his skin. Furry’s legs were swollen and his shirt was drenched in drool.
¹

This is not what President Kennedy had in mind 50 years ago when he promised that for people like Mr. Furry “reliance on the cold mercy of custodial isolation will be supplanted by the open warmth of community concern and capability.”
²
The home health aides responsible for Mr. Furry’s care were employed by Sierra Health Services, Inc., a
highly profitable private company. We should not allow human beings to be treated in this manner if we claim to be truly civilized.

Having lived in the nation’s capital for most of my adult life, I have also been intrigued by the federal angle to this story. Here is a case study of a federal policy that went astray. In most such cases, there is a course correction. Yet in this case, there has been none, even now, a half-century later. Why is that? Each day after work, thousands of government workers gather over drinks to discuss their Grand Idea for solving one national problem or another. Like Robert Felix, the first director of the NIMH, they wait for the stars to align and the approval of their supervisors to implement their Grand Idea. This is thus also a cautionary tale.

If we are to correct our errors, then it is necessary to understand how we got where we are. We have made many mistakes in how we care for the most vulnerable among us and, alarmingly, other countries such as Canada and Britain are following us down this path. What can we learn from the past?

ACKNOWLEDGMENTS

This book would not have been possible without the generous donation of many people’s time. Special thanks go to Bertram S. Brown, who unhesitatingly shared his ideas and memories for a book that he knew would not be flattering, and to Henry Foley, who retrieved his valuable 1972 interview tapes from his garage shelf and generously shared them. Others who kindly responded to my inquiries include Robert Atwell, Jerry Dincin, Matthew Dumont, Sister Ann Dyer, Rashi Fein, Mary Herbert, Robert Keisling, Anthony Lehman, Bentson McFarland, Frank Ochberg, Lucy Ozarin, Anthony Panzetta, Roger Peele, Steven Sharfstein, Alan Stone, John Talbott, and Claudwell Thomas. Archivists and librarians are a writer’s best friends and I am specifically indebted to Tracy Holt at NIMH; Doug Atkins at the National Library of Medicine; Gary McMillan at the American Psychiatric Association; Amy Lutzke at the Fort Atkinson Public Library; and Eric Robinson at the New York Historical Society.

Faith Dickerson, Doris Fuller, Jeffrey Geller, Stephen Hersh, D. J. Jaffe, and Robert Taylor read portions of the text and contributed valuable comments. My best reader, as always, was Barbara Torrey, who contributed not only suggestions but everything else that makes writing a book possible. Sarah Harrington and Andrea Zekus at Oxford University Press made the revisions and publication of this book hassle-free, and it has been a great pleasure to work with them. Melissa Bolla is an excellent research assistant, and Judy Miller provided invaluable editorial and administrative assistance once again.

In addition to the above, I gratefully acknowledge the following:

• Chloe Raub, Special Collections Research Center, George Washington University, for permission to use the picture of Dr. Walter Freeman

• Michael Gorman, for permission to use the picture of his father

• Keith Ablow, MD, for permission to quote him from Fox News

• The
San Francisco Chronicle
, for permission to quote from “Homeless by the Bay”

• The American Psychiatric Association, for permission to quote from the
American Journal of Psychiatry
and
Hospital and Community Psychiatry

• Mental Health America, for permission to quote from
Mental Hygiene

American Psychosis

1
JOE KENNEDY: A MAN WITH PROBLEMS

September 1, 1939: Ambassador Joseph P. Kennedy was preoccupied with two deeply distressing problems. The first had become apparent at dawn that day, when German tanks rolled into Poland. This was a clear invitation for Britain to declare war, as Britain had publicly guaranteed Poland’s independence. Two days later Parliament obliged, and Kennedy immediately telephoned the president. According to Michael Beschloss’s history
Kennedy and Roosevelt
, “Roosevelt could barely recognize the choked voice from across the Atlantic. . . . [He] tried to comfort his old ally, but the voice was inconsolable. Over and over Kennedy cried, ‘It’s the end of the world . . . the end of everything . . .’ “
¹

Joe Kennedy knew that “everything” included his own aspirations to run for president in 1940. Anticipating that Roosevelt would not run for a third term, Kennedy had spent the previous 2 years carefully positioning himself. A recent poll had ranked Kennedy fifth among possible Democratic nominees, and some pundits claimed that Roosevelt had appointed him as ambassador to Britain to remove him from the American scene. In London, Kennedy had joined Prime Minister Neville Chamberlain as a major voice for the appeasement of Hitler, even as the Nazis were sweeping over Austria and Czechoslovakia. According to Beschloss, “both Kennedy and Chamberlain interpreted Hitler’s eastward expansionism as a bid mainly for resources and markets.” Indeed, just 1 week prior to the German invasion of Poland, Kennedy had assured Roosevelt that Hitler had limited ambitions and that once these had been achieved Hitler would “go back to peaceful pursuits and become an artist, which is what he wanted to be.” As Kennedy was painfully aware, Hitler’s signing of a nonaggression pact with the Soviet Union and his invasion of Poland were not the acts of an artist.
²