Nuts to Torrey - Letter to the Editor

Washington Monthly, June, 2002

There is a very good reason why California law prohibits the incarceration of mental patients ("Hippie Healthcare Policy," by E. Fuller Torrey, April 2002). Mental illness is not a crime. In the nominal case, that is how it should be. Medication, hospitalization, and prison are all forms of societal treatment. All should require due process on behalf of the accused.

It is a serious matter to judge someone unfit to make their own decisions. Yet doctors continue to argue for this exemplary power that even judges and elected officials do not have. An accusation of murder affords a certain set of rights. Yet the author seems to argue that an accusation of depressive, schizophrenic, or suicidal behavior should afford even fewer rights than this.

The author makes some very good points as to how the CMHS is running amok with a very large federal grant. However, his underlying thesis rests on the assumption that people who eat from garbage cans should be medicated as a matter of course. That is the 1950s' mindset, and in this context, it is not at all clear why the 1960s anti-establishment view is any less relevant today.

MICHAEL SHURPIK
Cambridge, Mass.

E. Fuller Torrey would have Washington Monthly readers believe that large numbers of people with mental illness don't get needed treatment because state legislatures won't enact tougher forcible-treatment laws. In contrast, the U.S. Surgeon General's definitive Report on Mental Health highlights the formidable financial barriers that profoundly limit people's access to needed mental healthcare. Yet Torrey would recklessly slash the modest funding provided the single federal agency dedicated to improving the quality and availability of mental health services, the Center for Mental Health Services (CMHS), because the agency doesn't subscribe to his dogma.

Torrey displays loose or highly selective regard for fact in attacking those who reject his anachronistic views. I take particular exception to his mischaracterization of the National Mental Health Association (NMHA) and its advocacy work. As the oldest, largest nonprofit organization addressing all aspects of mental health and mental illness, NMHA has aggressively and successfully supported federal funding for mental health programs for over 90 years--long before CMHS was created. Our view has been, and remains, that the federal investment in mental health and prevention and treatment of mental illness is grossly inadequate.

We are but one of over 300 CMHS grantees. NMHA also vigorously lobbies Congress on behalf of other agencies and departments which provide it no funds. NMHA is proud of the successful work it has done with support from CMHS, for example, creating a National Consumer Supporter Technical Assistance Center (NMHA put up nearly $80,000 to match the CMHS's 1998 grant of $250,000). We are proud to be a voice--across a broad spectrum of federal programs and departments--for people with or at risk of mental illness and substance abuse disorders.

MICHAEL FAENZA
President and CEO National Mental
Health Association, Alexandria, Va.

Dr. Torrey replies: The issue that underlies the letter by Mr. Shurpik is whether individuals with severe psychiatric disorders are competent to make decisions about their own care. Multiple studies have shown that approximately half of them have significantly impaired awareness of their illness because of brain dysfunction and thus may not be competent. Would the writers also defend the rights of individuals with Alzheimer's disease to eat from garbage cans and to "debate the issues in order to reach a consensus"? When treatment must be imposed, it should, of course, be done with extensive checks to prevent abuses.

The issue that underlies Mr. Faenza's letter is simpler. As a major beneficiary of the federal faucet under attack, he would understandably like to see the funds continue to flow.