Mental Health

 email page    print page

All Topic Reviews
50 Signs of Mental IllnessA Beautiful MindA Beautiful MindA Bright Red ScreamA Casebook of Ethical Challenges in NeuropsychologyA Corner Of The UniverseA Lethal InheritanceA Mood ApartA Research Agenda for DSM-VA Slant of SunA War of NervesAbnormal Psychology in ContextADD-Friendly Ways to Organize Your LifeAddiction Recovery ToolsAdvance Directives in Mental HealthAggression and Antisocial Behavior in Children and AdolescentsAl-JununAlmost a PsychopathAlterations of ConsciousnessAm I Okay?American ManiaAmerican Psychiatric Publishing Textbook of Neuropsychiatry and Clinical NeurosciencesAn American ObsessionAngelheadAnger, Madness, and the DaimonicAnthology of a Crazy LadyApproaching NeverlandAs Nature Made HimAsylumAttention-Deficit Hyperactivity DisorderAttention-Deficit/Hyperactivity DisorderBeing Mentally Ill: A Sociological Theory Betrayal TraumaBetrayed as BoysBetter Than ProzacBetter Than WellBeyond AppearanceBeyond ReasonBinge No MoreBiological UnhappinessBipolar DisorderBipolar DisorderBipolar Disorder DemystifiedBlack-eyed SuzieBlaming the BrainBleeding to Ease the PainBluebirdBlueprints Clinical Cases in PsychiatryBody Image, Eating Disorders, and ObesityBorderline Personality DisorderBrain Circuitry and Signaling in PsychiatryBrave New BrainBreakdown of WillBrief Adolescent Therapy Homework PlannerBrief Child Therapy Homework PlannerBrief Therapy Homework PlannerCalm EnergyCassandra's DaughterCaught in the NetChild and Adolescent Treatment for Social Work PracticeChildren Changed by TraumaChronic Fatigue Syndrome (The Facts)Clinical Handbook of Psychological DisordersClinical Manual of Women's Mental HealthCognitive Theories of Mental IllnessCommonsense RebellionCommunity and In-Home Behavioral Health TreatmentComprehending SuicideConcise Guide to Child and Adolescent PsychiatryConquering Post-Traumatic Stress DisorderConscience and ConvenienceConsciousnessConsole and ClassifyContesting PsychiatryCoping With TraumaCopshockCrazy for YouCrazy in AmericaCrazy Like UsCreating HysteriaCritical PsychiatryCruel CompassionCultural Assessment in Clinical PsychiatryCulture and Mental HealthCulture and Psychiatric DiagnosisCultures of NeurastheniaDaddy's GirlsDante's CureDarwinian PsychiatryDaughter of the Queen of ShebaDaughters of MadnessDeinstitutionalization And People With Intellectual DisabilitiesDelivered from DistractionDepression In Later LifeDepression SourcebookDepression-Free for LifeDescriptions and PrescriptionsDestructive Trends in Mental HealthDevil in the DetailsDiagnosis: SchizophreniaDiagnostic and Statistical Manual of Mental Disorders DSM-IV-TRDirty Filthy Love DVDDisorders Of DesireDisrupted LivesDissociative ChildrenDivided MindsDr. Andrew Weil's Guide to Optimum HealthDr. Weisinger's Anger Work-Out BookDSM-IV SourcebookDSM-IV-TR CasebookDSM-IV-TR in ActionDSM-IV-TR Mental DisordersE-TherapyEccentricsElectroshockEmergencies in Mental Health PracticeEmergency PsychiatryEmotional and Behavioral Problems of Young ChildrenEmotions and LifeEmpowering People with Severe Mental IllnessEssential PsychopharmacologyEssentials of Cas AssessmentEssentials of Wais-III AssessmentEthics and Values in PsychotherapyEthics in Mental Health ResearchEthics in Psychiatric ResearchEthics, Culture, and PsychiatryEverything In Its PlaceFamily Experiences With Mental IllnessFatigue as a Window to the BrainFear of IntimacyFinding Iris ChangFinding Meaning in the Experience of DementiaFlorid StatesFolie a DeuxFor the Love of ItForensic Nursing and Multidisciplinary Care of the Mentally Disordered OffenderFountain HouseFrom Madness to Mental HealthFrom Trauma to TransformationGandhi's WayGender and Its Effects on PsychopathologyGender and Mental HealthGenes, Environment, and PsychopathologyGetting Your Life BackGracefully InsaneGrieving Mental IllnessHandbook of AttachmentHandbook of DepressionHandbook of Self and IdentityHealing the SplitHerbs for the MindHidden SelvesHigh RiskHope and DespairHow Clients Make Therapy WorkHow People ChangeHow to Become a SchizophrenicHow We Think About DementiaHughes' Outline of Modern PsychiatryHumanizing MadnessHysterical MenHystoriesI Hate You-Don't Leave MeI Never Promised You a Rose GardenI Thought I Could FlyI'm CrazyImagining RobertImpulse Control DisordersIn Others' EyesIn Two MindsInsanityIntegrated Behavioral Health CareIntegrative MedicineIntegrative Mental Health CareIntuitionJust CheckingKarl JaspersKissing DoorknobsKundalini Yoga Meditation for Complex Psychiatric DisordersLaw and the BrainLaw, Liberty, and PsychiatryLegal and Ethical Aspects of HealthcareLiberatory PsychiatryLife at the BottomLife at the Texas State Lunatic Asylum, 1857-1997Life Is Not a Game of PerfectLithium for MedeaLiving Outside Mental IllnessLiving with AnxietyLiving With SchizophreniaLiving with SchizophreniaLiving Without Depression and Manic DepressionLost in the MirrorLove's ExecutionerLoving Someone With Bipolar DisorderMad in AmericaMad TravelersMad, Bad and SadMadhouseMadnessMadness at HomeMadness in Buenos AiresManaged Care ContractingMandated Reporting of Suspected Child AbuseManic Depression and CreativityMary BarnesMasters of the MindMeasuring PsychopathologyMedia MadnessMedicine As MinistryMelancholy And the Care of the SoulMemory, Brain, and BeliefMental HealthMental Health At The CrossroadsMental Health Issues in Lesbian, Gay, Bisexual, and Transgender Communities Mental Health MattersMental Health Policy in BritainMental Health Policy in BritainMental Health Professionals, Minorities and the PoorMental IllnessMental Illness and Your TownMental Illness, Medicine and LawMental SlaveryMindfulness in Plain EnglishModels of MadnessMothers Who Kill Their ChildrenMozart's Brain and the Fighter PilotMultifamily Groups in the Treatment of Severe Psychiatric DisordersMuses, Madmen, and ProphetsMyths of ChildhoodNapkin NotesNeural MisfireNew Hope For People With Bipolar DisorderNight Falls FastNo Enemies WithinNolaNormalNot CrazyNovember of the SoulOf Two MindsOn Being Normal and Other DisordersOn Our Own, TogetherOn The Stigma Of Mental IllnessOrigins of Human NatureOut of Its MindOut of the ShadowsOvercoming Compulsive HoardingPathologies of BeliefPathways through PainPersonal Recovery and Mental IllnessPersonality Disorder: Temperament or Trauma?Pillar of SaltPoints of ViewPoppy ShakespearePosttraumatic Stress DisorderPsychiatric Cultures ComparedPsychiatric Diagnosis and ClassificationPsychiatric Genetics and GenomicsPsychiatric Illness in WomenPsychiatrists and Traditional HealersPsychiatryPsychiatry and ReligionPsychiatry in SocietyPsychological Dimensions of the SelfPsychology and the MediaPsychopathia SexualisPsychopathologyPsychopathyPsychotic DepressionQuitting the Nairobi TrioRaising a Moody ChildRapid Cognitive TherapyRebuilding Shattered LivesReclaiming Soul in Health CareReclaiming the SoulRecollection, Testimony, and Lying in Early ChildhoodRecovery from SchizophreniaRecovery in Mental IllnessRedressing the EmperorRelational Mental HealthRemembering TraumaRepressed SpacesResearch Advances in Genetics and GenomicsRestricted AccessRethinking the DSMReviving OpheliaRewarding Specialties for Mental Health CliniciansSaints, Scholars, and Schizophrenics: Mental Illness in Rural IrelandSchizophreniaSchizophrenia RevealedSchizophrenia: A Scientific Delusion?Self-Determination Theory in the ClinicShunnedShynessSigns of SafetySilencing the VoicesSlackjawSocial Cognition and SchizophreniaSocial Inclusion of People with Mental IllnessSoul Murder RevisitedSounds from the Bell JarSpeaking Our MindsSpontaneous HealingStop PretendingStraight Talk about Psychological Testing for KidsStranger Than FictionStreet CrazyStudy Guide to the DSM-IV-TRSurviving Manic DepressionSurviving SchizophreniaSurviving SchizophreniaTaking Charge of ADHD, Revised EditionTaking the Fear Out of ChangingTalking Back to PsychiatryTarnationTeen LoveTelling Is Risky BusinessTelling SecretsThe Age of InsanityThe American Psychiatric Press Textbook of PsychiatryThe American Psychiatric Publishing Textbook Of Child And Adolescent PsychiatryThe Anger WorkbookThe Anorexic SelfThe Behavioral Medicine Treatment PlannerThe Betty Ford Center Book of AnswersThe Bipolar ChildThe Bipolar Disorder Survival GuideThe Body in PsychotherapyThe Borderline Personality Disorder Survival GuideThe Broken MirrorThe Burden of SympathyThe Cambridge Medical Ethics WorkbookThe Case for Pragmatic PsychologyThe Center Cannot HoldThe Chemical Dependence Treatment Documentation SourcebookThe Chemical Dependence Treatment PlannerThe Child and Adolescent Psychotherapy Treatment PlannerThe Clinical Child Documentation SourcebookThe Clinical Documentation SourcebookThe Complete Adult Psychotherapy Treatment PlannerThe Condition of MadnessThe Construction of Power and Authority in PsychiatryThe Couples Psychotherapy Treatment PlannerThe Criminal BrainThe Cultural Context of Health, Illness, and MedicineThe Day the Voices StoppedThe Death of PsychotherapyThe Depression WorkbookThe Difficult-to-Treat Psychiatric PatientThe Early Stages of SchizophreniaThe Employee Assistance Treatment PlannerThe Employee Assistance Treatment PlannerThe Epidemiology of SchizophreniaThe Essential Family Guide to Borderline Personality DisorderThe Essentials of New York Mental Health LawThe Ethical WayThe Evolution of Mental Health LawThe Explosive ChildThe Fall Of An IconThe Fasting GirlThe Forensic Documentation SourcebookThe Forgotten MournersThe Gift of Adult ADDThe Good EaterThe Green ParrotThe Healing Power of PetsThe Heart of AddictionThe Heroic ClientThe Insanity OffenseThe Invisible PlagueThe Last Time I Wore a DressThe Limits of Autobiography The LobotomistThe Madness of Our LivesThe Mark of ShameThe Meaning of AddictionThe Meaning of MindThe Medical AdvisorThe Mind/Mood Pill BookThe Most Solitary of AfflictionsThe Mozart EffectThe Naked Lady Who Stood on Her HeadThe Older Adult Psychotherapy Treatment PlannerThe OutsiderThe Pastoral Counseling Treatment PlannerThe PDR Family Guide to Natural Medicines & Healing TherapiesThe Places That Scare YouThe Plural SelfThe Problem of EvilThe Psychology of Religion and CopingThe Quiet RoomThe Real World Guide to Psychotherapy PracticeThe Right to Refuse Mental Health TreatmentThe Rise of Mental Health NursingThe Roots of the Recovery Movement in PsychiatryThe Savage GirlThe Self-Help SourcebookThe Talking CureThe Trick Is to Keep BreathingThe Unwell BrainThe Virtuous PsychiatristThe Way of TransitionThe Wing of MadnessThe Wisdom in FeelingTheoretical Evolutions in Person-Centered/Experiential TherapyTherapy's DelusionsTheraScribe 3.0 for WindowsThis is Madness TooThoughts Without a ThinkerThrough the Looking GlassTo Have Or To Be?Toxic PsychiatryTransforming MadnessTraumaTraumatic PastsTraumatic Relationships and Serious Mental DisordersTreating Affect PhobiaTreating Chronic and Severe Mental DisordersTreating Self-InjuryTreatment and Rehabilitation of Severe Mental IllnessTreatment Plans and Interventions for Depression and Anxiety DisordersTwinsUnderstanding and Treating Violent Psychiatric PatientsUnderstanding Child MolestersUnderstanding DepressionUnderstanding ParanoiaUnderstanding the Stigma of Mental IllnessUnderstanding Treatment Without ConsentUnholy MadnessUnspeakable Truths and Happy EndingsUsers and Abusers of PsychiatryViolence and Mental DisorderVoices of MadnessVoices of RecoveryVulnerability to PsychopathologyWarning: Psychiatry Can Be Hazardous to Your Mental HealthWashing My Life AwayWhen History Is a NightmareWhen Someone You Love Is BipolarWhen the Body SpeaksWhen Walls Become DoorwaysWitchcrazeWomen and Borderline Personality DisorderWomen and Mental IllnessWomen Who Hurt ThemselvesWomen's Mental HealthWrestling with the AngelYou Must Be DreamingYour Drug May Be Your ProblemYour Miracle Brain

Related Topics
The Insanity OffenseReview - The Insanity Offense
How America's Failure to Treat the Seriously Mentally Ill Endangers Its Citizens
by E. Fuller Torrey
W.W. Norton, 2008
Review by Daniel D. Moseley
Apr 21st 2009 (Volume 13, Issue 17)

The Insanity Offense is an informative and important book about a social problem of pressing concern in the United States: the enormous number of preventable tragedies involving severely mentally ill individuals. These tragedies take the forms of homelessness, incarceration, victimization, violence and homicide. Torrey illustrates the nature and the scope of the problem by focusing on statistics augmented by narratives from three states with relatively good mental health care systems: California, Wisconsin and North Carolina. Torrey's lucid and moving descriptions of the problem are rich with reliable statistics and gripping stories whose pathos is on par with the work of Euripides and Sophocles.

Torrey selects a single case study from each of the three selected states. The chapter entitled "Death by the Roadside" reports the story of Malcoum Tate, a severely mentally ill man from North Carolina, who was shot to death by his sister. Tate's mother and sister conspired in his death because they had strong reasons to believe that Malcoum was going to kill his sister's daughter (or one of them). The local police and mental health authorities were not authorized to intervene, since Malcoum's threats were not perceived to be an "imminent threat" to anyone. The chapter "Thirteen Murders to Prevent an Earthquake" describes the case of Herb Mullin; a severely mentally ill individual from California who murdered thirteen people, sacrifices that he believed had to be made in order to prevent California from slipping into the ocean. The chapter "The Killing of Three Devils" details the case of Bryan Stanley, who was a severely mentally ill man from Wisconsin who killed three people after Mass at a Catholic church. He thought that three devils were in the church and they had to be destroyed. Torrey's reports of these cases are detailed, reliable and serve to advance his case. In each situation there was strong evidence that the severely mentally ill individuals involved were a threat to themselves or others. But it could not be established that these men were an "imminent threat" to themselves or others, in the sense required for them to be involuntarily committed. Torrey's central claim is that mentally ill individuals like those described in the cases above should receive psychiatric treatment, involuntarily if need be, before the danger that their illnesses pose is realized.

According to Torrey, there should be strict regimes of treatment for severely mentally ill individuals in order to prevent tragic outcomes like the ones suffered by Malcoum Tate and the victims of Herb Mullin and Bryan Stanley. Torrey's description of their cases is interwoven with a discussion of the historical origins of the legal and social policies that provide the background setting for these tragedies. He identifies two main trends that have led to the current widespread presence of untreated and dangerous mentally ill individuals in the community. The first trend is the deinstitutionalization movement that began shortly after World War II and ended during the 1980s. This movement resulted in the release of the vast numbers of psychiatric patients from mental health hospitals, placing them in the community without any form of follow up treatment. The second trend is the legal reform initiated by civil libertarians during the civil rights era of the 1960s. These legal reforms changed mental health laws by creating a very strict standard of "imminent threat" (defined in terms of imminent physical harm) that must be satisfied to commit mentally ill individuals to psychiatric treatment. Malcoum Tate, Herb Mullin and Bryan Stanley could not be involuntarily treated for their mental illnesses because they did not meet the civil commitment criterion used in their states: they were not considered to be "imminent threats" to themselves or others. Torrey provides a plausible and detailed account of how deinstitutionalization and the legal reforms initiated by civil libertarians led to the current state of civil commitment laws and the presence of approximately 40,000 unmedicated, dangerous and severely mentally ill people in the community.

Torrey articulates four suggested reforms to the current mental health system that are intended to provide greater protection to mentally ill individuals and to their communities. The first proposal involves modifying the current civil commitment laws to allow for more outpatient treatment. Torrey is a member of the board for the Treatment Advocacy Center in Arlington, Virginia, and their webpage contains specific proposals for legal reform along these lines. The second proposal is the construction of a nationwide database that contains a list of severely mentally ill individuals that are particularly susceptible to becoming violent. To be placed on this list, a mentally ill individual would have to manifest all of the following characteristics: a past history of violence, substance abuse, anosognosia (i.e., unawareness of one's own illness) with medication noncompliance, and antisocial personality disorder. The third proposal is to ensure that severely mentally ill persons who are likely to become violent are treated with the use antipsychotic medication. Torrey recommends that the most dangerous mentally ill persons are treated with clozapine, a powerful antipsychotic drug with massive side effects. Also, to prevent those individuals from abusing drugs, Torrey recommends that Disulfiram (Antabuse) be the mandated treatment for those individuals who are also alcoholics and that methadone be the mandated treatment for those individuals that are also heroin addicts. The fourth proposal is the recommendation that the federal government does more to fund research about the issues surrounding violence and mental illness, and then they should use the findings of that research to play a more active role in evaluating the effectiveness of state and regional public mental health facilities.

The book has two main shortcomings. Torrey's proposals for revising the mental health system are given in one chapter of twenty pages and his case for them would greatly benefit from more details and argumentative support. Moreover, Torrey's arguments against the perspective of civil libertarians are underdeveloped and often loaded with ad hominem arguments appealing to various civil libertarians' specific ideological leanings and personal vendettas against psychiatric treatment. Torrey reports that civil libertarians maintain that (1) individuals have a right to refuse treatment and (2) individuals also must give their informed consent to receive psychiatric treatment. He responds to the first claim by asserting that individuals have a right to adequate treatment and the type of liberty advocated by civil libertarians leaves severely mentally ill persons "rotting with their rights on." Torrey responds to the second claim by maintaining that it is an egregious error to assume that severely mentally ill individuals can make informed decisions about their own psychiatric care; especially since their condition also commonly involves a lack of awareness of their own condition. Torrey's claim that a right to receive adequate treatment is more fundamental than an individual's right to refuse treatment does not undermine the civil libertarian position, because even if individuals have a right to receive adequate treatment, it does not follow that those individuals do not have a right to refuse that treatment. Torrey's argument against the claim that mentally ill individuals must give their informed consent to receive psychiatric treatment is suggestive but a convincing case would need to say much more about the nature of informed consent and who is going to decide which mentally ill individuals are in a position to give it. Moreover, important issues surrounding the potential for abuse of the involuntary commitment power are largely ignored. Presumably some kind of government official or mental health professional will be given the authority to make treatment decisions for those who are incompetent, but without spelling out the exact details of this proposal it raises genuine worries about giving too much paternalistic power to the state or the mental health care system. Torrey's own proposals, such as the nationwide database and giving the government greater use of parens patriae powers (i.e., the right of the government to make decisions for persons declared mentally incompetent), seem to reflect an enormous amount of trust in government officials and mental health care professionals. There is a long history of the abuse of parens patriae powers (in the U.S. and elsewhere) and Torrey's discussion does little to register the magnitude and scope of those abuses.

In sum, The Insanity Offense is essential reading for anyone interested in issues related to civil commitment laws and the plight of the severely mentally ill people in the U.S. that are not receiving psychiatric treatment.


© 2009 Daniel D. Moseley



Daniel Moseley received a Ph.D. in Philosophy from the University of Virginia.  He is currently a Visiting Assistant Professor of Philosophy and a Clinical Assistant Professor of Psychiatry at the University of North Carolina at Chapel Hill.


Welcome to Metapsychology. We feature over 8200 in-depth reviews of a wide range of books and DVDs written by our reviewers from many backgrounds and perspectives. We update our front page weekly and add more than twenty new reviews each month. Our editor is Christian Perring, PhD. To contact him, use one of the forms available here.

Metapsychology Online reviewers normally receive gratis review copies of the items they review.
Metapsychology Online receives a commission from for purchases through this site, which helps us send review copies to reviewers. Please support us by making your purchases through our Amazon links. We thank you for your support!

Join our e-mail list!: Metapsychology New Review Announcements: Sent out monthly, these announcements list our recent reviews. To subscribe, click here.

Interested in becoming a book reviewer for Metapsychology? To apply, write to our editor.

Metapsychology Online Reviews

Promote your Page too

Metapsychology Online Reviews
ISSN 1931-5716