behind new york citys shift on mental health a solitary quest

Behind New York City’s Shift on Mental Health, a Solitary Quest

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“This was a very important man,” he said. “I think she died thinking it was true.”

In the 1970s, when the country was discharging hundreds of thousands of patients from public psychiatric hospitals, it was the era of “One Flew Over the Cuckoo’s Nest,” and the move was lauded as a forward-thinking reform. But Dr. Torrey warned that many former patients were being left wandering city streets untreated, describing them in his writing as “a legion of the inner-city damned.”

He recalled a woman he had encountered while treating patients at a homeless shelter in Washington, D.C. She struck him as familiar, so he pulled out her records: A decade earlier, while psychotic, she had been treated at St. Elizabeths, the public psychiatric hospital where he had worked, after attacking her daughter so brutally that the girl lost her arm. The woman had refused medication once she left the hospital.

“I said, ‘There’s something very wrong with this system,’” he said. “How is this woman allowed to be completely psychotic again?”

Credit…via E. Fuller Torrey

It was unusual for a psychiatrist to take such a blistering stance against deinstitutionalization, which had been celebrated by liberals. Over the years that followed, Dr. Torrey said, his arguments found more support from conservatives, landing on the opinion pages of The Wall Street Journal.

He went on to challenge all of the profession’s power centers. He lambasted the National Institutes of Mental Health for funding too little research on treatments for debilitating illnesses like schizophrenia. He fell out with the National Alliance on Mental Illness over his advocacy of outpatient commitment. He refused to pay dues to his local chapter of the American Psychiatric Association — an act of protest over its spending on a lobbyist — and was expelled, he said.

“I’m a longtime friend and colleague of Fuller’s, but Fuller caused institutional psychiatry a big pain in the butt,” said Dr. John Talbott, 87, a past president of the American Psychiatric Association. He traced the friction to deinstitutionalization. “Fuller was one of the few people who said from the very beginning that it was a big mistake. In part, he said it because of his sister.”