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Transcript: An American Psychosis? – A Conversation with Psychiatrist E. Fuller Torrey

Thinking in Public with E. Fuller Torrey

April 21, 2014

Mohler:

This is Thinking in Public, a program dedicated to intelligent conversation about frontline theological and cultural issues with the people who are shaping them. I’m Albert Mohler your host and President of The Southern Baptist Theological Seminary in Louisville Kentucky.

Dr. E. Fuller Torrey Is a research Psychiatrist specializing in schizophrenia and bipolar disorder. He is the Executive Director of The Stanley Medical Research Institute, The founder of the Treatment Advocacy Center and a professor of psychiatry at The Uniform Services University of The Health Sciences. He was educated at Princeton University McGill University and Stanford University School of Medicine. He is the Author of over twenty books, his latest book is American Psychosis: How The Federal Government Destroyed The Mental Illness Treatment System. As he began that book, he wrote these words “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.” It’s a good thing that he wrote this book and I’m glad to know that this question bothered him. I’m looking forward to this conversation with Dr. Torrey.

Mohler: Dr. Torrey, your book American Psychosis: How The Federal Government Destroyed The Mental Illness Treatment System, is about more than that subtitle, but it begins with one of the most interesting stories from American History that points to the intersection of the personal and the political you begin with the story of the Kennedy Family.

Torrey: It does indeed, Dr. Mohler. And that’s really the beginning of how things changed radically for the mentally ill in the United States. What The Kennedy family had, was they had a daughter Rosemary who was mildly retarded at birth almost certainly because her mother had been infected with the influenza virus. She was born in 1918 when it was going through Boston. And we know that that can cause some mental retardation. However, Rosemary was not really bad off, she was able to function at a fourth or fifth grade level. However, when she got to be about age twenty, she developed psychotic symptoms. What sounds like a form of schizophrenia. That also can be caused by the influenza virus during pregnancy. And that was a potential disaster for the family. First of all, in 1941 families did not admit that they had mentally ill people, it was terribly stigmatized. And secondly they were very politically ambitious family; the father was determined to get high national office for himself or other members of the family. And then the daughter Rosemary became progressively more psychotic and with major problems in her behavior and there was really no medication available at that time so the father, Joe Kennedy had a lobotomy done on her. A lobotomy at that time was one of the only things that they did, it really is a desperation kind of treatment, and it turned out to be an utter disaster that left Rosemary profoundly retarded and really functioning at a three or four year old level for the rest of her life. That was then when John Kennedy became president that was in the impetus to do something for the mentally ill and mentally retarded in The United States although publicly the family never said anything about it, of course.

Dr. Mohler: You know, one of the questions that came to my mind when reading your book,  and by the way it includes a chilling absolutely chilling recounting of how the lobotomy was done. I had the question, is there a link between the lobotomy and her later development of mental illness or merely the mental incapacitation?

Dr. Torrey: Well, the mental illness came on, as it usually does in the late teens early twenties. And it was the mental illness that then forced the hand of her father that led to the lobotomy, but the mild retardation by itself would not have led, in fact they would have never done a lobotomy on someone who is just mildly retarded. People who had major psychological problems and very psychotic behavior, out of desperation at that time, they were doing lobotomies. It’s a very crude operation; it cuts part of the brain. In some cases, it led to some decrease in violent behavior, but in this case it was an utter disaster, and just led to her being almost a vegetable for the rest of her life.

Mohler: That had profound impact on the Kennedy family and that led, especially when JFK was elected president of the United States, to an increased federal attention to the question of mental illness and mental retardation and you tell that story extremely well. I think it’s a story that, given our current circumstances and controversies, desperately needs to be told. Draw us a line from Rosemary Kennedy to the federalization of mental illness and of mental retardation concerns in the late 50s especially in the 1960s.

Torrey: That’s absolutely right and that was really the beginning of a shift of responsibility from the state governments to the federal government, a shift, which in retrospect has been a major mistake on it. Up until that time, the states were in charge of people with both mental retardation and mental illness. That’s why we had the state mental hospitals, which were very widespread at that time. The federal government had never played much of a role in this at all, and it was John Kennedy who basically changed that and said we will provide a federal program and basically take the responsibility away from the states. It was done with the best of intentions as many federal policies are, but in retrospect it was exactly the wrong thing to do. The federal government, I believe, personally does a few things well; it does some research well; it does wars well when it has to on it; but it doesn’t do social services or medical services very well at all. This has been really the origin of why we have the problems we have today because of the federal involvement in taking over the services for the mentally ill.

Mohler: When I saw your book, I knew immediately that I wanted to read it. Again, the title is American Psychosis. The subtitle sounds, perhaps to some people, less interesting: “How the Federal Government Destroyed the Mental Illness Treatment System.” I want to tell our listeners I think this book is profoundly important, and not only that, but it is an incredibly riveting narrative because you’re really telling us about how the best political intentions led to some of the worst of personal disasters and to a pathological situation that we face right now. So I’m going to ask you to tell that story as you do in your book. If you were to rewind history to the midpoint of the 20th century, the states are responsible for mental healthcare. They may not be doing it elegantly, but the way that it is assumed it should be done is by institutionalizing those who had very significant mental health problems or mental illness. By the time you get to the end of the 1960s, there is an entire pattern of changed ideas of a federal assumption of authority of a deinstitutionalization of mental health patients and basically a problem of homelessness and crime that inevitably followed that.

Torrey: What you say is exactly true. One of the great ironies is that the shift from the states to the federal government, which started in the 1960s, came at exactly the same time when, for the first time in history, we had effective treatment to treat the seriously mentally ill people. We had the introduction of what we call antipsychotic drugs. Prior to about 1960, we had almost nothing to offer them and that’s why Joe Kennedy had the lobotomy done on his daughter because there was nothing else to offer her. Just at the time that we got an effective treatment and when the states could have really taken off and done a good job, that’s when the feds decided that they would make this a federal issue and have these community health centers and told the states not to worry about this anymore. One of the reasons I did the book was because I was intrigued with and knew many of the people involved. I started work at the National Institute of Mental Health in 1970. Many of the people I write about in the book I knew personally and I went back and checked with many of them. The thing that is most striking is almost to a person they really meant well. They thought they were doing a good job, and yet, in retrospect as we look back, it has been a disaster. It has led to the number of mentally ill homeless we have, the number of mentally ill in jails and prisons, and certainly to an increase in the number of homicides committed by people will severe mental illnesses who are not being treated.

Mohler: You know it strikes me when reading your book, there are some minor changes in nomenclature that can indicate massive changes in worldview and approach. One of them is the shift from a mental health asylum to a community mental health center. More is changed there than real estate, you really tell an incredible story of how that re-conceptualized how we should consider mentally ill people and how they should be treated.

Torrey: Well the state hospitals were set up starting in the 1840’s, 1850’s they were set up to take care of the people with the most severe illnesses. By most severe illnesses I mean schizophrenia, bipolar disorder, severe depression. These are kind of the heart and core of the – autism also I would add in there – of the state hospitals although they had no effective treatment until the 1960’s they did provide asylums, they did provide some protection for people who were severely mentally in and who often could not protect themselves on it. Now there were certainly abuses in the hospitals also because there were no effective treatments. Shifting to the Federal Government, the Federal Government basically said well, we’ll close down those hospitals because they’re not very nice places and we will set up these federally funded community mental health centers. Well, the problem was from day one the federally funded community mental health centers had little or no interest – with a few exceptions – in taking care of those severely mentally ill people, who were coming from the state mental health hospitals. So what we did effectively is we were emptying out the hospital—we were very good at that—but then not providing the treatment for them once they were in the community. The community mental health centers (since they were not interested in the people with severe mental illnesses) became psychotherapy centers for what I would call the “worried well.” They did a lot of psychotherapy for less severe mental illnesses, a few of them did a good job, but those are few and far between. Most of the community mental health centers that were funded with federal funds failed to take care of the people who were coming out of the hospitals so you had from day one, you had a pending disaster and you could absolutely predict the kinds of problems we have today. Just by looking at what was going on by the late 60’s.

Mohler: Several paragraphs of your book are just riveting. One is just this paragraph, you write “during the decade of the 1960’s public psychiatric care in the United States changed markedly at the beginning of the decade. States and counties had been actively developing programs to provide follow up care for patients already being discharged from the state hospitals. By the end of the decade state and local efforts had largely ceased usurped by the federal community mental health centers program.” You then end that paragraph by saying “by 1969, however, it had become clear that prevention, the centerpiece of the Federal mental health program was without substance.” That sentence cries out for some elaboration. What did you mean when you wrote that prevention, the centerpiece of the Federal mental health program, was without substance?

Torrey: One of the great surprises was when I went back and looked at the old records was to find how much was going on at the state level. Just as a community mental health centers were starting. In other words, the states were really picking up the medication available. They were starting to provide their own mental health centers and to focus on the people with severe mental illnesses. But this is by the very earliest community mental health centers were funded in the mid-sixties even within the first few years the studies that were done showed that the mental health centers were not taking care of the people coming from the state hospitals. If you go back and look at the reports within the national institutes of mental health at that time, it was very clear to the people even in the center. In the National Institute of Mental Health at that time that the program was not working. However, also very clear that by then it had become politicized and so once something starts in Washington, Dr. Mohler, it is very hard to stop it.

Mohler: Well, you  make that point very graphically. And similar points are made when people consider the way the federal defense budget works or just about the entitlement programs when you start something it becomes an industry with all kinds of constellations of feeder organizations and all the rest and all kinds of vested interests and you mention financial incentives that basically became very perverse incentives in terms of the mental health picture. But in the same chapter in which you deal with that failure prevention, you also go to something else, and I want to back up and say I really appreciate the way you stated that many of these things though disastrous, were done with the best of intentions. So I want to grant, sympathetically, the best of intentions to all parties here. But that does lead me to a very hard question. Why did anyone, such as a series of Federal judges and groups like the American Civil Liberties Union, why did they believe that people had basically a constitutional right to be mentally ill? And to be de-institutionalized regardless of the state of their illness?

Torrey: I think a lot of it was ignorance, a lot of it was a ideology. Remember, this was the era of the civil rights issues, the civil rights movement. So, the mentally ill, in a sense, became another group that needed to be freed. This was done by people who had, really, no understanding of what was wrong with the mentally ill at all. These were people who had read Ken Kesey’s One Flew Over the Cuckoo’s Nest and thought that the people in the hospitals really didn’t have anything much wrong with them, that the evil psychiatrist had locked them up and really all you needed to do was open up the doors and let them out they’d live happily ever after. Well of course, we know now that’s not true we know these people have brain diseases, but the lawyers and the civil rights people who passed a lot of legislation that has led to the release of the mentally ill people without any treatment, really didn’t understand any of this and they had a political ideology that nobody should be forced to do anything nobody should ever be held involuntarily in a hospital. They thought that by freeing people they were doing the society a favor. In retrospect of course we know how wrong they were.

Mohler: A book like American psychosis by Dr. Torrey helps us to understand the patterns that we see in the culture at large. The de-institutionalization of the severely mentally ill is something that we see. We see it in the phenomena of the homeless and we see it also in current political debates. We see it in a failed mental health industry and we also see it in broken lives. And we see it in a society at large that seems to have lost any sane understanding of what mental illness is. And how those who have severe mental illnesses should be treated and cared for. And as I talk to Dr. Torrey it became more and more clear that even as many people are looking at the parts very few are looking at the whole. And he’s looking at the whole question. He tells it in terms of a narrative and he documents it with an incredible amount of data. He also brings more than four decades of personal experience as a psychiatrist to this book, and thankfully also, to this conversation.

Mohler: I think the most clarifying sentence in your entire book is found on page 148 when you write “The freedom to be insane is a cruel hoax perpetuated on those who cannot think clearly by those who will not think clearly.”

Torrey: That’s exactly right, to have a severe mental illness, bipolar disorder, schizophrenia, is really a terrible thing. There is nothing nice about these diseases at all. They take over your mind, you are not able to think clearly, you hear voices you have delusional thinking. That’s really not any freedom at all. You are not free because you are constrained by a biological illness of your brain your brain is not working normally. And yet the civil libertarian civil rights lawyers who insisted on just letting everybody out of the hospital without providing follow up treatments for them, really were, it was a cruel fate for many of these people. Who many end up homeless on the streets. Many to this day and in increasing number are in jails and prisons. It is a cruel hoax, there’s no question about that.

Mohler: Well you talk about the people who still defend the right of homeless mentally ill people to be free (you put quotation marks around “free”) to live on a sidewalk or bridge or in jail, what they don’t realize, you write, is that most such people are not free, rather, their actions are dictated by their delusions and auditory hallucinations however irrational those may be. You cite psychiatrist Gary Meyer who put it “when the personal freedom of the mentally ill is given priority over all other considerations the tyranny of some will jeopardize the autonomy of all.”

Torrey: Yes I thought that captured it very well. I volunteered for sixteen years from the early eighties until late nineties in the homeless shelters in Washington. Twice a month and took care of many several hundred people with severe mental illnesses who were homeless. And I could tell you that the quality of life for someone who is severely mentally ill and living on the streets both men and women, is really a living hell. They’re victimized, having their money stolen, being raped, it is all very common and as well as freezing to death and not getting medical care, the fact that we have tolerated this for so long I think is a real blot on our society. And our failure to understand the fact that these people really need help.

Mohler: In your book you talk about the reasons why we have arrived at this point and you tell a story that we traced in the beginning but didn’t follow through if you can quickly summarize, how do we get from the nineteen sixties, to the second decade of the twenty first century. A lot took place, and a lot of it was sheerly political, but political with a lot of psychiatric and world-view implications. Well, like everything in Washington, Dr. Mohler, it becomes political very quickly. The community mental health center program became an icon for the Kennedy years, and especially then after Kennedy was assassinated. It was associated with him, so to be against community mental health centers was somehow to be against Kennedy, to be against democrats, and you know, only those mean republicans would try and say that this program wasn’t working. So when I was in the IMH when I first came there in 1970 it was very clear by then that the whole thing had developed into a Republican/Democrat stand-off and if you could assize the community health centers, you were assumed to be a Republican because Democrats, even though they knew the program wasn’t working, simply didn’t say so.

Mohler: By the time you arrive at the beginning of the 21st century, it’s not working and virtually everyone knows it’s not working, and yet no one seems to have the political, or for that matter the psychiatric will, to solve the problem. You don’t end your book without suggesting what would make the situation far better. Walk us through what you would have us now to do.

Torrey: You’re absolutely right. We’ve gone on for 40 to 50 years with a failed program. Each year is getting worse. I’ve been tracking, for example, a number of mentally ill in jails and prisons. It has gone up steadily since in 1965, 1970, and we can count it getting worse. The question is what should we do? What would we do if we had a magic wand in Washington? The first thing I would do is I would put the responsibility back at the state level. I do not think the federal government knows how to do this. I think the country is too big and the states are too diverse. I don’t think the federal government has the wisdom to order these kinds of programs for the whole country on it. But I would also hold the state responsible. I would give the state the money that goes with it and I would then measure the outcome and we can measure the outcome by seeing how well these people are doing: how many are homeless; how many are in jails and prison; how many are living reasonably good lives; how many are working part-time. Yes, I would put the responsibility at the state, and then I would hold the governor and the legislature responsible for that. It would be a political issue at the state level. So when someone is running for governor, not only would their education policy be very clear, but their policy with what you do with the severely mentally ill would be very clear. That would be for public discussion. I think that’s the first and most important thing. The second thing is we clearly need leadership. We’ve had virtually no leadership on this at all, either at the federal or state level. I can say this is an equal opportunity political disaster. We’ve had five Democrat and five Republican presidents during this period and not a single one of them has really understood the problem. Carter made one effort on it first, then Ford made an effort on it, but they didn’t really understand the problem, and didn’t improve it at all. The first person who has really shown some leadership emerged this year in Congress, Republican Congressman Tim Murphy from Pennsylvania. He has introduced some legislation last year, which is the first federal effort that I have seen to start to shift things and to put the responsible back where it belongs. So far we’re simply going downhill, and we’ve been going downhill, and until there’s more awareness among the public of what is needed, I don’t think things are going to get better.

Mohler: I was really interested to read in your book some explanation that clarified our current situation in terms of how things became what they are now. You use a very interesting phrase and that’s “transinstitutionalization.” By that you mean that even though we say and as culture claim that the severely mentally ill had been de-institutionalized, they’ve basically been transferred from one kind of institution to another. You point out that the two intuitions have basically become the holding pattern for people who had previously been in these state mental asylums. They are now basically in prisons and in nursing homes, having been transinstitutionalized into those two new settings.

Torrey: That’s exactly right. We released a report this week that claims there are now 10x more people with serious mental illness in jails and prisons in the United States as remaining in the state mental hospitals. So that’s about 365,000 people with severe mental illness in the jails and prisons today. There’s also about 200,000 of them who are homeless and there’s an uncounted number, probably 300,000-400,000 who are in nursing homes. So, yes, we say we’ve deinstitutionalized, that we’ve emptied out the hospitals, but many of these same people are in different institutions. Certainly nursing homes are very much like where they came from in the state hospitals. Jails and prisons of course are much worse. It hasn’t really been de-institutionalization, it’s simply been transinstitutionalization from one kind of institution to another.

Mohler: So I had a horrifying thought as I read that chapter, and that is this: are we now supposedly suppressed as a society to the point that we simply wait for someone to commit a horrible crime before we will face up to the reality of mental illness, and so we just transfer the insane asylum into a prison, and have to build these massive mental health wings onto our prisons and jails?

Torrey: That’s exactly what we’re doing, and it is horrifying. One of the things and reasons I wrote the book and do the public education I try to do is to make people realize that, that it was not always this way. You know, in terms of the jails and prisons, we’ve gone back to where we were about 150 years ago. 150 years ago there were a lot of people with mental illness in the jails and prisons, so Dorothea Dix said and other people said, “we should build some hospitals and transfer the people to the hospitals,” which they did. By the 1870s there were relatively few people with mental illness left in the jails and prisons. We have now reversed all that. We’ve gone back really to pretty much where we in 1838-1840. I don’t think this is progress and think we ought of be ashamed of it.

Mohler: There were some other huge insights from you book. Quite honestly, it gets to a basic worldview level, which is really of interest to me. Unexpectedly, in terms of one of the twists and turns in your narrative and documentation, I came across the fact that two figures you mention, both of them Republican presidents, Richard Nixon and Ronald Reagan, basically represented what you describe and geographically locate in terms of intensity in places like Orange County, California. You said at that point there was a huge distrust in the entire field of psychiatry.

Torrey: That existed then and still exists to some extent. It comes from a variety of sources. One, it comes from the Soviet model where the dissidence in the Soviet Union were put in the psychiatric hospital to discredit them. It comes a little bit from Nazi Germany, where the Nazi’s under Hitler killed many of the mentally ill people in the hospital. So there is a distrust of psychiatry that has been quite widespread in the United States that’s less now than it was. That has also impaired our understanding. People don’t understand why we have to have mental hospitals, why we have to sometimes treat people involuntarily because they have brain diseases. That has also led to some of the politicization of it, in that the people in the mental health field are often widely regarded as liberals and democrats, and some of the opposition is regarded as conservative and republicans on it. That has really slowed down our understanding. It’s impaired the dialogue. These are brain diseases. Schizophrenia is no more a Republican or Democrat disease than diabetes is. The fact that this has become politicized has really been to the detriment of all of us because it has made it much more difficult to move forward with a joint understanding of what needs to be done.

Mohler: At the same time, I think as in the case so many other issues, if everything is psychiatry than nothing is psychiatry, and if everything is mental illness than nothing is mental illness. So I bet if you go into a major trade bookstore in a place like Orange County, you’re going to find a self-help psychology section that’s going to be massive because I think most Americans think of psychiatry in terms of what you very interestingly defined a few moments ago as the “worried well,” whereas you’re really concerned as a practicing psychiatrist with decades of experiences with those who have very serious mental illness. So define mental illness for us. Help us to understand a definition of what we’re actually talking about when we’re talking about this kind of genuine mental illness.

Torrey: Well, the problem you’re raising is absolutely right and that is that what was originally mental illness in the United States, and in fact the origins of the American Psychiatric Association, was a organization of the superintendents who ran the state mental hospitals. Originally what was psychiatry in the United States was serious mental illness. It was brain diseases. We know these are brain diseases like schizophrenia, bipolar disorder, severe depression, these are disease of the brain where the chemistry of the brain is out of whack and which can in most case be treated with medications and sometimes with therapy. What happened then over the years is that psychiatrists became more and more ambitious and developed a wider and wider purview of what they should be looking at. At this point if you look at the handbook of the American Psychiatric Association it doesn’t just include things like schizophrenia and bipolar disorder, it includes all kinds of human behavior, most of which I don’t personally regard as a disease; I regard them as unpleasant behavior, but not diseases. The whole thing becomes a big mishmash of not only brain diseases, but mixed in with all kinds of human behaviors, and that’s one problem that the public has. They think that the psychiatrists are taking too much on themselves and the drug companies are trying to provide drugs for behaviors that are not brain diseases, but are human behaviors.

Mohler

Mohler: I think, speaking on behalf of many of those who are very concerned about that, what Philip Rieff called the “triumph of the therapeutic,” what you’re looking at there is the reality that there is serious mental illness. I think Christians operating out of a biblical worldview, who are very suspicious about the making of everything into a mental problem that the answer is therefore therapy, still understand there is a reality of serious mental illness and I think your book helps to clarify the kinds of things that should genuinely be understood to require psychiatric treatment, and the kinds of concerns that ought to lead the public to believe that something has to change.

Torrey: I think that’s absolutely right.  I think the fact that the psychiatrists have taken so much on themselves has discredit the attempts by those of us who really focus on severe mental illness because the public gets confused. They think the whole thing all runs together, when in fact something like schizophrenia, which is what my sister had for many years, the evidence is overwhelming that something gets in the brain and changes the chemistry in the brain and that is a brain disease. It’s like Alzheimer’s disease, multiple sclerosis, Parkinson’s disease, etc. That’s quite different from somebody who is going through a mild depression or anxiety, which are normal human behaviors, and not real brain diseases. The way psychiatry is organized the whole thing becomes mixed together and it makes it difficult for the public to understand that some of these really are brain diseases and really need to be treated like any other brain disease is treated.

Mohler: You end your book citing a book written in 1947 by Frank Wright. The book was Out of Sight, Out of Mind. The book stated, “Throughout history the problem of the mentally ill has been dodged. We have continually avoided mental patients. We’ve segregated them, ostracized them, turned our backs on them, tried to forget them. We have allowed intolerable conditions to exist for the mentally ill through our ignorance and indifference. We can no longer afford to just disregard their needs, to turn a deaf ear to their call for help. We must come face to face with the facts.”  You then end with the question: “Isn’t it time to finally do so?” Do you think the nation has this as a major concern in the present that could lead to change?

Torrey: I’d like to think we’re moving in the right direction on it. I’ve been watching this for longer than I want to remember, but I’m encouraged that within the last 2 or 3 years, especially following some of these major shootings like Newton and Aurora and Tucson, the general public now seems to realize that there is something seriously wrong, that we have untreated seriously ill people who are committing horrific acts, and that whatever we’re doing is not working very well. That’s different than from five or ten years ago, and certainly from 20 years ago, when I don’t think the general public had the understanding that things are not going well. In addition, I’m encouraged as I mentioned earlier by the legislation that Representative Murphy’s introducing in Congress. I am encouraged to see a member of Congress step forward and say this system is a mess, and the way we’re treating the mentally ill is a mess. We need to do it better. This is something we haven’t seen before, at least something I haven’t seen in the 45 years I’ve been in Washington. That gives me some hope that things may change before too many years.

Mohler: The book is American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System. The author is Dr. E. Fuller Torrey. Dr. Torrey, thank you for joining me for Thinking in Public.

Torrey: My great pleasure, Dr. Mohler. Thanks for having me.

Mohler: In retrospect, I think I read Dr. Torrey’s book from several different vantage points. At one point, I was reading as a concerned American citizen, an American citizen who has been tracking the political process and its interaction with psychiatry, and, in particular, who has been looking at how politically and culturally we come to deal with severely mentally ill. I also, however, read the book as someone who has a deep worldview interest in what’s going on in this country and what lies behind and beneath the political and psychiatric considerations that tend to dominate the headlines. Looking at it from that perspective, I had the deep interest in understanding why did certain people believe that certain actions could be plausible. What view of the human being was beneath the understanding of mental illness, or for that matter, the absence of mental illness? Of course, you look at this from a worldview perspective and you recognize that’s one of the problems. You had politicians looking at this with a certain worldview, and psychiatrists trained in psychiatric disciples and in the school of medicine with that worldview. Then of course you had underlying worldview issues that are far more determinative even than those, those that are basically theological and ideological in orientation. That gets to my third vantage point. I read this book as a Christian theologian. As a theologian who quite publically has grave concerns for the entire mental health complex, the triumph of the therapeutic, the translation of theological problems and theological issues, and biblical concerns into the merely psychiatric or psychological, and often at the most popular level, the self-help category. The triumph of the therapeutic has been spiritually disastrous, even as the deinstitutionalization of the mentally ill has been likewise disastrous. So reading the book from several different vantage points the good news is I found value in every single reading. In other words, this really is an important book. My fear is that it will escape a great deal of public attention because people will think it will be of interest only to mental health professionals or perhaps to the politicians and kinds of administrators and public leaders dealing with the questions. But it really should be of concern to all of us.

My favorite part of the conversation with Dr. Torrey was actually when we got to the end and I asked him to define “mental illness”; and I thought some of his most perceptive comments came not just in tracing the problem of the federalization of the mental healthcare system in America, but furthermore the failure of the entire field of psychiatry to limit itself to the kinds of severe mental illnesses that, as he said, were the originating concern of the medical specialty in the first place. The triumph of the therapeutic, the translation of everything into pop psychology, the assumption on the part of most Americans that if something is wrong with them it must be psychiatric to be cured with therapy or a pill—that has been spiritually disastrous. It is a great theological and biblical and spiritual evasion, and it has infected the church horribly. That is why it is so important have a return to a biblical sanity on these issues through fields such as biblical counseling; and why we have to un-think the wisdom of the world in trying to think as Christians about what we should consider.

When we are dealing with someone who might be actually severely mentally ill, we need to understand that in a Genesis 3 world we actually do believe that there are severe mental illnesses. We do believe that there are some actually rightly under the care of medical professionals, and we need to be clear about that. But we also need to be clear about the fact that even a psychiatrist, like Dr. Torrey, understands that vast millions of Americans who think they need psychology or psychiatry, in terms of treatment or therapy, actually are what he called—and I loved his expression—the “worried well.” These “worried well” have no symptoms of any kind of major psychiatric illness, and yet we are selling pills and therapies by the millions of pills and the millions of hours of therapy, we’re telling them you can find salvation in therapy or in a pill. And the reality is that both of those are horrible lies. That’s why as Christians who read this book we are looking at it from that third vantage point: the vantage point of the Christian biblical worldview and there is much to be gained here. There’s a great deal of evidence about what it means to look at society’s rather inept, although as Dr. Torrey said very clearly, often well-intended efforts to deal with many among us who desperately need help.

He also deals with something in this book that Christians need to face very clearly, and that is the fact that there is a sinful stigma on so many mental illnesses who genuinely need help. And the sinfulness is not upon those who need the help; the sinfulness is upon those who will refuse to look at it for what it is and, furthermore, find embarrassment in dealing with this as an issue. These are not just people who had been locked up in insane asylums and psychiatric hospitals; these are people we knew as brothers and sisters, cousins and aunts and uncles, mothers and fathers, as fellow members of churches, as those within our neighborhoods, those who deserved our care and concern, not our scorn and disinterest.

Finally, it was also really interesting to read how Dr. Torrey reorganized this book, beginning with the personal tragedy in the Kennedy family. In suggesting it was guilt that motivated that family, the guilt over the treatment of their daughter and sister Rosemary, that led that family to want to do something when it came to mental illness. And yet, as he makes clear in this book, doing something in some cases is worse than doing nothing. But he doesn’t actually argue that nothing should’ve been done. He just argues that something better than what happened should’ve happened and what’s better than what happened can happen now. And as we look at this book and as we consider these issues, Christians need to come face to face with the realities that he discusses in this book and understand that we too, committed to human flourishing as we come to understand every single human being isn’t merely psychiatrically healthy or unhealthy but an individual made in God’s image. That changes our perspective infinitely, and it also makes the importance of a book like this even more clear and the conversation we just had even more valuable and for that I’m very grateful.

Again, many thanks to my guest Dr. Fuller Torrey for thinking with me today. Before I close I want to invite you to join us on the campus of the Southern Baptist Theological Seminary on June 23-26 or June 30-July 3 for the 2014 D3 Youth Conference. It’s designed to develop students’ understanding of leadership, worldview, and missions. D3 will set the foundations for discipleship and will forge friendships with likeminded young Christians. For more information, go to events.sbts.edu. Thank you for joining me for Thinking in Public. Until next time, keep thinking. I’m Albert Mohler.