In psychiatry, “serious mental illness” is substitute language for bipolar disorder and schizophrenia. These two difficult diseases account for much of the homelessness that American cities see. Thus, these two diseases also account for much of where tax dollars go. The utterly tragic part, however, is that decent biomedical treatments exist for these diseases; in America, the infrastructure to treat them does not. Why? And what can be improved? This book, originally published in 1988 but readapted to 2025 in a second edition, attempts to answer those questions.
The author Dr. E. Fuller Torrey spent a lot of his career at the National Institute for Mental Health (NIMH), a part of the National Institutes of Health (NIH). Thus, he had a high-level view of America’s mental healthcare system. He’s spent most of his professional life advocating that serious mental illness receive a larger share of the mental healthcare financial pie. He does so not by tugging at one’s heart strings but rather by presenting overwhelming data that we’ve misappropriated governmental spending going back to JFK’s time.
We indeed can combat homelessness, he maintains, by building a better mental healthcare system that addresses these difficult, yet treatable, conditions. We might even be able to save money in the long run! Starting with Great Society reforms in the 1960s, attempts to create a mental healthcare system shut down state mental institutions. Most of those “freed” were unable to keep a steady job and simply entered the trap of homelessness. He argues that freedom from mental institutions without “freedom from psychosis” is a mirage.
Homelessness continues to tax urban infrastructures, but few politicians offer any real solutions other than sweeping them under the rug. To his credit, Torrey offers two handfuls of specific ways to improve our policy. He shows how mental health expenditures went to surface-level psychological topics instead of research to address the most difficult of problems.
Policy wonks and mental health workers will benefit the most from this work. Its offerings focus on systemic answers rather than individual ones. It offers a deep history of how we got here and why we got here. It also begs the question of when will we get the collective will to confront these problems. I’m concerned that the stigma of mental illness – still so pervasive – limits constructive conversations. If we’d only be able to fund treating serious mental illness as much as we fund other serious but common diseases, we might be able to build a better society and a more productive country.
Nowhere to Go: The Tragic Odyssey of the Homeless Mentally Ill
By E. Fuller Torrey
2nd Edition
Copyright (c) 1988, 2025
Springer
ISBN13 9783031846847
Page Count: 213
Genre: Psychiatry, Health Policy
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