I’ve been around the block a few times, so I was not shocked by the revelations in Art Levine’s absorbing and well-researched new book, Mental Health, Inc.: How Corruption, Lax Oversight and Failed Reforms Endanger Our Most Vulnerable Citizens. But I was certainly appalled.
Planning to review the book, I started reading it with a pencil in hand so that I could make little check marks in the margins when I read anything that seemed worth noting. By the time I finished reading the book, there was a forest of check marks!
The story begins with the harrowing saga of 38-year-old army veteran Steve Tompkins (not his real name), who had spent the 10 years after returning from service in Iraq drugged to the gills with Seroquel, Depakote, lithium and other antipsychotic medications in an attempt to treat his PTSD. He had been trying to get into the 60-day PTSD unit at a local hospital in West Virginia, and his anger finally erupted into an event that led to hospitalization. But, more than a year later, he still had not gained admission to the special PTSD inpatient unit.
While Tompkins’ story is heartbreaking, it pales in comparison to what many of those profiled in Levine’s book have suffered—since at least Tompkins survived (as far as Levine reports). Even reading the book’s table of contents is horrifying. It includes “Drugging Our Seniors to Death,” “…the VA’s Tragedies” and “…the VA’s Scandals,” “Torture in Alabama,” “Florida: Free-Fire Zone for Killing, Abusing and Raping Kids?” and other chapter titles that are similarly terrifying.
The book’s “nut graf”—editorial slang for a paragraph that tells readers why the story matters—may be this one: “Indeed, a hunger for profits has corrupted just about every conceivable arena of mental health care, from the overdrugging of foster care kids and the elderly to abusive teen residential facilities. Not only that, it’s been abetted by what this book shows are indifferent professional associations, pharmaceutical-subsidized patient advocacy groups and government regulators that either push a drug-industry agenda or fail to halt what amounts to an epidemic of behavioral health malpractice.” As Levine quotes Philadelphia attorney Steve Sheller (interviewed in the Philadelphia Inquirer), “The industry is infected with greed. You can’t trust the approvals, you can’t trust the studies, and now you can’t trust the FDA.”
Much of the book focuses on the devastation wreaked by the dangerous “off-label” prescribing of antipsychotics. Levine also shines a damning spotlight on the “multibillion-dollar residential treatment industry.” He accuses it of “profiting off of the misery and suffering of all those mishandled by their communities’ outpatient programs,” and tells numerous stories that back up this claim.
The book has a companion website, www.mentalhealthinc.net, where some of the wrongful death lawsuits and state health reports can be viewed. In addition, there are 48 pages of endnotes that readers can access here.
It’s true that sometimes Levine gets it wrong, including in regard to the spurious link between mental health conditions and violence. While acknowledging that people with serious mental health conditions are 11 times more likely to be the victims of violence than its perpetrators, he nonetheless leans on a “meta-analysis” by an Oxford psychiatry professor to claim that people with untreated schizophrenia are up to five times more likely to commit violent acts, largely due to their higher rates of substance abuse. He also writes, “It’s likely, in fact, that most mass killers have some form of mental illness, even if many don’t meet the narrow legal definition of insanity: the inability to tell right from wrong at the time of the crime”—in spite of the fact that many experts, such as Vanderbilt University researchers, dispute this1—and refers to “crazed (emphasis added) gunmen like Adam Lanza and James Eagan Holmes.”
Levine also blindly accepts the conventional wisdom of The New York Times editorial page and a few other ill-informed pundits when he disparages the overturning of an Obama administration regulation that “required the Social Security Administration to report to the FBI background check system mentally impaired beneficiaries who were incompetent to manage their own finances”—even though this regulation was considered discriminatory by the ACLU and most of the mental health advocacy community. And, without irony, Levine calls the Helping Families in Mental Health Crisis Act—legislation that many in the mental health advocacy community worked hard to defeat—a “reform” bill. (However, he is critical of the involuntary treatment mandated by this law.)
But while he does get a few things wrong, he gets much more right.
By the way, Levine briefly covers the movement for social change of individuals with psychiatric histories. While the movement gets short shrift, that isn’t the subject of this book. Art Levine is writing about the depredations of the mental health industrial complex, and that is enough to make this book disturbing and indispensable.
Full disclosure: The author names me—not the Susan Rogers quoted on page 47, who served on the board of the Texas Federation for Children’s Mental Health—in the Acknowledgements, and he includes the National Mental Health Consumers’ Self-Help Clearinghouse in his brief “Assistance, Advocacy and Information Resource Guide,” calling us “a tiny but dedicated group…” These acknowledgements did not influence me in writing this review.
