• Out of the Shadows: Confronting America's Mental Illness Crisis
  by E. Fuller Torrey '59, M.D.
• Duchamp: A Biography
  by Calvin Tompkins '47
• Books Received

The Shadow Life
Rx for improving care for the mentally ill

Out of the Shadows:
Confronting America's
Mental Illness Crisis
E. Fuller Torrey '59, M.D.
John Wiley & Sons, $27.95

"One measure of a civilized society is the care it provides for its disabled members. The care being provided for people with severe mental illnesses in America today is a disgrace. We have the knowledge that is needed to do much better. Whether or not we have the will is the question."
With these words, E. Fuller Torrey '59, M.D., concludes his most recent of 12 books on people with severe mental disorders. Preceding this statement, he chronicles the current, almost unbelievable, plight of these individuals, describes how they and society arrived here, and argues for broad changes to improve their care.
Torrey, a leading researcher on schizophrenia, has spent years working with persons who have severe mental disorders, and helped found the support and lobbying organization, the National Alliance for the Mentally Ill. His presentation is at once passionate, authoritative, and provocative. It is impossible to read this book without experiencing a growing sense of understanding, concern, and outrage.
The basic story of persons with severe mental disorders-schizophrenia, for example-is well known by now. For centuries, treatment brought little change in their symptoms. Most were committed to overcrowded public mental hospitals, living under abominable conditions, serving as guinea pigs for experimental interventions such as lobotomies, and generally deteriorating. Enter the 1950s. Clinical scientists discovered a number of medications for such disorders. Government and social leaders and mental-health practitioners alike concluded that the medications could enable individuals to leave the hospitals to reside in the community, and the "deinstitutionalization" movement began. On any day in 1955 more than 550,000 persons with a mental disorder were inpatients at mental hospitals; today fewer than 80,000 patients live in the same hospitals.
Unfortunately, this monumental shift toward outpatient care has been a disaster. Around 150,000 people with severe mental disorders are now homeless, even more are in jails and prisons, and many live in nursing homes and other care facilities. These and millions more with such problems are presently condemned to live in the "shadows of life." Medications alone are usually not enough to help them function, and communities have typically failed to provide the mental-health services that are now known to complement medications and to bring genuine improvement.
While this basic story is widely known, its details are not. Nor are its causes or remedies. Torrey takes on all these tasks. Writing with the flair of an investigative reporter, the care of a historian, and the vision of a social reformer, he offers a book that is as readable as a good novel, yet as scholarly as a work of science.
Torrey goes beyond the usual culprits to explain why deinstitutionalization has failed-for example, misjudgments about the power of medications-and cites a more complex set of intersecting economic, legal, and ideological factors. His remedies appear controversial at first glance, but they emerge so naturally from his analysis that most of them ultimately seem long overdue and workable. He proposes, for example, that all government funding for the care of persons with severe mental disorders be provided by the states and that the states also be held accountable for treatment outcomes; that society and the judicial system acknowledge in word and deed the exigency of involuntary treatment; and that severe disorders such as schizophrenia be divorced, both ideologically and economically, from quality-of-life and emotional problems.
Though important and compelling, Torrey's analysis could easily become too abstract and complex were it not for his use of case examples, provocative quotes, and facts and figures-all interwoven to leave an indelible impression. The case examples, many of them moving, focus on family members as well as the individuals themselves. In one, a Miami woman stops for a red light and sees crossing in front of her car "the repulsive vision of a tall, hunched over woman with a snarled nest of hair . . . legs blotched and swollen, carrying a bundle wrapped in a piece of cloth, hobo style"; the driver realizes that she is looking at her homeless, mentally ill sister. Also stirring is the recollection of a deinstitutionalization pioneer: "Those of us who were once so enthusiastic now weep a little as we look backwards at what has happened to the promising child of the 1960s and early 1970s."
I did occasionally find myself taking issue with Torrey. For example, while I agree that severe mental disorders should be distinguished from other kinds of psychological problems (such as adjustment problems) to better prioritize research and clinical services, I disagree when Torrey suggests labeling the former "brain disorders" and the latter "mental-health problems." Because he suggests assigning brain disorders to one division of scientific study, and mental-health problems to entirely different ones, his categorizations could unintentionally narrow both the scope and results of future research. But this point is small compared to my admiration for Torrey's insights and suggestions.
Torrey brings to this ambitious book special credentials that qualify him for the task. Perhaps most importantly, his sister has suffered from schizophrenia for 40 years. This book is a magnificent tribute to her plight.
-Ronald Comer
Ronald Comer is the director of Clinical Psychology Studies in the Department of Psychology, where he has taught for 22 years.
He is the author of two textbooks, Abnormal Psychology and Fundamentals of Abnormal Psychology.

Duchamp, Man and Legend, Revealed
Duchamp: A Biography
Calvin Tompkins '47
Henry Holt, $35

Calvin Tompkins '47 first met Marcel Duchamp in 1959. When he interviewed the legendary artist for Newsweek, Tompkins says he knew nothing about Duchamp and very little about modern art. He was so disarmed by Duchamp's gift for putting people at ease, his lack of pretense, and his refusal to take himself seriously, that Tompkins became a fan.
Forty years later-in the interval Tompkins moved to The New Yorker and wrote Living Well Is the Best Revenge, a biography of the Jazz Age figure Gerald Murphy, and Merchants and Masterpieces: The Story of the Metropolitan Museum of Art-he has produced this admirable, illuminating, and accessible biography.
Born in 1887, Marcel Duchamp was ahead of his time, anticipating many developments of modern art-Conceptual, Pop, Minimal, Performance, Process, Kinetic, Anti-form, and Multi-media. He was clearly, Tompkins thinks, more influential on artists of this century than were Picasso or Matisse.
The son of a notary in Blainville, in Normandy, France, Duchamp had two brothers and one of three sisters who became artists. At age 10, Marcel went away to the lycée in Rouen where he had drawing lessons. At 14 he did his first paintings in oil. At 17 he left home for Paris to live with his brother Gaston in the heart of the artists' quarter of Montmartre, in Paris.
He tried Impressionism, which he deemed an "absurdity," post-Impressionism, Fauvism, Symbolism, and Cubism, and arrived at his own version of Cubism with Portrait of Chess Players. He wanted to create art that was not "retinal," that appealed to the mind more than the eye. His first really controversial picture, Nude Descending a Staircase, which his Cubist friends thought was a mockery of Cubism, created a sensation at the Armory Show of 1913 and has continued to excite people ever since.
Duchamp went on to create his "readymades"- the urinal dubbed Fountain, Bottle Rack, and Bicycle Wheel. Then came his masterpiece, Bride Stripped Bare by Her Bachelors (The Large Glass), a huge installation now in the Philadelphia Museum of Art.
Duchamp, who disliked what he called "the artistic life" and all organizations of artists, moved to the United States during World War II and in 1959 became an American citizen. For the last 20 years of his life, he worked on a secret project, a huge installation, viewed through two peepholes in an ancient door brought from Spain. This work, too, is in the Philadelphia Museum.
Before his death in 1968, Duchamp enjoyed a flurry of new fame-his work appeared in many exhibitions, and several monographs were written about him. Tompkins has done an enormous amount of research in this country and in France and a spectacular job of bringing to life this enigmatic artist. His book is a three-dimensional installation itself.
-Ann Waldron
Ann Waldron is the author of True or False, a book about art forgeries.

Books Received
Emerson's Aesthetic
Robert K. Hudnut '56
Edward Mellen Press, $29.95

On Constitutional Ground
John Hart Ely '60
Princeton University Press, $69.50 cloth, $24.95 paper