Tighter controls on mentally ill urged Concerns about violence cited

A prominent psychiatrist called yesterday for more stringent controls over seriously mentally ill patients to minimize the risks of violence.

In a lecture before the American Psychiatric Association, which concluded five days of meetings in Baltimore yesterday, E. Fuller Torrey, a psychiatric researcher at St. Elizabeth's Hospital in Washington, acknowledged that his views were not "professionally or politically correct."


For too long, he said, psychiatry has bowed to the "civil libertarians," opening the way to avoidable acts of violence committed by a small portion of the mentally ill.

"The public stereotype that links mental illness to violence is based on reality and not merely on a stigma," said Dr. Torrey, a clinician and researcher. "As such, our present attempts to combat this stereotype by campaigns of public education will fail until the problems of violence are addressed."


Dr. Torrey, long considered an iconoclast in psychiatric circles, said he would partly reverse 30 years of giving psychiatric patients more autonomy.

That autonomy began with the release of hundreds of thousands of psychiatric patients from state hospitals. States must now reimpose some of the control lost in the era of deinstitutionalization, he said.

Dr. Torrey, who has studied the mentally ill in jail and among the homeless, stressed the need to ensure that the most disturbed patients living in the community take their medication. Not taking it, he said, should be grounds for committing those patients to the hospital.

He also said hospitals should automatically be allowed to medicate patients who are involuntarily committed, a practice strongly opposed by advocates for the mentally ill.

Many others within psychiatry also view Dr. Torrey with suspicion.

"Our role in mental health is to help people regain their autonomy, and he would have us control their autonomy," said Jonas Rappeport, the retired medical director of the Baltimore Circuit Court and a well-known forensic psychiatrist. "He wants to turn back the clock."

Stuart Silver, director of Maryland's Mental Hygiene Administration, agreed that Dr. Torrey's approach would be overkill.

Maryland law allows for sufficient control over psychiatric patients who have committed crimes, Dr. Silver said. For other patients who have not committed crimes, he said, the goal is to help them understand their disease and, with assistance from the state, take responsibility for it.


Dr. Silver also took issue with Dr. Torrey's insistence that the mentally ill pose a greater threat of violence than does the general population.