American Madness

A psychiatrist tells the story of her struggle to help her patients in our broken American mental health care system. In this clinical memoir, Alice Feller brings the reader into the world of serious mental illness using patient vignettes and personal accounts of her work, drawn from medical school, hospital wards, private practice, public clinics, and beyond, spanning a career from the 1970s to the present day. Individual chapters are devoted to cases describing the impact of homelessness, substance abuse, racism, family involvement, and early intervention for schizophrenia cases, on treatment outcomes. Feller identifies specific barriers to care and advocates for reparative strategies that would make the most meaningful and immediate improvements. This book is meant for anyone whose life is touched by mental illness, whether a patient, in the family, or more personally.

Alice Feller's American Madness is a must-read if you're at all interested in the mental health crisis besetting this country. Dr. Feller embodies the staggering complexities of our system in vivid human stories. Her book is entertaining, illuminating, and absolutely necessary.

Alice Feller's American Madness is a personal memoir of her experience spanning almost 50 years of psychiatric practice. This is an important book that documents the collapse of effective mental health care in America, which has led to inadequate treatment for a large part of the American population. The mental health system has become an ineffective treatment provider of the severely ill, the substance dependent, the poor, and racial minorities. This book is the work of a fine writer whose stories, while desperately sad, are written artfully in a way that reminds me of William Carlos Williams in his Doctor Stories and John Berger in A Fortunate Man. This book is a must-read for all those who care about the repair of an insane system for treating the mentally ill.

I can't recommend American Madness enough. Alice Feller uses anecdotes drawn from her years of practice as a psychiatrist to convey, in a few strokes, the realities of serious mental illness, not only from the perspective of the provider but also in the experience of the patient. The writing is engaging and the vignettes flow smoothly in a way that is accessible and illuminating for the general public and those dealing with these issues in their own lives. She defines anosognosia, the inability by many with serious mental illnesses to have insight into their condition, in the clearest way I have seen. The personal narratives culminate in the final expository chapters, where Dr. Feller evaluates our mental health system and its failures. Most importantly, her heart and commitment to her patients comes through, and I wonder how different our outcomes might be if the system didn't make it so hard for these patient-first attributes to guide treatment.

In American Madness, Dr. Alice Feller invites us on her decades long journey through a shattered mental health system that is failing to treat our sickest, those with severe neurological brain diseases like schizophrenia and bipolar disorders. From when she began practicing medicine in 1977 to today, she recounts the step-by-step deterioration of a failing "system" in which people are blocked from urgently needed lifesaving medical treatment and are thereby denied the chance for a robust recovery. She states that early intervention is the key to recovery, but that is not happening, as evidenced by this shocking statistic: today 90% of all inpatient psychiatric care in the U.S. is behind bars!

Dr. Feller's book addresses the many reasons we have let this population down, including our laws, insurance practices, the absence of accountability at every juncture, and the maze of siloed service systems that do not communicate with one another. She brings to light the frustrating obstacles dedicated, caring doctors now face to help their patients live their best lives. Her patients' poignant stories are recounted, bringing to life the avoidable human tragedies that continue to play out on our streets, in jail and prison cells, and in homes across our country.

I highly recommend this thoughtful and compassionate recounting of a doctor's career in the trenches fighting for her patients' right to healthcare, dignity, and life.

Our son's schizophrenia crippled his ability to succeed in school and later in life's pursuits, changing our lives forever. His illness led to his involvement with the justice system, both as a juvenile and later as a young adult, with terrible consequences. And I became an advocate for treatment over incarceration and the decriminalization of people with serious mental illness.

Dr. Feller's book examines the history that led to the failure of our mental health systems and the policies that drove this catastrophe. She shares a compelling personal story of her life as a clinical psychiatrist who has worked many years in both the private and public mental health systems. American Madness shares her struggle to provide high quality mental health care in a dysfunctional system, allowing us to see the delivery of treatment through her eyes. It is a book on a complex subject that is accessible to anyone.

This book takes the reader through deinstitutionalization of the mental health system and confronts the systemic issues that have developed over the past fifty years. It takes clinical vignettes from the real life practice of a psychiatrist and lets the reader see the complexities of severe mental illness and substance use disorders from a humanistic perspective. The use of clinical vignettes is the perfect way to provide context to the history of the mental health system. This is a great book to have students read to see this population at a deeper level.

This important and engaging book describes a complex national crisis through the lens of one thoughtful psychotherapist's life experience. Alice Feller has worked in almost every part of our fragmented mental health 'system'. Her book--part memoir, part policy discussion--helps the reader understand the causes of the crisis, the frustration of being a participant in a failing system, and what policy and program changes are needed to restore our communities to true mental health.

This text allows for a true-to-life and relatable account of working in the mental health field, including a provider's personal feelings and frustrations as it relates to micro and macro treatment and policy. I think this book would make an amazing supplement to any psychology-based course and would benefit the class for open discussion about expectations in the field. I envision using this text as part of a final paper to highlight all the objectives of the course.

While not all students have internships that have them working with individuals that have severe and persistent mental illness, this book could open their eyes to the brokenness of our current system. I imagine that some of Dr. Feller's stories can be adapted into a role play activity for students to explore how they would handle working as a therapist for multicultural and diversity counseling courses.

Alice Feller, MD is a writer and a clinical psychiatrist. She has worked in private practice, hospital emergency rooms, psychiatric wards, chemical dependency programs and public clinics in East Oakland and beyond. Her writing, focused on mental health, addiction and homelessness, has appeared in the East Bay Express, the Laney Tower, CalMatters, fort da and Interconnecting Circles, as well as the opinion pages of the San Francisco Chronicle and the New York Times. She has served two terms on the City of Berkeley Homeless Commission and is an analyst member of the San Francisco Center for Psychoanalysis. She lives with her husband and daughter in Berkeley, California.

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