Doubts about the reality of mental illness and the benefits of psychiatric treatment helped foment a revolution in the law's attitude toward mental disorders over the last 25 years. Legal reformers pushed for laws to make it more difficult to hospitalize and treat people with mental illness,
and easier to punish them when they committed criminal acts. Advocates of reform promised vast changes in how our society deals with the mentally ill; opponents warily predicted chaos and mass suffering. Now, with the tide of reform ebbing, Paul Appelbaum examines what these changes have wrought.
The message emerging from his careful review is a surprising one: less has changed than almost anyone predicted. When the law gets in the way of commonsense beliefs about the need to treat serious mental illness, it is often put aside. Judges, lawyers, mental health professionals, family members,
and the general public collaborate in fashioning an extra-legal process to accomplish what they think is fair for persons with mental illness. Appelbaum demonstrates this thesis in analyses of four of the most important reforms in mental health law over the past two decades: involuntary
hospitalization, liability of professionals for violent acts committed by their patients, the right to refuse treatment, and the insanity defense. This timely and important work will inform and enlighten the debate about mental health law and its implications and consequences. The book will be
essential for psychiatrists and other mental health professionals, lawyers, and all those concerned with our policies toward people with mental illness.
Industry Reviews
"I have always thought of Dr. Appelbaum as a scholar and a wise man. His latest contribution only reinforces my opinion. To understand and explain the past 25 years of mental health law, the author has reviewed the revolution in the field from the perspective of research studies and on the basis of his own practical knowledge gleaned from working at the interface between the clinic and the court. He has brought to this knowledge his own marvelous capacity to
place things into perspective....As usual, Dr. Appelbaum's thinking, writing, and logic are remarkably consistent and lead clearly to his conclusions....I commend him and recommend this book to anyone
interested in this cross-disciplinary field. I am sure I will use this book repeatedly in my teaching and practice over the years and will loan it to students and colleagues; I only hope they remember to return it."--The New England Journal of Medicine
"A medicolegal work by Appelbaum is a brand name product. The reader confidently expects sophisticated analysis of current legal trends and clinical issues, meticulously logical organization, pellucid writing, and valuable, often unique insights into the sociological underpinnings of new developments in mental health law. [Almost a Revolution] superbly fulfills these prophecies....Mandatory reading for advocates, policy makers, legislators,
sociologists, and political and social theorists of every stripe. Meticulously researched, thoroughly documented and persuasively argued, this is a landmark publication."--Journal of Nervous and Mental Disease
"[An] excellent book. It should be required reading for all residents and practitioners."--Bulletin of the American Academy of Psychiatry and Law
"Appelbaum couples his erudition with an absorbing style of writing and the result is deeply impressive...An author who can effortlessly captivate his readers on the subjects of, for example, involuntary commitment standards and the insanity defence has rare and enviable gifts of communication. Appelbaum is a rarity and I confess my envy....An outstanding monograph, beautifully crafted, intelligently researched, and written with compassion and extraordinary
wisdom."--Journal of Forensic Psychiatry
"A book written with an exceptional analytic clarity that will be of equal interest to mental health experts and novices....Fascinating reading for specialists in mental health, social sciences or law, as well as the interested but otherwise uninformed layperson."--Developments in Mental Health Law
"Paul Appelbaum...has made yet another outstanding contribution to the forensic psychiatry literature...The references are thorough...[Appelbaum] gives a useful clinical perspective to the data presented."--Jeffrey Janofsky (Johns Hopkins University School of Medicine) in Psychiatric Services
"Paul Appelbaum [is] perhaps the most distinguished and scholarly forensic psychiatrist of our day....The essays uniformly share two great strengths: (a) sensitive integration of clinical and legal perspectives and (b) a scholarly approach to the problems analyzed...An excellent collection of essays on the limits of mental health reform."--Stephen L. Golding (University of Utah) in Contemporary Psychology
"[Appelbaum's] analysis of the impact of recent legal changes on mental health intervention is insightful and pertinent...References are detailed and up-to-date, and the author's conclusions are important for professional mental health caregivers, judges, and attorneys practicing in this arena."--Readings: A Journal of Reviews and Commentary in Mental Health
"A thoughtful critique of the era of legal activism of the late 1960's through the early 1980's...To his substantial credit, Appelbaum achieves what other critics from the psychiatric community have not: a fair and honest assessment of the empirical literature that evaluates the effect of mental health law reform....As always, he fairly and accurately presents his arguments and leaves the reader informed and contemplative. This book will play a pivotal role in
our historical assessment of the past generations of mental health law and in mapping the discipline's future. It should be required reading for mental health professionals, scholars, and
advocates."--Journal of Health Politics, Policy and Law
"An excellent book, not only because of Appelbaum's conscientious scholarship but also because he is a superb writer....Appelbaum has done a masterful job...Should hold fascination for any medical care provider....A vigorously scholarly book that gives us pause but also renews our faith in human beings' ability to transcend headlong rushes to judgment."--Journal of the American Medical Association
"Historically faithful, empirically rock-solid, and clinically astute. Almost a Revolution is the one definitive source for understanding three tumultuous decades of 'reform' in the mental health system. This book is a brilliant accomplishment; written with grace, argued with rigor, and imbued with compassion for people with mental disorder, their families, and those who toil in mental health law. Only Paul Appelbaum could have produced such a
clear-eyed masterpiece."--John Monahan, University of Virginia
"Almost a Revolution is a scholarly, thoughtful and thought-provoking meditation on the limits of legal reform that has implications extending far beyond the bounds of the mental health law questions it addresses. It should be required reading for those interested generally in legal solutions to social problems as well as for mental health law specialists."--Stephen J. Morse, J.D., Ph.D., Ferdinand Wakeman Hubbell Professor, University of
Pennsylvania Law School, and Professor of Psychology and Law in Psychiatry, School of Medicine
"Brilliant, erudite, comprehensive and ground-breaking....A classic....What we have come to expect from Appelbaum." --John Talbott, University of Maryland
"The most engaging statement of the problems at the interface of mental health and the law that I have ever read. The exposition of the issues is so clear that one wonders why so many have struggled with them. Dr. Appelbaum has a genuine appreciation of the problems that created the radical changes in mental health law in the seventies and eighties. He also, however, has a realistic awareness of the difficulties created by the attempts to apply a legal and
sociological approach to reforming the case and treatment of people with mental illness. This is a rare book which combines excellent scholarship with an engaging writing style which will charm both the
academic specialist and educated layperson alike."--Charles Lidz, University of Pittsburgh
